Ep. 69 | Too Much of a Good Thing

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In the late summer of 2012, a 55-year-old man lay in a hospital bed surrounded by his loved ones.

The man was at a skilled nursing facility, recovering from a bad fall that had nearly killed him.

Thankfully, now he was on the mend and things were looking good.

But today, as the man looked around at the familiar faces of the people gathered by his bed, his eyes suddenly filled with terror.

None of them were supposed to be here.

The man squeezed his eyes shut in fear, and when he opened them a few seconds later, he breathed a sigh of relief.

The friends and family were gone, and he was alone.

The man leaned back on his pillow and shook his head.

He knew he was just seeing things.

He had been alone all along.

But it was still disconcerting to have people pop in and out of his room like that.

He did his best to relax and let it go, but then he caught a flash of movement in his peripheral vision, and his eyes went wide with fear once again.

This time, it wasn't people appearing by his bedside.

There was smoke coming through the walls, and the smoke was about to consume him.

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From Balin Studios and Wandry, I'm Mr.

Ballin, and this is Mr.

Ballin's Medical Mysteries, where every week we will explore a new baffling mystery originating from the one place we all can't escape, our own bodies.

So, if you like today's story, make sure to apologize to the follow button for all the tricks in the past.

But when you lean in for a hug, steal a piece of their hair and plant it in all the evidence bags for every cold case file at your local police station.

This episode is called Too Much of a Good Thing.

At a popular diner in Waterbury, Connecticut, 52-year-old Gina Hale finished the last bites of her lasagna, being careful not to leave behind even a speck of the rich, delicious cheese.

Across the table, her 55-year-old brother, Tony, downed his cheeseburger.

This restaurant had been their hangout since they were kids, and whenever they came to this diner, where the old jukebox still had songs from the 1980s, it made them feel like they were teenagers again.

From the moment they sat down on this July day in 2012, they were both wiping tears of laughter from their cheeks.

Seeing Tony this happy made Gina smile.

He'd been battling depression for a while now and had finally gotten on the right antidepressants to help him feel like himself again.

But as Gina watched Tony take a sip of his beer, she couldn't help but feel concerned.

Now, with anybody else, a beer with lunch was no big deal.

But Tony had abused alcohol for many years, and Gina couldn't hide her concern anymore.

But Tony didn't even let Gina get a word out before he promised her this would be his last beer before he quit drinking cold turkey.

Gina gave her brother a weak smile, trying hard not to remember all of his previous failed attempts at getting sober, which included four attempts at an actual rehab facility.

She hoped this time it would stick.

because all the drinking had really taken its toll on her brother.

A little while later, when they got up to leave, Gina noticed that her brother was a bit slower than usual as he inched his way out of the booth.

Out in the parking lot, Gina gave Tony a big hug as he hopped on his Harley and promised her he was okay to ride.

He had the same brown eyes as their mother, and for a split second, it was like their mother's face flashed in front of Gina's eyes.

Their mother had been an alcoholic too, and she eventually had died of cancer.

And so as Gina watched her brother ride off down the street, she hoped he was not following in his mother's footsteps.

Three weeks later, Gina broke a pane of glass at the back of her brother's house, then pried open the window, and climbed inside.

Gina hadn't heard from Tony in a few days.

After their lunch they had together, he'd quit drinking cold turkey just as he'd promised.

But it had not gone well.

He'd been overcome by a condition called delirium tremens.

which is when the body starts to shut down from alcohol withdrawal.

Tony had been forced to spend an entire week in the hospital to recover, but he'd gotten through the worst of it, and Gina had hoped that this time he'd be able to stay sober.

But now, it was clear something was wrong.

Gina didn't know if Tony had gone into withdrawal again or maybe fallen off the wagon.

But either way, he never just went radio silent like this.

And now, looking around at the inside of his house, Gina knew it was bad.

She crept through the rooms, calling her brother's name over and over, but there was no response.

The unventilated house felt like an oven.

As she wiped the sweat from her face, she looked at the dirty dishes and the overflowing garbage in the kitchen.

She hadn't heard from Tony in days, and now, finding his home in this condition, she just couldn't stop the panic rising in her chest.

Just then, a yellow streak flashed past her and she jumped.

Her brother's tabby cat was suddenly at her feet, brushing up against her legs and yowling for attention.

Gina could see that the cat's food dish was empty, and so she wondered why Tony hadn't fed his cat.

As Gina was about to feed the cat, the cat just took off running down the hall and disappeared through the open door to the basement.

Gina followed the cat down the hall, she turned to go down the stairs, she flipped on the basement light, and immediately she stopped.

That's when she found her brother.

Tony lay crumpled in a motionless heap down on the basement floor.

Gina ran down the stairs to his side, and she could immediately tell he was badly hurt.

His hair was matted with blood, his skin was a yellowish gray, and he had dark bruises all over his legs.

Tony looked like he'd been lying there for a while, maybe even days.

Gina pulled out her cell phone and dialed 911.

After she described what was going on, the dispatcher asked if Tony was breathing.

Gina shakily replied that she couldn't tell.

But just then, Tony's mouth opened and he began to cough.

And as he gasped for air, his cracked, dry lips tried to form words.

Gina begged the dispatcher to send help right away.

After hanging up with the dispatcher, Gina took her brother's hand and leaned in close to hear what he was trying to say.

But she couldn't make it out.

He was just babbling something.

And soon, his mysterious whispers were drowned out by the sounds of the ambulance pulling into the driveway.

Three hours later, Gina sat down in the only seat left in the crowded ER waiting room, a tiny plastic chair in the kids' play area.

As she sat there, she ate a bag of chips from the vending machine, wishing she had something more filling to eat.

But mostly, she just couldn't stop thinking about the sight of her brother at the bottom of the basement stairs.

His body twisted from the long fall.

She really had thought Tony was dead, and she felt so grateful that he had a pulse when the EMTs finally reached him.

Gina shifted uncomfortably in her chair for a few more minutes until the waiting room door swung open and a doctor finally called her name.

Gina raced up to him, bracing for the worst.

Tony was still alive, the doctor explained, but barely after his fall down the stairs.

Tony had a severe concussion that may have damaged his brain, and he had suffered so much damage to his muscles in the fall that his kidneys had shut down.

The doctor said he very likely would need dialysis, which is a process in which machines remove waste from the body when kidneys no longer function correctly.

Even worse, Tony had suffered damage to his heart too, going into cardiac arrest in the ambulance.

The paramedics had managed to restart his heart, but he was hanging on by a a thread.

Tony had gone comatose.

To keep him alive, his doctors had put him on a ventilator to help him breathe and chilled his body temperature to 91.4 degrees to protect his brain.

Gina asked if she could see her brother.

The doctor nodded and said that Tony had been sent to the intensive care unit, but he warned her that Tony was in really bad shape, and so it wouldn't be easy to see him like that.

Gina nodded and set off for the ICU.

A few minutes later, the doctor's words were ringing in Gina's ears when the nurse on duty led her to her brother's door.

But the sight of Tony still made Gina stifle a gasp.

Her brother lay unconscious on the bed, covered in a pile of gel pads that were cooling his body.

His swollen chest heaved up and down as the ventilator pumped oxygen down his throat and into his lungs, all while an IV line sent fluids and medicine into his body.

Gina had never seen her big brother look so helpless.

She walked up to him and touched his hand.

It was cold and limp.

Gina always knew Tony's alcohol abuse was going to hurt him if he didn't stop, but she never expected anything this bad.

Five weeks later, Gina stepped into Tony's hospital room carrying an almost empty donut box.

Tony had spent three weeks in the ICU and then two more weeks in a regular hospital room.

And as those five weeks had passed, Gina had gotten to know every staff member in the wing.

And she'd brought them donuts because today was a special day.

Tony was finally well enough to move out of the hospital and into a skilled nursing facility.

Tony's room was quiet now that many of the monitors and tubes had been disconnected, but he was still bedbound.

He needed dialysis three times a week while doctors kept trying to save his kidneys.

And the ventilator that had been breathing for him was now replaced by a hole in his throat with a tube sticking out, so oxygen could go straight to his lungs.

Tony couldn't speak at all because of this tube, but through it all, he was somehow managing to hold up okay emotionally.

Gina was genuinely impressed by his determination to get better.

Gina sat down next to Tony's bed, looked into his eyes, and took his hand.

It was warm and pink, and with great effort, he managed to give her a corny, exaggerated thumbs up.

She knew instantly her brother was joking with her.

Tony often mocked other people who gave the thumbs up gesture.

Gina laughed and gave it right back to him.

That was the brother she remembered and loved.

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Two weeks later, a nurse's aide named Matilda Rogers pulled her cart down the hallway inside of the skilled nursing facility where Tony was staying.

Matilda really enjoyed the early shift.

In the hours before the building got busy with deliveries and family visits, she had a chance to really connect with most of her patients and give them a little inspiration for the day.

She stopped the cart and locked the wheels outside of Tony's room.

Tony was one of her favorites.

Matilda loved his sense of humor, and she developed a morning ritual of greeting him with a joke or a riddle.

During his two weeks at the nursing center, Tony had learned to speak again by using a special valve on the hole in his throat.

His voice was still raspy and low, but Matilda loved it when she could make him laugh.

She also encouraged him to imitate her silly dance moves, and that helped him slowly strengthen his arms and legs, and so he had been making steady progress.

But when Matilda stepped into Tony's room, armed with a new joke she'd gotten from her 11-year-old niece, Tony sat stone-faced and silent in the corner.

Matilda instantly knew he was not in the mood for jokes this morning.

Tony didn't say a word as she crushed his meds into a fine powder and administered them through his feeding tube.

When she was done, she washed her hands and asked permission to sit in his guest chair so they could talk.

He nodded, so she took a seat and then tried her joke, but Tony didn't respond.

She asked if there was something going on that maybe he wanted to share.

And eventually, Tony's eyes began to well up and he would tell her something very strange.

He told her in his slow, raspy voice that people from his past had been visiting him in his room.

Old friends and family, including folks he hadn't seen for many years, had been suddenly appearing by his bedside.

They would stand there and sometimes even speak to Tony for about 10 seconds, but then they would just disappear.

Matilda asked him if he'd been having trouble sleeping again.

She told him she thought he might have had a disturbing dream, but Tony was adamant that he had not been asleep at all.

He said he knew that the people he was seeing in his room were not real, but he definitely was seeing them.

It was not a dream.

Matilda could see how frightened Tony was and told him she was going to do everything she could to keep him safe.

She walked back into the hallway to the medicine cart, then pulled up her notes from the weekly meeting with the staff psychiatrist.

She saw that Tony had been prescribed a new sleep medication a few days ago.

Her notes from the night nurse said Tony had tolerated it well, and there were no indications that Tony had been suffering bad dreams or hallucinations.

She couldn't understand why cheerful Tony had suddenly turned so dark.

Matilda finished delivering meds to the rest of the patients along Tony's hallway and returned to Tony's room half an hour later to see how he was doing.

His mood had not changed.

In fact, he was even more argumentative and agitated.

He insisted that two of his former co-workers had come to his bedside while she was gone.

Matilda said it was too early for visitors, but Tony didn't even seem to hear her.

Suddenly, he pointed across the room, his eyes wide, and told Matilda he saw a little girl trying to pick up a needle off the floor behind her.

Matilda turned to look, and of course, there was no girl and no needle.

That's when Matilda noted that Tony's face was flushed and he was breathing rapidly.

When she checked his heart rate and blood pressure, she saw those two were rising.

This was moving from perhaps just a bad dream to a potential emergency.

Matilda asked the change nurse to call 911.

15 minutes later, she helped escort a flailing, agitated Tony, now strapped to a gurney, into an ambulance for an emergency room evaluation.

Dr.

Mary Shaughnessy was on duty in the ER when paramedics wheeled in a thrashing confused Tony.

The 35-year-old doctor quickly reviewed the notes sent over by the skilled nursing facility, so she knew that Tony had a host of medical issues, from his damaged heart and kidneys to his recent severe concussion.

But the first place she looked for a clue about Tony's erratic behavior was the extensive list of medications he was taking.

Dr.

Shaughnessy noticed that he'd been taking an antidepressant for a few years, so that was nothing new.

Many alcoholics suffer from depression, which is part of the reason they drink to excess.

But the psychiatrist at the nursing facility had added a sleeping medication called Ambien just four days earlier.

Dr.

Shaughnessy knew that ambiene can actually cause delirium in some people, even at seemingly normal doses.

Maybe that's what was going on with Tony.

Dr.

Shaughnessy called a psychiatrist to review Tony's blood work, and they agreed that the ambien could be responsible for Tony's hallucinations.

So they took Ambien off of Tony's medication list and sent him back to the nursing facility with a prescription for a different kind of sleep medication.

Two days later, when nurse's aide, Matilda Rogers, parked her medicine cart in front of Tony's room, she was hopeful that Tony was back to his upbeat positive self.

So she walked into Tony's room wearing a big smile.

But she found him flopping and rolling around on the floor, gasping and yelling through the speaking valve on his throat.

He was clearly having some kind of a seizure, and so Matilda immediately immediately pressed the emergency call button.

Matilda managed to get Tony to stop thrashing and tried to calm him down.

Through his garbled cries, she could make out that he was clearly terrified that someone was coming to get him.

He claimed that smoke was coming through the walls, and his wide eyes scanned the room constantly, looking for some unseen menace.

A moment later, two staffers raced into the room to help get Tony back onto his bed, followed by the doctor who was on duty.

Clearly, something dangerous was going on in Tony's head and they needed to find out what it was immediately.

The doctor asked Matilda to call for an ambulance to take Tony right back to the emergency room.

Three hours later, Dr.

Shaughnessy reviewed Tony's lab results on a monitor next to his bed inside of the ER.

Tony's sister, Gina, paced back and forth beside her.

Gina had made it clear to Dr.

Shaughnessy that she was not leaving until someone could explain to her what was going on with her her brother.

Dr.

Shaughnessy wished she knew.

Seeing Tony being wheeled back in from the nursing center 48 hours after she had discharged him was discouraging.

It meant that her first guess must have been wrong.

Maybe the ambient sleeping pills were not causing Tony's problems after all.

And there was no denying that Tony's condition had deteriorated.

He couldn't tell Dr.

Shaughnessy what day it was, or where he was, or where he had just come from.

And not only was he more agitated, he now had a low-grade fever, and his heart was racing.

In addition, his legs were swollen and they shook involuntarily when she manipulated his feet.

All these signs suggested that Tony might have suffered some injury to his nervous system.

Dr.

Shaughnessy worried she might have missed something crucial the last time she saw Tony.

She had ordered yet another round of scans and x-rays, plus the usual blood work and urinalysis.

And all of the tests came back just like the last time, normal.

All except the urinalysis.

Dr.

Shaughnessy explained to Gina that her brother's urine showed that he had contracted a serious urinary tract infection.

This sort of infection is common among people who are bedridden, the doctor said, and it could explain Tony's delusions and paranoia.

She said that severe UTIs can cause psychological symptoms as the body fights off the bacteria.

But she said the good news was that urinary tract infections are completely treatable.

Relief washed over Gina's face as Dr.

Shaughnessy told her that she was going to admit Tony to the hospital.

She was sure that a strong course of antibiotics would get him back on track.

Two days later, an attending physician named Lucinda Bragg made her way to Tony's hospital room as she did rounds with her staff.

As a senior physician, part of Dr.

Bragg's job was to do rounds with the hospital interns and examine particularly challenging cases.

And Tony's certainly fit the bill.

So far, nobody had been able to figure out what was causing his hallucinations.

Dr.

Bragg hoped that this collective group might be able to come up with a new idea.

As Dr.

Bragg introduced herself and the group to Tony, she could see that he remained frightened and trembling, and the monitor showed that his blood pressure and heart rate remained elevated.

Dr.

Bragg explained to the staff that Tony was being treated for urinary tract infection that doctors believed was causing the hallucinations.

But after two days of treatment with strong antibiotics, Dr.

Bragg said that Tony's UTI was getting better, but his mental state was not.

Just then, Gina entered Tony's room.

Dr.

Bragg could immediately see the anxiety on Gina's face with all these people in the room, and so Dr.

Bragg asked the other doctors to leave for a moment.

After reassuring Gina that she was determined to help, Dr.

Bragg took another look at Tony's medical history.

Everything looked completely normal.

There wasn't anything that stood out to her.

But then, something occurred to Dr.

Bragg.

There was was a very rare condition that she'd heard about, but had never actually personally treated.

It was a condition that most doctors had never heard of, and was caused by something that few people would think could be harmful, let alone potentially fatal.

From what Dr.

Bragg remembered about it, this condition could cause hallucinations and confusion, affect heart rate, blood pressure, and body temperature, and have a severe impact on muscle function.

Basically, it explained all of Tony's symptoms, and if it was left untreated, it could be devastating.

But before Dr.

Bragg said anything about this to Gina, she wanted to get a second opinion.

So Dr.

Bragg excused herself to the hallway and tracked down a neurologist colleague.

When Dr.

Bragg told the neurologist about her suspicions, the neurologist could hardly believe it.

But he double-checked Tony's charts, and from what he could tell, Dr.

Bragg had finally found the answer.

Tony and his doctors didn't know it, but he had been unknowingly overdosing on a potent chemical that plays a huge role in controlling our moods and feelings.

It's called serotonin, and its primary job is to carry messages between nerves in the brain and throughout the body.

But serotonin is best known for the way it improves mood.

A whole industry has grown up around pills that stimulate the body's production of what many people call the feel-good chemical.

And Tony's blood was flooded with it, to the point where it was causing his brain to go haywire and his body to shut down.

This condition is called serotonin syndrome, and Tony was experiencing it because of a mix-up in his medications.

When Tony was admitted to the skilled nursing facility, he was accidentally prescribed a second antidepressant.

Antidepressants work by increasing the serotonin levels in the brain.

But even a double dose of these antidepressants was not enough to trigger the adverse effects of serotonin syndrome.

However, Tony was also prescribed yet another medication that can increase serotonin levels.

This one was a treatment for his heartburn.

And so it was this third medication on top of the double dose of antidepressants that combined to cause his serotonin syndrome.

And so after the neurologist confirmed Dr.

Bragg's diagnosis, Tony was taken off of those two antidepressants and right away he made an incredible recovery.

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Bollins Medical Mysteries on the Wondery app, Amazon Music, or wherever you get your podcasts.

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Ballin's Medical Mysteries early and ad-free right now by joining Wondry Plus in the Wondery app, Apple Podcasts, or Spotify, or by listening on Amazon Music with your Prime membership.

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From Bollin Studios and Wondry, this is Mr.

Bollin's Medical Mysteries, hosted by me, Mr.

Ballin.

A quick note about our stories.

They are all inspired by true events, but we do sometimes use pseudonyms to protect the people involved, and also some details are fictionalized for dramatic purposes.

And a reminder, the content in this episode is not intended to be a substitute for professional medical advice, diagnosis, or treatment.

This episode was written by Allison Taylor.

Our editor is Heather Dundas.

Sound design is by Ryan Potesta.

Our senior managing producer is Nick Ryan.

and our coordinating producer is Taylor Sniffin.

Our senior producer is Alex Benedon.

Our associate producers and researchers are Sarah Vitak and Teja Peliconda.

Fact-checking was done by Sheila Patterson.

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