Another one will bite the dust, but God only knows why.

As if two cases of CJD in six weeks weren't enough, today I had a patient who has something. We don't really know what it is. Current ideas range from something called OPCA (olivoponto cerebellar atrophy, and don't ask, because I Googled it and *still* don't understand it) to various metabolic disorders that only hit in mid-adulthood.

More than likely, we'll get a diagnosis on autopsy. That's how these things normally work.

I'm betting against CJD. Well, only sixty percent against at the moment. People with CJD have a sort of distance and flatness that this woman doesn't have. She's right there with you the whole time you're talking to her, she doesn't hallucinate. All she does is shake. And tremor. And occasionally spasm, her thigh muscles becoming rock-hard in half-second bursts. Her pupils are dilated and she has gaze deficits. She loves her poodle and her bulldog and her cat who takes over the seat of the wheelchair whenever she's not in it.

She's been all over God's green acre trying to get a diagnosis with no luck so far. I doubt we'll be able to do more. I mean, hell, if Mayo can't figure it out, the only way we'll be able to is because her disease has progressed to the point where we could find something with a biopsy.

This is when the job gets frustrating. This is when it gets scary. And this is when the sight of a person whose brain is deteriorating can make you bitter and resentful.

But when her eyes opened wide on my face and she laughed or smiled, I felt glad that she was still in there and that I was able to hang out with her.

So I make lists on the way home of things I like, things I'd like to do, things I'm grateful for. My time off got approved today, so I'll be heading to Canada to see friend Joey during the hottest part of the summer. I had good fried rice for lunch. Our weather has been better lately than Ohio's. My car is still running. My dishwasher works. My cat is healthy and as crazy as ever. I found a pair of texturing shears at the beauty supply store and didn't ruin my hair with them. My cup overfloweth.

But at the same time...I'd really, really like to know what's wrong with her.