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September 4, 1987

Inside the Diagnosis

Author Affiliations

Potomac, Md

Potomac, Md

JAMA. 1987;258(9):1225. doi:10.1001/jama.1987.03400090109046

The beginning was innocent. In July 1985I received a shock from a hand-held electric drill. Within a week I'd recovered and felt fortunate to be alive.

But this minor accident heralded a permanent change in my life. I passed through the transparent curtain that separates physician from patient: I moved inside the diagnosis.

I have always enjoyed good health and was successful in competitive swimming and running. An ophthalmologist, I took pleasure in performing microsurgery. Approaching age 50I feared any disability that would interfere with providing for my wife of 27 years and our five children. By the following November, however, progressive weakness of my left arm forced me to abandon performing any more surgery and prompted consultation at a university neurology department.

The differential diagnosis was broad; a major concern was a motor-neuron syndrome. I was relieved by the consultant's conclusion: the injury from the shock seemed isolated to