“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.