THE "DIFFICULT PATIENT" | Kendra Peterson
I was running late
and you were running off
at the mouth
a litany of complaints
profanities and sexual innuendos
with scattered apologies
to me, a Lady
for your inappropriate language
but followed up with more.
I hadn’t yet been biased
by a chart review
and though you did your best
to antagonize and provoke
when I stayed calm you got calmer, too,
revealed your vulnerability and fear.
And it crossed my mind, you might be suffering.
a contorted mix of symptoms and dysfunction
spiced angrily with descriptions
of how you’d been mistreated
devalued and dismissed.
the muscle atrophy and reflex change
were certain to be real (those can’t be faked)
and muscle weakness, too, seemed real to me
if perhaps exaggerated
so you’d be sure that I would notice.
I didn’t know the diagnosis yet,
yet had no doubt
that something was awry.
And I sensed that you were suffering.
When I reviewed the prior doctors’ notes
they read as a litany of accusations:
“Malingering, conversion, factitious disorder,
elaboration, secondary gain, personality disorder,
non-physiologic, behavioral, body dysmorphic disorder”.
Between the lines I gleaned disdain
and a hint of smugness
at having blown your cover.
But I could not discern
if each had reached his own conclusion
or if the theme of disbelief
self-propagated within the chart.
And no one mentioned that you were suffering.
I wondered, briefly,
if I’d been fooled
taken in and gullible.
But there is that muscle atrophy and reflex change
and regardless what disorder underlies
or if not all can be explained
by misbehaving nerves and muscles,
I believe that you are suffering.
Kendra Peterson is a neurologist in Palo Alto, California. She is a member of Stanford's Pegasus physician writers.