Doctor’s Clinical Diary 7 – At the Door of Memory

Prologue

At the Threshold of Memory

I have been a neurologist for fifteen years.
I have seen countless patients—those struck down by sudden strokes, those trembling with Parkinson’s disease, those whose names were lost to the silence of dementia. Yet on that particular day, a woman led me to a doorway I had never crossed before.

She was fifty-five years old. According to her family, she had been changing for months—once lively and social, she had grown strangely distant, irritable over trivial matters, and forgetful. On top of this came seizures.

When she walked into my office, her gaze was hollow. She sat before me, yet seemed unable to hold my eyes. At that moment, I sensed that somewhere deep within her brain, a catastrophic transformation was unfolding.

Thus begins this journal.
Today, I stand face to face with Creutzfeldt-Jakob disease (CJD)—a cruel name for an even crueler illness. And with it begins not only the story of a disease, but of a patient, a family, and a physician who must walk beside them.

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Chapter 1: A Strange Shadow

“Doctor, my wife is not herself anymore.”

The husband’s voice trembled as he spoke. His hand clutched her shoulder, desperation carved into every gesture.
The woman, however, said nothing. She gazed out the window, her expression vacant.

I opened the chart.

• Chief complaint: behavioral changes, depression, seizures
• History: progressive decline over several months
• Exam: Myoclonus (sudden, jerking muscle contractions) observed

I tried to engage her gently.
“Can you tell me your name?”
She paused for a long time, then whispered, “… I don’t remember.”

Her family stifled their tears. As a physician, I had to balance objectivity with compassion.
“First, we’ll need to perform a brain MRI. This doesn’t look like typical dementia. We have to investigate more carefully.”

Days later, the scans arrived. On the T2-weighted and diffusion-weighted images, there were abnormal signals in the cerebral cortex and basal ganglia. Not the pattern of Alzheimer’s or vascular dementia—something far more ominous.

“Sir, may I show you the images?” I gestured toward the screen.
“These bright regions here… they can appear in several conditions. But I must be honest—one of the possibilities we must consider is Creutzfeldt-Jakob disease.”

He fell silent, then asked in a shaking voice:
“… If it is that… what does it mean?”

I hesitated. The truth was heavy.
“It isn’t confirmed yet. More tests are needed. But this illness… it progresses quickly. And treatment is very limited.”

The room grew still. Even the sunlight outside seemed to dim. I closed the chart, silently vowing:
From this moment on, I will walk with her through whatever time remains—not just to record a disease, but to protect her dignity as a human being.

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Chapter 2: Time Collapsing

When I entered the ward, I sensed the weight in the air.
She sat on the bed, her body shaken by sudden myoclonic jerks. Her eyes no longer followed the world around her.

Her husband whispered, exhausted:
“Doctor, she screams at night. She dreams of terrible things… Sometimes she doesn’t recognize me.”

“This disease,” I explained gently, “destroys memory, personality, and emotion as parts of the brain deteriorate. For a spouse, it is unbearably cruel.”

He lowered his head.
“I can’t stand the helplessness.”

I nodded slowly.
“Creutzfeldt-Jakob disease is caused by a misfolded protein called a prion. Normally, this protein exists harmlessly in the brain. But once it misfolds, it spreads the error, turning healthy proteins into diseased ones. The brain, little by little, becomes like a sponge—full of holes, losing function.”

He looked at me with eyes brimming with tears.
“So… there’s no cure?”

I held his gaze.
“There is no treatment. Worldwide, most patients decline rapidly and pass away within a year. What we can do is ease her pain and preserve her dignity.”

His shoulders shook. The woman, by his side, stared into the void, already drifting away from the family she once knew.

A few days later, her EEG arrived.
I traced the jagged lines on the screen. There they were: periodic sharp wave complexes, the classic rhythm of a brain unraveling.

In my journal I wrote:

“Today, her brain waves resembled the faltering beat of a weary heart. Each sharp wave was a silent testimony of collapsing time.”

When I explained the results, her husband sat in silence.
“… Doctor, why her? There’s no history in our family.”

“Most cases are spontaneous,” I said quietly. “No family link, no infection. It just… happens. That is the cruelty of sporadic CJD.”

He nodded, but his eyes remained lost. And I realized again:
Medical knowledge can explain, but it cannot soothe.

Her meals dwindled. She no longer walked. I held her hand and wrote in my diary:

“I must record not only the disease, but the humanity. This is my duty—not as a scientist alone, but as a fellow human being.”

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Chapter 3: The Shadow Without a Name

She could no longer leave the bed. Words dwindled into whispers, then incoherence.
I spoke to her husband:
“We need a spinal tap. Cerebrospinal fluid will reveal certain proteins. It will help us confirm the diagnosis.”

He asked anxiously, “Will it hurt her much?”
“We will minimize the pain. But the result… may be hard to bear.”

The report came: 14-3-3 protein: Positive.
One line that sealed the truth.

I stared at the page for a long time.
In my diary I wrote:

“A single sentence can change the fate of a family. Medicine, in its cold precision, can feel merciless.”

That evening, I sat with her husband.
“The results strongly support CJD. It is, for all practical purposes, confirmed.”

He closed his eyes, hands trembling.
“… Should I tell her everything?”

It was an impossible question.
“She no longer understands the full reality,” I answered softly. “The choice is yours. What matters most is that she feels your love, until the very end.”

Days later, her eyes briefly cleared.
“Where… am I?”
“You’re in the hospital,” I said gently. “I’m your doctor.”

She studied my face.
“Will I… get better?”

My chest tightened.
I breathed deeply, then said, “You are not alone. We will stay by your side.”

She smiled faintly. It was fragile, yet unmistakably human—the last flicker of her true self.

That night, I could not sleep. Her smile, her husband’s despair, echoed in my mind.
And I remembered:
This disease offers no cure. Only the courage to endure together.

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Chapter 4: At the Bedside of the End

Her decline was swift.
She wasted away, her words gone. Even the jerks of myoclonus had faded—not from healing, but from exhaustion.

Her husband never left her side. His hands clutched hers, though hers no longer clutched back.

“Doctor,” he whispered, “all I can do is hold her hand, isn’t it?”
“That,” I told him, “is the greatest gift. No medicine, no machine can replace it.”

One night, the nurse called me urgently.
“Doctor, her breathing is irregular.”

I hurried to the ward. Under the dim light, her chest rose and fell in shallow, faltering waves. Her husband held her close, tears flowing freely.

I placed my stethoscope against her chest, listened, and looked up.
“… It will be soon.”

He leaned down and whispered into her ear:
“My love, I’m here. You can rest now.”

Her chest lifted once more, then fell silent.
The room froze in stillness.

I recorded quietly:

• Time of death: 02:17
• Diagnosis: Creutzfeldt-Jakob Disease

I laid down my pen and breathed heavily.

Looking out the window, I saw faint stars in the night sky.
“This disease takes everything in an instant. But love—love remains untouched.”

In my journal, I wrote:

“As a physician, I was defeated—there was no cure.
But as a human, I remained. That is my one and only victory.”

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Epilogue

A Name in My Journal

A month has passed since she left.
As I walk the hospital corridors, I still see her face—the vacant gaze, the fragile smile, her husband’s whispered “I love you.”

Creutzfeldt-Jakob disease.
The textbooks describe it in cold words:

• “Prion misfolding.”
• “Rapidly progressive dementia.”
• “Death within a year.”

But my memory of her is not cold. She was not a case; she was a person, a wife, a daughter, a friend. A name, not a diagnosis.

I ask myself often:
“What is a physician? When no cure exists, what meaning remains?”

And I think I know.
A physician stays. Even when medicine fails, we refuse to let a patient walk alone.

Life is finite, but the warmth of human presence endures.

Today I meet new patients, each with their own story and pain. And again I vow:
“I will write—not only of disease, but of humanity.”

In the final page of my journal, I wrote:

“A 55-year-old woman, whose story began with strange behavior.
Final diagnosis: Creutzfeldt-Jakob Disease.
But her life was never just a disease.
She was loved until the very end.
And that, above all, is the true human face of medicine.”

I close the journal. And in the quiet of the evening, I whisper her name once more.
It lingers on the page, a memory that will not fade.

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