Crazy People Get Sick Too

“Crazy people get sick too.” a professor of mine in medical school told me, as we walked through a crowded urban emergency room.  He firmly emphasized to his small crowd of followers that it was nothing short of criminal to instantly brand every human being who presented to the ER (or anyplace else) with a medication list that included psych drugs, or was delusional, or disoriented, or hallucinating, or even violent, as being a “crank,” and ignoring the possibility that this person might be physically ill, just like anyone else.

I took that lesson very much to heart, even though I was not officially among the mentally ill at that point.  It made all the sense in the world that mentally ill people could still get heart attacks, and strokes, and kidney stones, and life-threatening infections.  It even made sense that people who were not diagnosed with a mental illness could have conditions that might mimic conditions normally associated with, say, a psychotic break or an overdose: acute liver failure can cause hallucinations and stupor; uncontrolled diabetes can cause disorientation and lethargy progressing to coma; hypoglycemia can cause uncontrollable tremors, delusions, and hallucinations progressing to unconsciousness and sudden death; brain tumors can cause auditory and visual hallucinations, personality changes, depression, mania, paranoia, and just about anything else.

Then there was the lady who kept vomiting and vomiting for almost a year.  The gastroenterologists did every test in the world and it all came back normal, except for her serum electrolytes, which were screwed up from her constant vomiting.  They branded her a psychogenic vomiter, which means  they blamed the vomiting on something psychological and that was not their department, so they discharged her from their care.  A few months later she presented to the ER, this time vomiting up fecal matter (sorry).  Yes, it was really gross, and my heart went out to this poor lady, who had been branded a “crank” simply because the doctors did not know what was wrong with her.

This time the ER requested an acute surgical consult.  The surgeon decided to take her to the OR the next day for an exploratory laparotomy, which means they would open her up from guggle to zatch (my terminology) and wudge around in her innards to try to find the cause of her awful condition.  Luckily, I happened to be on the surgery service then, so I was pressed into service holding retractors.  (N.B. anyone who has a question about any of these terms is welcome to leave a comment and I will explain.  I figure that most people watch all these medical shows they have now, but since I don’t own a T.V. I don’t know what they have on them.)

Where was I?  Oh yes.  Holding retractors.  So.  When the surgeon got in there, he found, to his great surprise, a gigantic tumor in the middle portion of her small intestine.  Now, the small intestine is notoriously difficult to evaluate due to its extreme length (about 20 feet) so you can’t just stick a periscope down there and look around, like you can with the large intestine.  So all kinds of weird shit (excuse the pun) can hang out down there and go on with its dirty business undetected.   So when he opened this lady up and found a grapefruit size tumor like a donut surrounding the tube of her small intestine, he was shocked and amazed.  I was ecstatic.  The lady was vindicated.

The surgery turned out to be very messy.  I will not go into the particulars.  I had the immense satisfaction of bringing the news of the positive surgical findings to the attention of the arrogant asshole gastro people, who pretended that they thought something was the matter all along.

Oh, I forgot to tell you, this lady had a diagnosis of anxiety disorder and was on two or three meds for it.

One piece of good news is that since then there have been many new developments in medical imaging.  It is doubtful that things would have got that far without a CT scan, or an MRI, or both; and either of those would have revealed the weird tumor.  But given her diagnosis of anxiety disorder, would she have been taken seriously enough to even get to the point of imaging before she started throwing up shit?  I really don’t know.

Next post, I will tell you why I wrote this one.

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18 Comments

  1. Oh that poor woman, there was a lady on the liason psych ward I stayed on who had a similar issue, they still hadn’t figured out what was going on by the time we both were discharged and hers had been going on since she was a child.
    I’m glad there are doctors out there like you who have taken that lesson to heart and will look past the psych meds/conditions if we present with problems. If you’re at a teaching hospital I can only hope some of the students who you come across will take that lesson with them too 🙂

    Reply
    • Thank you. When I was teaching I tried to inculcate humane and respectful treatment of all people regardless of disability into my students. Now that I am the one who is disabled, I find myself the target of medical stigma routinely. I am branded as a “crank” from the minute they read my chart and see my extensive med list.

      Reply
      • It’s silly, I know why they look for an easy answer and are happy enough to assume that everything is due to a psych disorder but surely they all got into medicine because they wanted to help people and solve those little mysteries that are presented. It was such a relief to find a GP practice with a couple of them who wouldn’t! I’ve found myself hiding things from them until I get an unbiased opinion lol.

        Reply
  2. A friend of mine has a psychiatric history and before she found a new GP whenever she went in saying she was physically sick the doctor would tell her it was all in her head. Not only would this keep her physically sick but it would continue to keep her mentally sick since she was being shut down by a doctor and being told she didn’t know what was going on with her body.

    Reply
    • That kind of thing makes my blood boil. It completely goes against the Hypocritical Oath that we take when we graduate med school: First Do No Harm. It makes it into a Hypocritical Oath. Unfortunately, most doctors seem to operate under the latter.

      Reply
  3. She could have died! She should not have had to suffer this. It sounds like you had really good advice in your training. She should have had a far more extensive investigation. Like you say…would she have had but for her prior diagnosis….irrelevant! Jen

    Reply
    • Yes, the poor woman would have died a horrible death if she had not been a persistent advocate for herself. Yes, I had some wonderful role models who shone above those who were not so good.

      Reply
      • I dared to suggest to a doctor that he had missed the artery on a blood oxygen test (biology 101 blood was not red enough). He was not impressed or in agreeance but came back to do another within 1/2 an hour. I realized this in a semi-conscious state and without medical training. That is not a nice blood test to repeat! I imagine you would be amazing at what you do. Jen

        Reply
      • I dared to suggest to a doctor that he had missed the artery on a blood oxygen test (biology 101 blood was not red enough). He was not impressed or in agreeance but came back to do another within 1/2 an hour. I realized this in a semi-conscious state and without medical training. That is not a nice blood test to repeat! I imagine you would be amazing at what you do. Jen

        Reply
  4. People love diagnosing me with anxiety. The first time, it turned out to be hydrocephalus and I had brain surgery and gained a shunt. The second time, it wasn’t just the fatigue of having a new baby and constantly changing nappies and playing with other household chemicals. I had dermatomyositis, a serious systemic auto-immune disease. Is it any wonder that I do experience some anxiety???

    Reply
    • Oh dear, I shudder to think of the pain and humiliation you have suffered due to the medical profession’s love of labeling anything and everything, provided it pertains to a female of our species, “anxiety” or “psychosomatic.” Actually the latter term has fallen somewhat out of usage in our day, substituted with the slightly more vague and marginally more politically correct term “functional,” which translated means “we haven’t a clue what’s causing it, therefore we will give it this moniker that implies that it’s psychosomatic.”

      I have my own interesting “anxiety” story, which you’ve jogged my memory to, well, remember. Now I’ll have to remember to post it. Anxiety is an awful illness, and I do sometimes have nasty attacks; I know others who are virtually paralyzed with it. On the other hand, your story shows us how once again, if it doesn’t walk or quack like a duck, can it really be a duck?

      Reply
  5. Thank you dear Ruby

    Reply
  6. Thank you, my dear.

    Reply
  1. Crazy People DO Get Sick, Too | I Was Just Thinking. . .

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