An Alternative Explanation

Entry by: Freya

17th March 2017
An alternative explanation

The moment I step into the surgery, the receptionist’s lips curve in a smile-like grimace which doesn’t reach her eyes. In her large glasses and short-cropped grey hair spiked in all directions, she looks like an owl who’s just been in a fight.

‘How was your weekend, Wendy? Dr Wilson will see you shortly.’

I nod. No point engaging in a chit-chat. We are already past this stage of acquaintance, though it has been a short one. We are both now clear on what we think of each other. I sit on one of the tired chairs upholstered with what used to be a pink plush and now brings to mind Winnie-the-Pooh’s closest friend, Piglet, on a drizzly day.

‘How are you, Wendy? Hope the weekend wasn’t too taxing?’ There is little joy in Doctor Wilson’s gaze as he greets me. As I pass him in the door to his office, his back arches as if he carried a fifty-pound bag of flour. He told me on Friday he wasn’t to be on call over the weekend and so, as it isn’t his work that makes him exhausted, I conclude it is me. I draw a long breath and try to remain calm. No point getting annoyed. He is the tenth doctor I am seeing this year and this one must be a keeper. I need some predictability and routine in my life. I still hope he might be the one who will offer me a diagnosis and treatment. He doesn’t.

‘Wendy, the additional tests I requested are back.’

‘I’m guessing by your expression that they are negative.’

He doesn’t meet my eyes as he says: ‘You don’t have cancer which we really should be grateful for.’

‘Was there any other change spotted? An ulcer perhaps?’ I ask hoping against hope.

‘The good news is that you are completely healthy, Wendy.’

‘This is impossible. I run to the loo twenty times a day. I’m constantly in pain. To come here I had to take three Loperamides. Can we repeat the tests?’

He shakes his head.

‘Wendy, you’ve had all possible tests done this year. It was clear from your previous doctors’ notes you brought me that there is nothing major wrong with you but I agreed to run some additional tests to reassure you.’

My heart starts racing. I don’t think I can be calm anymore.
‘I’m not reassured. If anything, I’m more worried than before. What if you all have missed something important? What if the tests you are running are not strong enough to detect the pre-cancerous growth?’

‘This is very unlikely. What you suffer from is most likely irritable bowel syndrome.’

‘Most likely? That means there is a possibility it is something different, isn’t there?’ I grab at the slightest of hopes.

‘No, Wendy. There is no such chance. You don’t have the cancer and no other test or doctor will find it. Please, believe me.’ He places his wiry hand on top of mine. This time he looks me deep in the eyes.

I know he believes in what he is saying. But what if he is wrong? I’m tempted to run away from his office, to look for another doctor, for the eleventh opinion, but then I recall all the previous doctors saying the same thing. I’m removing my hand from under his.

‘So, what you are saying is that it’s all in my head? That I’m imaging the pain? That I run to the loo to show off?’

‘I’m not saying your pain isn’t real. We simply don’t know what exactly is causing it.’

‘I would much rather know I have cancer. At least there is a name for it and some treatment.’ My eyes fill with tears.

‘No, you wouldn’t, Wendy. There is a name for what you suffer: IBS. It is a functional illness, meaning we don’t know what is causing it. Would you consider seeing a psychologist?’

‘If we don’t know what is causing it, why are you sending me to a psychologist? This implies that I’m mad.’ I’m still fighting it. I don’t want to have a functional illness nobody knows much about.

‘You are not mad. I’m sending you to a psychologist as psychologists and psychiatrists are specialists who treat medically unexplained symptoms. We know for example that stress makes IBS worse so it makes sense to learn how to relax.’

‘If it's due to stress, will it go away when I take a Valium?’

‘It’s not that simple, I’m afraid, though antidepressants for example may help some patients. But I would rather you started by engaging in a talk therapy. We know your symptoms are not due to an organic pathology. A psychologist may help us find an alternative explanation for them.’

‘And, what if I don’t visit a psychologist? Will this IBS ever disappear on its own accord?’

‘It may or it may not. We simply don’t know. What’s the problem with seeing a psychologist, Wendy? Why not at least giving it a try?’

I nod. I don’t think I want to answer. I’m taking a referral, thanking him and I leave. A medically unexplained symptom? What a crappy explanation for a lack of knowledge. I know it is cancer and I understand myself best. It’s a pity I need to wait for the growth to manifest before they believe me. But it’s what my acupuncturist said would happen. Go to hell with Western medicine.

‘I’m really sorry, Wendy, but I think the only thing we can do is to extract the tooth.’

‘But you told me that removing the nerve and doing the root canal treatment would help. How can a tooth ache when there is no nerve?’ I’m becoming suspicious of this dentist, a tall middle-aged man, I thought competent at first. It’s been weeks since the treatment started and I am no better. Now, it’s the pain in my gut and the pain in my mouth. As if one wasn’t enough. But at least a tooth can be extracted, I reassure myself. What a pity one can’t remove all the digestive system. I would volunteer even if it was merely an experimental treatment.

‘And, after the extraction, will I be finally painfree?’

‘It can’t hurt when it’s not there, can it?’ He grins at me and I trust him again.

The receptionist is not even pretending to smile at me. She greets me with a brief 'hello' and withdraws into her office. I decide I will wait for him standing. I have no wish to be sitting in the waiting room of a liar. I have done it too many times before.

‘Wendy, please come in.’ I see fear in my dentist’s eyes. He is like a wild animal cornered by me into an animal cage but I’m indifferent to his feelings. I’m done being nice to doctors.

‘I still have the toothache. You removed the nerve, did the root canal treatment and then extracted the tooth. It’s still no better yet you promised that I wouldn’t be in pain. Explain to me, how a tooth which is no longer there can still hurt so much,’ I request in the rudest tone I can muster.

‘I’m at a loss, Wendy. We scanned and checked all the other teeth in the proximity of the one removed and they are intact.’ The perspiration marks his thick brows.

‘It’s not the other teeth!’ I growl at him and his tall figure seems to shrink in front of me. ‘It hurts when I touch the gum. It’s as if you didn’t remove the nerve properly or something was left deep within the gum. I don’t know what it is. You are the doctor, not me.’

‘Let me examine it again.’ His hand shakes as he inserts one of his stainless-steel tools into my mouth.

I’m counting to ten and then backwards in my mind to calm myself. Surely there must be a reason for this pain. What if I have cancer of the gum? I examine this new thought. Would that explain it? Perhaps it’s a metastasis from my bowel? I could check that online. Many cancers start in the gut and then leap to other body parts. Maybe the pain comes from my jaw? I imagine how stupid Dr Wilson will feel when I throw an oncologist’s letter on his desk. I settle with that picture in my mind.

‘There is nothing wrong with the gum, Wendy. I’m afraid it’s one of these rare situations when we deal with a functional pain.’

‘A functional pain? You mean a medically unexplained symptom?’ My breathing accelerates.

‘I can see you know the term. It’s a sort of phantom tooth ache, if you know what I mean. Your brain still thinks there is a tooth while there is nothing there. I will give you some pain killers but the best may be doing some relaxation therapy and seeing a psychologist. I can refer you to a lovely lady. We need to find an alternative explanation for this pain, as from the dental perspective, there is nothing wrong with you. It’s a good news you are completely healthy, Wendy, isn’t it?’ He grins at me but I don’t trust this grin anymore.

A thought springs to my mind.

‘Do you by any chance know Dr Wilson, a gastroenterologist?’

‘No, I can’t say I’ve had the pleasure of meeting him. Why?’

I frown and stare at him. He doesn’t seem to be lying, his eyes meeting mine unflinchingly. If it isn’t a conspiracy, what is it? Do both these doctors have an affair with some struggling young psychologist they want to support? I wonder what the acupuncturist would tell and then I remember I no longer visit her either. Her treatment didn’t help my diarrhoea. What is there left for me to do? It seems I can only start looking for an alternative explanation. A psychologist it is, then, but how admitting I’m mad might help, I have no idea.