Getting Sick: Iatrogenic Woes

February 1971

A junior in high school living and learning at a boarding school in Austin, she enjoyed the occasional free weekend in Houston with her sister, her husband and their two young daughters.This trip started out like all the others. A happy reunion with family, a different routine, freedom from tasteless school cafeteria food.  She remembers eating Fulshear sausage dripping in barbeque sauce, maybe too much but it tasted so good.  A freshly made bed waited upstairs. If her real home was thousands of miles beyond, this had to be second best.

No one would have expected that she'd not make it back to school for class on Tuesday. No one would have predicted she'd get sick enough to be popped in the hospital with a nasogastric tube and IV fluids to decompress a hugely distended stomach and guts which simply quit working for over a week. No one would have expected she'd be out for the better part of the trimester, leaving the hospital to recover in Aruba and then back to school in late March.

I know that what happened to me was iatrogenic.  When all that rich food and a possible overlay of irritable bowel syndrome or norovirus infection gave me the belly gripes, I was able to get a Saturday appointment with my sister's internist. I remember getting an injection which would "relax your belly" which was apparently in knots. In retrospect, this was not a good move on his part.

I don't blame the doctor. The problem is my unique and unpredictable patho-physiology, an unusual, amplified reaction to a medication designed to relax the gut and offer relief of symptoms. In my case, the drug paralyzed my entire GI tract. I know very well that patients don't come to us with an instruction manual about which drugs may have a paradoxical, harmful reaction in their system.

I put together my theory about a drug causing my gut woes and hospitalization only after having a similar experience years later, during my thrid trimester of pregnancy with Laura. I self medicated my abdominal discomfort and bloating with an anti-motility drug and paid the price. A drug that should have helped me backfired so badly that I wound up in the hospital for three days until my insides started working again. Paralysis.

I used to think that the term iatrogenic meant that the doctor made a mistake in the care of his or her patient. Not so. Iatrogenesis plagues all physicians. We deal with human physiology which presents without an accurate road map. We do the best we can. I doubt any of us intends to cause harm.

How it Began

"Acute viral gastroenteritis with paralytic ileus" was the diagnosis on the medical records from March 1971 when I left Methodist Hospital in Houston at the age of 16. After my last post about "seminal events" this was my own version of a a life changing experience which brought my professional passion into focus. I moved from an interest in biology to a determination that a career as a physician was the goal.

I have some very clear memories of this ten day hospital stay and some that have faded over the years.  I'll be returning to this story to explore in more detail how and why the experience catalyzed the dream. There were also facets of the experience that were so vintage 1970's that I laugh in retrospect.

I've always identified this event as the start of  my journey. The reasons for the infatuation (remember this was the mind of a 16 year old) had more to do with charisma and fantasy than a sudden commitment to a  life of service  in the care of  the ill.  My doctor was young and attractive. The comings and goings of the hospital staff as they tended to my every need, the blood tests and xrays, and the delirium of the illness crystallized into a vision of myself as the one in my doctor's shoes, directing the show and witnessing the miracle as health returned to my patients. Overly dramatic? I think not.

Weeks after my discharge from the hospital, home in Aruba recovering and eating everything in sight to re-gain the lost weight of a ten day stint with minimal caloric intake, I told my parents, "I want to be a doctor".