Mr N was a humble, lowly paid insurance agent, 45 years of age, who decided to consult me for severe spasmodic torticollis of more than two years' duration. The dystonic twisted posture of his neck had become so bad that he could only "look at the world on his right side." As a result, driving had become impossible. In his struggle to keep his job he had to walk along the streets of Bombay to meet his clients, and the permanently dug up roads made walking more miserable for him. He had seen his family doctor, osteopaths, orthopaedic surgeons, and physiotherapists, had many scans, tried many medications, collars, and even considered suicide. That was the time when someone advised that he needed to see a neurologist.
Now, as any neurologist knows, spasmodic torticollis is the bane of a neurologist, a most unrewarding condition to treat; after a few visits, both neurologist and patient end up equally depressed. I gave him the usual advice, including x rays, muscle relaxants, anxiolytics, more physical therapy, neuroleptics, new medications, dopamine antagonists, more scans, biofeedback techniques, and so on. I dared not refer him to a psychiatrist as he had already cursed another doctor for having suggested it. My attempts at amateur psychotherapy failed, and eventually things went from bad to worse. It was at this point that I mentioned to him botulinum toxin injection therapy--with trepidation--knowing that the astronomical cost and follow up programmes would be unsuitable for him. "A major recent advance in treatment," I told him. After I had set out the lengthy schedules of the programmes he stood up rather worriedly and said that he would think about it.
A few months later Mr N appeared in my office, and I was unable to recognise him at first. He had come to ask if I would like to take out some life insurance. He was smiling, the torticollis had vanished, and he was truly a changed man. I asked him about his reincarnation, and this was his story.
After he left me, he had visited Puttaparthi, a village on the outskirts of Bangalore in Karnatak State. This village was famous for the presence of the ashram of Sathya Sai Baba, a sage who had performed miracles and was known far and wide for his prayer meetings, telepathy, and clairvoyance. It was to one of the prayer meetings that Mr N had gone in utter despair. Sai Baba would usually walk through the large throng of his devotees, touch many of them, and conduct mass prayers with them. He put his hand on Mr N's head saying that with God's blessing his worries would be soon over. After spending a week at Puttaparthi ashram, Mr N rapidly improved and reached home feeling well and normal.
M D Manikal consultant neurologist, Alkhobar, Kingdom of Saudi Arabia
We welcome articles of up to 600 words on topics such as A memorable patient, A paper that changed my practice, My most unfortunate mistake, or any other piece conveying instruction, pathos, or humour. If possible the article should be supplied on a disk. Permission is needed from the patient or a relative if an indentifiable patient is referred to.
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