Why is it that when doctors don’t have an idea in their own heads, they assume that pain is all in yours?
Last November, my normal, happy, never-been-really-sick ten-year-old suddenly started having severe stomach pain and spewing noxious fluids out every orifice. While the spewing quickly ran its course, the pain didn’t. It never goes away. Never. Goes. Away.
If ever I needed a sense of humor, this was it. Or at least, that’s what I thought until we started going to doctors to try to find help. Answers, perhaps. That’s when it got really funny.
The first doctor was cheerful, confident.
–Probably just being bullied in school. No? Then it must be acid reflux. Take Prevacid, and let’s get some blood work just to be sure. And by the way, you should make an appointment with a psychiatrist.
It turned out that my son’s blood work was normal, except for an odd item. His eosinophil count was really high. Now, if you’re like me, and like most of the doctors we went to see, you have no idea what an eosinophil is, so I’ll share what I’ve learned. It’s a bizarre type of white blood cell that protects us by blanketing an affected area and releasing a toxin to kill an invader. Problem is, eosinophils often don’t do your innards any good either. High blood levels over a 6-month period can lead to organ failure and death. Charming.
One thing that can cause high eosinophil levels is a parasite infection. So, on December 23, Dr. Cheerful prescribed a high dose of the same medication you give a horse, ivermectin.
Heigh-ho, Silver! Merry Christmas.
After a brief respite, the pain came back, worse than ever.
Dr. Cheerful then called a new doctor he wanted us to see, a pediatric gastroenterologist. This guy was so good, he diagnosed my son from that phone call, and prescribed medicine he wanted my son to take for two weeks before our appointment: an antidepressant that has a secondary effect of pain suppression.
Now I’m getting depressed. Maybe I should take it.
We went to our appointment. This guy was boisterous, talked like we were in an episode of SpongeBob SquarePants, poked my son in the stomach a few times, and slapped him cheerfully on the back so hard that he knocked him off the table.
–Yup. I was right! crowed Dr. Sponge Bob. –Post-infectious visceral hyperalgesia, that’s what he has. Keep taking the pills you’ve got. Add this, gabapentin. If this doesn’t work, double the dosage. If that doesn’t work, triple it. Come back and see me in another two months at the low, low price of $500 per visit.
Wait, I said. What is this post-infectious visceral hyperalgesia, really? And why are you sure this is what he has?
He looked at me pityingly. –“Post-infectious” means “after infection.”
I know that, I said. I do have a Ph.D. in English.
–“Visceral,” he continued loudly, –means having to do with the stomach cavity, whereas “hyper” means “excess” and “algesia” means “pain.”
Did I mention that I have a Ph.D. in English?
So, basically, I said, your diagnosis is that he’s in pain?
When we got home, I looked up “post-infectious visceral hyperalgesia” and found out that it is the gastroenterologist’s “holy grail,” with a diagnosis rate rising something like 44% in the past year.
The “holy grail.” I’m not kidding. This is a direct quote from the editorial pages of Gastroenterology. So, obviously, there’s no need for actual diagnostic tests. After all, we’ve found the holy grail. I looked up gabapentin, too. According to the U.S. Library of Medicine, it decreases “abnormal excitement in the brain” and changes “the way the body senses pain.” I suppose finding out why he’s in pain is out of the question.
Why worry? Holy. Grail.
Maybe I need to take this, too. My brain is certainly getting abnormally excited.
Sponge Bob’s nurse called me a few days later.
–Blood work is normal, she said cheerfully.
Really? I said. That’s exciting news.
–Oh, yes. Perfectly normal.
His eosinophil count is down? It’s actually normal?
Silence. Long silence.
–Well, now that you mention it, it is a little high. Let me check with the doctor.
–He says to keep taking the medicines, and if your son is still in pain in six months, you should find a psychiatrist.
No, thanks, I said. I think perhaps we’ll try to find a real doctor. Or perhaps change the way Dr. Sponge Bob’s body perceives pain.
The next doctor was even funnier, because he introduced us to the modern miracle of twenty-first century diagnostic medicine. Perhaps I expected too much, schooled by eight interminable seasons of House, with his irascible and (by the way) unsound medical practices. But, honestly, how do doctors keep a straight face when they tell you that a single test “rules out all serious conditions that cause abdominal pain”? Especially Dr. Modern Miracle’s test:
–Hold my hands. Jump up and down.
Up and down.
I’m not kidding. Up and down.
This doctor is clearly is a graduate of the if-there’s-nothing-loose-we-don’t-have-to-sew-it-back-on school of medicine.
Up and down.
–Okay, terrific, said Dr. Nothing’s Loose. –We’ve now ruled out everything serious, but we need to get an HIV test, just to be sure.
What? I said, not sure I heard correctly. Wait. He’s ten. With severe stomach pain. HIV? Why?
–Just to be sure. But we’ve ruled out everything serious.
HIV’s not serious? Why would you suspect HIV?
–We don’t really. But just to be sure. Oh, and by the way, he should learn to meditate. Or maybe see a psychiatrist.
Do we recognize a pattern growing here?
And it’s not just my son. Even dead people aren’t safe from this trend. I recently read an article that asserts that Darwin’s stomach ailments were caused by the pressures of genius and the effort of writing On the Origin of Species. Not only that, but he apparently made hypochondriacs out of his entire family, convincing them that they, too, had some sort of stomach ailments, to the point where they were debilitated by them. Totally destroyed their lives with his hypochondria.
Gee, it couldn’t have had anything to do with the fact that Darwin spent 5 years on the Beagle, traveling the world, collecting and preserving dead animals and strange plants, constantly “sea-sick,” sleeping (and puking presumably) in the same room with bags of dead birds? Or with the fact that in his lifetime, doctors routinely went from autopsies to childbirths without washing their hands, because they found the idea of “germ theory” hilarious?
Of course not. It was all in his head.
All in all, I’m reminded of something Ann Landers or maybe Dear Abby once said. “Remember,” she said. “Fully 50% of the doctors out there graduated in the bottom half of their class.”
Think about it.
Disclaimer: This blog is in no way a reflection on the medical profession as a whole. Heck, some of my best friends are doctors. Some of them are pretty funny, too, and good doctors to boot. Nor is it intended as a libelous attack on any specific members of the medical profession, because all of it happened pretty much this way (who me, exaggerate?). Besides, I used carefully crafted aliases to protect the innocen–. . . well, to protect them, anyway. But if the shoe fits. . . .
As a great man once said, “Persons attempting to find a Motive in this narrative will be prosecuted; persons attempting to find a Moral in it will be banished; persons attempting to find a Plot in it will be shot.” He won’t mind my using his words. Sam had his own troubles with the medical profession. Besides, he’s dead. With impunity, I can say that it’s all in his head.
Epilogue: We did finally find some doctors who actually practice medicine. Because children often exhibit symptoms that are counter-intuitive or counter to adult symptoms, they can be difficult to diagnose. In July, several biopsies revealed that while the pain is in my son’s stomach, he actually has eosinophilic esophagitis, a serious condition, especially with numbers as high as his, that can lead to Barrett’s disease and esophageal cancer. He’s being appropriately treated at last, and we expect a full recovery, though life’s ironies don’t end: one of the primary side effects of the new medications is – are you ready for it? – stomach pain.
In the words of Etta James, you need “a sense of humor, ‘cause life ain’t funny.” Not to mention “a big stick to keep the [doctors] away.”
©September 12, 2011, by Sharon McCoy
Regular postings on the ways life and literature inspire us to keep “laughing to keep from crying” will appear every third Monday.