Poison Pill

“You know, I really haven’t felt good since Christmas,” the 81-year-old woman remarked, a little sadly. “Must be getting old.” A brief smile softened the features of the patient’s tired, well-lined face. Dr. Anna Rae Ong, a resident in her first year of training, tried again. “But can you remember exactly what happened that made you come to the hospital two nights ago?” Ong reviewed the chart of the patient before coming into the room, and the story she found there seemed strangely incomplete.

The E.M.T.’s arrived at the patient’s Connecticut home that night to find her sitting on the edge of her bed, struggling to breathe. Her husband of 63 years hovered anxiously behind them. “She was fine when she went to bed,” he said. She felt lightheaded, she told them, and nauseated, and her right leg hurt. On the way to the hospital, she vomited.

Finally Holt could put together a story that made sense. The patient had probably developed an allergy from the small amount of quinine contained in tonic water. Maybe that’s why she didn’t care for it. He found a lab that could test her blood for evidence of such a reaction. And in fact, she was allergic.

Sir William Osler, the father of modern medicine, taught his students that the patient’s story will often contain the key to making a diagnosis. It was important advice at the turn of the 20th century, when few diagnostic tools were available. And it is still true, as research shows. Even now, 75 percent of diagnoses are based on the patient’s story alone. “Listen carefully to the patient,” Osler exhorted. “They will tell you the diagnosis.” You just have to pay attention.

Ong quickly examined the patient and wrote up her notes. Maybe this woman was going to be one of those patients who come to the hospital and get better, and no one ever figures out what made her sick in the first place.

Ideopathy seems to be the term used for that phenomenon. Hubby is dealing with reduced lung function right now because his right hemi diaphragm is elevated and paralyzed, and they can't tell him why. The worst part isn't that it doesn't move, but that when he breathes in, his left diaphragm goes down, as it should, but then seems to one creates a 'pressure wave' causing the right side to go up higher, reducing the capacity in the right lung. Neither the Pulmonologist, nor the Radiologist has a clue as to what is wrong.

So hubby is doing a LOT of research on the Internet, reading Gray's Anatomy, and discussing the situation with his best friend, who is also a Radiologist in another state. In fact, hubby's local Radiologist was on her way out of town for vacation, when hubby called to try to get a 'sit down' with her. She made the comment that she wasn't sure she could help him, and that she'd have to give him an 'anatomy lesson', to describe what is happening. *snicker* She has NO clue what's about to happen, cause he's not in the mood to be condescended to by someone who considers herself the "professional" in this relationship.

Thanks, I'll pass along that site to him. He might actually have seen it. He had a 'back adventure' in 2001, having to be flat of his back for a couple of weeks, and not able to move much at all for six weeks. He'd seen the first doctor when the pain started. That one thought it was probably his kidneys and gave him some vicodin, and a screened scoop to catch the stones. Not even the vicodin helped, and no stones were passed.

The following Tuesday, he woke up in agony, calling the doctor's office. Turns out, we'd had 18" of snow overnight, so the Doc's office told him to call the ER. The ambulance came, shoveling through the driveway, and took him to the hospital. I couldn't even go, because the street hadn't been plowed, I knew I might not be able to get down the street or back up, until the end of the day. He laid there for 6 hours in agony while 4 other doctors kept asking if he had pain in his upper leg, because they assumed it was a disc injury. He told them that the pain was just behind his belly button, which confused them completely. Finally a friend happened to call, and when I told him what was going on, he took me to the hospital in his Jeep, and we were able to bring hubby home.

He literally laid in the bed for days, hardly being able to move! I was able to get him up to go to a friend who is a chiropracter, and he determined there was no nerve damage and suggested cold packs. So we did that, and it helped quite a bit.

The only thing that got him through that period were the Physical Therapists. It was the first Therapist to whom he went for Therapeutic Massage, who actually diagnosed the problem. She told him that the muscle near the T12 vertebra had been torqued, which in turn inflamed the fascia, which pressed against a nerve that went from the vertebra, and around the trunk of his body, and going under his belly button, which explained the strange pain in his abdomen.

He thinks it's not coincidental that the phrenic nerve, which goes along beside the diaphragm, and the damage of which can cause paralysis to it, also goes through the same area where the pain was back in 2001. He just wants someone to at least LOOK at that possibility, but it's like pulling teeth to find someone to consider it.

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