When I watched the video of Novak after his accident I had an itchy feeling about it. Based on that video, some bloggers wondered if Novak was drunk. That just didn't feel quite right, although I didn't reflect much on it other than to generate a couple of other hypotheses. We really can't diagnose from afar, so I didn't think about the matter beyond my quick intuitive reaction. Learning that he has been diagnosed with a brain tumor takes me back to my initial uneasy feelings about what I heard on the video.
When you do clinical work, you learn to pay attention to vague intuitions. Something seemed incongruous in Novak's presentation and, in retrospect, that incongruity may have been a tip-off. Novak seemed a bit too anxious for an intoxicated man and too anxious for a man on tranquilizers (although for some reason I felt this was a stronger possibility), but his speech was definitely impaired. While this isn't enough to diagnose an organic impairment, it's one of the thoughts I'd have in mind if someone presented to me in Novak's condition. You look for convergences and you look for disparities as you try to make an assessment. I have no doubt that if this man came to my office he would have ended up with a referral to a neurologist.