This million-dollar workup is probably all for nothing
March 18, 2015 11:14 AM   Subscribe

Earlier this week somebody found me passed out on the floor. From there, I got dragged in to see the doctor, who ran some tests (all negative so far). That's not the problem. The problem is: I feel ashamed and guilty, like I'm making this all up, despite that the objective facts are that I fainted, my blood pressure was found to be 50/40 (after fluids), and that I have a history of syncope.

I've fainted frequently throughout my childhood and adulthood (while sitting in class, while visiting a museum, while going on a short walk, while working out...), but I never thought anything of it because it happened so often that I'd brush myself off and get on with my day. My baseline blood pressure has also declined quite a bit in the past 1-2 years to around 70/50 (though I fainted before that, too).

I'm not opposed to looking more into the reason as to why I faint so frequently or why my blood pressure has dropped, and part of me feels like taking care of this is a positive thing. For the most part, though, I feel ridiculous following through with this million-dollar workup (EKG, Echo, Holter, tilt-table, CBC, 24-hr blood pressure...). I have a feeling that the remaining tests will come back negative anyway, and I feel like I'm making a big fuss out of something that could probably be managed by just eating even more salt than I already do.

I felt like I was making a dramatic fuss when I called my doctor this morning to update him on my symptoms. The doctor who is working me up for this is great and definitely not dismissive or anything, so the issue isn't with him.

I've had this issue for most of my life. For example, I was hospitalized for a few weeks in elementary school and I remember feeling like I was making up the whole illness (though my chest x-ray indicated otherwise). A year or two ago, when I was dealing with the aftermath of an assault, I also felt ashamed and felt I was probably being overly dramatic and fussy and making things out to be worse than they actually were, despite the facts. This communitychannel video ("When People Call in Sick") also captures some aspects of what I am feeling. The ironic thing is that I'm a medical student myself, and I don't think I would ever want my future patients to dismiss their health concerns as I am right now.

Does anybody else know what I'm talking about here? I know that the rational response should be, "Wow, good thing somebody convinced me to go get this checked out!" and not "Argh, why did I have to faint in a public space and get dragged to the doctor's office?" I know that the responsible thing to do is to follow my doctor's instructions and to be honest about my symptoms, and that's exactly what I have been doing. But why can't I go through these tests without making myself feel so guilty and ashamed? Why do I feel like this is all in my head? Why can't I take my healthcare (and perhaps my needs in general) seriously? Why do I feel like I'm wasting my doctor's time? Can anybody talk some sense into me?
posted by gemutlichkeit to Health & Fitness (22 answers total) 5 users marked this as a favorite
"The ironic thing is that I'm a medical student myself..."

Um, bingo. This is a pretty common experience for people seeking higher ed in the medical sciences. Resist that weird urge, because you know it's incorrect. (I had a TIA when I was in grad school and almost talked myself out of going to the ER. Even then I took Metro instead of calling an ambulance, or even taking a cab, because I was broke and uninsured and, well, it's probably not going to help anyway... Sound familiar?)

The good news is doctors et al. tend to live longer themselves, despite visiting other physicians for screening and procedures less frequently than the general population does. The presumption is that you'll simply know more about which signs and symptoms to be really worried about and that'll add up over time, but also that you know the opposite: when not to seek care, or when not to take a med that probably won't benefit you, and so on.

So breathe deep, keep studying, but power through seeking this medical attention that you know you'd advise for a patient.
posted by late afternoon dreaming hotel at 11:24 AM on March 18, 2015 [6 favorites]

You should talk to a therapist, definitely. It is a big deal. What if you fainted and someone ran over you? Or if you hit your head so hard your brain hemorrhaged?

You matter. People care about you. Let us care. You're worth all the tests, no matter how much they cost.

Tell yourself that. And if you knew someone like a friend who had a history of syncope, you'd want to run all the tests in the world and figure out how to keep them safe.

You're worth all of it, and all the worry.

FWIW, I had a classmate who used to faint every time she got very stressed. Once across the teacher's desk. Somebody had to wait behind her to make sure she didn't hit her head when she slipped off eventually (no one was supposed to move her).
posted by discopolo at 11:27 AM on March 18, 2015 [3 favorites]

This can be fairly common in adults who were abused or neglected as children; if one's parents' didn't take one's needs for care and support (emotional, physical) as a child seriously, one can internalize the message that one shouldn't have any need for care or support.

If that applies to you at all, it may be worth unpacking that in therapy. Alice Miller's books, especially Drama of the Gifted Child (which is about how parents who put their own needs first create children who are emotionally "gifted" at putting others first and devaluing their own needs), might also be helpful. This article on Childhood Emotional Neglect might also give you some ideas to look into.
posted by jaguar at 11:28 AM on March 18, 2015 [14 favorites]

Wow, I'm sorry this is happening to you.

The biggest question I had wasn't "how do we get you to stop feeling like that," but "who put that thought into your head in the first place". LateAfternoonDreamingHotel had a good theory above (that maybe it's some weird syndrome of your being in med school), but I also noticed that you've always kind of felt that way, even since you were a kid. So I was wondering - how did your parents react when you fainted when you were a kid? Did they also dismiss this as being a problem, or did they freak out and make a huge deal out of it and that made you feel weird, or...?

The reason why I think it's important to get at the root of "why do I feel like this in the first place" is that that always helps you combat such a feeling, if you know where it comes from. You know? If you figure out that your parents over-reacted and you felt weird, then it would be more helpful to start to work on "this isn't like when Mom overreacted, this is a problem" - but if your parents under-reacted, it would be more helpful to start to work on "I have the right to see a doctor, this isn't like Mom saying I was spoiled" or whatever.
posted by EmpressCallipygos at 11:29 AM on March 18, 2015 [1 favorite]

> Um, bingo. This is a pretty common experience for people seeking higher ed in the medical sciences.

It may well be, but that's not the answer here, because this is a lifelong issue for the asker. I concur with the therapist suggestion.
posted by languagehat at 11:29 AM on March 18, 2015

It might help to think about this as two sides of a coin. You might be independent/don't like asking for help in other things. If so, you're probably a high-achiever and a really reliable person. You just have a blind spot as to whether or not you need help. Know your blindspot and enlist others to help you see it (like you are here!).
posted by CMcG at 11:31 AM on March 18, 2015 [2 favorites]

I totally get this, though most of my health stuff has been mental rather than physical. Even so, I continually downplay the importance of my symptoms, and in the past I've generally avoided seeing a doctor until the point where I can no longer handle my life, which isn't ideal. Anything non-urgent gets put off or not dealt with - I've been avoiding getting a pap smear for over a year now, in spite of repeated letters from my GP asking me to come in for one, because I can't justify seeing a doctor if I'm not on fire or I haven't lost a limb or my entire brain isn't imploding. I know exactly how much I should just suck it up and make the appointment, but I'm struggling to.

I've started to make very, very small inroads into this - again on the mental health side, because that's where I have the most contact with the medical profession. In the past I've avoided making an appointment even when a doctor has explicitly asked me to make an appointment if x happens/if I feel y because even when they've said this, I struggle to believe I wouldn't be wasting everyone's time.

The only thing that's helped is repeated positive reinforcement from my psychiatrist, my therapist and my partner. I had a mood episode earlier in the year, and actually managed to call my psychiatrist and see if she could fit me in while it was still manageable - one med tweak later and what could have been a much worse crisis was thoroughly averted.

What helped was the fact that she thanked me for coming in and told me I made the right call 100% without doubt, and she told me this multiple times, and she also told me to do exactly the same thing again if I experienced more symptoms. It helped when I called and made the appointment and the guy on the phone looked at my notes and said "yep, says here you should get an appointment as soon as possible when this stuff happens" - it was reassuring to know that my understanding of events was mirrored in the system, rather than them thinking I was an idiot and a hypochondriac and making a big fuss over nothing, which is how I'd been feeling up until then. It helped that my partner thought I'd done the right thing. It helped when I talked to my therapist and she said she was relieved I'd made the call, and that I'd done the right thing.

Basically, my judgement is extremely flawed on this stuff, and the only thing that seems to help is recognising that this is the case and getting external input from people I trust. Might it help you to think of it like that? You say your doctor is good and not dismissive - do you trust them enough to have a conversation along the lines of "I feel kind of silly coming here and I can't tell if this is a proportionate response to my symptoms - is this the level of treatment/investigation you'd expect for someone in my position?"

That probably won't fix the whole problem - you may well still have issues about seeing medical professionals for other things from cold, as I most definitely still do - but it might help you start to evaluate situations like this a little differently.
posted by terretu at 11:37 AM on March 18, 2015 [2 favorites]

gemutlichkeit, I too hate manifesting illness in public (particularly if it is where someone knows me like work or school). I'm a bit of a control freak and so this out of my control stuff is upsetting. Maybe that control/out of control thing is an issue for you as well?? Also, U.S. culture (I assume you are in the U.S.?) has a lot of emphasis on being stoic and powering through any illness that does not involve open wounds. (As others say, therapy may not be a bad idea to investigate why you feel the way you do.)

You owe it to yourself to at least try to investigate the fainting, for your own sake as well as for others. Suppose it happens when you are driving, standing on a street corner by busy traffic, treating a patient ... Also this: power through seeking this medical attention that you know you'd advise for a patient.

For personal anecdata - it turns out me being tired all the time and struggling to get to work every day was not a sign of any moral failure or slacking (as my nasty boss interpreted it), but an actual thyroid problem.
posted by gudrun at 11:39 AM on March 18, 2015 [1 favorite]

If it makes you feel better, I am currently in the process of getting myself evaluated for the shortness of breath/inability to breathe after a very short period of aerobic exercise/general feelings of tight-chestedness that I have also dealt with pretty much as far back as I can remember. I feel like I'm totally faking it, too, and have only sought treatment after friends encouraged me to go in and please get that looked at. (Preliminary results showed I have pretty awful peak flow test results, but that just made me feel weirder and more like it's somehow my "fault," not that I was entirely vindicated or anything. And I still feel like I'm making a huge deal out of nothing.) I've also had experience coaxing other people to get evaluated for things like learning disabilities and gotten the same "I'm pretty sure this is normal and not something to get checked out" sort of response, even when they're pretty obviously causing big deficits."

I think there is something to the idea that, since this has been your experience your whole life, that that is your normal even if it's something you would call pathological in someone else. And it's really hard to look back at your normal, growing up, and say "This is abnormal and should be evaluated for something bad." You see the same kinds of responses in e.g. people who are working through the idea that their parents did a less than stellar job. It doesn't mean that it's not worth investigating this fainting and finding out whether you have a treatable condition, and you do deserve to go through these tests and find out what is going wrong. But this feeling of "oh, I'm not REALLY sick, this is just how I am?" Yeah. That is really common in my experience, and not just among med and PhD students.
posted by sciatrix at 11:43 AM on March 18, 2015 [3 favorites]

This is incredibly common, people do it all the time. "Go to the doctor? Nah, it's just a virus and everyone knows they can't do anything about it. It's just a big fuss for nothing. By the time I get in there, I'll be over it!"

And it doesn't have to be the result of abuse or trauma or neglect - a lot of people just dis-enjoy that kind of attention, don't like being in a position of vulnerability, don't like to be the center of a fuss, worry about being judged (another kind of vulnerability), don't like hearing bad news, don't like not being experts, and hate having their routines fucked with.

It engages our prey instincts, to be publicly sick. That's why you'll see people take a nasty fall and then jump up - "I'm okay, I'm okay!" - and then flee, embarrassed, until the adrenaline wears off and they realize they broke their wrist. Deep down in the lizard brain, Concern #1 is not to attract the lion's attention. That's why EMT's don't believe you when you say you're fine. Everyone says they're fine, sometimes even as very horrible things are happening.

I think it's a valuable lesson for a medical student to experience, so maybe just try to embrace it as education, because you really should get that checked out. Hopefully it's no big deal, but that's not quite the same as "undeserving of treatment".
posted by Lyn Never at 11:46 AM on March 18, 2015 [15 favorites]

Best answer: As someone who's been through medical school, I do have a suggestion of how to combat this feeling, although I've not been in your shoes myself.

Every time you see a patient with a heart attack who says they thought it was just indigestion, think "that could have been me."
Every time you see a patient with back pain that turns out to be cancer, think "that could have been me."
Every time you order a test on a patient to rule out the worst case scenario and you FIND it, think "that could have been me."

Remind yourself every time you see someone whose serious medical issue is diagnosed because even though they thought it wasn't a big deal, it turned out that it was - put yourself in that patient's shoes. I think for a lot of med students and doctors, this turns into a minefield of hypochondria, but it doesn't sound like that's going to be the case for you, and I think eventually you might get used to thinking of yourself as a patient for whom serious medical concerns need to be investigated with the same workups as everyone else gets.

Whenever a patient says "I feel so bad that I'm wasting your time with this. You probably have other patients who are actually sick." You tell them "Absolutely not. I'm glad you came in. This is why we're here." But think of yourself. You are why we are here, too! You are no less than any other person we take care of every day.

For the record, too, your workup is not even close to a million dollar workup. Know how much a CBC and chemistries cost? $20. EKG? $36. The echo costs about $300. Tilt table test is $425. (I don't have a number for the Holter, but I doubt it's more than a couple hundred either. These numbers are from our CMS cost reference). You think your life isn't worth more than a couple thousand bucks? Because you know that they're looking for cardiac etiologies here that could be life threatening.... That's why therapy is a good answer here.
posted by treehorn+bunny at 11:47 AM on March 18, 2015 [25 favorites]

I have a mystery ailment that causes excruciating pain once in awhile in my abdomen. Most of the time, it's just low-grade, stabby pain there, which my doctor has prescribed Ultram for, and so far, nothing has been identified as the cause, including having a perfectly healthy appendix removed "just in case."

I have had this pain for over 5 years, and I have convinced myself many, many times that it's all in my head. A couple of weeks ago, I had to go to the ER because the pain was so bad I couldn't control it at all, and again, no cause found. However, this has convinced me to try again, because I'm unwilling to let my own embarrassment about thinking I'm crazy or something get in the way of diagnosing, at the very least, what is causing this.

I hope you'll continue to do the same. We deserve to know what's going on in our own bodies.
posted by xingcat at 11:58 AM on March 18, 2015 [6 favorites]

Were you by any chance abused as a child? Neglected or perhaps heavily criticized? Kids who grow up in environments like these tend to grow up feeling like everything is their fault. And they can feel automatically guilty about everything- including things they didn't do.

I go through the same thing. Also whenever I pass a police car or police officer I get scared and start to feel guilty as hell as if I had done something wrong. Then I start wondering what it is I might have done wrong to make me feel that way- and the answer is always nothing. Also when I was a kid when I would say something wasn't my fault or if I would say I wasn't feeling well my parents would accuse me of faking it or lying. (This was especially lovely when the illness I was "faking" turned out to be cancer, but that's another story).
posted by rancher at 11:58 AM on March 18, 2015 [6 favorites]

I'm sorry you're going through this. Here's a different line of thought - while I hope you find a solution soon - I think it's a good experience to go through tests that come back normal. It's frustrating, right? Well I think that gives you a very valuable insight into what your potential patients are going through. You may see people that are really struggling but have normal tests or something. This is coming from someone who took over a year of normal tests to finally get a faulty gallbladder yanked out. I appreciated when medical staff understood my frustration with normal tests and not finding an answer.

In addition, you must care for yourself in order to care for others. You are worth the fuss.
posted by Crystalinne at 12:01 PM on March 18, 2015 [1 favorite]

As a medical student, being on the other side of healthcare is going to be some of your most valuable education. One strategy might be to see this as an experience that will set you apart from other providers, and help you understand the patient experience. If it helps, you can focus less on this being your healthcare and more on this as part of your (also million-dollar) education.
posted by latkes at 12:17 PM on March 18, 2015 [2 favorites]

Best answer: I experienced the feeling of faking into my late twenties, and until reading your question, I hadn't realized that I stopped doing that after some years in therapy.

I felt that way any time I called in sick; I felt that way at home with my husband when I had the flu (and the symptoms to prove it); and even 6 months into pregnancy I had moments of horror that I'd been pretending, despite multiple OB visits, sonograms, etc.

Anecdotally, I was abused as a child and didn't tell people until decades later. I suffered greatly from dissociation. A lot of traumas (ie, not only abuse) can kick off a degree of dissociation and/or derealization, and I wonder if you've ever looked into that.

I'm not one to think therapy is always the answer, but when I was asked, "Do you ever feel like you're lying, even when you're not?" I was truly shocked that this was not unique to me and found that therapy really did help.

Please do take care of your physical health, and consider therapy for the self-doubt.
posted by whoiam at 12:28 PM on March 18, 2015 [9 favorites]

I've had this sort of feeling before, though to a lesser degree. For me, it's stemmed from a fear of conflict, a need to be accepted or please other people, or a belief that I should be self-sufficient and tough things out instead of being "weak" and asking for help. Any of those ring a bell to you? It doesn't have to be a result of abuse, neglect, or trauma; sometimes we get it into our heads that we're, say, "strong" or "well-behaved" or some other supposedly-good quality, and to maintain that quality we sometimes learn to exaggerate our responses or act against our needs and wants.

Also, I remember reading something (possibly on MeFi, though I can't find it right now) about how women are less likely to seek medical attention because they're likely to have their concerns dismissed, or be led to believe it's "all in their head," etc.

Therapy wouldn't hurt. In the meantime, remember: you have just as much of a right to seek medical attention as anyone else. You are not taking your doctors' time away from another patient, and even if your problem was minor - which it isn't - doctors see people for the slightest of complaints all the time. It's okay to make a fuss.
posted by Metroid Baby at 12:34 PM on March 18, 2015 [1 favorite]

I'm not a medical student but I can identify with feeling like you don't want anybody to make a big deal of your illnesses. Problem is, sometimes I am actually ill, and I need to acknowledge that and seek treatment. I struggled for a few years with an 'invisible' illness (vertigo)-- imagine trying to walk down the hall at work while you're clinging to the wall like you've had a pint of vodka because the world is spinning and you're sweating and praying that you'll make it to the toilet before you vomit. My biggest worry, however, was that I might vomit in front of my co-workers.

In my case I think the tendency to minimize is linked to childhood experiences of illness. My mother is a nurse and she was unimpressed with normal childhood sickness (coughing, fever, chicken pox, etc.). I don't think she meant it this way but I got the message-- "you'll be fine, quit making such a fuss." I wonder if your parents/caregivers had some negative response to childhood illness that you've internalized?
posted by tuesdayschild at 12:37 PM on March 18, 2015

Hey, I've been going through just about the same thing since fainting about two weeks ago, including the battery of tests and the weird guilt (both the "seriously I'm fine no stop worrying" and the "oh Christ I'm going to be paying these bills for a million years" varieties.) Even with 2/3 EKGs that have come back "weird."

I think part of the issue is that apart from the actual injury that I got in the fall (broke my jaw and several teeth), I feel fine, and it sounds like you do, too. It's not that I want to feel sick--and it's a relief that I'm not missing much school/work--but I think it'd be a lot easier to accept that this is a Problem that requires Medical Attention if I weren't already back at full-speed grad student energy/activity levels.

The other thing is that, like you, this isn't my first time at the syncope rodeo* and it feels like I should've been able to prevent it, or at least not have been walking across a tile hallway when it happened. Eventually I just started telling myself "too late for that now, just deal with what you can actually control." It mostly works.
*sort of: this is the first time I've actually fainted, but I've had similar episodes of dizziness before; just in those cases I was able to lie down for a while and then be fine.

The other thing I've tried to remind myself of, every time I find myself inwardly grousing about how I don't need an EEG or whatever is that as dumb and unnecessary as it all seems right now, it'll have been worth every penny and second if it means that I don't break my jaw again (or pass out at the wheel, or when I'm working around high voltage at my job, etc.)

Good luck. Feel free to memail me if you ever want to kvetch about how the Holter adhesive is itchy or the gross EEG paste.
posted by kagredon at 12:51 PM on March 18, 2015 [1 favorite]

To me this line of thinking is a form of denial - downplaying and trying to convince oneself that something serious probably isn't that serious. Life is so much easier when things go predictably and your body functions healthily as it did 5 minutes ago.

When I got into a bike accident, the most frightening part of the whole thing was seeing everyone around me freaking out. Immediately after the crash, I was fine, taking stock of my scrapes and picking my bike up. The panic and tears only started coming after everyone started yelling and frantically asking if I was all right. Maybe this is similar in that having all these scary tests make it more real than you want it to be and is forcing you to address this directly.

Anyway, props to you for sticking through this despite your gut reaction. It's admirable to keep making rational decisions while your emotions are going awry dealing with health problems.
posted by blueberrypuffin at 2:07 PM on March 18, 2015 [1 favorite]

Is the shame more about being an inconvenience, or that you, as a medical student, should know enough about your health to not have been in that situation in the first place? Either way, part of this process may be embracing your humanity, because this stuff happens and it doesn't make you bad or defective in some way. I could be reading your inquiry wrong though.
posted by Hermione Granger at 4:44 PM on March 18, 2015

Lots of good suggestions in this thread, but while you're digesting everyone's advice, look from other points of view. Let's suppose the roles are reversed and you're the one finding someone passed out on the floor. I highly doubt your first reaction is going to be "oh, it's probably nothing." You're probably going to assess the situation and call for help immediately, as you should. Now let's suppose you're working in a clinical situation and you're brought a patient that was found passed out on the floor. Again, your first reaction isn't likely to be "it's probably nothing." You're going to do the best you can to get some answers and make sure the patient is OK, and that they're not in further danger once they leave. You're not going to be thinking "Well, this guy just ran up several hundred dollars in tests."

So don't be ashamed. You ended up in a bad situation through no fault of your own. People did for you what they're supposed to do. Things worked as they're supposed to.
posted by azpenguin at 10:34 PM on March 18, 2015

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