Those Who Will Not Be Healed

Abstract

\4vian Kleinfelter was a thirty-nine-year-old patient with nineteen Chief Complaints. Her feet tingled. Her ears rang. She saw spots in front of her eyes. Gas pains kept her awake all night. Daily attacks of nausea were accompanied by cramps and rainbow-colored vomitus. It took me an hour and a half, rushing a bit at the end, but I got everything down in twelve scrawled pages: all nineteen Chief Complaints, followed by her Past Medical History, Family History, and Review of Systems. Physical examination took ten minutes-normal head to toe, except for the well-healed scar of a biopsy on her left breast (done three years before, a benign cyst) and a varicose vein on her left calf. To the semi-skilled eyes and hands of a medical student, Vivian seemed the picture of health. Tall and solid, ramrod straight, with curly auburn hair, she had the body and skin tone of a woman ten years younger. Such bright eyes. And such vitality. She talked on and on with the momentum of eager, well-rehearsed speech, her hand flitting about like a hummingbird as she touched the body part that harbored each complaint: eyes, ears, nose, throat, bosom, stomach.... But alas, her visit to the Stanford General Medical Clinic came to naught. Less than naught. Alan Barbour, the clinic director, gave Vivian his best. He examined her body and reviewed every detail in her chart, which included voluminous records from the Cedars-Sinai in Los Angeles and the Pacific Medical Center in San Francisco, then delivered his diagnosis. He spoke with the deepest compassion, but the noble fellow insisted on telling the truth -it was all in Vivian's head, every symptom a hypochondriacal paradigm-and his efforts only enraged her. A disastrous consultation. In the end she stormed out of the clinic. I called her