Eli Daniel Ehrenpreis
Skokie, Illinois, United States
One who performs odd jobs or piece work; a derogatory term for a wrestler who is booked to lose a match.
“Thank you for seeing us.”
“Of course, that’s what I do.”
Her son sits quietly, holding a small toy plane that he moves around in wide arcs. Then he gracefully gets out of the chair, takes steps backward and forward, turns the plane around, hits it against the wall, then sits back down for just a moment before starting the process again. I look at the anxious patient and smile so that she can relax and explain her history to me.
“You’re supposed to be the opinion guy?” Her husband took time off from work for the visit. He is standing, not sitting. His tone says “skeptic” and the look on his face says “hopeless.”
I don’t surrender very easily.
It isn’t my place to tell them my circumstances, that I am just a jobber, another of the department’s assets. It’s odd to be a doctor and a contracted employee, but I do this now so that I can feed my family. Although the term “opinion guy” isn’t written on the contract that I signed after my accident, it does summarize my part-time job in the system.
I keep myself available when the regular doctors have had enough. This means that the standard tests, procedures, scopes, and everything else have already been done. The patients that are referred to me usually have puzzling symptoms and normal test results. Then the regs want to move on. Their schedules are packed with new patients and follow ups. The patients are frustrated with the insecurity of their diagnoses and the lack of improvement of their condition.
That’s when I get called. The patient’s records are sent to my home, a consultation is scheduled, and follow-ups are not allowed. The examination room is fitted to accommodate my disabilities.
I make new diagnoses. I try complementary and alternative treatments. I fill a niche.
We talk about her symptoms. “I have headaches and my stomach hurts. I have a lot of trouble falling asleep. Maybe that’s what is making my brain so foggy.”
She is eating poorly and has lost some weight. She no longer goes for long walks or meets with friends. Because her energy level is so low, she can’t keep up with her son’s needs. Her mouth always feels dry. Many tests were done, and she was always told that the results were normal.
A sensible diagnosis is celiac disease.
But celiac disease can be tricky to diagnose. Her biopsies are reported to be normal, of course, but I look at the slides on the microscope in my office myself and notice a few tiny white blood cells that are setting up shop around the lining cells of the intestine. A celiac panel had been performed. This test looks for antibodies to enzymes that help with the digestion of wheat proteins. These antibodies can trigger inflammation in the intestine in people that carry certain genes. The panel measures levels of IgA antibodies to these proteins, but like some patients with celiac disease, this patient’s IgA levels were low, so the normal result was not helpful. She also reduced many things, including gluten from her diet, to stop her intestinal symptoms, which could also have made the results of these tests appear to be normal, and as such, difficult to interpret.
My diagnosis is a clinical one. I hope that the treatment will help her.
I explain the condition and its symptoms. I also describe the many ways that celiac disease can affect a person’s life. How it can even cause depression and fatigue.
The patient becomes less tense. The room no longer feels like my dungeon.
Then I share information about the appropriate diet for celiac disease. We review relaxation techniques that she can do at home. I suggest a test for her son. We stop the medication that was prescribed for abdominal spasms, since it has many side effects, including dry mouth and fatigue.
The little boy takes the plane for another spin around the room, no crashes. The family is ready to leave.
They ask to return for another appointment, but I see the scheduler, who sits just outside the door of my examination room shaking her head “no.”
Then I go home and wait for another call.
ELI DANIEL EHRENPREIS, MD, started life as a musician, then became a physician, educator, writer, and inventor. He stopped seeing patients due to disability. His latest book, The Mesentery in Health and Disease, was published by Springer International. His prose and poetry writing often focuses on his own experiences. He has three adult children, and lives with his wife Ana and two small dogs in Skokie, Illinois.