Sick But Not Sick

The neurologist Jean-Martin Charcot holding the arm of a female patient suffering from locomotor ataxia, Hôpital Salpêtrière, Paris, circa 1885
Adoc-photos/Art Resource
The neurologist Jean-Martin Charcot holding the arm of a female patient suffering from locomotor ataxia, Hôpital Salpêtrière, Paris, circa 1885

Several years ago, my right wrist became swollen and inflamed. My primary care physician ordered blood tests and X-rays, but the cause remained obscure. Empirical treatment with a splint and anti-inflammatory medication did not improve my symptoms, and so I was referred to a hand surgeon. He ordered further tests, including a bone scan, which evaluates not only the wrist but all of the bones in the body. That night, the surgeon called me at home.

“I just saw the results of the bone scan,” he said. “The wrist is not your major concern. It looks like there are multiple metastases in your ribs. You’re an oncologist. You need to speak with one of your colleagues about what to do next.”

I hung up the phone in shock, and within minutes my ribs felt as if they had been hit by a hammer. I lay down and took deep breaths, but the pain did not abate.

My wife, also a physician, was away on a ski trip. After several hours of phoning, I finally reached her. She tried to be reassuring, saying what I already knew, that bone scans can produce artifacts, suggesting disease where none exists. First thing in the morning, she said, I should have X-rays of my ribs; if there really were multiple cancer deposits, they would be obvious.

I was unable to sleep. Although I realized that I had had no discomfort before the call from the surgeon, I couldn’t shake the sense that the accelerating pain was confirming what the bone scan had found. And as a cancer specialist, I knew the implications were dire. Few tumors that have metastasized to bones can be cured.

Early the next morning, I arrived at my hospital’s radiology suite. X-rays of the ribs showed nothing abnormal. Slowly, the pain subsided.

I didn’t expect my reaction to the surgeon’s telephone call. During training, medical students often become hypochondriacal, developing symptoms of a disorder like Hodgkin’s disease after learning about it. I didn’t. And in one of our classes, a psychiatrist demonstrated techniques of hypnosis, selecting me as a subject. I proved not to be “suggestible,” a person who can be easily hypnotized. But after the incident with the deceptive bone scan, I experienced how powerful the mind can be in generating bodily symptoms.

Suzanne O’Sullivan is a neurologist specializing in epilepsy who practices in London. Many of her patients suffer from so-called conversion disorders: somatic symptoms caused by psychological distress that defy ready diagnosis by medical tests or physical examination. “They are medical disorders like no others,” O’Sullivan writes. “They obey no rules. They…

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