Sunday, February 03, 2008

Maybe the doctors are the ones that are nuts...

Zebra Sometimes it is a zebra and not a horse

Life is hell for those of us who have gone through chronic undiagnosed problems. There is a clear way that medicine works and as a whole, despite impressions and shock TV, it actually works really well for most of the people most of the time. Routine rules supreme.

Take the Bobblehead's father's heart attack. Fourteen years ago my dad had a heart attack in his one horse town while planting flowers. Classic symptoms: sweating, chest pain, loss of breath, light headed, etc. My mom called 911 as he passed out on the bed. The EMTs arrived (after getting lost going to his not get me started...) and took him to his local hospital home of their resident serial killing “Angel of Death” nurse...true story, but that is for another post. The ER staff stabilized him and fought the clot with tPA (tissue plasminogen activator). They saved his life. For years my father bragged about how his local doctors saved him.

Like most fathers and sons I have a special way of pissing him off. I was not impressed. His heart attack, while very lethal, was text-book. It was also caught early. He did not go into major arrest massive fribrillation (quivering as opposed to beating of the heart. Bad. Death-bad). Again, not to downplay his trauma. It was horrible and his and indeed his entire family's lives were changed forever. But nothing out the ordinary for the medical staff occurred. Treatment was by the book.

Could I do it? No, I have no desire to be an MD. It is easier being a Ph.D. and heckle from the sidelines :-)

Now twist things onto its side. Take symptoms that do not fit together into a simple diagnosis. Take common problems and have an uncommon cause. Take a patient that is persistent but imprecise in some of their description and you can easily send some doctors into a tailspin. “Blame the patient” is a common game amongst doctors. My personal experience has been the ones that are either too cocky or overworked fall into this category. Of course, some doctors are just plain asshats.

I went to a neurologist here in the Atomic City. I had a plethora of symptoms (see past posts). I was in my trusty wheelchair racer. I was head bobbing, crying, spinning, rambling. I was vertigo numbed, insomnia laden, fatigued, headache bound. My face was green and my fingers were bone-white. I was normal. I was coherent. I was prepared with notes and a health journal. I had past diagnosis (all either incomplete, inaccurate, or nonexistent.) The neurologist smiled, interviewed me, said my symptoms did not add up. There was no single root cause for everything he saw.

That was a key. The medical profession loves the phrase single root cause.

Occam's razor. The simplest explanation is usually the correct explanation. This doctor even used this phrase when he spoke to me.

Two weeks later, he saw us again and said he could not help me. He knew I was heading to the Cleveland Clinic and was going to defer to their views. He also was beating around the bush. I felt betrayed but could not quite put my finger on why. I had a cold feeling forming in my gut...

Then on the day before we climbed aboard a plane for Ohio we saw my internist. He told us that the neurologist had called him. The neurologist told my PCP that the problem was “all in my head.” All in my head. I was depressed. I was faking it. It was all physcosymatic. In essence, I was nuts.


He failed in this diagnosis because of the lumping methods of doctors. My parents are still pissed off beyond belief.

Ironically, I am not that upset. Disappointed, yes. Pissed off, no not really.

Occam's razor usually does apply. My condition was strange. There were several underlying cause playing off of each other like a pinball slamming back and forth in the game while the lights flash and buzzers ring out. It really did take a doctor who specialized in complex systems to get to the root cause.

However, he was still an asshat. He did not even give an option that maybe the patient was telling the truth. Blame the patient is a game I have seen a number of times now. This was the worst I had to deal with.

My internist was also perplexed. He asked Dr. Asshat how did he explain some of the blood work? How about the documented hypoglycemia. “Maybe the patient is injecting himself with insulin before he gets tested just to get attention,” was the reply.

I know doctors and I understand the medical profession. I also know my symptoms and know I was not faking anything. I will not be back to Dr. Asshat although he will be hearing from me.

Bottom line: if you are stuck, fire your doctor and keep trying. Be willing to drive or fly to a center of excellence if needed. Fight for your life. There are thousands of great open minded doctors out there. Find them.

[posted by Bobblehead]