22
Tuesday, June 6, 2006 – 1:53 p.m.
Neurology Floor – Office of Dr. Slaterbaugh
Ken Slaterbaugh caught himself nodding off to sleep while sitting at his desk. Snapping his head back up, he unconsciously looked around to make sure no one had seen him. No one had since he was alone. Resting his head in his hands, he cleared the cobwebs from his brain and re-focused on his task. His day had been extremely busy so far. After talking with Maisie, he’d gone up to deal with the situation in Hank’s room. Now he was studying the notes from his patients charts’ trying to figure out what was going on.
Lying on his desk were the notes from Benita’s chart, Hank’s chart and Maisie’s. Ken was trying to find some common thread that would tie them together. Earlier, he had ordered blood tests for all three patients, although only two were still alive. Amongst the various tests he’d requested were toxicology tests. Something about his patients’ had to be similar. Ken reached over and took another bite of his Caesar salad. He washed it down with a swig of semi-cold water. Tapping his fingers lightly on his desk, Ken sat staring at the computer screen, thinking. Just then, there came a knock on his door.
“Come in,” Ken yelled.
The door opened and the mail boy walked in.
“Hi doctor Slaterbaugh. I have a package for you.” Walking over to Ken’s desk, the mail boy brought Ken a rather worn, beat-up looking box.
“What happened to this?”
“I have no idea. This is how Fed Ex delivered it to us. They said that’s how it looked in their warehouse when they received it.”
“There’s no return address. Do you think it’s a bomb?”
“No. They said it was scanned before being delivered. It’s just a package.”
“Hmmm. Okay, well, thanks.”
“You’re welcome. Have a good day.”
The door shut behind the mail boy. Ken looked at the strange worn out package sitting before him. Its dimensions were about eight inches square. Ken turned it over in his hands. He lightly shook it, but no sound emanated from it. It smelled like an old bookstore, as if the paper were ancient. Ken thought it strange that he should be getting some package like this. He wasn’t expecting anything from anyone. Just then, the phone rang. Ken answered it. Setting the package to the side of his desk, Ken grabbed a pen and wrote down a few notes as he talked. After about ten minutes, the phone call was terminated. Ken torn off the sheet of paper and laid it aside in his ‘to-do’ basket. The discussion had been about another patient that he’d been dealing with over the past few months. The call was from a fellow colleague in Boston. Ken promised to get back to him within a week. For now though, he needed to get back to the more pressing situation he was facing. Ken sat back in his chair thinking about all that had taken place within the last few days, especially the last few hours.
Ken thought about Hank. Currently, he was resting. He’d not awakened since his apparent nightmarish ordeal. All of his vital signs were fine and Dan had not called about any changes. Maisie too was doing well. Since her nightmare that morning, she’d had no other troubling nocturnal visions. Ken was planning on visiting her within the next half an hour and probably releasing her to go home. Benita’s death still bothered Ken. Why had she died? What caused her to go over the edge? He had no clue. Ken’s mind drifted back to Maisie. She’d mentioned something about lucidity. His curiosity piqued, he wondered if there was anything on the Internet about it.
Moving his mouse to activate the screen, Ken’s face began to glow as the CRT came to life. He typed in the address for the Alta Vista search engine. Once linked to the site, he typed in “lucidity” in the search line. Immediately, an entire list of websites appeared. Coming up near the top was a link to http:\\www.lucidity.com. Clicking on it, Ken was instantly connected via high-speed cable modem to the site. He began to peruse it. Ken found the contents intriguing. He’d never heard of lucid dreaming before, but here, at the behest of a nine-year-old Shirley Temple look-alike, he was staring at an entire website, among many, that dealt with the subject.
Scanning through the contents, Ken came to a heading labeled Chapter 10: “Overcoming Nightmares” helps you use lucid dreaming to face and overcome fears and inhibitions that may be preventing you from getting the most out of your life. Ken began to read. Before long, he was fully absorbed in the contents of this information. Coming to the heading Nightmare Causes and Cures Ken’s attention was focused on a few particular paragraphs that he thought might begin to answer some of his questions.
Some factors that seem to contribute to nightmare frequency are: illness (especially fever), stress (caused by situations like the difficulties of adolescence, moving, hard times at school or work), troubled relationships and traumatic events, like being mugged or experiencing a serious earthquake. Traumatic events can trigger a long lasting series of recurrent nightmares.
Some drugs and medications can cause an increase in nightmares. The reason for this is that many drugs suppress REM sleep, producing a later effect of REM-rebound. If you go to sleep drunk, you may sleep quite soundly, but dream little, until five or six hours into sleep. Then, the alcohol's effect has mostly worn off and your brain is prepared to make up for the lost REM time. As a result, you will dream more intensely than usual for the last few hours of your sleep time. The intensity is reflected in the emotionality of the dream, which often will be unpleasant.
There are a few drugs which seem to increase nightmares by increasing the activity of some part of the REM system. Among these are l-DOPA, used in the treatment of Parkinsonism, and beta-blockers, used by people with some heart conditions. Since research has shown that lucid dreams tend to occur during periods of intense REM activity, [2] I believe that drugs that cause nightmares may also facilitate lucid dreaming.
Ken was fascinated by what he was reading. Perhaps there was some common thread between his patients. A drug or drugs, stress, trauma. Whatever it was, this information gave him some things to go on. Engrossed in this information, Ken didn’t notice that Dan had walked into the room.
“Dr. Slaterbaugh?”
Ken jumped, startled by the intrusion. “Yes?”
“Sorry. I didn’t mean to scare you, but I’ve got those labs results back for Benita, Hank and Maisie.”
“Great! Thanks Dan. I’ve been waiting for those.”
Dan walked over to Ken’s mahogany desk and handed the reports to him.
“Have you figured anything out yet?”
“No, not yet. But I have some ideas. These reports will definitely help.”
“Let me know if you need anything else.”
“I will. Thanks Dan.”
With that, Dan turned to leave. The Hippocratic Oath hung in a frame on the wall by the door. Dr. Slaterbaugh’s diplomas of medicine were also prominently displayed on the walls around Ken’s office. Bookshelves filled with books and reference works lined the walls. Two leather armchairs sat at angles to each other in front of Ken’s desk and a beautiful Persian rug adorned the floor underneath. The door shut and Ken was once again alone.
Ken leaned back in his chair to study the reports. Scanning them, he noticed that all three patients’ blood and urine samples had been taken as he’d requested. Each patient had provided 14 – 20 ml of blood and 50 – 70 ml of urine for the tests. The tests had been run as requested and the computerized results had been printed out. Ken now began to study the results. When he reached the toxicology results, what he found surprised him. According to these reports, all three patients’ were showing increased levels of tryptamines. Tryptamine compounds resemble the neurotransmitter serotonin. Serotonin in turn usually has an inhibitory effect and plays a role in regulating mood, controlling eating and sleeping and arousal. It is also involved in regulating pain and the control of dreaming.
Ken thought it odd that these levels of tryptamines should be present in these patients. From his experience, Ken knew that the hallucinogenic drug Lysergic Acid Diethylamide or LSD could stimulate the serotonin receptors, which would in turn lead to hallucinations, vivid after images, and that it would also distort perception and could lead to paranoia and panic. It was possible that Hank was using LSD and perhaps Benita also got a hold of some somehow, but it seemed highly unlikely that Maisie would have injected the drug or allowed it to be injected. Her mother was not a likely candidate either. Ken reached up, stroked his mustache, and scratched his head. Staring off into space for a few minutes, he tried to comprehend what he was reading and put it all into perspective. Why would all three patients be showing these increased levels? What link was there between them?
Ken again called up the Alta Vista search engine to see if he could find anything that would tie these occurrences together. Typing in the words tryptamine, LSD and serotonin, Ken was immediately connected to an index of hundreds of links that would take him to various web sites dealing with the subject. Rubbing his eyes and stretching, Ken prepared to do some reading and surfing to find anything that might indicate the odd connection between his patients.
As Ken scanned web site after web site, nuggets of information from his years in college, medical school and as an intern began to solidify in his mind sculpting a clear picture of what was happening. Flashes of knowledge and experience came together as Ken made the connection between many of these tryptamine-based chemicals and their effects on the brain. Although the duration of his patients supposed hallucinations seemed to be far less than the average hallucination of someone taking one of these drugs for recreational use, the very idea and realization that they were experiencing hallucinations, in the form of nightmares it seemed, indicated that he was on the right track. Refreshing his mind further, Ken continued to peruse the Internet.
For example: While scanning the Serendipity web site, Ken read the following blurb with interest. Although LSD is not a tryptamine its molecular structure includes that of the tryptamine molecule. We cannot thereby simply classify it as a tryptamine psychedelic because its molecular structure also includes that of some psychedelic phenethylamines such as 2,5-dimethoxy-4-methylamphetamine (DOM) (Nichols [81], p.114). Nevertheless LSD is usually classified with the tryptamine psychedelics and seems more closely related to the them because it is more readily displaced from receptor sites by the tryptamines than by the phenethylamines. This seemed to indicate that perhaps the high levels of tryptamines Ken was seeing in the tox screens could very well be from something other than LSD. As he continued to search, he came across more information that shed light on his dilemma.
Tapping into the web site www.shroomery.org, Ken found further evidence that the effects his patients were having could indeed be coming from another source. The compounds responsible for the psychological effects of the Psilocybes are known as tryptamines. Tryptamines are those compounds that contain an indole ring. These compounds resemble the neurotransmitter serotonin. They are thought to be competitive agonists of 5-HT2 receptors (a particular subtype of the serotonin receptor.) Psilocybin is the most abundant tryptamine in Psilocybe mushrooms and has been present in concentrations ranging from 0.36% in P. stuntzii to 0.98% in P. semilanceata . However, after ingestion it is rapidly dephosphorylated by the enzyme alkaline phosphatase in the intestine. Thus, it is the metabolite psilocin which is thought to be responsible for hallucinations and psychological effects.
The term “indole ring” caught Ken’s attention. Earlier in his perusal, he had read that many psychotomimetic drugs or drugs that sometimes mimic psychosis and are called mind-expanding, hallucinogenic or psychedelic, share this basic chemical structural unit, the indole ring. Although Ken was no chemist, his years in college chemistry and his studies of chemical interactions on the brain in medical school allowed him to ascertain what was being said. This “indole ring” is also found in the nervous system substance known as serotonin. It is also similar to mescaline and the adrenal hormone epinephrine. Ken recalled the outcome of ingesting these substances. An alteration of light and space, enhanced colors and details of things, visions of nonexistent people or things, conversations with no one and other psychological phenomena. One line that struck Ken while reading in the online version of the Columbia Encyclopedia was that “physiologically, the drugs act as mild stimulants of the sympathetic nervous system, causing dilation of the pupils, constriction of some arteries, a rise in blood pressure, and increased excitability of certain spinal reflexes.” Those were some of the exact symptoms that his three patients had experienced.
Ken went back and re-read the paragraph containing references to the indole ring. The term “psilocin” which was derived from Psilocybin mushrooms made him stop and think. Maybe those mushrooms are to blame. Since they have a higher level of tryptamines than LSD, it is possible that my patients’ symptoms are emanating from them or something like them. Ken glanced at the digital clock on his desk. It read 3:26 p.m. He needed to get back down and check on Maisie shortly. He didn’t want to leave her all day since she’d been there from early that morning. After having had one nightmare, she’d been able to wake up. Her headache had diminished, but Ken had kept her there for a while just to see how things went. He’d also prescribed some medication and wanted to see how that was working.
In view of Hank Maverick’s incident, Ken had postponed the MRI until Hank was conscious and able to communicate. He wanted to be able to observe what was happening and actually talk with Hank. Since Hank was in no current state of emergency, Ken felt comfortable waiting on running the MRI. Re-focusing on the idea of mushrooms possibly being the culprit in his patients’ hallucinogenic episodes, Ken went back to the Internet and began researching Psilocybin mushrooms.
As he began to dig, Ken found that these mushrooms had many similarities to LSD. The symptoms resulting from their ingestion also confirmed his suspicions that they could be to blame. Inability to concentrate, restlessness, increased heart rate, hallucinations, high temperatures, especially in children and more. Could that be what caused Maisie’s temperature to go so high? Ken wondered. As Ken read trying to absorb everything, the biggest question that he asked himself was how. How were these tryptamines introduced into Benita, Hank and Maisie? Who or what introduced them? How could Ken counteract the effects? Ken continued to scan several web sites in search of answers and solutions to his current dilemma. By 3:45 p.m., Ken decided he’d better get back downstairs to check in on Maisie. Printing off a stack of papers containing the information he had saved off the Internet, Ken took the last swig of his water, stood up, stretched, and then headed downstairs to the ER.
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