Part 1:

Fresh out of college with a computer science degree in hand, 24 year old Jan had the world at his feet. Having
graduated from a prestigious university in the United States and boasting numerous accolades, Jan was quickly
snapped up by one of the premier technological firms in silicon valley. This particular company had a
reputation for being extremely demanding - only accepting the most elite applicants, and holding them to the
highest of standards. Rumors had it that employees worked nearly 20 hours a day, with work breaks only being
given out of concern for the company’s reputation, more than anything else. On the outside, however, this
company was at the forefront of their industry, with their rigorous production agenda enabling them to push
out new innovations at a rapid pace. Needless to say, Jan, full of ambition, was up to the task.

Because of the pandemic, all of the meetings and group collaborations were conducted online - this didn’t mean
standards were held any lower, far from it! Employees were required to be on a call for 16 hours of the day
(with only a few 5 minute breaks scattered sporadically throughout the day, and a much anticipated, unusually
long, 30 minute lunch break), work diligently on their projects, and maintain a strict dress code at all times. The
first day of work, Jan got up bright and early, forgoing one of his weekly jogs in order to look presentable.
Making a bad impression on his boss and fellow employees simply was not an option.

At 7:25 AM sharp, 5 minutes before the meeting, Jan got onto his computer. His palms were sweaty with
anticipation. His breathing was noticeably faster. His heart was racing. Finally, adjusting his tie one more time,
he clicked the button to join the meeting. Jan was instantly greeted by a buzz of activity, with employees doing
everything from chatting about their latest projects to feverishly trying to change their zoom background
picture before their boss got online. Jan recognized many faces, many of whom he had idolized as a child. Some
of the greatest technological minds on the planet were present: Leroy Smith, who founded and sold a healthcare
startup at 17 for millions, Theodore Ivanov, one of the world’s leading experts in artificial intelligence, and
Szymon Bartel, former Google developer, holding two PhDs. Even meeting one of these tech giants, to many,
represented the pinnacle of their careers, and to have an opportunity such as this one at 24 years of age was
incredibly rare. Jan was committed to doing anything and everything it took to impress.

Their boss got online at 7:30 AM and gave a brief speech, welcoming Jan and a few other new employees, and
delegating them to current projects. Jan was assigned to work on a healthcare app. The announcement was met
by warm applause, particularly from Leroy Smith, head of the healthcare project. When the speech was over,
the employees got assigned to breakout rooms to work on their project. Leroy quickly showed Jan the ropes:
filling him in on their timelines, work structure, and his tasks. “I will send you your task by email. Should be
fairly straightforward …I’ll send you a list of additional features to implement. For the rest of the week, we’re
going to be working off-call - although you must still be online and able to respond to any messages. At the end
of the week next Friday, we will be presenting all of our tasks in a meeting. We will have an additional full-day
meeting at the end of this week to report on progress and to collaborate with others for the remaining hours.
Any questions?”, asked Leroy, quickly. “None at all sir”, replied Jan, flustered. With that, Leroy and Jan left the
meeting.

Jan checked his inbox for the email from Leroy, excited for his first project. He dreamed of impressing Leroy in
his first few weeks, going above and beyond on his task, and achieving the respect and admiration of his peers.
Jan, however, upon opening the email, was quickly shaken out of his reverie: his task seemed daunting,
extremely difficult, and far from “straightforward”. Jan wasn’t someone to give up, though. Instead, he saw this
as the perfect opportunity to impress his new bosses. Jan got to work.
Jan soon realized that this was even harder than he thought. There were so many little nuances and
requirements, and he had no idea how he would manage to put together something vaguely presentable for the
upcoming check-in at the end of the week. He didn’t even know where to start. Before he knew it, his clock read
2:30 PM. He had been working on this project for 7 hours straight, making little progress. He got up briefly to
get some coffee and then returned to his work. He worked on the project for 3 more hours, and at 5:30 PM got
some lunch. He hadn’t eaten the whole day and was famished. When he returned, he decided to go read a book
to take a break. At 8:00 PM, he got back to work. Not a single sign of his fervour remained: his eyes were glued
together, his neck ached, his head drooped. None of it made any sense to him at all.

The next few days leading up to the meeting, a typical day in Jan’s shoes was as follows:
6:00 AM - Wake up
6:15 AM - Eat breakfast
6:30 AM - Work on project
8:30 AM - Coffee break
8:35 AM - Work on project
2:00 PM - Get lunch
2:30 PM - Work on project
8:00 PM - Get dinner
8:15 PM - Work on project
9:00 PM - Coffee break
9:05 PM - Work on project
11:50 AM - Go to sleep

He was no longer jogging 3 times a week, and was working for virtually the whole day. Physically, Jan wasn’t
feeling well either. His vision was often blurry, and his legs, particularly his left leg, felt very stiff. This wasn’t
unusual for Jan: in his latter 2 years of college, he experienced similar, but milder symptoms every few months
or so, but nothing quite like this. Jan, however, wasn’t concerned, attributing these signs to working for many
hours online. He had only one goal in mind, and he would do anything to achieve it.

By the time the end-of-week check-in rolled around, despite his efforts, Jan only had a barely functioning
prototype. It was missing many of the features Leroy requested, and was far from what he had envisioned when
he started. Jan was embarrassed, and prepared himself for the longest 16-hour meeting of his life.

To start off the meeting, each employee spent 10 minutes running through their prototype and progress thus
far. Jan was in awe: these prototypes were leagues beyond anything he could have ever built. He was nervously
awaiting his turn to present. Did he even have 10 minutes worth of content? How would others react to his
work? Would he get fired in his first week? These thoughts circled in Jan’s head in an endless spiral, his brain
barely able to process his peers’ presentations. He was like a hiker who had lost his sense of direction:
completely disoriented, lost, and unsure of what to do next. Soon enough, it was his turn to present.

Jan stumbled through his presentation, his blurry version not helping his cause. His sentences lacked any clear
connection, he missed several key points, and skipped an entire section of the presentation altogether. All in all,
an incredible first impression. Confusion was visibly written on the faces of the employees. They were unsure
whether to laugh, applaud, or frown. Jan wanted to disappear in his seat. For the rest of the meeting, the
employees were supposed to collaborate, trouble-shoot and work together to solve any problems. Everyone
stayed away from Jan and Jan got back to work.

Jan continued to work on his project throughout the week. He followed the same long schedule, wore the same
languid expression, had the same blurry vision, and had the same stiff feeling in his legs. At the end of the week,
he managed to cobble together a functioning program. It was far from his best work, but he was relieved to get
it done. This time, Jan was ready for the meeting.

The meeting went relatively smoothly. Surprisingly, his colleagues weren’t too critical of his work, but they
weren’t enthusiastic either. After finalizing a few details during the remainder of the meeting, Jan submitted his
project. He felt as if a huge weight had been lifted off his shoulders. At the end of the meeting, Leroy
announced their new endeavour. Jan was assigned an even more difficult task.

For the next 6 months, Jan continued working for this company. The projects got progressively harder as the
weeks went by, but Jan was up for the challenge. He often spent 18 hours a day working, completely forgoing
his weekly jogs, and often neglecting his sleep and social life. Jan, however, felt at the top of the world. Things
were going well, he was gaining the respect of his boss, his vision was no longer blurry, and his legs were no
longer stiff.

However, during the course of the next few weeks, Jan’s legs felt stiff again, his vision was blurry, and his
speech was slurred. Dismissing it as a symptom of working online, Jan decided to go for a run to stretch his legs.
Instantly, it felt like something was off. The hot June sun was beating down on his body as he started to jog. His
movements felt sluggish, his head ached, his vision was blurry, his balance was off, and his legs felt stiffer than
ever. 15 minutes in, Jan was feeling lightheaded, on the verge of passing out …and then it went black.

Questions for Part 1:

1) Describe the timeline of Jan’s symptoms

2) Describe the changes in Jan’s lifestyle, as a result of his new job.
3) Discuss how Jan’s work might have disguised, or sped up the progression of his symptoms.

Part 2

Jan woke up in a hospital room bed. He was dressed in a hospital gown, with a surgical mask attached
haphazardly to his face. He still felt lightheaded, disoriented, but, above all, confused. He had a million
questions - how did he get here? What happened to him? Why did he pass out? He glanced at a chart to his
right which read:

PATIENT INFORMATION:
Name: Jan
Surname: van Kampen
Age: 24
Gender: Male
Height: 5’9”
Weight: 180 lbs
Allergies: None
Family history: Came from a family of heavy smokers on his dad’s side. Family history of high blood pressure.
Past medical encounters: Complained of blurry vision (2019). Visited an opthamologist, concluded that it was a
result of eye strain. Went away after two weeks.
Lifestyle: College student, jogs regularly 3-5 times a week.

Attached to the chart were a few other papers, presumably filled with his immunization records and
development history. On reading the last line of his chart, Jan felt a guilty tinge in his stomach - he no longer
jogged regularly, or even at all. It had been a while since his last doctor's appointment.

Shortly after, a physician greeted Jan. Jan explained what had happened up until this point. He explained his
new job, how he had stopped jogging, and how he was working on a computer for nearly 18 hours a day. The
physician, looking concerned, asked Jan if he had experienced any similar symptoms in the past. Jan told him
how he used to experience milder versions of these symptoms during his last two years of college. He said that
he usually had them for a few weeks at a time, and then they would go away for a while. “Probably just from eye
strain and sitting at a desk”, he added. The physician scribbled something on his chart and sent him to get his
vitals, and to take an MRI brain scan. A few hours later, the following was collected:

Vital Result

Blood pressure (SBP) 135

Temperature 38C

Pulse 85 BPM

Respiratory Rate 14 breaths per min

CITE SOURCE

CITE THE DATASET

Questions for Part 2:

1) Discuss anything unusual you notice about Jan’s vitals

2) What differences (if any) do you notice between Jan’s MRI scans and that of a healthy adult’s?
3) The typical systolic blood pressure (SBP) for a 24 year old male is 120. Discuss what factors might have
contributed to Jan’s high SBP.
4) Given the information above, and what you know about Jan, make a prediction about his diagnosis