Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Wednesday, September 06, 2006
    The Heidi Treatment

    I stopped by V.'s office the other day along about Phone Call Time (similar to Twilight Time) to find her staring at one particular chart. The annotations on the message slip attached to it were so copious as to inspire a mental comparison to War and Peace... in case you're wondering, this is never a good sign.

    "I'm supposed to cure her," V. said grimly. "She's been in the hospital repeatedly, seen every specialist you can imagine, and her neurologist gave her mother my name. Now they're begging me to see her."

    I picked up the chart and started flipping through it idly. "What's her problem?" The chart consisted of copies of hospitalization records and studies. It was pretty thick for someone who hadn't even been to the office yet.

    "She's got all these neurologic symptoms nobody understands. She's too weak to walk. She was seen by Psych and they think it's conversion syndrome. I've never even seen anybody with conversion syndrome, have you?"

    I was impressed. Conversion syndrome was first described, if I recall correctly, by Sigmund Freud. Basically it's a phenomenon in which a person develops a physical symptom or problem for no good reason and no medical cause can be found. The idea is that it's a subconscious psychological defense that allows the person to avoid some overwhelming issue. (Think hysterical blindness, for example.) I've never seen such a case; it isn't a very common problem.

    "How long has she had this?" I asked, flipping through the chart.

    V. sighed. "A few years." Without going into details, the patient in question underwent some severe physical and psychological trauma while she was a college student and had had the problem more or less ever since. The family was unwilling to accept the diagnosis of conversion syndrome and was insisting that there had, simply had, to be some sort of physical explanation; hence the multiple visits to specialists and V.'s dilemma.

    I began to free associate, thinking of ways to miraculously cure someone with this type of problem. "Maybe she needs the Heidi treatment," I suggested as a memory popped into my head.

    "And what is the Heidi treatment?"

    "If you remember your childhood reading, Clara was Heidi's best friend who was unable to walk. She was stuck in a wheelchair until she went to visit Heidi and her grandfather in the Swiss Alps. A few months of goat's milk, fresh air and sleeping on hay and voila, she was miraculously cured and able to walk again."

    V. looked thoughtful. "Yeah, I think I remember that." (V. and I seem to have read many of the same books during childhood. I haven't asked her about The Five Little Peppers and How They Grew yet, but I'm sure that will be next.)

    "Well, there you go. Just get her a ticket to Switzerland and you're all set." I left before she could hit me with the chart.

    [Postscript: this happened a few months ago. At last report the patient is doing much better.]



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