A riveting exploration of the most difficult and important part of what doctors do, by Yale School of Medicine physician Dr. Lisa Sanders, author of the monthly New York Times Magazine column "Diagnosis," the inspiration for the hit Fox TV series House, M.D.

"The experience of being ill can be like waking up in a foreign country. Life, as you formerly knew it, is on hold while you travel through this other world as unknown as it is unexpected. When I see patients in the hospital or in my office who are suddenly, surprisingly ill, what they really want to know is, ‘What is wrong with me?’ They want a road map that will help them manage their new surroundings. The ability to give this unnerving and unfamiliar place a name, to know it–on some level–restores a measure of control, independent of whether or not that diagnosis comes attached to a cure. Because, even today, a diagnosis is frequently all a good doctor has to offer."

A healthy young man suddenly loses his memory–making him unable to remember the events of each passing hour. Two patients diagnosed with Lyme disease improve after antibiotic treatment–only to have their symptoms mysteriously return. A young woman lies dying in the ICU–bleeding, jaundiced, incoherent–and none of her doctors know what is killing her. In Every Patient Tells a Story, Dr. Lisa Sanders takes us bedside to witness the process of solving these and other diagnostic dilemmas, providing a firsthand account of the expertise and intuition that lead a doctor to make the right diagnosis.

Never in human history have doctors had the knowledge, the tools, and the skills that they have today to diagnose illness and disease. And yet mistakes are made, diagnoses missed, symptoms or tests misunderstood. In this high-tech world of modern medicine, Sanders shows us that knowledge, while essential, is not sufficient to unravel the complexities of illness. She presents an unflinching look inside the detective story that marks nearly every illness–the diagnosis–revealing the combination of uncertainty and intrigue that doctors face when confronting patients who are sick or dying. Through dramatic stories of patients with baffling symptoms, Sanders portrays the absolute necessity and surprising difficulties of getting the patient’s story, the challenges of the physical exam, the pitfalls of doctor-to-doctor communication, the vagaries of tests, and the near calamity of diagnostic errors. In Every Patient Tells a Story, Dr. Sanders chronicles the real-life drama of doctors solving these difficult medical mysteries that not only illustrate the art and science of diagnosis, but often save the patients’ lives.


From the Hardcover edition.

Introduction: Every Patient's Nightmare

Barbara Lessing stared out the window at the snowy field behind the hospital. The afternoon sky was dark with yet more snow to come. She looked at the slender figure in the bed. Her daughter, Crystal, barely twenty-two years old and healthy her entire life, was now--somehow--dying. The young woman had been in the Nassau University Medical Center ICU for two days; she'd been seen by a dozen doctors and had scores of tests, yet no one seemed to have the slightest idea of just what was killing her.

It all started at the dentist's office. Crystal had had a couple of impacted wisdom teeth taken out the month before. But even after the teeth were gone, the pain persisted. She'd called her mother halfway across the state just about every day to complain. "Call your dentist," she'd urged her daughter. And she had. Finally.

The dentist gave her a week's worth of antibiotics and then another. After that her mouth felt better--but she didn't. She was tired. Achy. For the next week she'd felt like she was coming down with something. Then the bloody diarrhea started. And then the fevers. Why didn't you go to the doctor sooner? the trim middle-aged woman scolded her daughter silently.

Barbara had gotten a call from a doctor in the emergency room of this suburban hospital the night before. Her daughter was ill, he told her. Deathly ill. She drove to Syracuse, caught the next flight to New York City, and drove to the sprawling academic medical center on Long Island. In the ICU, Dr. Daniel Wagoner, a resident in his second year of training, ushered her in to see her daughter. Crystal was asleep, her dark curly hair a tangled mat on the pillow. And she looked very thin. But most terrifying of all--she was yellow. Highlighter yellow.


Wagoner could feel his heart racing as he stood looking at this jaundiced wisp of a girl lying motionless on the bed. The bright unnatural yellow of her skin was shiny with sweat. She had a fever of nearly 103°. Her pulse was rapid but barely palpable and she was breathing much faster than normal despite the oxygen piped into her nose. She slept most of the time now and when awake she was often confused about where she was and how she had gotten there.

To a doctor, nothing is more terrifying than a patient who is dying before your eyes. Death is part of the regular routine of the ICU. It can be a welcome relief to the patient, or to his family. Even a doctor may accept it for a patient whose life can be prolonged no longer. But not for a young girl who was healthy just weeks ago. These doctors had done everything they could think of but still there was a fear--a reasonable fear--that they'd missed some clue that could mean the difference between life and death for this young woman. She shouldn't die, but the young resident and all the doctors caring for her knew that she might.

Crystal's thin chart was filled with numbers that testified to how very ill she was. Wagoner had been through the chart a dozen times. Virtually every test they'd run was abnormal. Her white blood cell count was very high, suggesting an infection. And her red blood cell count was low--she had barely half the amount of blood she should have. She'd gotten a transfusion in the emergency room and another after she was moved to the ICU, but her blood count never budged. Her kidneys weren't working. Her clotting system wasn't either. Her yellow skin was covered in bruises and her urine was stained deep red.

Sometimes, if you just work hard enough to keep a patient alive--to keep the blood circulating, the lungs oxygenating, the blood pressure high enough--the body will be able to...

 

"Lisa Sanders is a paragon of the modern medical detective storyteller. The tales here crackle with suspense. But what sets her apart is her Holmes-like eye for the clues--and her un-Holmes-like compassion for those who suffer."

 

"Dr. Lisa Sanders is the most acute observer of health care in America. In this compelling book, she opens the black box of diagnosis and lets us look inside."

 

"Not 'whodunit' so much as 'whatdunit,' Lisa Sanders's book brilliantly conveys the sleuthing that lies at the heart of medical diagnosis. But this is more than a set of suspenseful tales unfolded by a skilled storyteller. Amid all the flash and dazzle of the modern doctor's high-tech armamentarium, Dr. Sanders finds that all too often it is the ancient skills, of touch and of attentive listening, that serve the physician, and her patients, best of all. Enlightening for patients, essential for practitioners, this book should be read by every doctor. I'm praying that mine will."

 

"Lisa Sanders has written a beautiful, thought-provoking book about the sine qua non of medical care--diagnosis. She tells stories about great diagnostic triumphs and explains both the pitfalls and successes of diagnosis. Her patient stories captivate the reader as we try to solve the unfolding mystery. Through these stories we understand and remember the importance of accurate diagnosis."

 

"Every Patient Tells a Story is a must-read for anyone who has ever been a patient or is a doctor. Written by a physician I respect and a writer I love, the book is filled with intriguing diagnostic dilemmas that will draw you in, and with human stories that will linger in your mind--and heart--long after you are done."

 

Every Patient Tells A Story by Lisa Sanders
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