Darryl had had a virus for a few days, but was feeling better. As a matter of fact, he felt bloody marvelous. He felt like he had been touched by an angel. He hadn't felt that good in years. He got out of bed with a bounce in his step and a smile on his lips. The day went by quickly and he finished his day at work with a flourish. The only residual symptom he was feeling from the virus was that he was pissing more than normal. He had to stop at gas stations twice on the way home to urinate. This wasn't a mere bladder infection though, he was producing huge volumes of urine.
He decided to buy some flowers and candy for Brydie, his wife, on the way home. Darryl was feeling romantic. After his daughter, his wife and he had eaten, Darryl and Brydie retired to bed and indulged in a long night of lovemaking. The went to sleep and made love again in the morning before he went to work. That day went like the day before and he repeated his previous night's performance. This went on for three days more before he noticed that he middle-aged pot belly had disappeared. He weighed himself on the bathroom scale and discovered he had lost sixty-nine pounds. He had to cinch his belt in six inches when he dressed to go to work. When he looked at himself in the bathroom mirror, he looked years younger. "It must be all the exercise I'm getting at nig ht," he thought with a chuckle.
He had never performed that well in his life; to be honest his lovemaking skills were lackluster at best and his sexual endurance had always been poor. Still, his new found sexual energy was a pleasant surprise for Brydie who was enjoying his sudden attentions. The next morning found him as horny as before, perhaps more so. He weighed himself again and found he had lost an additional twelve pounds. He urine output hadn't decreased any either, he was still pissing what seemed like a gallon a day. Despite how good he felt, Darryl decided to call in sick and go and see the doctor. True, the doctor had told him on numerous occasions that he should lose weight, but eighty-one pounds was an incredible amount to lose in one month. The constant need to urinate was worrying him too. He called his doctor and explained he had experienced severe weight loss and had a frequent need to urinate. Darryl also told him that his appearance had changed too, he looked like he had when he was nineteen. The doctor arranged an emergency appointment that morning for him.
When he doctor saw him, he couldn't believe it was Darryl. He thought that Darryl had talked a younger brother into impersonating him as a joke. When Darryl finally convinced him that he really was Darryl, the doctor became very concerned. He explained to Darryl that the rapid weight loss he was experiencing was extremely dangerous when coupled with the high urine output he was having. The doctor convinced Darryl that something was very wrong. He thought that perhaps Darryl had contracted a new form of virus and should be hospitalized until the cause of his symptoms could be determined. He made Darryl agree not to have any more sexual relations with Brydie until it could be determined that he wasn't contagious. Darryl reluctantly agreed to enter the hospital the next day.
North Central Memorial Hospital
Doctor's Progress Notes
Date: Aug. 30, 1998 Time: ~9:00 pm Patient: Darryl Burr
Diagnosis: Patient admitted to hospital with Dx of Idiopathic Somatic Regression,
Vitals:
Pulse
61
B.P.
119/72
Resp.
14
Temp. 99.6° F
(oral)
Weight
143 lb.
[approx equal]w
-11 lb. since office visit 8/29/98
Height
69 in.
Lab: urine (~6300 ml) [normal ~1000 ml.], pO2 88, pCO2 38
Other: Dental: third molars have disappeared
General: Pt. complains that he is becoming younger. Pt. complains of frequent urination with some weight loss, Pt. age appears to be ~17 yrs. old, although age is known to be 41 yrs., otherwise appears to be in good health with slightly elevated temp.
Notes: Pt. was admitted to Adolescent Unit due to lack of space in other units.
Orders: Ordered complete isolation of Pt.; mask, gown and gloves required for staff safety. No visitors, including Pt.'s wife, until Pt. has been fully screened for infectious diseases. Ordered complete news blackout on Pt. to preserve Pt.'s and family's privacy. Pt.'s measurements are to be taken each shift; height, weight, arm and leg length, etc.; details in Nursing Orders. Called Pt.'s Dentist for dental records, Ordered full set of dental X-rays each day, Ordered full photographic set by medical photographer every 24 hrs.; asked Pt.'s family for photo album for age comparison purposes, Ordered full radiographic set of major skeletal bones, as well as a Tanner-Whitehouse survey to determine RUS bone age, Standard Lab values including, Urinalysis, CBC, etc. Ordered multiple tissue cultures, antigen/antibody tests for pathogenic organisms, DNA tests
Darryl was bored. True, the hospital room had a tv, but nothing was on except talk shows and soaps. Darryl lay in bed and waited for the next visit by hospital employees. The doctor had ordered that he be allowed no visitors, including his wife, but that did not, of course, include employees following doctor's orders. So far this morning, he had had every inch of his body x-rayed while in his bed with a portable x-ray machine, another x-ray tech had come in and taken a full set of dental x-rays, a hospital photographer had had Darryl strip to the buff and photographed him from multiple angles standing in front of a folding cardboard grid to measure his body size, medical technicians had come up from various departments of the laboratory and taken samples of blood, urine, throat swab, and (ugh!) stools and finally a pair of nurses had come in and weighed him before measuring and recording the length and circumference of all his limbs. Then they took his temperature, pulse, blood pressure and listened to his heart and lungs with a stethoscope. He had suspected that a single nurse could have done the job alone, but one of them must have wanted to see the "incredible shrinking man" for herself. Darryl would have liked to see the employee's faces but everyone was gowned, masked and gloved into anonymity.
Darryl lay back in the bed and sighed. He had been poked, prodded, probed, photographed, bled, and irradiated. He was beginning to feel like a visitor from another planet being cataloged by medical science. The hospital personnel had been courteous but firm in their demands for samples from his body. Darryl hadn't realized how entertaining it had all been until they left. The employee's conversation had been formal and job related, but at least it was conversation. Darryl wondered how long he should wait until he tried to call Brydie again. Darryl had never been a big reader but he decided to have Brydie bring him some books to read to relieve the boredom. He looked at the clock on the wall at the foot of the bed; it read eleven thirty am, they would be serving lunch in thirty minutes according to the brochure that he had found on the bedstand. Maybe the nurse would have time to talk to him at lunch. He rolled over and lay on his side trying to nap. Darryl was sure they'd wake him when lunch came.
North Central Memorial Hospital
Doctor's Progress Notes
Date: Aug. 31, 1998 Time: ~9:00 pm Patient: Darryl Burr
Diagnosis: Idiopathic Somatic Regression,
Vitals:
Pulse
65
B.P.
117/70
Resp.
17
Temp.
99. 8° F
(oral)
Weight
112.2 lb.
[approx equal]w
-21.1 lb.
Height
64 in.
Lab: urine (~9800 ml) [normal ~800 ml.], pO2 88, pCO2 38
Other: Measurements: (normalized to values at admission), thigh 89%, calf 89%, foot 91%, upperarm 85%, forearm 86%, hand 87%, muscle width; arm + calf 11.3 cm (reduced from 14.1 cm at admission), height 93%, weight 78%
Dental: missing two canines as well as third molars
General: Facial Alopecia of the lower maxilla and mandible (baldness-Pt.'s mustache and beard have fallen out), Nail shedding of both hands and feet, testes have shrunk from 21 ml. to 7.2 ml.
Notes: The Pt.'s upper layer of dead epidermis sloughed off during the night, exposing fresh, pink skin. No lesions or dermatitis, skin normal in appearance. The Pt.'s family album was delivered today, comparison of pictures of the Pt. as a 14 year old boy and today's medical photograph seems to indicate that the Pt.'s physical age is approximately 14 years.
Orders:
When Darryl woke up the next morning, he felt like he had been skinned and dipped into an acid bath. He had dreamed that he was lying painfully face down on a bed of thorns and the thorns had impaled themselves into his chest. He awoke to find the pain was real. He threw back the sheet on the bed to see what was sticking him and found hundreds of short, stiff brown hairs lay on the sheet amid large flakes of dead skin. He tried to brush them off the sheet and discovered that he could barely use his hands. Darryl looked at his hands; the calluses were gone and they were a bright pink. He had lost the entire upper layer of skin! The ends of his fingers ached dully; he was surprised to see that he had lost his fingernails too. He got out of bed and immediately found that he had lost the toenails and calluses on his feet as well! He could barely walk. Darryl hobbled over to the sink and looked in the mirror. His face was pink and his mustache had fallen out! He groaned in dismay, what was happening to him? His body seemed to be falling apart. When he opened his mouth to groan he saw that he had gaps in his teeth. He gingerly pulled back his upper lip and examined his teeth, somehow during the night he had lost his upper canines. Suddenly he realized that he had to urinate. He had to urinate now! He shuffled to the toilet and sat down just before he started to go. He had almost pissed on the floor! Darryl put his head in his hands and wept. "I can't deal with this," he thought in confusion, "What's happening to me? My teeth are falling out, my skin is peeling, and I've lost my fingernails. Is this a virus? I've never heard of a virus that does anything like this. Do I have radiation poisoning? I've heard of cases of radiation poisoning where the victims lose their fingernails and hair, but I hadn't heard they lose their teeth and skin too. If I have radiation poisoning, then why don't I have diarrhea? Doesn't radiation kill the lining of the intestine? Is this some kind of heavy metal poisoning? Why do I have to piss all the time? Mercury poisoning will cause loosening of the teeth, loss of fingernails and hair, and can act as a diuretic. But, if that's it, why is my skin peeling? Mercury poisoning is famous for making people salivate excessively. I'm not salivating and other than the fact that I'm shrinking, I feel good. I don't feel like I've been poisoned. I wish someone would tell me what's going on." He finished urinating and got up from the toilet, then turned around to look at the color of his urine. There was some kind of white plastic container that was fitted into the top of the toilet under the seat that was being used to collect his urine. It was a dark shade of orange against the white plastic. He had seen that color before in his life when he was a teenager in high sc hool football. His urine used to turn that color after summer football practice in the sun. It looked like he was severely dehydrated. The funny thing was, he didn't feel thirsty. Darryl limped back to bed and called the nurse. If he could get her to come in here and see what he looked like, perhaps she would call the doctor. Maybe this time someone would explain what was happening!
North Central Memorial Hospital
Doctor's Progress Notes
Date: Sept. 1, 1998 Time: ~9:00 pm Patient: Darryl Burr
Diagnosis: Idiopathic Somatic Regression,
Vitals:
Pulse
67
B.P.
115/71
Resp.
23
Temp.
100.2° F
(oral)
Weight
77 lb.
[approx equal]w
-35.2 lb.
Height
56 [fl] in.
Lab: Pt. voids urine continuously (~15000 ml) [normal ~750 ml.], pO2 88, pCO2 38
Other: Measurements:(Normalized to values at admission), thigh 80%, calf 82%, foot 87%, upperarm 81%, forearm 81%, hand 82%, muscle width; arm + calf 10.3 cm, height 82%, weight 54%
Dental: 20 teeth; first molars (4) [permanent], incisors (8) [permanent], bicuspids (8) [permanent]
General: Alopecia of underarm hair, secondary sexual characteristics have disappeared, reduced penis size, testes have shrunk considerably- size 2.5 ml., aureole diameter halved from 1 in. to [fl] in., size of Pt.'s voicebox has reduced; voice has become higher and more childlike, forehead has become less pronounced, mandible has receded. Epidermal sloughing continues.
Notes: Teeth do not disappear entirely; the roots are absorbed and the balance of the tooth either falls out or is swallowed (crowns of teeth were found in the bed by nurses during bed changes and by lab technicians in stool samples)
Orders:
Darryl awoke in a puddle of urine. He was pissing in the bed! He grabbed his penis to shut off the flow and ran to the bathroom, heedless of the pain shooting up from the soles of his feet. He sat on the toilet and released himself and pissed a full five minutes before he stopped. He hobbled back to the bed when he was finished and pushed the button to call the nurse. When the unit clerk answered, he asked her to have the nurse change the bed. The unit clerk asked why the bed needed changing and he explained he had had an "accident". The clerk promised him the nurse would by there right away. He stood by the bed in shock. The sound of his voice this morning had surprised him. He wasn't talking as much as squeaking his requests. The nurse arrive a minute later, changed the bed and emptied the urine collection container in the toilet. She had explained to him yesterday morning that he needed to call her after he urinated so she could chart his output. He ended up calling her a dozen times a shift. Darryl dressed in the clean gown she had given him and sat on the easy chair by the close to the bathroom door. It wasn't worth it to go back to bed, he'd be getting up to go to the bathroom in a few minutes. He was glad that there was never anything good on tv in the mornings. When he had tried to watch tv at night, he had had to get up and go to the bathroom every few minutes. He couldn't keep track of the plots. He hoped that Brydie would bring him some books and magazines soon, at least he could read them while sitting on the toilet. He decided not to try and call her again. The change in his voice might worry her. She find out soon enough about his bodily changes.
North Central Memorial Hospital
Doctor's Progress Notes
Date: Sept. 2, 1998 Time: ~9:00 pm Patient: Darryl Burr
Diagnosis: Somatic Regression,
Vitals:
Pulse
70
B.P.
112/72
Resp.
28
Temp.
99.7° F
(oral)
Weight
61.6 lb.
[approx equal]w
-17.6 lb.
Height
52 in.
Lab: urine (~8200 ml) [normal ~700 ml.], pO2 88, pCO2 38
Other: Measurements:(normalized to values at admission), thigh 72%, calf 74%, foot 81%, upperarm 72%, forearm 73%, hand 75%, muscle width; arm + calf 9.6 cm, testes 1.6 ml. , height 75%, weight 43%
Dental: 18 teeth; first molars (4) [permanent], incisors (8) [permanent], bicuspids (2) [permanent], posterior molars (4) [deciduous]
General: Alopecia of pubic hair, pronounced epidermal sloughing, Pt.'s face has become childish in appearance. Pt.'s appearance compares favorably with photos taken at age 9
Notes: The deciduous teeth erupted very quickly; within a few hours. X-rays of the mandible and maxilla show other deciduous tooth buds developing and the absorption of the roots of the permanent teeth
Orders:
The next day Darryl woke feeling much the same as he had the day before. His skin was still raw and tender. The bed sheet was covered in flakes of dead skin, it looked like he was molting during the night. When he got out of bed to go to the bathroom, he had almost fallen on his face. The bed seemed to have grown in the night. He was still shrinking. Darryl hurried to the toilet as fast as his tender feet would carry him. He sat down and exploded urine into the collection container. He pissed until he thought surely he must have filled the plastic bucket in the toilet. He looked down at his penis and was shocked by it's appearance. He had been denuded! All of his pubic hair had fallen out! His penis had shrunk too; it was only half the size it had been the day before! Darryl reached down and cupped his scrotum in his hand and felt his balls. His balls had shrunk too! They had been the size of small eggs yesterday and now they were the size of marbles; small marbles! His penis and balls looked like a little boy's organs. "If only I knew what was happening to me. Can't they stop this? Why won't they tell me what's wrong with me? I could handle this a lot better if I knew what was going on." He was hit by a renewed urge to piss again and hastily stuffed his penis between his legs before he had an accident in his hand. Darryl began to weep in frustration. He felt trapped. Alone. He was terrified by the thought of what he would look like tomorrow. Would he continue to shrink? What about the day after? And the day after that? Would he dwindle into nothingness? Why was his hair falling out? Why wouldn't someone tell him what was going on? Did they know what was happening to him? Darryl finished on the toilet and went to the mirror to see what his face looked like. He was shocked by the image the mirror returned to him. It was his face alright. His face when he had been nine or ten. He opened his mouth to check his teeth and saw multiple gaps in his dentition. He wasn't just shirking, he was regressing! His body was becoming younger! He looked closely at his gum and thought he saw a tiny tooth bud erupting from the gum. That explained why they were taking a complete set of dental x-rays every day. He had understood the need for regular x-rays of his body, but the dental x-rays had baffled him. Now he understood why the medical photographer was taking pictures of him every day as well. They intended to use them in medical textbooks. They hadn't explained to him what was happening because they didn't know! His condition was totally unknown to them. That's why they took all his measurements three times a day. They were gathering data for study! He went back to bed and pulled the covers over his head. He was supposed to call the nurse and tell her after he had urinated so she could chart his urine output and empty the collection container, but it was too much trouble. Besides, he didn't want to see anyone right now. He wanted to be by himself. He would have to get up and piss again in a few minutes anyway.
North Central Memorial Hospital
Doctor's Progress Notes
Date: Sept. 3, 1998 Time: ~9:00 pm Patient: Darryl Burr
Diagnosis: Somatic Regression,
Vitals:
Pulse
75
B.P.
110/70
Resp.
28
Temp.
99.4° F
(oral)
Weight
50.6 lb.
[approx equal]w
-11.6 lb.
Height
48 1/2 in.
Lab: Urine (~5650 ml/day) [normal ~650 ml.], pO2 88, pCO2 38
Other: Measurements:(Normalized to values at admission), thigh 63%, calf 65%, foot 73%, upperarm 66%, forearm 67%, hand 69%, muscle width; arm + calf 9.0 cm, height 70%, weight 35%
Dental: 20 teeth; first molars (4) [permanent], incisors (4) [permanent], upper lateral incisors (2) [deciduous], lower lateral incisors (2) [deciduous], canines (4) [deciduous], posterior molars (4) [deciduous]
General: Nocturnal enuresis, PMI (point of maximum impulse of heart) relocated from the 6th left intercostal space to 4th intercostal space, just left of midclavicular line
Notes: Epidermal sloughing continues at the same pace. Pt.'s dental records arrived today, comparison of daily dental X-rays and dental records substantiates the hypothesis that the Pt. is physically regressing in age. The Tanner-Whitehouse study of the radius, ulna, metacarpels and phalanges corroborates this evidence with an error of ±2 years. The photographic evidence also supports this conclusion with a physical age estimate of 7 years. The medical statistician has predicted on the basis of this evidence that if the regression continues unabated, the Pt. will be 1 year old in 4 days. The Pt. is already too small to wear hospital gowns or b.p. cuffs in unit. The Head Nurse of Adolescent Care and the Medical Chief of Staff have requested that the Pt. be transferred to the Pedi Unit.
Orders: Transferred to Pedi.- Isolation Room
Darryl woke up early in the night in a puddle of urine. He had wet the bed in his sleep. He called the nurse, who came and changed the bed sheets and he slept the rest of the night without incident. In the morning, Darryl got sleepily out of bed and promptly fell on his face. A blood vessel broke and his nose started bleeding. The pain from his nose stunned him and he sat motionless on the floor, forgetting his urgent need to urinate. Without warning, his bladder cut loose and he peed all over himself. This was too much, he began crying. A passing nurse heard him and looked in the room to see what the commotion was about. When she saw him sitting in a puddle of urine with his face covered in blood, she rushed in to check his condition. She helped him up, removed the wet gown and called his nurse. The bleeding stopped just as his nurse arrived. She took over for the other nurse while the passing nurse sopped up the puddle with the already wet cotton gown. His nurse soaked a washcloth in cold water in the sink, wiped his face clean of blood and told him to hold the washcloth to his nose while she got a clean gown from the cabinet for him. As Darryl was standing there at the bedside, he noticed that the height of the hospital bed mattress came up to his solar plexus. The bed height was still set to the height it had been set to when he came in and was now too tall for him. No wonder he had fallen. His nurse came over and attempted to dress him in the fresh gown only to find it was too large for him. When she put his arms through the gown, the bottom of the gown dragged on the ground by a good four inches. He had become too short to wear even the smallest adult sized gown. She called the unit clerk on the nurse call system and asked her to call housekeeping to mop the floor in his room while she went to pediatrics and borrowed a gown to fit him. Darryl sat on the easy chair and waited for her return.
She bustled in his room with a stack of disposable paper pedi gowns in her arms and restocked the cabinet. Then she gowned him and helped him back into bed. She put the side rails up on the bed saying, "I think we should have these up on the bed from now on. That was quite a fall you took. If you need to get out of bed to go to the bathroom, call me with the nurse call button and I'll lower the side for you and help you out of bed. Here, I'll clip the call button on your pillow so you can find it easily." Darryl lay in bed morosely after she left. This was humiliating! Not only had he fallen and bloodied his nose, but he had had an accident on the floor besides. He was surprised that she didn't lower the bed height for him to get out of bed without assistance i nstead of raising the bed rails. Was this her way of insuring that he would stay put in the bed until she came to get him out? His need to urinate lately had been so urgent that he wasn't sure he could wait until she arrived. What would they do if he started to wet the bed on a regular basis? Catheterize him? The housekeeping maid came in and looked at him with a disgusted expression on her face. The mask prevented Darryl from seeing her pursed lips but he could read the angry look in her eyes easily enough. This was the fourth time this morning she had had to clean up a patient's "accident" on the floor. "If these people can't control themselves," she thought, "...then why don't the nurses put them in diapers?" Darryl turned over in bed and faced the wall while she mopped the floor, he didn't care for the expression in the maid's eyes as she worked.
North Central Memorial Hospital
Doctor's Progress Notes
Date: Sept. 4, 1998 Time: ~9:00 pm Patient: Darryl Burr
Diagnosis: Somatic Regress,
Vitals:
Pulse
84
B.P.
109/71
Resp.
28
Temp.
100.8° F
(rectal)
Weight
41.8 lb.
[approx equal]w
-8.8 lb.
Height
43 1/2 in.
Lab: Voids urine every 45 min-1 hr (~4200 ml/day) [normal ~600 ml.], pO2 88, pCO2 38
Other: Measurements:(Normalized to values at admission), thigh 54%, calf 57%, foot 66%, upperarm 57%, forearm 60%, hand 64%, muscle width; arm + calf 8.5 cm, height 63%, weight 29%
Dental: full set of baby teeth
General: Early childhood Lordosis has reappeared, Pt.'s physical age estimated at 5 years. Behavior: outbursts of uncontrolled temper (temper tantrums?), Pt. unable to shower unassisted. Pt. increasingly confused & attempts to leave bed unassisted, Pt. wets self and requires constant assistance to toilet. Pt. cannot control tongue for oral temp., nurses took rectal temp instead, Pt. strongly objected to use of rectal temp. probe. Pt. has begun sucking thumb when there is no one present. Pt. has formed an emotional attachment to one of the day shift nurses and calls for her constantly.
Notes: DNA tests have revealed an abnormality at site p51; the gene involved in cellular replication usually associated with carcinoma. The study suggests that a plasmid of unknown structure and origin has inserted itself into the site. The growth this plasmid may be causing in the Pt. is unusual, but not a oncological type growth pattern. An alternate possibility for this structure is a jumping gene, switched on by unknown environmental factor(s).
Orders: Nurses requested Pt. be placed in diapers, Nurses requested use of crib with crib top device to control night wandering, also high chair to facilitate feeding- Ordered
If yesterday had been bad, today was terrible. He had been transferred into the pediatric side of the floor with all the children. The nurses had told him it was an administrative move to free up space for other patients, but he suspected they were lying to him. He had simply become too small to be cared for in an adult unit. Every time they had wanted to take his blood pressure yesterday, they had had to borrow a pedi cuff from the other unit. When they tried to take his temperature he rebelled. The nurse had told him to drop his pants and lay down on the bed. He had thought she was only going to examine him. When he felt the rectal probe placed into his anus he battled the nurse fiercely. She rang for assistance and three pairs of hands compelled him to submit to the intrusion. Darryl was told afterwards that the unit policy was that all the patients in the pedi unit were required to have their temperatures taken rectally, regardless of age. He had also had problems getting immediate assistance to go to the bathroom. He had been right in his guess that he wouldn't be able to wait until the nurse got him out of bed to urinate. He had wet the bed twice yesterday waiting for the nurse and three times today. The first time it happened he exploded. He vented and screamed his rage at the embarrassment her delay had caused him. The second time he was climbing over the side rails and his gown got caught in the bedframe. He was forced to balance on the rail while he attempted to extricate his gown from the bed's lifting mechanism. The pressure of the rail on his stomach had proven to be too strong for his overfull bladder to tolerate and he peed helplessly while stuck on the rail. He was forced to call his nurse to extricate him from his ignominious predicament. When she arrived, she went ballistic. She cut the trapped end of the gown off with a pair of bandage shears from her pocket, lifted him up form the rail and put him back in bed. She told him in no uncertain terms that he was not to get out of bed unassisted and would be strapped in the bed if necessary. He had snuck out of the bed three times after that by climbing over the foot of the bed.
Today he got caught out of the bed twice and when the nurse demanded to know what he was doing, he was too frightened and embarrassed to explain clearly. He had mumbled something about wanting to sit down on the easy chair to watch tv. When the nurse reminded him that the sound from his tv came from the pillow speaker attached to his pillow, thus making listening from the chair impossible, he looked vague, put his thumb in his mouth, and told her he forgot. She put him back in bed, told him she would be watching him and left the room. The second time he had been trying to take a shower when the nurse burst into the bathroom. He was startled by her entry and slipped on the wet floor and landed in a heap on the tile. He was livid! He told her that she caused his accident and if this happened again he would sue her and the hospital. She told him it was all his fault; he had no business being out of bed without assistance and his accident only proved that he needed to have someone with him in the bathroom while he showered. She helped him up and assisted with his shower despite his demands that she leave immediately. When he had finished, she dried him off, regowned him and helped him into bed. She told him his accident would be reported to his doctor and measures would be taken to keep him in bed.
The nurse left the room shaking her head. No wonder the day shift said this patient had an attitude. She intended to talk to his doctor when he made rounds tonight. His threats had irritated her; she had read the nurses notes about how he had wet the bed three times today. She'd fix it so he didn't have to leave the bed to pee. For that matter, she intended to fix it so he wouldn't be able to get out of bed.
North Central Memorial Hospital
Doctor's Progress Notes
Date: Sept. 5, 1998 Time: ~9:00 pm Patient: Darryl Burr
Diagnosis: Somatic Regress,
Vitals:
Pulse
87
B.P.
104/70
Resp.
28
Temp.
100.8° F
(rectal)
Weight
35.2 lb.
[approx equal]w
-6.6 lb.
Height
39 in.
Lab: Urinates every 30-45 min. (~3300 ml/day) [normal ~550 ml.], pO2 88, pCO2 38
Other: Measurements:(Normalized to values at admission), thigh 44%, calf 47%, foot 58%, upperarm 47%, forearm 52%, hand 56%, muscle width; arm + calf 8.0 cm, height 57%, weight 24%
Dental: full set of baby teeth [deciduous]
General: Complete childhood Lordosis, Pt now has appearance and sound of small child of approximately 4 years Behavior: Pt. initially resisted, but now accepts use of diapers for urination. Pt. requests the use of the toilet for bowel movements, but on one occasion, soiled himself before nurses could assist him to bathroom. Pt. is becoming increasingly dependent on his nurse for assistance in basic activities. Pt. has difficulty using knife to eat and needs his food cut up for him. Pt. sucks thumb frequently, sometimes in the presence of favorite nurse. Pt. appears to be regressing emotionally to apparent age. Pt. appears frustrated by crib top device and cries when placed in crib.
Notes:
Orders: Nurses requested that the Pt. be given sponge baths in the crib instead of showers due to the Pt.'s size and increasing loss of motor skills.- Ordered
Life for Darryl became more and more difficult to bear; late last night, night nurse had come in and forcibly put him in diapers. He had screamed and tried to fight it, but to no avail. She had left and then returned a few minutes later with another nurse in tow and a baby board in hand. This was a three-quarter inch thick plywood board with straps attached to allow recalcitrant babies to be tied down and treated. Darryl fought like the devil incarcerated in a nunnery populated by charismatic nuns, but he was quickly overpowered. They were too strong for him. He struggled valiantly within the straps of the board, but once he was belted to the board, he was defeated. Frankly, he needed to wear diapers and knew it. He just didn't want to the nurses to think he wanted to wear them. His nurse promised him he could use the toilet to poop in if he wanted to, he just had to wear diapers to keep him from wetting the bed. Then the next morning the nurses had come in and replaced his bed with a baby crib. This was not just any crib but an all steel crib with a matching steel barred top that enclosed the entire crib. It was for all practical purposes, a cage. He cried for hours when they first put him in the crib. When the nurse brought in a high chair for him to eat his breakfast in, it was anticlimactic. He had fully expected it after they had put him in a crib. An hour before, Darryl had a serious accident in his diaper. He had called the nurse to take him to the bathroom, but she had been delayed. His bowels had cut loose and he had filled his diaper while he stood at the crib rail and screamed for his nurse. One sniff had told her what he had done in his diaper. She dropped the rail and laid him on his back to change him. Darryl had never felt more vulnerable in his life. Darryl whimpered in embarrassment and frustration. He turned his head away from her and put his thumb in his mouth without realizing it. She comforted him saying, "There, there Darryl. It's okay. It's just a little accident. You're clean now. I put a fresh diaper on you. Don't worry, Honey. I'm not mad at you. Lots of our patients have accidents."
The knowledge that she was speaking as a pediatric nurse did nothing to quiet him. He knew that the patients she was talking about were all children. He was losing his toilet training. His whimpering changed into distraught weeping then anguished crying. The nurse picked him up, held him to her and patted his back as if he was an infant needing cuddling. He continued to wail for fifteen minutes before he became quiet. From that moment on, she began to coddle and pamper him like a small child. At first, he found her pity humiliating, but the loneliness of his condition made any sympathetic human contact attractive. He found himself becoming more and more dependent on her. When his coordination deteriorated to the point where he had problems cutting his meat with a knife, she cut up his food for him. He began sucking his thumb in her presence and putting his arms out to be held by her. He felt silly sucking his thumb, but lately the urge was irresistible. He tried to hide it, but the other nurses had caught him sucking his thumb several times. His regular nurse hadn't said anything when she caught him, she had only smiled understandingly and continued with her duties. He was glad she hadn't made an issue of it, sucking his thumb made him feel better, more secure. Now Darryl sat in his crib, sucking his thumb and watching tv. His tastes in tv had changed since he had been in the hospital. He had quit watching news shows and watched cartoons almost exclusively. He knew his behavior was regressing to match his apparent age, but he was unconcerned. There was nothing he could do about it, so he had resolved not to worry about it. He found himself wanting to have his nurse beside him at all times. He called her constantly on the slightest pretext. When she asked him what he wanted he was unable to answer; he was finding it increasingly difficult to talk in compete sentences. Later that day he soiled his diaper again after lunch. He had not been able to exert any control over his bowels, they had acted on their own. Darryl was glad he was wearing diapers, the thought of soiling his bed was unbearable.
North Central Memorial Hospital
Doctor's Progress Notes
Date: Sept. 6, 1998 Time: ~9:00 pm Patient: Darryl Burr
Diagnosis: Somatic Regress,
Vitals:
Pulse
93
B.P.
98/64
Resp.
28
Temp.
100.4° F
(rectal)
Weight
30.8 lb.
[approx equal]w
-4.4 lb.
Height
35 1/2 in.
Lab: Urinates every 30-45 min (~2300 ml) [normal every 2-3 hours ~500 ml/day], pO2 88, pCO2 38
Other: Measurements: (Normalized to values at admission), thigh 37%, calf 42%, foot 52%, upperarm 40%, forearm 47%, hand 54%, muscle width; arm + calf 7.6 cm, height 51%, weight 22% (Normalized to values at admission), thigh 44%, calf 47%, foot 58%, upperarm 47%, forearm 52%, hand 56%, muscle width; arm + calf 8.0 cm, height 57%, weight 24%
Dental: 20 teeth; lower central incisors (2) [deciduous], upper central incisors (2) [deciduous], upper lateral incisors (2) [deciduous], lower lateral incisors (2) [deciduous], anterior molars (4) [deciduous], canines (4) [deciduous], posterior molars (4) [deciduous]
General: Three large bowel movements during day; after breakfast and after supper, there was a third in the midmorning standing at the side of the crib. Alopecia of scalp; considerable thinning of hair, but no bald spots. Fontanelle closed, big muscles well developed, abdomen protrudes slightly, Lordosis receding, arms and legs shortened giving Pt. appearance of toddler 2-3 years old.
Reflexes: Plantar reflex absent, neck righting reflex absent, Babinski sign present, Landau reflex absent, accommodation present Behavior: Pt. has little control over bowel movements, Pt. recognizes when he has soiled himself & asks to be changed, loss of speech; Pt. says short sentences only, shows cooperation at being dressed, uses spoon, uses cup hesitantly. Pt. frequently sucks thumb in the presence of others. Pt. has emotional reactions of a toddler of 2-3 years. Demands constant attendance of favorite nurse.
Ambulation and range of motion: Unable to balance self on either foot, Pt. losing fine muscle coordination, although can build a high tower with blocks and fit a peg into its proper hole, throw a ball into a box, walks unsteadily alone, good control with a spoon, poor control with cup
Notes: Screening for infectious agents negative, if final tests return negative, will remove Pt. from isolation status and allow Pt. wife to visit Pt.
Orders: Nurses requested the removal of the crib top device to facilitate Pt. care - Pt. is now unable to get out of crib without assistance, Nurses requested the removal of the Nurse Call button from the Pt.'s crib., also requested the use of baby bottle when Pt. can no longer control cup- Ordered
When Darryl awoke, his diaper was sopping wet. He called the nurse repeatedly before anyone would answer him. His muscular control had deteriorated badly during the night; he couldn't even stand on the crib mattress without holding on to the bars. She changed him without comment and thirty minutes later he was wet again. His noticed his body was changing in shape as well as proportion; when he sat in the high chair his protruding stomach almost touched the tray where there had been an inch of clearance the day before. Eating was becoming more difficult too. He had to grip his spoon in his fist instead of his fingers and he had almost lost control of his drinking cup several times. His gown had served as a bib and caught most of his spills. He soiled his diaper again at midmorning while standing in the crib waiting for his snack, causing him to wail in distress. He couldn't help himself, it was becoming impossible to control his emotions and his thinking was becoming foggier with each passing hour. He was becoming a infant in every sense of the word. He realized that soon he'd be unable to utter any intelligible sounds and would be reduced to infantile babbling. He lost interest in tv cartoons, they were too difficult to comprehend. He sat in his crib most of the day, staring out the window and sucking his thumb. His bladder emptied itself every hour. He quit calling the nurse to come and change him; it was too much trouble. Besides, he was getting used to wearing wet diapers. Sleep came more easily to him; he found h imself napping almost three hours a day in addition to the ten to twelve hours he was sleeping at night. When he went to sleep that night, he said goodbye to the world he had known. He knew that tomorrow his personality would regress into infancy, taking his reason with it.
North Central Memorial Hospital
Doctor's Progress Notes
Date: Sept. 7, 1998 Time: ~9:00 pm Patient: Darryl Burr
Diagnosis: Somatic Regress,
Vitals:
Pulse
135
B.P.
93/63
Resp.
33
Temp.
100.8° F
(rectal)
Weight
23 lb.
[approx equal]w
-7.8 lb.
Height
30 in.
Lab: Voids urine continuously (~3650 ml/day) [normal 6-8 times day ~400 ml/day], pO2 88, pCO2 33
Other: Measurements: (normalized to values at admission), thigh 33%, calf 37%, foot 48%, upperarm 37%, forearm 45%, hand 52%, muscle width; arm + calf 7.2 cm, height 43%, weight 16%
Dental: 6 teeth; lower central incisors (2) [deciduous], upper central incisors (2) [deciduous], upper lateral incisors (2) [deciduous]
General: Sleeps 10-12 hours night, naps easily - 20 min. to 3 hours daytime naps, loss of large muscle development. fontanelle open, pronounced protuberant abdomen, Pt.'s age estimated at 1 year old.
Reflexes: Plantar reflex present, neck righting reflex absent, Babinski sign present, Landau reflex present,
rooting reflex present, accommodation present
Behavior: gives attention to people and objects, shows fear of strangers and strange situations, Pt. has become uncertain and fearful; cries if left alone, demands to be picked up and held by favorite nurse. Pt. eliminates urine & feces automatically and does not recognize when he has wet or soiled himself. Pt. cannot speak intelligible words or say his name, but makes sounds like da-da and ma-ma, Pt. does not appear to understand simple sentences when spoken to, Pt. indicates wants by crying, Pt. will not feed himself with spoon, must be fed by nurses, demands bottle for drinking, eats some chopped foods, a very picky eater, more negative, especially at meals and naptime, Pt. sucks thumb continuously, if given pacifier, Pt. will suck in preference to thumb. Ambulation and range of motion: cannot walk alone, walks a side-step pattern along furniture, otherwise walks a wide-legged gait, but prefers crawling, creeps like a bear; hands and soles of both feet in contact with floor, gets to a standing position from a squat, pivot a quarter of the way around, can sit up strongly without support, uses one hand more than the other, fine motor coordination nearly absent; builds a tower of two blocks and fits a peg into its proper hole with difficulty, cannot throw a ball into a box, cannot control cup, cannot lower himself from a standing to a sitting position without falling.
Notes: Removed Pt. from isolation status in a.m., Pt. will remain in isolation room to insure privacy. Allowed wife to visit, but restricted visits from other family members.
Orders:
Brydie sat gloomily in the Pediatric Waiting room looking out the window. A fast moving storm was coming in; the black clouds boiled angrily as the front swept over the city. The cheerful pastel designs on the wall were muted by the room's growing darkness. Brydie waited impatiently for the doctor to arrive, the nurses had told her that the doctor had taken Darryl off isolation status and she could visit Darryl. Dr. Halstead had requested that she talk to him before visiting her husband. She waited about an hour in the Pedi waiting room becoming increasingly frustrated. The nurses were taking care of patients and the nurses' station was unoccupied except for the unit clerk. She decided to take matters in her own hands and slipped into the isolation room when the unit clerk was occupied. She entered the room quietly, expecting to see Darryl in bed. The room smelled of disinfectant and baby powder. There was a curtain around a bed in the center of the room. She went to the curtain and pulled it back. All she saw was a sleepy rosy-cheeked tot wearing a small paper patient gown standing in a crib. The crib was stainless steel and completely surrounded the little boy; even the top of the crib had bars. He looked like he was in a cage. He must be a handful if they have to put him in a crib like that, she thought. She turned to leave when Darryl's nurse came in the room with a stack of diapers in her hand. "Oh, there you are Mrs. Burr. Is Dr. Halstead still here? I need to talk to him."
Brydie shook her head no and demanded, "Where is my husband now? The clerk at the nurses station told me that he was in this room, where have you moved him?"
The nurse looked puzzled and said, "He's right here......Ohhhh...You haven't talked to Dr. Halstead yet, Have you?"
Brydie replied testily, "No, I've been waiting a hour, but I haven't seen him. What do you mean he's right here? There's no one here but this baby," Brydie said turning and pointing at the crib.
She glanced at the card taped to the footboard of the crib and saw that the patient's name had been written on the card with a black marker. It said Darryl Burr. "This has to be some kind of horrible mistake! That's not my husband," she said angrily.
The nurse looked at her sympathetically and said, "If you'll come with me, I'll see if I can find Dr. Halstead."
Brydie looked at her stubbornly, determined not to move until she found Darryl. She said, "What's going on here? Why does this crib have my husband's name on it? Why did you say he was here? Where is he?"
"I think I'd better let Dr. Halstead answer that question," the nurse said primly.
Brydie stood her ground and said softly, "He was getting younger when he came into the hospital. You can't mean that this is my husband?", she said turning back to look at the nurse.
The nurse's face was set in an expression of barely concealed sorrow and nodded involuntarily. Brydie turned and looked at the baby again and saw the resemblance between her husband's baby pictures and the tot in the crib. "Darryl!', she cried. "What have they done to you?"
She ran to the crib and dropped the side. Brydie wrapped her arms around him and hugged him tightly. She kissed him repeatedly on the face and said, "Oh my darling, What's happened to you?"
Her hands moved lower on his body and felt the diaper. "They've put you in diapers!", she said in a surprised tone.
She turned back to the nurse and demanded, "Why is he in diapers?"
The nurse looked embarrassed and said, "Doctor's orders, Mrs. Burr. He's lost his toilet training."
"He's a grown man, no matter how he looks. He doesn't need diapers!", Brydie said defiantly.
The nurse looked at her sadly and said, "He's wet right now, Mrs. Burr. I checked his diaper a few minutes ago. I left to get some clean diapers. That's where I was when you came in here."
The nurse sniffed and said, "And I think he just pooped too. Let me get him in some clean diapers"
Brydie look at her in disbelief and turned to Darryl. She lifted the gown and looked down at his diaper. It sagged low on his hips and was obviously soaking wet. She could smell it too. The nurse was right. He had pooped in his diaper. She hadn't noticed it in the excitement. "Oh Darryl, Now look at what you've done!", she said in dismay.
He smiled innocently at Brydie, completely unaware of his dirty diaper. "I'll change him," Brydie said resolutely.
The nurse nodded and handed a diaper to Brydie, who began to change Darryl. She laid him on his back and removed the diaper tapes and pulled the front of the diaper down between his legs. Darryl chuckled happily and kicked his feet. "Be still, Darryl!", Brydie said and finished changing him.
She folded the dirty diaper together and handed it to the nurse. Brydie picked up Darryl from the crib and carried him over to the easy chair and sat with him in her lap. Darryl looked up into Brydie's eyes and patted her cheek affectionately with his hand. "Oh my poor darling, what's happened to you? Speak to me!", she said.
Darryl smiled at her, then made a cooing noise. "You can't talk anymore! Nurse, how long has he been like this?"
"About a day, Mrs. Burr. Yesterday he could say simple sentences, but today he hasn't talked at all," said the nurse.
"I should have stayed with you the whole time you've been in the hospital," Brydie said miserably.
"It wouldn't have changed anything, Mrs. Burr. We're doing all that can be done," the nurse said, trying to comfort Brydie.
"Try and talk to me, Darryl. Please try and say something!", pleaded Brydie.
Darryl's face assumed an expression of concentration and he said, "Mmm....Ma...Ma-ma!"
"Oh my poor husband, you're talking just like a baby!", she said pityingly. She cuddled him to her breasts and said, "It's okay, Brydie's here honey. Brydie will take care of you. Don't worry darling, everything will be alright."
She comforted him, murmuring sympathetic noises lovingly over him as the nurse silently left the room. An hour later the nurse returned and announced, "It's time for lunch, I'll be bringing his food in a few minutes. Would you like to feed him?"
Brydie nodded and the nurse left and re-entered with a high chair. She set it up and said, "Go ahead and put him in the high chair. Leave the gown on him, we don't have any bibs. I'll bring him a new gown after lunch."
She went out of the room and returned with some jars of baby food, a feeding spoon and a small pre-packaged bottle of infant formula. "He drinks formula from a bottle too?", Brydie asked unhappily.
The nurse nodded and handed Brydie the food and bottle. She told her she would be back later and get the high chair after he finished lunch. Brydie fed him mixed vegetables from the jar, followed by a chicken dinner with macaroni. She gave him the jar of apple cobbler for dessert, then wiped his face and hands with the gown and removed it. Brydie folded the jars into the gown and put it in the trash can. She took him out of the high chair and sat him in her lap on the easy chair. She fondled his cheek gently with her fingers and smiled knowingly as she saw his mouth make unconscious sucking movements. Darryl reminded her of their daughter Carol when she was little. Rain started to patter on the window as she tilted him back against her arm and put the nipple of the bottle in his mouth. He seized the bottle with both hands, eager for his noon bottle. She stroked his hair as he surrounded the nipple with his mouth and suckled hungrily, murmuring in delectation while making loud sucking noises. "He looks like his baby pictures taken when he was a year old," she thought to herself as she watched him consume the formula greedily.
He finished the bottle and she sat him upright on her lap. She patted his back to bubble him and was rewarded with a loud burp. She laid him back on her arm again and cuddled him close to her. Distant thunder rumbled in the background as he smiled winsomely and tugged on the front of her blouse. He thoughtlessly put his thumb in his mouth and began sucking it. He looked like every mother's dream of a charming, cheerful baby. "Oh my precious angel, you've regressed into infancy!", she wept, cuddling him with both arms to her bosom.
"I'll get the best doctors for you, Honey. We'll get you in rehabilitation so you can re-learn how to walk and talk again. You'll have to wear diapers until they can do something about your incontinence though. I hope they can reverse the changes in your body and make you grow again. You look like you're a year old. Poor Darryl, I don't know if you'll ever be normal again."
Bitter tears rolled down her face as she wept for Darryl. He reached up and touched her cheek, bewildered by the tears. She looked back into the baby face gazing up at her in confusion. He smiled at her hopefully and touched her lips with his tiny fingers, trying to capture her attention. Drool rolled down his chin as he bubbled and cooed at her. The storm clouds outside parted momentarily and a shaft of sunlight came through the window and illuminated his face. She looked into his eyes and saw that behind them lay a fundamental lack of comprehension of the world around him.
"Oh God, Darryl, your mind is gone!", she said, stunned by the sudden realization. "What's happened to you? Can you understand me? Wave your hands if you can understand what I'm saying! Do something Darryl! Don't just lay there! Oh God, it's affected your mind too! You not only look like a baby, you are a baby! You can't even understand what I'm saying! You have the mind of a infant! No wonder they've been treating you this way, you've become a diaper-wetting, drooling baby again," she sobbed.
He sensed her anguish and started to whimper. Brydie snuggled him protectively against her and comforted him saying soothingly, "Shhhhhh.....There, there, Darryl... I'm right here. ...Don't worry, I'll take care of you! ...Don't cry baby, it'll be okay."
She rocked him silently, tears streaming down her face. He quieted and lay his head serenely against her breast. She sat looking down at her diaper-clad, infant husband tenderly as the last silver beads of rain ran down the window pane and hoped the doctors could reverse this dark miracle. He put his hand to his side and tugged on the adhesive diaper tab, trying to take it off. Brydie took his hands away from the diaper gently, saying, "My darling, you've lost control of your bladder and bowels, you're going to have to wear diapers until you're potty-trained again. When you can control your peeing and pooping, I'll let you wear regular underwear."
He gurgled happily, blew bubbles, then grinned a gap-toothed smile while peeing in his diaper.
"He looks so much like Carol looked when she was a baby. If Carol had been a baby boy instead of a girl, she would have looked just like him," she thought.
He yawned sleepily, then stretched his small fat arms and clenched his tiny fists. He turned his head and nestled it between her arm and her breast. "He looks so terribly innocent. You'd never know he'd been a man once," she told herself as she pulled the top of the diaper up over his protruding tummy.
Her maternal instincts were aroused by the sight of her infant husband snuggled protectively in her bosom. "Look at him. He's completely helpless. He can't do anything for himself," she whispered to herself. "I'll have to take care of him like he's a baby. He supported and cared for us all these years. Now it's my turn to take care of him. He needs me to be his mommy now," she thought.
"Would you like me to be your mommy, Honey? Do you want to be Brydie's baby boy?"
Darryl bubbled with glee as he reached up and plucked at her breast. "Darryl likes that idea, doesn't he? Darryl will have a mommy to tend to him and watch over him. Darryl will never have to worry about anything again."
She smiled down at him indulgently as he put his thumb in his mouth and resumed sucking. Brydie tickled him under his chin and said, "You're the most adorable baby boy I've ever seen. Aren't you, honey? You're sooooo sweet mommy could just eat you up! Mmmmm!", she nuzzled his chest as if she was going to eat him and he cackled in delight.
"He has such an angelic face. If I'm not careful, I'll spoil him rotten," she thought, caressing him fondly. Brydie thought of how they had spoiled their daughter when she was a baby. It was too bad she had given away all the baby furnishings. She would need to buy a roomful of baby furniture and toys for him. Some indoor-outdoor carpeting would be nice too, it would give him a warm floor to play on and cushion his bottom when he falls," she thought to herself. Carol's nursery was now her bedroom; she would need to convert another room into a nursery. Brydie decided she would turn his den adjoining the master bedroom into a nursery. He wouldn't need a den now.
She smiled, thinking how cute it would look when she got finished. Their eleven year old daughter, Carol, could help her decorate it, she could help her take care of Darryl too. Carol would love the opportunity to take care of a baby. She and Darryl had planned to have another baby years ago, but she had not been able to conceive after Carol's birth. Now Carol would have a baby brother. She would being Carol tomorrow to visit him. Darryl's nurse opened the door and said from the doorway, "Is he finished with lunch now?"
CONTINUE TO PART 2