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Strange Things Aren’t Getting Any Better…
I had a patient nearly succeed in killing herself recently, despite my best efforts to intervene. She is a type of patient that scares every doctor: She doesn’t like medicines or ‘chemicals’ that she doesn’t understand, but she takes 20 pills a day of various supplements and herbal remedies that she doesn’t understand. She complains of an endless list of bizarre symptoms (her left eye cramps when she urinates or whatever), when the only diagnoses on her chart are fibromyalgia, irritable bowel syndrome, and anxiety. She lists 14 drug allergies, but the symptoms experienced with those drug allergies don’t make any sense. And worst of all, she says, “I know my body.” I get chills just thinking about it.
That patient is dangerous, because one of these days, she’ll actually get sick, and I’ll miss a recognizable disease in all the random background noise of her being in touch with her body. And then I’ll have to explain to the husband how his wife died of a bladder infection while under my care.
On her first visit with me last year, Karen opened the conversation: “I’ve heard a lot about you.”
Me: “Don’t believe a word of it. Those people have no idea what they’re talking about.”
Karen: “Everybody says you’re the smartest doctor in this part of the state.”
Me: “Oh, well, those people obviously know exactly what they’re talking about.”
Karen: “Good. Because my previous doctors were all a bunch of idiots.”
Over my career, I’ve learned that that’s a bad sign. Because when all her previous doctors were idiots, that means that I’m not just her new doctor, but I’m also the next idiot. If no one else can meet her needs, then what are the odds that I’ll be able to do so? So I keep my eyes open after I hear that.
She called me recently, saying that she felt terrible and that the medicines I was giving her were killing her.
Karen: “I stopped that stuff you gave me a couple of days ago. I felt just horrible.”
Me: “Which medicine did you stop?”
Karen: “I can’t remember.”
Me: * pause *
Karen: “I felt horrible. That drug just didn’t fit with my system. I know my body, and it was making me feel horrible.”
Me: “How did you feel? What exactly were you feeling?”
Karen: * spends several minutes listing every side effect she’s ever read off of any warning label for any drug *
Me: * interrupts Karen * “Ok, so you’re off whatever medicine that was now. Ok. So do you feel better?”
Karen: * pause * “Well, I just stopped it a few days ago.”
Me: “So you feel better now?”
Karen: “No. I feel horrible like I said.”
Me: “Why don’t you come into the office, so I can figure out what’s wrong?”
Karen: “I told you. It was the medicine you gave me.”
Me: “So you feel better now that you’ve stopped it?”
Karen: “No. I feel horrible.”
Me: “So why don’t you come into the office, so I can figure out what’s wrong?”
And around and around we went. I couldn’t get her to come in. She didn’t need to see me, because “I know my body.” I got her to promise to call me if she got worse. And we hung up. Both of us rolling our eyes, wondering what the other one was thinking. I went to bed that night wondering if she was actually sick this time, or if she was just in touch with her body.
I don’t sleep much.
The next morning, her husband found her on the floor of their bathroom. She was semi-conscious and didn’t know where she was, or who he was. He called me, very stressed out, as you might imagine. I had him call 911. They took her to the ER.
I called the ER doc, to give him a heads up. He asked what he should be looking for. I said, “I’m really sorry, but I have absolutely no idea.” He said “Thanks a lot” and hung up. “Happy to help,” I mumbled, as I clicked off my phone.
They scanned her head, looking for a stroke or a bleed. They did bloodwork looking for every disease under the sun. They did chest X-rays, CTs, EKGs, and God knows what else. She was extremely dehydrated. Her pulse was racing and her BP was barely detectable. So they were pushing IV fluids. She was in kidney failure, probably from the dehydration. She finally produced a little bit of urine, and they found a raging kidney infection with sepsis.
Once they figured that out, they called me to ask if she had any drug allergies. I didn’t even look at her chart and said, “Nope.” So they gave her two antibiotics (both of which, as it turns out, were on her allergy list). They worked well, and today she is recovering nicely. Thank God.
But she nearly died of a bladder infection. That I could have found in my office with a $2 urine dipstick, and fixed with maybe $5 worth of antibiotics. Except that I couldn’t have treated it, because she says she’s allergic to every antibiotic in the world.
Her hospital bill will probably be over $100k and she nearly died. She was lucky her husband found her when he did. And she was lucky the ER doc did such a nice job, so quickly. Nice save, buddy.
I would have called him to thank him, but I didn’t want to have to listen to him asking me how a patient of mine nearly died of a bladder infection.
This story may sound odd. But it’s not.
My patient may sound irrational, but she’s not. At least, not any more irrational than the rest of us.
Black Lives Matter has burned down cities for over a year protesting how many blacks are killed by white cops. While they ignore how many blacks are killed by other blacks. While ignoring the social problems that lead to such violence in their neighborhoods. While refusing to acknowledge that when a criminal resists arrest, he is engaging in a high-risk activity.
When you have a problem, it always feels better once you decide that it’s someone else’s fault. But the catch is that at that point, the problem becomes un-solvable. The first step to solving a problem is to take ownership of it. Blaming others makes that impossible. Which then makes it impossible to solve the problem.
It’s not that my patient’s illness is her fault, of course. It’s just that she needs to play a role in fixing the problem, regardless of why it happened. And if she refuses to do so, then things might get out of hand.
It’s hard to know who to blame for the problems in the black community, although it really doesn’t matter as much as we wish it did. All that really matters is improving things now, regardless of how we got here. And that will involve those in the black community playing a role in the improvements. And there are many, many people in black communities doing exactly that. God bless them.
This is why Black Lives Matter is so toxic. BLM is not just unhelpful – it is setting back progress that is hard earned by those who live in these communities and want to improve them.
When BLM encourages blacks to blame others for their problems, then progress stops (even if others are partially to blame for those problems). When BLM encourages blacks to be resentful and distrustful of whites, then it becomes more difficult for us to work together to improve anything.
Fear of others trying to help, because they might discover that perhaps your problems are at least partially your problems, is understandably met with deflection:
“It’s a Black thing. You wouldn’t understand.”
“I know my body. Your drugs are killing me.”
It’s very difficult to fix a problem that you refuse to acknowledge. It’s very difficult to accept help from someone that you don’t trust. So we take herbal supplements and we burn down cities. These responses may not seem to be completely rational.
But at least we’re doing something, right?
Strange that things aren’t getting any better…
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Famous reply to a similar argument- the sign pointing the way to Boston doesn’t have to go their (made after a lecture on fidelity by a man known to fool around).
I always am amused by all the naturopathic, herbal, and homeopathic meds patients take. First, very few are proven to help & the compositions & dosages aren’t standardized in many cases. Secondly, many patients take them b/c “drug companies just want my money”- as if the herbal companies are all run by saints (newsflash the markup on many herbal products exceeds the markup on pharmaceuticals). I have seen serious complications from such meds-intracranial bleeds etc. But the Americans spend ~$30BILLION on such stuff-spending on fish oil, glucosamine, echinacea etc was 1/3 of the out of pocket spending on medications-and much of it is of dubious (or worse) value. $3billion on homeopathy- if less is better perhaps none at all is best. But it is near impossible to discuss it with patients-even in the cases where the “natural” remedy is contraindicated.
I am not sure the diagnosis is correct. I think BLM (grifters and Marxists) are a separate problem and not some bad medicine. Marxists/Commies will always be around to exploit any weakness to destroy the host. They are like the sepsis. The root cause is the destruction of the nuclear family. If you fix families, all the other symptoms will clear up. Crime will go down and test scores will go up. But fixing families is hard–very hard and politicians don’t do hard things. (JFK is dead in spirit too.) The DNC now exists to perpetuate crises as to expand power and enrich their cronies. The GOP does the same thing with war.
We need a religious revival and we need to replace all the corrupt politicians that tell the people that they will fix their problems with easy solutions. The people need to fix this problem.
The added benefit about nutty patients is that they also carry a higher risk of malpractice claims precisely because they don’t provide accurate info or follow instructions and then look to blame somebody else. I have seen more than a few come to my old firm seeking to file and invariably get rejected–my colleagues have vastly higher standards than that but some others do not.
I once had a case (pawned off on me by a more senior lawyer) involving a claim of age and race discrimination on behalf of a client who was obsessively and instantly annoying. The alleged villain was her boss, a really delightful, nice young woman who had been as accommodating as humanly possible and was now visibly pregnant at her deposition. Given the trial dates, I would have supposedly have had to grill on the stand an attractive 8.5-month pregnant lady sitting uncomfortably in the witness chair while some a-hole lawyer (moi) tried to paint her patient actions in a bad light. It may have been one of the silliest cases with the worst optics in the history of American civil litigation.
I went higher up for guidance to a brilliant old trial lawyer. He took my proposed detailed case analysis letter to the client recommending accepting the (absurdly generous) settlement and slowly drew a red line through every word on all three pages. And then wrote a single sentence.
He then asked me if the client had arrived with a stack of papers with an enormous number of sticky tabs and notes in the margins on every page. I said yes, exactly so. He nodded and said that it had been a mistake to have let her in the door. People who have developed an obsession like that are nuts and all communications and discussion of details will just feed the obsession in endless circular conversations. You have to draw back and force the nut to make binary choices. No details. No opportunity to circle back to facts she loves to rehash. Nothing to recharacterize. She took the settlement. We did not want a fee–just leave, please.
“I know my body”
“Oh? What are your current glucose levels and white cell count?”
Yep. Because it gives the lie to the quote, widely (probably falsely) attributed to Winston Churchill, that “if you’re going through hell, keep going.” Life experience has taught me that if you think you’re going through hell, you should stop for a moment and ponder how much of your unhappiness and dysfunction is attributable to the fact that you’re making your own hell–something you can change if you want, and if you’re not completely invested in Sartre’s opinion that “hell is other people.” Sometimes, hell isn’t other people. Sometimes, it’s just you, and the doors of hell are locked on the inside.
Umm. No. She is.
Arsenic, syphilis, and botulism are all-natural.
Reminds me of a cartoon of a guy with his doctor from the 1960s with the caption. “A heart attack is just nature’s way of telling you to slow down.”
Botulism? Isn’t that what Nancy Pelosi uses?
BRILLIANT. THANK YOU.
Old Socrates took a famous herbal medicine- hemlock. Look at how that turned out. Digitalis is, historically, one of the most used herbal meds- and one of the more dangerous meds with a narrow therapeutic range.
This brings back a really funny story for me. I was working for a publisher during my first pregnancy. I was in the college division, and once a year the sales reps would come to Boston for a major conference at which the new books would be presented by the sponsoring editors. It was a fun week for everyone. I was just a lowly editor, and I was never involved in the conference in any way. But this year, the sponsoring editor was out sick. The head of the department asked me to make a presentation on one of my books. I hated public speaking, and I was wreck. But I prepared a presentation. The day came, and I went into the conference room where the sales reps were sitting around a conference table, and I did the presentation as best I could.
The department head and I left together, and I asked him how he thought it went. He was chuckling. “It went really well, and they did not hear a word you said.”
“What? Why?”
“When you stood up, they started getting out their wallets and looking at pictures of their kids. You’ve gotta realize they haven’t seen their families for a week.” :-)
So does Joe Biden- I think we need to temporarily tax Botox a lot more every 4 years starting around late winter. I wonder if the injections into both their foreheads wasn’t a tad too deep- smoothing out their cortex and it is well known that smooth cerebral cortex is bad.
I mean Steve Jobs thought he could beat cancer by living healthier…He was lucky to have a treatable kind of pancreatic cancer and still screwed himself over by wasting time with alternative medicine first.
Reminds me of our family doctor when I was a child.
Percival, I think that Doc’s comment was meant as irony.
EXACTLY.
The people getting attention for their focus on the signs and symptoms of illness in black communities either don’t know what they’re talking about when it comes to diagnosis and treatment or are more out to profit from the situations they decry than to work with people for recovery.
Yeah. When I see fibromyalgia, IBS and migraine on the problem list in the ED I think “depression”.
I LOLed.
I would have been impressed you called.
I love that ” I know my body” line.
I remember an ad campaign in California for an HMO, that had billboards saying, “No need for a referral, you know your body”.
So the “dizzy” patient would go to the neurologist, for their cardiac arrhythmia.
Or the “heart burn” patient would go to the gastroenterologist for their cardiac angina.
It’s kinda like my grabbing the controls on the plane from the pilot because ” I know where I’m going”.
Nancy Pelosi’s is a billiard ball by now.
Can’t argue with a single point. However, we’ve gone so far down the road that I don’t see how we’ll ever get back.
Beginning in the late 60s, the Leftists began an all-out assault on American culture (including the nuclear family). No more Ozzie & Harriett or Leave It to Beaver. The 70s featured shows in which the father was portrayed as a doddering idiot or simply absent.
As far as a religious revival, I agree; however our religious institutions have embraced a feel-good philosophy that ignores the dogma that created them.
As far as education goes; forget it. We all know where it went…
Dr. – I’m not sure how many of you in the medical profession look at food allergies, but your patient sounded like a mild version of me. Of course, at one time I worked in several health food stores and was of the similar mindset – that herbs, and supplements could fix any ills and drugs last resort. I still feel that way, but several things happened to me so far in my life. I had to figure out that I had serious soy, wheat and dairy allergies. These were never diagnosed by a doctor. But I had drastic symptoms – all different from each, and the lightbulb came on later and much suffering.
I’m not sure if she could be tested and put on an elimination diet to see what happens. Even wheat can cause depression, anxiety and many physical ailments including fibro. Herbs were another lesson – combinations are the worst because if you are allergic to just one, you won’t know which one. I once took a formula for asthma and allergies that contained an Ephra-type herb that I think has been banned. I made it to work but was having an out of body experience – like I was really ill. I had an inhaler and had allergy shots, but the culprit was dairy. And that was not the worst symptom.
Go bless you and your profession. I am wondering if you could talk to her husband and get her to stop all the vitamins and herbs until she can screen what is causing her issues. Or does HIPPA prevent that discussion?
Yeah. If you look at the dilutions in Homeopathic meds that are common, x26, x 60, x400 for example, there is probably not 1 molecule of the original substance present. Very expensive distilled water.
Fantastic analogy! If you were my doctor, I’d sure do what you suggested. Minds like yours @drbastiat are too valuable to waste. Your post reminds me of my sister-in-law. She’s one of five siblings in the family…the black sheep, so to speak. She’s had a multitude of jobs, lived in many states, has a daughter who is 40 years old that has always lived with her. There has never been a job or an activity that she doesn’t know how to do better than her superior, Her daughter is capable of nothing more than being a cashier at a fast-food joint. Neither of them lacks sufficient intelligence. What they lack is the humility to realize that things are the way they are because a lot of people worked hard to make them this way. Although improvements can nearly always be achieved, one must appreciate the good of where we are before one can make things even better. Your story is so illustrative of the sad state of our country right now. I pray that just as Reagan followed Carter, there lies in the shadows another great leader to come forth and bring positivity back to America.
She is (as Road Island Red liked to exclaim) “as sharp as a bowling ball”
“I took [some essential oil] and it worked for me.”
Sigh.
You mean like Trump followed Obama? So maybe that already happened, and he got cheated out of office.
If that great leader is out there, then he’d better show himself pretty d*mned quick because the downward spiral is picking up speed every day. If the Dims’ court packing scheme is successful, there won’t be much left to salvage.
In the case of the 60X, I am curious whether the person who did finally get the molecule after all that jabbing and waiting would get better results, or worse, than the ones who did not receive a molecule. If there are any homeopathic medical experts on R., please answer.
(But not irregardless of the answer to that, it may not affect my decision: I’m not even sure I will be alive in 4 billion years, especially after getting a needle 2 billion times a second. Or, can you take the doses orally?)
In my experience, people believe in Christianity for exclusively emotional reasons. Can we return to faith if the family is broken? The relationship with G-d is one between a father and a their child so can we have a return of religion without Dads?
I’m betting on genetic engineering to raise I.Q.s and sex robots. I know that I don’t talk about that alot but I think they’re important ;)