‘‘Magic White Coats’’ 29
I questioned the diagnosis—it probably could be something else:
just a very high blood count. But my docs were pretty clear that the
diagnosis was not in doubt. My primary care doc drove me right to
the hospital himself!
Even after the diagnosis was made, based on objective data, ill doctors
often had trouble believing it.
Many sick physicians were surprised at the degree to which they
misinterpreted early symptoms and failed to conceptualize these cor-
rectly. Roxanne, the gastroenterologist with abdominal cancer, first felt
pain one night while preparing slides for a lecture. She examined herself,
but then kept working for hours on her lecture, and did not look at
herself with a clinical gaze, as she would another patient. Only in ret-
rospect did she put the events together.
I wanted to do a good job, but the lecture would not gel. It was
2 A.M . and it still wouldn’t click. I had the slides laid out on the
floor, and I was watching TV. As I bent over, I felt something,
a mass.
Nonetheless, Roxanne struggled with her talk for several more hours.
Even though she had had other significant symptoms, including the loss
of menstrual periods, she still hadn’t linked all her symptoms and signs.
The social role of a doctor and its accompanying perceptual framework
can take a long time to change.
For six months, my periods ceased. I thought I was too young for
menopause. Four weeks before, I woke up in the middle of the
night with epigastric pain. But there was no pain on my liver when
I palpated, and there was no pain in the back. I’m a gastroenter-
ologist. I examined myself. I thought it was irritable bowel syn-
drome, and I was surprised how painful, how terrible it could be! I
had bloods drawn on my own. I picked up the results, and the only
thing abnormal were platelets less than normal. But I still didn’t
put the whole thing together. A week after that, I was going to the
symphony, and in the taxi, the pain came again, and lasted two
hours. In retrospect, that was the expansion of the spleen. But I
didn’t know it at the time.
Roxanne had not yet accepted the disease or the role of patient, sug-
gesting the width of the chasm that separates doctors from patients,