In September 1984, Tony was a pre-medical student anxiously awaiting the day he would begin medical school at Georgetown University. While driving along a congested I-95 along the East Coast, the car immediately ahead swerved and crashed into the median while four lanes of traffic eked onward. Tony, already equipped with the “helper” mindset that he would hone in medical school, stopped his car and ran to help. The woman in the driver’s seat of the damaged car was suffering from a generalized tonic-clonic, or grand mal, seizure.
Tony did his best to ensure the driver’s safety while he waited for emergency personnel to arrive. Although he didn’t know it at the time, Tony’s first patient was suffering from the same illness that would plague him many years later.
Tony’s life preceding and immediately after his first brush with epilepsy on Interstate 95 was relatively worry-free and picture-perfect. He grew up in the suburbs of Washington D.C. and was an avid tennis player, skier, and straight-A student. He attended an esteemed private high school and was quickly admitted to an Ivy League college to continue his education. While in medical school at Georgetown, he met his wife. Together they moved to Michigan to complete their residency training.
Immediately after completing residency, Tony and his wife found jobs in their respective fields and settled into life in the upper Midwest. Over the ensuing years, they welcomed three beautiful girls to their family. Tony and his family remained active and carefree until early in the morning on a winter day in November 2006. Although he does not remember all of the details, Tony recalls waking in the middle of the night with his wife hovering over him and asking him repeatedly if he was OK. There were also two policemen and paramedics in the room, along with a neighbor sitting next to his bed and watching with concern.
Although Tony’s confusion was profound after his first generalized seizure, by the time he was transferred into the ambulance he had reassumed the physician role and gave advice to the emergency personnel. The ensuing hospitalization and diagnostic testing led to Tony’s diagnosis of “idiopathic epilepsy” and he began to take the antiepileptic drug Dilantin.
Tony dutifully took his medication for the following year and his seizures disappeared as quickly as they came. When the medication was weaned one year later, Tony hoped that his experience with epilepsy was a thing of the past. However, slowly but certainly, smaller, partial seizures marched back into Tony’s life. He had one in front of a patient, another one month later, and soon he was waking monthly in the middle of the night in the midst of a seizure.
As epilepsy reestablished itself in Tony’s life, further testing revealed a small area of atrophy, or injury, to his left anterior temporal lobe. Tony and his doctors estimated that the injury most likely occurred years previously when his brain bounced like a ping-pong ball inside his skull after a skiing accident or trauma playing soccer. Once the atrophic area was identified as a source for Tony’s seizures, he began the arduous process of trying to find a way to stop them.
Tony is currently undergoing evaluation to see if he is a candidate for epilepsy surgery. He is taking two antiepileptic medications but can list the series of medications that he has tried and failed as if he were reciting a grocery list.
“Carbamazepine didn’t work and caused horrible constipation,” he said. “I tried oxcarbamazepine for a few days, and felt like I was stoned without the fun. Zonisamide didn’t work and caused numbness and tingling in my hands and my feet.”
Tony states that he is currently tolerating phenytoin and levetiracetam relatively well although is emotions are more raw than ever before. “I don’t know if that’s a medication side effect or epilepsy itself,” he mused. “Recently my daughters saw me cry for the first time in twenty years.” Tony notes that since his seizures have escalated, his grown daughters have visited more, been in contact more, and are acting increasingly protective of their father. Tony’s wife watches him diligently and protectively. Moments of silence and contemplation or repetitive movements like scratching his nose now warrant questions from his loved ones about a possible seizure.
Through his experiences with seizures, hospitalizations, testing and medications, Tony finds what’s most frustrating about his epilepsy is how it has changed his perspective of himself.
“My disease conflicts with my inherent personality. Epilepsy has an incredible ability to change how I feel about myself.”
Throughout his career, Tony has enjoyed tremendous success as a physician. He has been promoted as a physician leader in his health care system. He repeatedly achieves the highest quality metrics in the care of his patients. Despite this, his epilepsy undermines his success and makes him fearful for the future.
“The pride in my profession is the brain and our mental ability. Epilepsy is all about how we can hurt our brains. Being a physician with seizures is kind of like telling a football player you can’t bench press anymore. How do you teach that person who always been the caregiver and first in line to help suddenly say ‘I need help, I need a hug?’ It’s so hard to say that.”
Despite his setbacks and frustrations, Tony has learned to ask for help and accept his limitations. He’s recently made the decision to decrease his clinic hours in order to reduce his stress levels. A former marathoner and triathlete, Tony has also backed off on his training and endurance exercise in the past year. While he’s made these changes reluctantly, Tony is willing to do whatever it takes. Like so many of us living with epilepsy, he hopes to once again live without the constant worry of when the next seizure will occur.
One in Twenty Six 