‘When will I be able to blow the whistle?’

I haven’t see Marble more than once in the last one year. He used to be a taxi driver but after wrecking his car a few years ago, he got a job in one of the local farmhouses. What exactly he did there I do not know, but I know he was obsessed with striking it big. His only hope for a better tomorrow was gambling. He once tried being a referee for the local Youth Soccer Clubs, but after a series of unproven allegations of favouritism and bribery, he was ignored. Marble had won little sums of money a couple of times from betting and lottery. He would start his day with a bottle of beer. It is amazing that gambling and alcoholism often go hand in hand. I had tried to wean him from drinking, but failed.

Today, he is in my clinic looking crestfallen and unkempt. “Marble what’s the matter?” I asked. Slow and a bit unsteady on his feet, I knew he was in trouble. “I just lost some money because I can’t blow the whistle,” he blurted out in an almost inaudible babble and with great difficulty. Losing money because he can’t blow the whistle? What has blowing the whistle to do with making money? “This guy has lost his mind,” I concluded. “Be patient with him,” I cautioned myself, “Listen attentively to his complaints.”

Marble described how he had gone to bed the night before feeling fine. He woke up the next morning with some funny sensation. As he spoke he was drooling from the corner of his mouth. Drooling is the unintentional spillage of saliva from the mouth. The right side of his face had drooped with the loss of the usual symmetry of his face.

Worse still, he was unable to close his eyelid or blink and he felt some dryness.

I asked him to whistle, but he was unable to perform the act. Whistling without the use of an artificial whistle is achieved by creating a small opening with one’s lips and then blowing or sucking air through the hole. One cannot whistle or smile when the muscles of the cheek (the wall of the mouth) are weak or paralysed. Marble has facial nerve paralysis. The picture is now clearer but still perplexed, I asked him, “How much did you lose?” “N300 million, million.. .. Naira,” he stammered incoherently.  With the slurred speech, confusion and difficulty finding the right words, I knew the answer. Examination of the limbs confirmed there was a weakness of the arm and leg.

Why has Marble developed facial nerve palsy? The commonest cause of facial nerve palsy is a viral infection of the facial nerve. We call this Bell’s Palsy. The facial nerve controls the muscles responsible for the movement of the face. A blow to the face in the area where the nerve passes through the narrow bony area within the skull or pushes against the skull’s hard surface may also cause a paralysis of the nerve. It wasn’t any of these in the case of Marble. Apart from the facial nerve muscles, he also had a weakness in his limbs Marble has had a stroke!

I asked my nurse to check his Blood Pressure. It was very high. I gave him a note to give to his family physician. But I was still very worried. He had dry eyes because he couldn’t shut his lids. Opening and closing the lids help to spread tears evenly over the ocular surfaces.

When there is a loss of this function, the tears dry up easily and the worst thing that can happen to the ocular surface is dryness. The surface lining soon disintegrates and an ulcer is formed which if care is not taken may lead to perforation and loss of the inner contents of the eye resulting in blindness.

“Marble close your eyes again,” I commanded. He couldn’t and the right eye remained open. Ordinarily, there should be an upward movement of the eyeball – a protective function. It should move up and disappear under the upper lid.  We call this Bell’s Phenomenon. It was absent – the black of the eye remained exposed! This was a bad omen – a warning that dryness and loss of the eye could occur.

To prevent this, I quickly taped the upper lid to the lower lid to close the eye and sent him off to see his family physician. “Marble, I may have to stitch the upper lid to the lower lid, then restore them to their normal position after the nerve has recovered. This is to prevent your cornea from suffering from the effect of dryness.” Marble asked again, “When will I be able to blow the whistle?” I knew he was still confused and managed to prevent myself from laughing. “When your facial nerve has recovered fully from the effects of the stroke,” I told him.