Unfortunately she lives alone so nobody could get a good history and tell what events could have lead to this, therefore making a diagnosis is extremely difficult. A whole bunch of illnesses can cause this.
Finally, after running a bazillion tests, a diagnosis of Botulism is made. Botulism is a disease caused by a toxin that is produced by a bacteria. This toxin and bacteria gain entry into the body somehow, through food or a wound, and once inside the body cause paralysis and often death.
Amanda was on the breathing machine. She was stable but very sick.
The question to us, the infectious disease doctor, was: where did she get it from? How did the toxin get inside her body? And how do treat this thing?
We started talking to family members separately, but nothing in what they said was suspicious. Amanda had several plastic surgeries in the past. We suspected that she had Botox done (a procedure where a very dilute toxin is injected into the face to tighten it up). However her sister who is very close to her denied that she had such procedure.
However, the sister confessed to something else. Amanda, who came form a very conservative Christian family and is single, had an abortion 2 weeks earlier and an IUD (lawlab) was placed, and she hid that from the rest of the family. The sister told us so because it might be helpful. Indeed it was. We decided to remove the IUD because it might have been the source of the toxin that was circulating in her body. We removed the IUD, tested it for the toxin, and that came back negative. Now we had to think of another source.
It turned out she had a boyfriend who wasn't visiting at the hospital. Eventually, he showed up and told us that the night before she got sick, he and Amanda bought food from a fast-food restaurant. They had exactly the same meal but because he didn't like potatoes he didn't eat them, but put the rest of the food in a bag and took it home. Being a guy he didn't throw away the food even after a week (I can relate to that!) and he was still having it by the time we were talking to him.
With help from CDC, we tested all the food he had kept from that night for the toxin, and we found that the potatoes contained exactly the same kind of paralyzing toxin that was present in Amanda's body.
Being an infectious disease physician means that you have to think of the story behind each infection, and think why did this particular healthy person get this particular infection at this particular time. Sometimes the answer is clear. In other occasions you have to dig deep and act like an investigator to try to collect every single information possible. It wasn't simple in Amanda's case. All what we saw was a paralyzed woman, with plenty of abnomral studies and abnormal lab results and abnomral X-rays and there were at least 50 explanations for each of the abnormal results that she had.
Amanda was already getting better while we were waiting for the test results to come back. One could argue that we could have left it there and not pay thousands of dollars in tests and waste all that time and effort to know where it came from. If we followed that argument we wouldn't be able to protect more than 500 daily customers of that restaurant from the food they were about to eat. In other times, it helps scientists learn more about infections, how they occur, and where do they come from, in order to help in developing new methods for prevention and treatment of these potentially fatal infections.
Last, but not least, it helps families understand why their loved one suffered from such an ailment. It answers many questions that can provide closure to many cases where the ending is not always as happy as Amanda's.
And.... you gotta do this when you still have 20 more patients to see and 2 lectures to prepare and a research you're working on, in addition to car brakes that you don't have time to fix.