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“I’m thinking, I’m thinking.” They started down the long, checkered-floor hallway, which was virtually empty at this time of the afternoon on this side of the building. “I know both nerve cells do pretty much the same thing depending upon which nervous system we’re talking about.”
“Which is which?”
“Schwann cells are…peripheral?”
“Are you asking me or telling me?”
They passed Emmaline’s office, and she glanced up, briefly making eye contact with him. Then, her gaze fell to Delilah and held until the college’s plain, off-white walls replaced the open doorway.
“Schwann cells are peripheral,” Delilah said, firmer. “Oligodendrocytes are part of the central nervous system.”
“So, what’s your answer?”
“What other symptoms do they have?”
“For several months, they’ve been getting sensations in their legs as if ‘walking through water.’ The morning before their appointment, they thought they were wearing socks but looked down to find their feet bare.”
“So, progressive muscle weakness and neuropathy. Any fatigue?”
“Fatigue, brain fog, and mild dysphasia.”
“Labs?”
“ANA is elevated, but only slightly, and the CMP and CBC are normal, but remember what I told you about that?”
“Treat the patient. Always treat the patient. Labs are a useful tool, but they’re still only one part of the puzzle.” She struck her index finger against an invisible surface. “Okay, so considering the involvement of the CNS and the history of optic neuritis, along with the progressive muscle weakness, I would include multiple sclerosis in my differential diagnosis.”
The exit doors took them to a raised walkway surrounded by walls made of glass. When he first started working at the university, he would stop on his way home and take a moment to stare out at the campus. At night, it looked like its own city, the lights funneled toward the areas of campus where students studied late into the night.
Sometimes, he missed those days.
Most days, he didn’t miss those times.
“How would you follow up?” he asked. “Spinal tap?”
She frowned. “Not to start. You always say to go from least to most invasive when possible to minimize the patient’s discomfort. I’d get the patient’s history and run more tests to rule out other possible autoimmune conditions and anything bacterial, metabolic, or viral.”
“What’s one bacterial possibility?”
“Lyme disease.”
“Viral?”
“Um…advanced HIV/AIDS can produce an immune response that may look similar to MS.”
“What bacterium causes Lyme disease?”
“That’s a trick question. There are two:Borrelia burgdorferiandBorrelia mayonii, although the latter is rare.”
Pride swelled in his chest. “And you’d only do the tests?”
“I’d also schedule an MRI to check for lesions in the brain, spinal cord, or both.” She looked up at him. “How’d I do?”
“You haven’t answered the question. What’s the significance of the oligodendrocytes?”
“Oligodendrocytes are glial cells,” she explained. “They produce myelin.”
“Which is?”
