Tuesday, March 22, 2011

Psychiatrist Dr. Troshinsky: this patient is mentally healthy but suffering from a serious physical illness

by Laura Hillenbrand:

I had never been in poor health and didn't have an internist, so I went to my old pediatrician. I sat in a child's chair in a waiting room wallpapered with jungle scenes, watching a boy dismember an action figure. When my doctor drew the thermometer from my mouth, he asked me if I knew that my temperature was 101. He swabbed my throat, left for a few minutes, and returned with the news that I had strep throat. Puzzled by the other symptoms, he prescribed antibiotics and suggested that I see an internist.

The doctor I found waved me into a chair and began asking questions and making notes, pausing to rake his fingers through a hedge of dark hair that drifted onto his brow. He ran some tests and found nothing amiss. He told me to take antacids. A few weeks later, when I returned and told him that I was getting worse, he sat me down. My problem, he said gravely, was not in my body but in my mind; the test results proved it. He told me to see a psychiatrist.

I went to Dr. Charles Troshinsky, a respected psychiatrist whom I had seen when I was fifteen, after my high school boyfriend had died suddenly. He was shocked at how thin I was. I was just under five feet five, but my weight had dropped to a hundred pounds. Dr. Troshinsky said that he had seen several people with the same constellation of symptoms, all referred by physicians who dismissed them as mentally ill. He wrote my internist a letter stating that he would stake his reputation on his conclusion that I was mentally healthy but suffering from a serious physical illness.

'Find another psychiatrist,' my internist said over the phone, a smile in his voice. How did he explain the fevers, chills, exhaustion, swollen lymph nodes, dizziness? What I was going through, he suggested, was puberty. I had just turned 20. 'Laura, everyone goes through this,' he said with the drizzly slowness one uses with a toddler. 'It's a normal adjustment to adulthood. You'll grow out of it in a few years.' He told me to come back in six months.

'But I'm not happy with my treatment,' I said.

He laughed. 'Well, I am.'

I called his secretary and asked for my medical records. I sat on my bedroom floor and flipped through the doctor's notes. Couldn't handle school, he had written. Dropped out.

My next doctor was a plump, pink man with the indiscriminate gaiety of a golden retriever. He was halfway through a hair transplant, and clumps of hair were lined up in neat rows on his scalp, like spring seedlings.

I again tested positive for strep, and he renewed the antibiotics. He ran a blood test for a virus called Epstein-Barr and found a soaring titer, a measurement of the antibody in my system. I had, he said with pep-rally enthusiasm, something called Epstein-Barr virus syndrome. He had it, too, he said, but he had discovered nutritional-supplement pills that cured it. 'Whenever I feel it coming on,' he said, 'I just take these.' He talked about how much skiing he could do.

I took the supplements. They had no effect. Nor did the antibiotics; the strep raged on. The doctor changed my prescription repeatedly, to no avail.

At the end of one of my appointments, ... Read more>>

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