Dr. Rachel Clark could see the patient through the glass walls of the Massachusetts General Hospital intensive-care unit. A young woman lay on the bed, unconscious. The girl's mother sat next to her, stroking her head. Just minutes earlier Clark's pager called her to this ward filled with the sickest patients. The text read: "Unresponsive patient in the I.C.U. Possible Gyn etiology. Please respond asap." As she made her way through the hospital, Clark, a first-year resident in obstetrics and gynecology, tried to imagine what kind of problem would lead critical-care specialists to call on her to help with a patient in a coma.
The 26-year-old woman fell ill two months earlier, her mother told Clark. It started with a headache — the worst of her daughter's life. Her mother took her to the emergency room near their hometown in rural Maine. The doctors there thought it was a migraine and gave her something for the pain. It didn't help.
Over the next 10 days her daughter saw six different doctors, had many blood tests and scans and tried a dozen medicines. No one had a diagnosis or a cure. "There's something wrong in my head," the young woman kept repeating. "It's just not right."
On their last trip to the emergency room, her daughter went crazy. She was talking to people who weren't there. She was afraid, paranoid. Then suddenly she became violent, lashing out at everyone around her. "They told me she was having a psychotic break, that she probably had schizophrenia," her mother reported, the horror of that night still audible in her voice. The patient was taken to a psychiatric hospital. A few days later she developed a fever and was sent to yet another hospital. There she had a seizure. After that, she never woke up. She was finally transferred to Massachusetts General in Boston. But even here the doctors had found no answers.
The young woman had a history of migraines but was otherwise healthy. She took no medications. She worked in an office and lived with her parents. On exam she no longer had a fever. Her eyes were sometimes open, but she was completely unresponsive, even to pain.
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