I’ve done it again. Ruined another good television show because I can’t get beyond the medical premise. I stopped watching The Good Wife (too heavy) to tune into Medical Examiner Light, also known as Body of Proof.
I consider the show the same way I do a Moliere play: get past the absurd premise and everything else is logical. Body of Proof’s initial premise, that a neurosurgeon would change professions to become a medical examiner due to tingling in the hands of unknown origin, doesn’t leave me tingling with excitement, in the hands or anywhere else.
Paraesthesias are tinglings, or pricklings of sections of skin. For example, when your hand falls asleep, you’ve had a paraesthesia. Family Practice Notebook.com lists 55 causes of paraesthesias. In this post, I will try to figure out which malady afflicts Dr. Megan Hunt.
First, I ruled out HIV and side effects of medicines to treat HIV, because television dramas are not about making social statements, at least not long term. And anyway, Philadelphia as a city has already contributed toward this cause with Philadelphia the movie, and the writers wouldn’t want to be considered derivative.
I was also able to rule out Leprosy: no skin lesions. I mean, look at the picture! It’s Dana Delany, babe, no signs of leprosy here!
I considered the six connective tissue diseases listed on the site and excluded them all because they all have obvious physical symptoms. The site forgot a disease I always remember from medical school, Van Recklinghousen’s Neurofibromatosis ( or Elephant Man’s disease). Think that could be what’s wrong? Take another look at that picture.
Not malnutrition, either. Same reasoning.
Then there are the central nervous system causes, such as a stroke or Transient Ischemic Attack. These are unlikely, as she has no residual effects other than the paraesthesias.
What about a brain tumor? She was a neurosurgeon, so how could she miss her own tumor? How about head trauma? Easy to dismiss: have you looked at Dana’s head and face? (Seriously, isn’t that what this show is really about? They didn’t cast Kathy Bates as the ME, after all. Oops. Bad male chauvinist-television-watcher.)
As to the diagnoses of brain abscess, Encephalitis, or vitamin B12 deficiency, we’re told that Dr. Hunt was a brilliant neurosurgeon prior to giving up her practice. Surely she’d make any of those diagnoses, requiring only simple blood tests, in her sleep. The same can be argued for all the entrapment syndromes such as Carpal Tunnel. One EMG and her treatment would have been underway.
Toxins and heavy metal exposure are easy to test for and the results rapidly known. No, the only thing toxic in this show is the concept of paraesthesias of unknown origin. (The medical term is idiopathic, and always makes me think of the Latin root word for idiot.)
Malignancies as the cause, such as Cancer, Paraneoplastic syndrome, or Plasma cell dyscrasias would be diagnosed by her internist. After all, she’s had the symptoms long enough to get divorced and find a new job. If she had one of these disorders, they would have been discovered by now.
We are left with a possible differential diagnosis of Multiple Sclerosis, a slowly progressive muscular weakness that waxes and wanes. But an MRI of the optic nerves would rule that in or out. So it would not be unknown to someone who orders excessive tests and runs over budget (a character trait of our dear doctor/patient).
How about Chronic Relapsing Polyneuropathy? It affects the legs with weakness greater than arms. Dr. Hunt does not appear to have any weaknesses.
Finally (but also in the first place), how could a neurosurgeon without enough feeling in her hands to operate successfully perform multiple autopsies with those same hands?! She pulls out microscopic fragments without damaging them. Incredible!
This is my biggest problem with the show. How could a specialist in neurology, now many years out of medical school, remember all that is necessary in another specialized field of medicine like pathology to become a medical examiner? Why wouldn’t she re-train as a neurologist, or become a non-operating neurosurgeon? These positions would pay more and allow her to continue to use her same skill set.
I have the diagnosis! The only disease that causes paraesthesias without any co-existing hard findings is psychosomatic delusional behavior. She is symptomatic because she wants to star in her television show.
Watson, my old friend, having solved our case, it is time to smoke that meerschaum and eat a TV dinner. Turn on the telly to that American mystery show with the hot woman ME.
Dr. Lewis Preschel aka TheMadMutt. Wouldn’t you be Mad, too?