What's the Matter with Heather?
Heather was either a hypochondriac or a malingerer trying to con me into helping her get federal disability. Though only 30, she'd come to her doctor's appointment on a stretcher and wearing a face mask, claiming she was too weak to walk and the "allergens and toxins" in my office would affect her "for weeks." She'd recently "strained" her back lifting a Pepsi can. Everything she ate gave her diarrhea or made her sick so she was living off organic rice, chicken noodle soup, and a handful of Chinese herbs and vitamins she'd purchased on-line. On a check-list of 100 possible symptoms, Heather checked yes to 78 of them. Her hair was thinning, her head pounded, she was exhausted, her thinking was cloudy, her nails were brittle and had weird lines, she hurt "everywhere," and her feet and hands tingled and felt numb. And that was just 7 out of the 78 symptoms! At this rate, we'd be here all night and my next patient would storm out in a huff because I'd kept her waiting too long. (Not that I could blame her!) I released a sigh. Heather was such a train wreck, I barely knew where to start, other than telling her I would not fill out disability forms until I'd come up with a definitive diagnosis for all her symptoms, and that would require blood tests and a thorough evaluation. No, that's already been done, she insisted. Six times. Her husband then handed over a pile of medical records two-feet deep from their last six doctors. I thumbed through the records. No obvious cause could be found. Several doctors, I noted, had recommended a psychiatrist. But Heather and her husband were convinced she had Chronic Fatigue Syndrome and no more testing needed to be done--I just needed to fill out the disability paperwork so they could get some money. (He had quit his job to take care of her.) But I wasn't convinced that was her problem. I had other patients with CFS and none had some of Heather's bizarre complaints.
After work that night, I poured over the mountain of records in laborious detail. Since Heather was penniless, I didn't want to waste money repeating any tests that had already been done. I researched her symptoms in hopes of finding one condition that would tie all her complaints together. Crazy as a loon came to mind. The other six doctors had already ruled out every condition I could come up with, except one: Arsenic poisoning. But why would she have that? She'd never worked in an industrial factory, wasn't a painter, and didn't drink well water. Was her husband trying to poison her? (The evil thought that I didn't blame him entered my head.) What about those on-line Chinese herbs she was swallowing by the fistful? Herbal products from overseas aren't tested for purity or safety.
Sure enough, her test for arsenic poisoning lit up like Las Vegas at midnight. We sent off her Chinese herbs for testing and the report came back confirming they were loaded with arsenic. I must confess, I was rather proud of myself for clinching the case when six other doctors hadn't.
Convinced Heather and her husband would sing my praises and declare "National Sally Burbank Day" for my brilliant discovery, I called them into the office to go over the test results and treatment. But instead of slathering me with praise, they were angry. Hostile, even. Why? Since I'd found a treatable and potentially curable disease, they would no longer qualify for long-term disability-- their major goal! Heather was livid I'd accused her precious Chinese herbs of poisoning her. "They're the only thing that's kept me alive these last two years," she insisted. They stormed out of my office, no doubt to find some other doctor willing to fill out their disability paperwork instead of treating her arsenic poisoning.