DAVID GREENE, HOST:
Today in Your Health, should unvaccinated children be allowed in day care? We'll explore that question a moment. First, a medical mystery of sorts and the doctor who solved it. Medicine has become a lot more scientific in the past century, but decisions can still be as much art as science, especially when they involve the brain and the nervous system. NPR's Jon Hamilton brings us the story of one medical decision. It begins in a house in Cohasset, Massachusetts.
JON HAMILTON, BYLINE: Bob Smithson lives here with his wife, Pat.
BOB SMITHSON: We were having dinner with some very good friends. One of our friends happened to be a doctor. And he said why are you dropping your head, Bob?
HAMILTON: Bob, who is 79, had no idea why his head was lolling forward, neither did his doctor friend. And Bob's wife, Pat, says before long other symptoms appeared.
PAT SMITHSON: The next day he couldn't swallow.
HAMILTON: And he had double vision, so Bob went to his primary care doctor who called the neurologist.
BOB SMITHSON: And the neurologist said I think he's got a very rare sickness.
HAMILTON: Myasthenia gravis - a disease that can leave muscles dangerously weak. It occurs when the body's immune system attacks the connections between nerve and muscle. Doctors treat myasthenia with drugs that improve the transmission of nerve impulses and suppress the immune system. Bob's neurologist referred him to Allan Ropper, an expert on myasthenia at Brigham and Women's Hospital in Boston. Ropper says he knew Bob might be headed for trouble.
ALLAN ROPPER: Myasthenia's known to be a very fickle disease. It can get bad very quickly. It has a substantial mortality rate, particularly in an individual his age.
HAMILTON: Ropper started Bob on several medications, but his patient's muscles continued to get weaker.
ROPPER: He was spending more and more of the day holding his head up by putting his arm under his chin or using a collar and to me that was enough to say you need to be in the hospital because you're on the brink of decompensating.
HAMILTON: A nice way of saying his body was barely able to function without help. Pat was spending her days at the hospital and sleeping at a Holiday Inn. Late one night, she got a call. Bob was being moved to the intensive care unit and wanted to see her. She took a cab back to the hospital.
PAT SMITHSON: I sat in a chair and put my arms around his legs and we sort of stayed until the morning.
HAMILTON: Pretty soon Bob was heavily sedated and full of tubes. One delivered air to his lungs, another sent food to his stomach.
PAT SMITHSON: He can't talk now. He can't write. I thought well, if it was me, I'm sure Bob would be right there.
HAMILTON: More than a week passed and Ropper realized that his patient had arrived at a critical juncture.
ROPPER: He was beginning to get a pneumonia, which is common from being intubated and on a ventilator. And was really in the kind of spiral that, as clinicians, is very feared.
HAMILTON: The medications weren't working, at least not yet. From time to time doctors turned off the ventilator to see if Bob could breathe on his own. He couldn't, but Pat still believed her husband was going to get better, until she got some really disturbing news.
PAT SMITHSON: One of the doctors came back after the rounds and said we've decided that he has to have a tracheotomy.
HAMILTON: Surgery to make a hole in his neck for a breathing tube - Ropper says for some patients the tube is permanent.
ROPPER: It's a big step. It's done all the time, but it, you know, signifies that you're in it for the long call and things are going to get bad.
HAMILTON: Bob had become despondent, and Pat was afraid one more setback might be too much for him and for her.
PAT SMITHSON: I just could not bear it. I said please just ask if Dr. Ropper can come. If he says it's OK I'll rest on it.
HAMILTON: Ropper understood what was going through Pat's mind.
ROPPER: She felt like the end was near. This meant, you know, that he was going to be a wreck(ph).
HAMILTON: So he paid a visit to the Smithson's.
PAT SMITHSON: He came in, walked over to Bob, said, Bob, we're going to try something.
HAMILTON: Ropper knew that weeks earlier Bob had stopped getting a medicine called Mestinon because it no longer seemed to be working. But over the years, Ropper had noticed that after patients stopped taking Mestinon for a while their bodies become more likely to respond to the medication again.
ROPPER: So I said don't do the tracheostomy. Put him back on the Mestinon.
HAMILTON: That was on a Friday. Ropper told the surgeons to wait until Monday to see if Bob responded. And on Sunday, Pat says, a team came by to test her husband's lungs one more time.
PAT SMITHSON: When they took him off the ventilator, he breathed. He took that breath. He took that breath.
HAMILTON: Bob would spend another week in intensive care and months regaining his strength. But a year after the dinner where his head began to loll, Bob and Pat had another party with the same guests.
PAT SMITHSON: It was the most fun, wasn't it?
BOB SMITHSON: Had we not had a doctor like Dr. Ropper, I'm not sure where I'd be today. And Pat was always with me 100 percent of the time.
HAMILTON: Jon Hamilton, NPR News.
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