Puzzling Over Medical Mysteries
By Laura Stephenson Carter
Modern medicine is so advanced, it's easy to assume nowadays that diagnostic and therapeutic choices are clear-cut. But there are still many medical mysteries, which doctors puzzle over in sessions called "morbidity and mortality" conferences. Here's an inside look at an "M&M" at DHMC.

"Good afternoon," says secondyear resident Nathaniel Hare, M.D. This week, it's his turn to relate a "mystery story" to a roomful of physicians, other health-care providers, and medical students at the Department of Medicine's Morbidity and Mortality (M&M) conference.

He'll pause in his narrative every so often, not so much to keep his audience in suspense as to give an opening to anyone who dares to solve the mystery before the end of the hour. But he knows it won't be easy. This is a case that had many of DHMC's top physicians stumped for weeks.

"The cases usually unfold like a puzzle, almost like a good mystery novel," says Donald St. Germain, M.D., acting chair of the Department of Medicine. "Everyone in the audience has the opportunity to be Sherlock Holmes as we look for clues and sort through the evidence."

"The format of the presentation permits the audience to walk in the shoes of the treating physician and struggle to understand what is going on with the patient . . .," explains neurologist James Bernat, M.D. . . .

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To the Outer Banks of the Soul
By Nancy Price Graff
We talk freely nowadays about many formerly tabu health topics—cancer, alcoholism, AIDS. The last bastion of "unmentionable" disease may be mental illness. A writer and editor who has been a patient on DHMC's psychiatric ward eloquently details her struggle with chronic depression, giving an enigma a very human face.

Several years ago, just about the time I stopped dreaming, two unusual phenomena began to disturb my nights. The first struck when I lay in bed at night waiting endlessly for sleep. Random images, vivid and surreal, would begin whipping past me, each lasting no more than a fraction of a second. Half of the images were fantastic but harmless: people I had never met hurtling through space toward me, packs of dogs running . . . The other half started off benign but turned grotesque. A tennis ball coming at me over the net might suddenly metamorphose into a hideous, disembodied face just as I swung my racket at it. . . .

The other phenomenon overcame me early each morning as I was waking, usually around 4:00 a.m., after a night of sleep so short and disturbed it left me irritable and ragged. In the pale light of every dawn, I had a powerful sense that I was underwater, struggling toward the surface. . . .

My descent into major depression was not linear . . .

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One More Byline
By Mary E. Daubenspeck
In which a writer chronicles her final struggle with cancer—illuminating a stormy course but elucidating what really matters in the human condition.

The late Mary Daubenspeck was many things—a dog lover, a sailor, an antique-car collector. And, above all, a writer. When she died in March of 2001, she left behind 17 volumes of personal journals. They contain descriptions of nature's unfolding glories, mundane but telling details of her daily life, and philosophical musings. And the last two chronicle her final struggle, physically and psychologically, with cancer. She had been successfully treated for cervical cancer in 1976 and breast cancer in 1991. In 1997, she was diagnosed with colon cancer. . . . Then, in March of 2000, her colon cancer recurred. In July of that year, she wrote in her journal:

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