The past two weeks, I’ve ended my workdays feeling rather…. depleted. I’ve had an unusual number of mystery medical cases, but not fun ones like in the New York Times Sunday Magazine. I haven’t solved many of these, and I’ve got some frustrated patients. I wish I could do some internet presentations and solicit all of your clinical opinions, but, HIPPA. I’d rather not lose my job.

I can, however, share some relatable cases from the distant, very distant, past. Here are two cases from training that still haunt me, well over a decade past:

I once took care of a young mother with postpartum cardiomyopathy, and refractory nausea that no one could figure out. She was repeatedly admitted to the hospital for nausea and vomiting, and became malnourished. Specialists from every discipline came to consult. The nausea wasn’t thought to be related to her heart failure or any GI or neurologic condition, and didn’t respond to any treatments. The cardiology team became frustrated and asked for a psychiatry consult, insisting that it must all be in her head. I rotated off the case and lost track of her, but when I ran into a colleague familiar with the case a year later, he informed me that she had passed away. He said it was odd, as her heart failure wasn’t that advanced, and she had had a feeding tube placed so she was getting nutrition. Despite all of that, her nausea had continued. He said he thought she died because she couldn’t live with the unexplained, persistent nausea anymore.

On another rotation, I met a middle-aged woman who had been complaining of a vague and progressive weakness for years. She’d been followed by a primary care doc and sent to a few specialists locally; she was diagnosed with severe anxiety and depression. It was only when she saw an optometrist in a different town that a breakthrough was made: the optometrist was struck by the fact that her facial bones were markedly visible. She had painfully obvious temporal wasting. He recommended that she see a neurologist at our teaching hospital, and thus she was correctly diagnosed with fairly advanced ALS: Lou Gehrig’s Disease. When I rotated off the floor, she was grappling with this terminal diagnosis and the fact that she was close to requiring- or declining- mechanical ventilation.

I was a mere trainee for these cases. But since then, I have been involved in more like these, where the doctors were not the heroes, or were even villains. I don’t want to be like those doctors. I want to be the doctor who believes in the patient, uses my brain, persists in the search, never loses hope, and solves the mysteries.

Unfortunately, that’s just not how it feels lately.

So I was leaving the office later than usual on Friday last week. One of our nurses was still there. She’d been helping me with one of our ongoing sagas of sickness, and we hadn’t been able to resolve much. I stopped in to say ‘bye, and we looked at each other like What the hell??, hands up, shaking our heads. But we laughed at each other and ended with:

“Have a great weekend!”

It felt good to have even that tiny bit of commiseration…

But I drove home in the usual late Friday traffic, and had the beginnings of a migraine before I got home.

I’m not sure if it’s due to heavy brain use, or the negative feedback from my unhappy customers, but I’ve been getting migraines almost daily.  I do think the commute is also a trigger: sitting in the car stopped in tunnel traffic, breathing fumes, listening to the usually really depressing local news, reviewing cases in my head…

The migraines clear up with a couple of Aleve and maybe an Imitrex, but the mysteries remain unsolved.

twisted stethoscope