Every patient tells a story by Lisa Sanders

Author:Lisa Sanders [Sanders, Lisa]
Language: eng
Format: mobi
Tags: Clinical medicine, Nursing, Medical, Differential, Physician-Patient Interaction, General, Diagnosis, Diagnostic Errors, Popular Works
ISBN: 9780767922463
Publisher: Random House, Inc.
Published: 2009-08-11T11:05:24+00:00

CHAPTER EIGHT

Testing Troubles

C arol Ann DeVries felt like she

was falling apart. A compact

woman with a cheerful, round face

and deep-set brown eyes, she had

been healthy all her life. Then, just

a few weeks after her fifty-ninth

birthday, everything changed. Out of

nowhere she got a rampant case of

hives. A short course of prednisone

cleared them up, but neither Carol

Ann nor her internist could figure

out where they’d come from.

Then, one Saturday morning, a

few days later, she awoke feeling

achy and hot, her throat was

sandpaper, and she had an odd red

rash near the base of her spine. Was

this more hives? Carol Ann had a

doctor’s appointment scheduled for

the next week, but she felt too awful

to wait. She drove herself to the

emergency room of her local

hospital.

The

ER

doctor

took

her

temperature, looked at the rash, and

briskly told her she had Lyme

disease. “An antibiotic will clear it

up,”

he

said,

scribbling

the

prescription. “One pill twice a day

for two weeks,” he told her, and he

headed out the door. “Wait a

second,” Carol Ann called after

him. “Aren’t you even going to get a

test to see if I have Lyme?”

“You don’t need it,” he told her,

ticking off the items that supported

his diagnosis. It was early summer,

when Lyme is most common. She

lived in suburban Connecticut—not

too far from the actual town of

Lyme, where the disease was first

identified. And she had a big, round

rash typical of those seen in the

early stages of Lyme disease.

He

acknowledged

that

her

symptoms weren’t the classic

headache and stiff neck, but, still,

she had the fever and body aches.

The odds were overwhelming that

this was Lyme, he told her.

“Besides, this early in the disease,

the Lyme test wouldn’t tell us a

thing.” Then he was gone, off to the

next room, the next patient, leaving

Carol Ann with his scrawled

prescription and a feeling of

uncertainty.

Every spring and summer some

version of this story is repeated tens

of thousands of times in states of the

Northeast, Midwest, and northern

West Coast. Often, as in Carol

Ann’s case, the diagnosis will be

made without a test, based on the

patient’s geography and symptoms,

and cinched by the presence of the

typical rash, known as erythema

migrans. The diagnosis will be

appropriate and reasonable, but not

definitive. And in Lyme disease,

that uncertainty has proved to be a

particularly noxious ingredient.

Carol Ann took the antibiotics as

prescribed.

By

the

following

weekend she felt almost back to her

usual self. For most patients with

Lyme disease, a single course of

antibiotics is curative. But if Carol

Ann had had a simple case of Lyme

disease, I wouldn’t be telling you

this story. Instead, a few weeks

later, Carol Ann developed pain

and stiffness in her knees and hips.

There was no swelling, no redness,

just this strange reluctance in the

joints of her lower body.

She went to her internist, who

thought the symptoms were from

Lyme

disease.

Untreated

or

inadequately treated, Lyme can

attack the joints, causing pain, and

usually swelling. He changed her to

another

antibiotic—doxycycline.

She stayed on that for three more

weeks but the stiffness continued.

Her internist was baffled; he sent

her to a rheumatologist. The

rheumatologist wasn’t sure what

was going on either. So she went

back to her internist. “He fobbed me

off on his physician’s assistant,”

Carol Ann said. “I was practically

crying over the phone because of

the pain. I told the PA I couldn’t

even sleep because the pain was so

bad. She wasn’t very sympathetic.”

Carol Ann felt abandoned. Her

doctor was a nice guy, she told me,

but he clearly didn’t know what

was causing her pain or what to do

about it.

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