An apology to patients with chronic fatigue syndrome

by professor TONI BERNHARD, JD:.

I’ve been sick since 2001 when I failed to recover from what appeared to be an acute viral infection. It has left me mostly house-bound, often bed-bound. In effect, I’ve had the flu without the fever for almost ten years: the aches and pains, the dazed sick feeling, the low grade headache, the severe fatigue. It cost me my career as a law professor; it cost me the ability to be active in the lives of my children and grandchildren. Because I meet the Centers for Disease Control (CDC) case definition, I’ve been given the diagnosis, Chronic Fatigue Syndrome (CFS).

Although there have been some promising developments (a possible connection to a retrovirus; the presence of unique proteins in the spinal fluid of CFS patients), as of this writing, there’s no proven cause and no cure.

This is not surprising, given that so little money is allocated for research into this debilitating illness. Why?

One reason is the absurd name. As others have pointed out, calling it, “Chronic Fatigue Syndrome,” is like calling Emphysema, “Chronic Cough Syndrome,” or Alzheimer’s, “Chronic Forgetfulness Syndrome.” On October 15, 2009, Dr. Nancy Klimas of University of Miami’s Miller School of Medicine spoke about the lack of research money to the New York Times: My H.I.V. patients for the most part are hale and hearty thanks to three decades of intense and excellent research and billions of dollars invested.

Many of my C.F.S. patients, on the other hand, are terribly ill and unable to work or participate in the care of their families.

I split my clinical time between the two illnesses, and I can tell you, if I had to choose between the two illnesses in 2009, I would rather have H.I.V. When doctors ask what’s wrong with me, I can give one of two answers, neither of which is satisfactory in the context of obtaining quality health care for myself and others with CFS. That leaves me in a no-win position in the doctor’s office.

Option #1: If I say, “I have Chronic Fatigue Syndrome,” I’m likely to be discredited as a witness to my own condition. I’ve had doctors tell me there’s no such thing as Chronic Fatigue Syndrome.

One doctor said: “Just drink some coffee.” Option #2: If I say, “I contracted a serious viral infection and never recovered,” it goes down better, but by saying this, I’m undermining the effort to bring legitimacy to the illness.

Legitimacy means research money.

By avoiding ...
By avoiding the phrase, Chronic Fatigue Syndrome, I’m also undervaluing the lifelong work of many doctors, including Nancy Klimas, Dr. Anthony Komaroff of Harvard Medical School, Dr. Charles Lapp of the Hunter-Hopkins Center, and Dr. José Montoya of Stanford University School of Medicine, all of whom have dedicated their careers to CFS research and patient care. A few weeks ago, I had an appointment with a doctor regarding something unrelated to my illness.

The New Patient Form asked, “Are you in good health?” I checked “no.” Next question: “If you checked ‘no,’ please explain.” How many times have I faced “please explain” on a medical form and had to choose between those two unsatisfactory options? I’ve lost count. I needed the best care I could get from this doctor so, playing it safe, I reluctantly took option #2 and wrote, “Contracted a serious viral infection in 2001 and never recovered.” On the back side of the form was a list of symptoms with instructions to put a check in the box next to any that applied. Looking down the list, I reached: “Fatigue.” What’s a person with CFS supposed to do with that choice? Most of the people I know say they’re tired. But the fatigue of Chronic Fatigue Syndrome?

The CFIDS Association of America calls it bone-crushing fatigue. I call it bone-crushing and sickly fatigue—that flu without the fever.

Laura Hillenbrand, bestselling author of Seabiscuit and Unbroken, and a CFS sufferer herself, put it this way: “This illness is to fatigue what a nuclear bomb is to a match. It’s an absurd mischaracterization.”

Given no alternative but “Fatigue,” I checked the box and moved on. In the exam room, the doctor looked at my form and asked: “What’s this viral infection you never recovered from?” Without using the phrase Chronic Fatigue Syndrome, I succinctly explained the different theories regarding the cause of my continued illness. He listened and then said:

“What’s the diagnosis?” I was cornered. “Chronic Fatigue Syndrome,” I said. I watched him disengage from me. He swiveled on his stool, put his note pad down, turned back to me as if we’d just met and said: “What have you come to see me about today?”

On March 3rd, Dr. Montoya said in a talk at Stanford University that it was his dream that the medical community would someday produce a formal apology to patients for not believing them all these years when they said they were facing a real illness.

Millions of us share your dream, Dr. Montoya.

Toni Bernhard was a law professor at the University of California—Davis, serving six years as the law school’s dean of students. She is the author of How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and Their Caregivers and can be found online at HowToBeSick.com.

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