Clark said she felt certain this was what the patient had. But the other doctors caring for the patient were skeptical. Every year thousands of patients develop some kind of encephalitis. It’s quite likely that some small percentage of these patients will have one of these common cysts, and yet, for most, the two conditions will be completely unrelated. There have been only a handful of cases that have linked a teratoma and encephalitis over the past 11 years. The odds of this patient falling into that category were infinitesimally small. But Clark persisted. A sample of the patient’s blood was sent to the author of the paper to have him look for the antibody he found in his patients. If that test was positive, then they would take out the tumor.

For the next two weeks, Clark checked for the results daily. She eventually discovered that the blood was never tested. Clark almost cried with frustration. While they had been waiting for these results, the patient became even sicker.

Another OB-GYN, Dr. Rebecca Kolp, was now in charge of Clark’s team. Clark sought out the doctor and described the patient and what she’d found in her research. She told her about the lost test. Should they wait another two weeks, or should they operate now?

Kolp thought about it for only a moment. The intern made a strong case, and although it seemed an unlikely diagnosis, Kolp thought it was worth the risk. Would the girl’s mother be willing to let them operate on her daughter? The mother agreed to the operation immediately. The girl had been sick for so long and seemed only to be getting worse. That afternoon, Kolp removed the tumor.

3. RESOLUTION

The next morning it was still dark when Clark arrived at the I.C.U. As she entered the patient’s room she called out the young woman’s name in a hushed voice. No response. The doctor checked the surgical site — it looked fine — and then tried once more to rouse the young woman. No change. Her heart sank. In the paper she’d read, recovery was rapid — often within hours of the operation.

At rounds, Clark told Kolp that the patient was no better. The attending physician was disappointed but not surprised. They had done all they could. But later that morning Kolp phoned Clark. “Rachel, you’re not going believe this,” she reported excitedly. “Your patient is awake.”

Clark sprinted up the stairs, arriving at the patient’s room out of breath. And there she was — awake, alert, fully dressed. Her mother was beaming. “Can you believe it?” she said and laughed giddily. The patient looked at her mother, looked at Clark and then she laughed, too. Her voice was raspy, and her words were slow, but she was awake; she was talking. About a week later she was discharged. Recovery was slow, but after several months she went back to work.

Rachel Clark was elated. Just a few months into her residency, she diagnosed a rare disease, one that she figured she would never see again. She was wrong. A year later another patient arrived with the same story of headache, psychosis and coma. A CT scan revealed a teratoma, and she was operated on the next day. This patient also recovered. It’s worrisome, Kolp said. “It makes you wonder how many other woman are languishing out there who might be saved.”