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At the same time, this focus on clinical practice is one of the real strengths of the HCMC center. "This is the only hospital in the state whose charge it is to take care of anyone who walks in the door regardless of whether they can pay or not," notes Mahowald. "So right away that picks out a certain sort of individual." One who, like Mahowald, has a practical mind: "This is not an esoteric branch of medicine where you identify strange and beautiful things and you can't do anything about it," he says. "The overwhelming majority of people with sleep disorders--be it insomnia, hypersomnia, parasomnia--have something that is very bothersome to them, but it's diagnosable and treatable."
Nonetheless, daily contact with patients and their complaints has a theoretical value, too. It gives HCMC doctors a clear and constant look into the heads of living dreamers. The smartest theoretician couldn't diagnose RBD sitting in an armchair. And now that Mahowald and his staff have described the condition, it forms a critical piece of evidence for the sleep theorists.
These are, to say the least, exciting times at the HCMC sleep center. Much of the credit goes to Mahowald, who co-founded the clinic 20 years ago so he wouldn't have to send patients with sleep disorders to hospitals on one of the coasts for treatment. "We actually worried about what would happen when we identified the 10 narcoleptics and the 10 apneacs in town," he says. "Back then nobody had a clue as to the prevalence of these disorders."
Today the HCMC clinic is one of half a dozen in the state, and even so sees more than 1,000 patients with apnea and nearly as many narcoleptics, plus hundreds of patients with parasomnias. Mahowald and his staff publish probably more scholarly papers on sleep disorders than any other clinic in the country. Television appearances and newspaper interviews are a monthly occurrence.
The Tuesday staff meeting breaks up. Doctors, nurses, and interns drift off to meet with patients. Several filter upstairs to the sleep lab, where a half-dozen new clients are checking in. The patients sit in the lobby, waiting to be hooked up to the machines, to sleep, and to dream.