Go Home and Forget About It – Colitis Misdiagnosis
There are few situations in the field of health which are more distressing both to patient and to doctor than being faced with a string of negative results of all examinations. Patients are often told, “there is nothing wrong with you. Go home and forget about it.” In a situation such as this, the patient begins sanely enough to suspect that he is a fit subject for a psychiatrist. Indeed, some physicians are prone to tell such persons that they are neuro-psychopathic cases. More lately they have been termed psychosomatic cases.
Yet it is hard for a patient who never in his life has given evidence of any mental disorder to believe that it is all a “matter of mind.” I, for one, will not deny the enormous influence which a disturbed mind can exert in disturbing the rest of the nervous system. This, of course, applies particularly to the sympathetic nervous system which is so greatly involved in the proper functioning of the intestinal tract.
Surely a patient’s mind should be set at rest. If there is any evidence of anxiety, of worry or of severe mental shock, it should be frankly dealt with and the person best fitted to do this is a psychiatrist. That specialty has achieved rightful recognition as a useful method of untying mental kinks and of pointing the way to a better understanding of the problems of life, particularly life with one’s self.
People nowadays, that is sensible people, no longer shrink from consulting a psychiatrist for fear that they will be considered “nuts.” They realize that all too often, in a civilization as complex as ours, mental lives can become confused and that a little straight thinking, with a psychiatrist pointing the way, has untangled many a mind in time to prevent an actual psychosis.
I trust that I have paid sufficient tribute to the legitimate standing of psychiatry to make the following statements without being accused of being prejudiced. It is my opinion that far too many patients are considered “neuro” cases on all too insufficient evidence.
I recall a case of intolerable itching induced by a colitis. The itching was so intense that it crowded into every waking moment of the patient’s life and in fact, allowed him few moments of sleep. Anyone who has suffered the agonies of intolerable itching will know how shattering it can be to one’s mental control. To tell such a person that it is all a “matter of mind” is cruel indeed, especially since in this particular case the colon had never been examined.
This is a world of cause and effect, and for every effect there must be a preceding cause. Therefore, if we are diligent enough it is to be hoped that the cause will eventually be found, although I freely admit that in the period of determination, the patient may suffer considerably. Here it is that patience and understanding and perseverance on the part of the physician can do so much in bringing about an eventual victory over suffering.
There is one form of worry, however, which I acknowledge and in fact openly charge is purely a “matter of mind.” I refer to those people who dwell upon their ailments, unduly speculate as to the probabilities and get themselves in a frightful turmoil needlessly. Such people very often are unduly obsessed with the fear of cancer.
It is readily agreed that the prospect of anything so dreadful is disturbing, but the reassurance of a physician, when such reassurance is based upon a careful examination supplemented by the various laboratory tests at his disposal, should set at ease the mind of the sufferer. Certainly no such gross deviation from normal could readily escape detection when such methods are followed.
If the panic which every now and then seizes a patient cannot be quieted by so convincing an array of evidence, the patient has the right and should request a consultation. No kindly, competent physician would ever object to this most reasonable request. Certainly anyone who has practiced medicine over a period of years knows that fallibility is a human trait. In the presence of such a distressing situation, I am sure that no mature man of medicine will hesitate to call for a consultation or impede further investigation by other qualified doctors of medicine.
The more I practice medicine, the more firmly am I convinced that the law should require a doctor personally to experience the siege of illness at least once before he can qualify for his medical degree. In this way I feel that the community at large and his own patients in particular would be definitely insured of his sympathetic understanding and a more kindly approach to what is often referred to as the product of an overactive imagination.
I make this suggestion with no thought of penalizing my colleagues but for the purpose of increasing their awareness of the fact that there is nothing so personal as pain nor so intimate as an itch. Only the person actually experiencing the sensation can really know as to its existence. Pain may be feigned and symptoms imitated by those who find it profitable or amusing to be malingerers.
Conversely pain can be borne, though less frequently, with a stoic indifference. Hence my assertion that no one really knows, not even the cleverest diagnostician, how intense a pain, an itch or an ache may be, except the patients themselves.
I, therefore, always feel that the patient who complains of various symptoms should be given the benefit of the doubt. If in truth his body is sound, his mind most certainly is not, so the end result is the same; the patient really is sick. The only difference is that we have a mind to treat as well as a body.
Now all the foregoing is merely a preliminary to the following story:
It concerns Bill Stevens and how he got back the digestion that he used to boast enabled him to eat nails and spit tacks. It only took a few kindly conferences, in which his past life was sympathetically reviewed, to discover the fact that he was suffering from the effects of a vicious circle.
“There is nothing the matter with you—go home and forget about it!” That is what the doctor said to poor Bill Stevens who had been complaining of “nervous stomach problems” for the past three years. Day after day, he would awaken with cramps in the lower abdomen—a feeling of distress or bloating in the upper part of his abdomen. All day long, he would have a vague hunger which never seemed to be satisfied very long by food. He was tired and had a most peculiar feeling of being “all in,” even when he got up in the morning. His nerves were jumpy, at times he felt dizzy, and his bowels were continuously constipated.
Upon returning home after a hectic day at business he felt ravenously hungry, yet found no enjoyment in eating the meal. A little later, he would drop dead tired into his bed, but he tossed so fitfully in his slumber and his sleep was invaded by a recurrent horror dream. In the morning, more tired than when he went to bed on the preceding evening, he plodded his weary way back to earn his daily bread.
Was the man sick? No, he couldn’t possibly be. There was the verdict of the doctor. “There is nothing the matter with you—go home and forget about it.”
Mind you this was not an off-hand opinion. The doctor had been most thorough. There had been an extensive series of x-rays of the whole stomach and intestinal tract, which had proven negative. A gall bladder series also proved negative. A cardiograph—an electrical survey of the heart’s function—showed nothing abnormal. Blood count, urine analysis, stool examination and a host of other various tests; all negative. From the top of his head literally to the soles of his feet, he had been painstakingly examined. Everything normal, nothing wrong, nothing the matter. Obviously a confirmed negative but a very miserable one just the same.
Maybe you have heard of cases like that. They are by no means infrequent. That is the story of Bill Stevens. Truly a problem to himself as well as to his doctor.
In the course of my lengthy career as a specialist in intestinal ailments, I have learned, among other things, not to doubt the existence of something merely because it is not apparent to me. Three people can look at a set of blueprints and two of them can see nothing but blue paper and white lines but the third, with engineering training, will make sense out of what seems to be a hodge-podge. So too, in the field of medicine, no one man can hope, in these complex days, to have the special experience and skill of all the various specialists.
Nowhere is the old adage “Jack of all trades and master of none” more true than in the field of medicine. It is the wise and honest practitioner, therefore, who recognizes his own limitations and seeks to render his patient the best possible service by obtaining for him the services of a man skilled in what appears to be his particular problem.
Bill Stevens’ problem very definitely was not physical but he did have a problem. It concerned some quirk in his mental life. He was referred to a competent and kindly psychiatrist who unearthed the true cause of Stevens’ ailment in childhood frustrations and misunderstandings. A few conferences with the psychiatrist enlightened Bill on the meaning of the word psychosomatic. In brief, he learned that the body can be very seriously disturbed in its function by some interference with the normal workings of his mind.
The psychiatrist found that Bill was suffering from a guilt complex of long standing and one oddly enough with little basis of fact. When he had been given a more mature viewpoint and came to realize that it was not he alone who had been guilty and that it was one of the phases of living through which he passed, his mind was set at ease and before the month was out he even thought it quite a joke. In fact, he dispelled the last wisps of his mental handicap by recalling the story of the smart aleck at school who heckled the physics professor. When the professor asked him: “What is mind?” he politely replied, “No matter,” and when the professor pressed him for a definition of matter, his answer was, “Never mind!” Having regained his sense of humor, he regained his health—as many others do.
I am by nature a patient soul and, I think, more than ordinarily sympathetic toward my patients. However, I recall one instance in which I came very near making an error. The mistake I would have made was that of disbelieving the story told me by one who came to me in great distress. The patient, a gentleman of obvious intelligence, brought a most strange complaint. He had by accident discovered, while at the toilet, that he had passed some living creatures in the stool. They jumped—that is how he knew they were alive.
I looked at him in frank wonderment. Silently I said to myself: “Now I’ve heard everything!” In all the years of my practice as a specialist in intestinal ailments, I had never heard or read anything so grotesque. It was manifestly absurd. However, I hid my disbelief and went on questioning him in the hopes of determining what he thought he saw.
His account was clear enough. Not once, but on many occasions, he had observed small specks actually jumping in the toilet bowel after a movement. I could have understood and almost believed had he said he saw motion because sometimes, when patients have certain types of worms, they actually do move and wriggle; but this jumping had me stumped.
Naturally I had a specimen examined at the laboratory especially for parasites—not only one but many specimens; all examinations were negative. I was indeed puzzled but the situation piqued my curiosity. I made an exhaustive study of all available books and articles but found in them no trace of an explanation. Methodically I examined him from head to toe and all examinations proved negative. I examined his clothes and his person from head to toe: negative, negative, negative. I could have dismissed the matter with a clear conscience since I had done all that the ordinary exercise of diagnostic skill called for. However, the man was so honest and so distressed I couldn’t quite believe him the victim of a hallucination.
One day while this case was under observation, chance brought to my office a school teacher of zoology. I asked her naively: “What living creatures of almost microscopic size jump?” Very promptly she answered: “Fleas, of course.” Now my acquaintance with fleas up until that time had been merely academic and happily scant in extent. “But,” I countered, “they live in sand, don’t they, not in water?” “Why of course,” she said, “some do but there are also water fleas.” I gasped, “Ah, at last a clue.”
I immediately called my patient on the telephone and requested him to bring me a specimen of the water from the toilet bowl and sent it to a sanitary engineer whom I knew and who worked for the city. That settled the problem!
He called me on the telephone shortly after receiving the specimen and said: “Why yes, there are water fleas in this water and I can tell you exactly where you got it.” To my amazement, he named the very locality where my patient lived. He then went on to explain that, for some reason, the main supplying that district had become a veritable habitat of countless water fleas and that, despite corrective measures employed by the engineers, occasionally a batch of them got through.
My patient wasn’t “nuts” after all—his eyes had not deceived him! The only error in the whole situation was his conclusion that he had fathered the brood.
When I explained the situation, both he and I had a well earned laugh, particularly when I confided to him my suspicions as to his sanity. How unfair it would have been to call him a psychopath or psychoneurotic!
You may rest assured that after the experience just related, I have been most reluctant at any time to consider my patients’ complaints, even the most unlikely, as being just a matter of the mind.
While I do not encourage people to become morbidly introspective, I certainly feel that they are entitled to an explanation of any apparent abnormality in function. Indeed, it is only by a sensible vigilance in these matters that a person can maintain his state of health and prevent those grave consequences which follow a long continued disturbance of normal function. Written By: J. F. Montague, M.D., Continue Reading: How Did I Ever Get This Way?