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.

 

The history

a contorted mix of symptoms and dysfunction

spiced angrily with descriptions

of how you’d been mistreated

devalued and dismissed.

On examination

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.

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