Berton Roueche - The Medical Detectives Volume I

"Lewis and I have been married for thirty-nine years," Betty Page told me in a conversation we had not long ago in her home. "They've been happy years. We have a lot more in common than just medicine. But we have our differences. I like to ski, and he prefers scuba diving. His hobby is mineralogy. Mine is archeology. His glass is always half full. Mine is always half empty. That was the way it was on that Wednesday three years ago, after that night. Lewis was satisfied that it was just one of those things. I wasn't so sure. I was still feeling a little funny. But I had some big distractions that took my mind off myself. Not just my work. Our daughter was getting married in July, on the twenty-eighth, and, as the mother of the bride, a lot of the arrangements devolved on me—for one thing, the invitations, the calligraphy. Plus I was making my own dress. Still, I got through the day on that Wednesday. I didn't feel too bad. At night, I fell right to sleep—and then it was the night before all over again. Except worse. This time, the warm milk wasn't really very effective. I took some Tigan, an anti-nausea medicine, and that helped, but only a little. And along with the nausea I had a little crampy feeling, abdominal cramps—what used to be called green-apple cramps. I got through the night. The next day, I did what I had to do, but it wasn't easy. I had an attack of diarrhea. I tell you, I felt like hell. Thursday night was another bad night. About the only thing that kept me going was the thought of our cottage on the lake. We had opened the cottage on the Memorial Day weekend—May 25, that year—as we always do. Actually, I had done most of the opening, starting on the Friday. Lewis sees patients all day Friday, and until late on Friday evening. He does that to keep his weekends free. So now, a week later—that would have been Friday, June 1—I took off for the lake. I love the lake. I always feel wonderful there. It beckoned to me like a haven.

"I felt some better when I got there. I began to think, to hope, that I was overreacting. I did the necessary marketing and got settled for the weekend. There was a lot of work to do. It was a little discouraging. I thought we had done all that the weekend before. The cottage is set in a lovely hemlock wood, and when we went up on the Memorial Day weekend there was hemlock pollen everywhere in the cottage. And now, a week later, there was another dusting of pollen all over the place. So I went to work again. Lewis arrived sometime after midnight. I woke up and we talked a moment, and then another wave of nausea came over me. Milk helped, enough to let me get back to sleep. In the morning, it was good being at the lake, but I really wasn't feeling any better. The nausea came and went, and my mouth was always filling with saliva. I kept having to spit. My abdominal cramps continued. And the diarrhea. I didn't complain to Lewis. I tried to keep it even from myself. I took my temperature. It was normal. That was something, but I still felt just punk. Lewis drove back home on Sunday evening, as usual, and I stayed over for another day of rest and then to close up. I drove down home on Monday afternoon. I hated to leave the lake and go back to work. I was sick, and I knew it.

"Well, now we were into June. I kept thinking, hoping, that tomorrow or the day after or the day after that I'd wake up feeling better. But nothing changed. I never vomited, but I was nauseated almost all the time. I had clammy cold sweats and an awful metallic taste in my mouth. I lost my taste for food. A little milk, some Cream of Wheat—I lived on baby foods like that. My normal weight is around a hundred and ten. Now I was losing something like a pound a week. And I was getting worried—really worried. I had a breast cancer back in 1963, and a radical mastectomy. There had never been any suggestion of a recurrence. But there is something that everybody who has ever had any kind of cancer knows. There is always a sort of subliminal anxiety. An ache, a pain, a feeling not quite normal, and you think, Is it cancer? So I pulled myself together and called a gastroenterologist I knew and made an appointment. Doctors are like lawyers. Lawyers don't represent themselves in court. Doctors don't treat themselves for anything that might be serious. I kept my appointment, and the gastroenterologist heard my complaints and was very concerned. He gave me a full examination—the complete mouth-to-anus workup. The results were negative, entirely normal. That should have been good news. But actually it was frustrating. And the gastroenterologist was frustrated, too. So he did what so many doctors do in a situation like that: he went the functional route. What else? He reminded me that I was almost sixty. He said, 'Betty, your trouble is that you're not growing old gracefully.' He said, 'Wait until the wedding is over. You're simply a nervous mother. Your histrionics are getting out of hand.' He said, 'Take a little nap in the afternoon. Try to relax.' He prescribed a medication. It was a mixture of his own—a mood elevator and a tranquilizer. I took his nostrum, and I thought I was going to die. I could hardly breathe. It did something to my chest muscles. I didn't have the power to move air in and out of my lungs. I got rid of the nostrum, and at once felt better. I mean, at least I could breathe again.

"I may have been a nervous mother. I may still be. But that was hardly the cause of my illness. The day of Elizabeth's wedding came, and everything went off very smoothly, very beautifully—and I still felt sick. I had to take a leave of absence from my job. I couldn't manage anymore. I wasn't exactly idle. I had undertaken an ecological study of our lake. There is an association of families who summer there, and I was expected to read my report at the annual meeting, on Labor Day. I thought if I paced myself I could make that deadline. My long weekends at the lake gave me plenty of time to do the necessary research. And rest. I needed rest. The symptoms that sent me to the gastroenterologist were still with me, and I also had some new ones. I was feeling a very unpleasant tightness in my chest, a viselike feeling, and my heart, even at rest, seemed to be skipping beats. You know how we doctors have fragmented ourselves with our medical specialties. My reaction was typical. I was choosing a doctor on the basis of my symptoms. When my symptoms were gastrointestinal, I went to a gastroenterologist. Now my heart seemed to be acting up, so I went to a cardiologist. I don't think he prescribed a nostrum. But the results were much the same as before. He gave me a thorough examination—everything known to cardiac technology. There was apparently nothing wrong with my heart. Then some new symptoms began to develop. I had difficulty reading. After perhaps half an hour, I would begin to get double vision. Another problem was muscle weakness. Another was involuntary twitching in my legs. They twitched like a twitching eyelid. Do you remember Fourth of July sparklers? How we used to light them and then pass our hands through the sparkle and get that funny, pinprick feeling? I began to have that feeling on the bottoms of my feet. That was more than a little frightening. I couldn't help but think of amyotrophic lateral sclerosis—Lou Gehrig's disease. Well, the doctor I went to this time was able to reassure me. It wasn't that. Believe it or not, I was still playing tennis. Or trying to. I wanted to keep up my muscle tone and my muscle strength. I thought that was the way to fight the weakness in my legs. But I was a blob. And my spells of double vision didn't help my game. Pretty soon, it was all I could do to climb the stairs to bed. Even marketing was exhausting. I remember one day at the supermarket. I was pushing my cart along and I just ran out of steam. I left the cart with all my groceries right there in the aisle and crept back home.