TW: Mentions of disordered eating
Written by: Leah Bush
What happens when you are labeled as something that you just aren’t? What if you received a diagnosis of anorexia nervosa when all you’ve wanted for a long time is to eat normally? When you’re terrified by how much weight you’ve lost, but you continue to be told that you’re doing it to yourself? How easy would it be to start thinking, “Maybe I am crazy?”
I worked in an emergency department at a regional hospital for 3 years. One night, in the middle of a practically dead night shift, a young woman came into the ER. Her chief complaint was abdominal pain. When her name came across the screen, the physician I was working with rolled his eyes.
“Dammit. Her again?” he sighed.
“Who? You’ve seen her?” I asked.
“Yes! She came in a week ago and then 3 days ago for the same thing, and she’s just anorexic and all her problems come from that! I’m not seeing her!” he said.
I checked her chart, and sure enough, she had been there and both times he had seen her. And on each visit, he discharged her after some lab work and diagnosed her with anorexia nervosa. This woman was a 30-something, otherwise healthy, 88-pound woman. Her ribcage was visible through her T-shirt, her hair was thin, and her eyes were sunken. Everything about her screamed “anorexic!” But she had a different story to tell if you took the time to listen.
She was crying, “I’m so tired of this! I want to eat! I want to gain weight! I feel awful all the time!”
Everything about her screamed “anorexic!” But she had a different story to tell if you took the time to listen.
I sat there and listened as she cried and reiterated her complaints to me. She tried to eat, but
every time she would eat, she would have severe abdominal pain, and vomiting, and had
subsequently lost 60 pounds. I acknowledged her complaints and told her that I was sorry that she had been dealing with this for so long without answers. I grabbed my stethoscope and began to listen to her. I anticipated that I would find the same things that everyone else had.
Heart sounds good....lungs are clear....abdomen is norm...wait. Wait, wait wait...is that...?
I had heard a phenomenon called a bruit, which is a whooshing sound created by an artery that is narrower than it should be. If you’ve ever squeezed a garden hose and heard the sound that the water makes right before the hose closes off completely, then imagine that in an artery. The whooshing from this particular bruit was very loud. A specialized CT revealed evidence of a very rare disorder called Superior Mesenteric Artery (SMA) Syndrome. For an extremely small number of people, one of the arteries branching off from the aorta will come off at too sharp of an angle and pinch the small intestine almost closed. The symptoms of SMA Syndrome are - you guessed it - strikingly similar to the physical symptoms of anorexia nervosa. SMA Syndrome is easily treatable, and most patients diagnosed appropriately have excellent results. Those not diagnosed and treated go on to have further complications and can even die of malnutrition in extreme cases.
Great story, right? The patient gets better, Leah gets her pats on the back, and everyone walks away feeling warm and fuzzy, thanks to the magic of proper medical care. But what’s the point? Am I telling you this to point out how awesome I am? Is it because I think you’re one of the 0.3% of the population that has SMA Syndrome? The answer is simple: because nothing I did was awesome. If I had grabbed you out of the ER hallway with no medical training, put my stethoscope in your ears, and stuck it to that woman’s abdomen, you would have heard a loud whooshing sound. You may not have known that it shouldn’t sound that way, but any individual with any medical training would know that abdomens don’t go “whoosh.”
So how did this patient get misdiagnosed twice in the span of a week mere days before I saw her? Once again, the patient could answer that question. In neither of her previous visits to the ER for complaints of abdominal pain had anyone listened to her abdomen. The physician had walked in, made a cursory appraisal of her situation without talking to her, and then determined that anything she said was a lie if it did not match his interpretation of her illness. Now, keep in mind that I didn’t listen to her abdomen because of her complaint. I listened to her abdomen because that is part of a basic medical examination. This is basic medicine. Unfortunately, this kind of treatment happens to women all the time. The first impression informs the rest of the exam for the provider, and women are routinely seen as being more dramatic or speaking from their anxiety instead of their true physical symptoms.
The physician had walked in, made a cursory appraisal of her situation without talking to her, and then determined that anything she said was a lie if it did not match his interpretation of her illness.
Doctors aren’t dumb. Nurse practitioners, physician’s assistants, nurses - they’ve all made it through school and licensing processes. These are intelligent people, and practicing medicine does require effort intellectually, but one thing we can’t forget about healthcare: it is quintessentially physical. Your healthcare provider should hear your voice, but they should also see, feel, and listen to your body. The same is true for you. Always listen to your own body, and find a provider who does the simple things, so they don’t miss the big things.
About the Author
Leah Bush - ElleTwo Contributor
Nurse Practitioner
Leah Bush is a Nurse Practitioner with over a decade of clinical experience in critical care, cardiac care, emergency medicine, and primary care settings. Her professional identity is rooted in her upbringing as the daughter of a pastor and cardiac nurse educator, experience in varied medical fields, and personal journey as a mother and kidney transplant patient. She has a passion for patient education and a desire to give every patient the care that they deserve but are often denied. This holds particularly true for her female patients, who are often the most overlooked and misunderstood patients in our healthcare system. Outside of work she is a lover of music, documentaries, and LSU football. Her personal heaven is warm buttered bread and a long nap, and her personal hell is matching children’s socks out of an endless sea of laundry. She’s been married to her husband Tony for 11 years, and they have 3 children together - James (10), Rebekah (4), and Henry (2). They’ve recently added another member to their family: a black-and-white house cat named Alfie.