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agonyaunt2022-10-29 09:06 pm
ermingarden) wrote in agonyaunt2022-10-29 09:06 pm
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Dear Prudence: The Plot Thickens
Two letters that seem to be about the same incident, and which offer very different perspectives.
The first letter was published October 3:
Q. Hypochondriac In Love: Is it a red flag that my partner initially refused to take me to the emergency room? I am a young woman who is living with my boyfriend of over six years. We are very happy except for my chronic medical issues occasionally causing me great pain and some tension between us. The other night I was having serious abdominal pain and vomiting. I begged him several times to take me to the ER and he refused, reminding me that I’ve gone to the ER before for what my insurance considered non-emergencies and charged me extra for it. Finally, I called 911 for an ambulance and he took the phone from me and told them not to come. He drove me then to the ER and was angry when I threw up in his car. They did a CT scan and diagnosed me with acute colitis, cystitis, and a kidney infection. I apologized to him and I admit I can sometimes be a bit of a hypochondriac and he’s normally compassionate about my illnesses. I love him very much but I wonder if I should take this as a bad sign.
A: No, you shouldn’t take it as a bad sign. You should take it as a relationship-ending, unforgivable sign.
The second letter was published today, October 29:
My wife (“Laura”) and I have been together for 10 years and we’ve mostly had a good relationship until the past couple of years. Laura is a hypochondriac. In the beginning, it was really minor and barely noticeable—she insisted any cold she got was actually pneumonia or an upset stomach was appendicitis. As time went on, she became convinced she was suffering from an undiagnosed illness and after years of seeing doctors and getting tested, a doctor diagnosed her with a syndrome that mostly consists of a collection of symptoms with no other cause, no test to confirm the diagnosis, and no treatment except lifestyle and diet changes. I had hoped by getting a diagnosis her hypochondria would calm down.
It has not and I fear it is getting worse and turning into Munchausen syndrome. It was brought to my attention recently that Laura may have written into this column about an incident that happened a few weeks ago where she was vomiting and I wouldn’t take her to the hospital and prevented an ambulance from coming to get her. In the letter, she changed some identifying information—but the other details matched an incident that happened between us. My concern with the letter was her presentation of her diagnosis with medical terms derived from the CT scan and not the actual diagnosis the ER doc gave her, as well as leaving out key information, such as the questionable leftover chicken she had eaten earlier that day and the UTI she was diagnosed with earlier in the week and was supposed to be taking antibiotics for. She wrote that she was diagnosed with “acute colitis, cystitis, and a kidney infection”, however, except for alluding to her UTI moving into her kidneys, the doctor told her that she likely had food poisoning (acute colitis) and needed stronger antibiotics for her UTI because of the slight bladder and kidney inflammation (cystitis). He gave her new antibiotics for the UTI and when I went to throw away the old ones when we got home, I noticed that they were much fuller than they should be and asked her if she’d been taking them. She said that she may have missed a “couple of doses” but there were a lot of pills remaining.
I’m really scared that she is trying to make herself sick. If she did write the letter, then I am also scared that she is trying to get public validation and sympathy and that she may continue to escalate. I’ve alluded previously that this is all in her head and it did not go well so I hesitate to ask her outright but I need to do something. I don’t want her to hurt herself and I want her to get the help she needs. Should I try to talk to her therapist about my fears? I know he can’t break doctor-patient confidentiality but can family members tell them about their fears so they can do some probing? Should I mention my fears to her physician? Her family? Even before this incident, I knew some sort of intervention needed to happen as we have nearly $10,000 in medical debt from her various tests and medical visits. Her health is more important than the money, but if this is Munchausen and it can be fixed by therapy, then I’d prefer that than to keep adding to our debt.
—In Love With a Hypochondriac
Dear In Love,
Well this complicates things… Sorry for telling her to leave you. I don’t know what a therapist or doctor will do with the information you provide, but it can’t hurt to share your concerns with them as well as a couple of trusted family members. I will add that, whether she made herself sick or not, she was actually sick and you should have helped her get to the hospital. If your suspicions are true, I hope she can get help but in the meantime, you should make it a priority to respond to her very real illness and suffering, despite your belief about its origins.
The first letter was published October 3:
Q. Hypochondriac In Love: Is it a red flag that my partner initially refused to take me to the emergency room? I am a young woman who is living with my boyfriend of over six years. We are very happy except for my chronic medical issues occasionally causing me great pain and some tension between us. The other night I was having serious abdominal pain and vomiting. I begged him several times to take me to the ER and he refused, reminding me that I’ve gone to the ER before for what my insurance considered non-emergencies and charged me extra for it. Finally, I called 911 for an ambulance and he took the phone from me and told them not to come. He drove me then to the ER and was angry when I threw up in his car. They did a CT scan and diagnosed me with acute colitis, cystitis, and a kidney infection. I apologized to him and I admit I can sometimes be a bit of a hypochondriac and he’s normally compassionate about my illnesses. I love him very much but I wonder if I should take this as a bad sign.
A: No, you shouldn’t take it as a bad sign. You should take it as a relationship-ending, unforgivable sign.
The second letter was published today, October 29:
My wife (“Laura”) and I have been together for 10 years and we’ve mostly had a good relationship until the past couple of years. Laura is a hypochondriac. In the beginning, it was really minor and barely noticeable—she insisted any cold she got was actually pneumonia or an upset stomach was appendicitis. As time went on, she became convinced she was suffering from an undiagnosed illness and after years of seeing doctors and getting tested, a doctor diagnosed her with a syndrome that mostly consists of a collection of symptoms with no other cause, no test to confirm the diagnosis, and no treatment except lifestyle and diet changes. I had hoped by getting a diagnosis her hypochondria would calm down.
It has not and I fear it is getting worse and turning into Munchausen syndrome. It was brought to my attention recently that Laura may have written into this column about an incident that happened a few weeks ago where she was vomiting and I wouldn’t take her to the hospital and prevented an ambulance from coming to get her. In the letter, she changed some identifying information—but the other details matched an incident that happened between us. My concern with the letter was her presentation of her diagnosis with medical terms derived from the CT scan and not the actual diagnosis the ER doc gave her, as well as leaving out key information, such as the questionable leftover chicken she had eaten earlier that day and the UTI she was diagnosed with earlier in the week and was supposed to be taking antibiotics for. She wrote that she was diagnosed with “acute colitis, cystitis, and a kidney infection”, however, except for alluding to her UTI moving into her kidneys, the doctor told her that she likely had food poisoning (acute colitis) and needed stronger antibiotics for her UTI because of the slight bladder and kidney inflammation (cystitis). He gave her new antibiotics for the UTI and when I went to throw away the old ones when we got home, I noticed that they were much fuller than they should be and asked her if she’d been taking them. She said that she may have missed a “couple of doses” but there were a lot of pills remaining.
I’m really scared that she is trying to make herself sick. If she did write the letter, then I am also scared that she is trying to get public validation and sympathy and that she may continue to escalate. I’ve alluded previously that this is all in her head and it did not go well so I hesitate to ask her outright but I need to do something. I don’t want her to hurt herself and I want her to get the help she needs. Should I try to talk to her therapist about my fears? I know he can’t break doctor-patient confidentiality but can family members tell them about their fears so they can do some probing? Should I mention my fears to her physician? Her family? Even before this incident, I knew some sort of intervention needed to happen as we have nearly $10,000 in medical debt from her various tests and medical visits. Her health is more important than the money, but if this is Munchausen and it can be fixed by therapy, then I’d prefer that than to keep adding to our debt.
—In Love With a Hypochondriac
Dear In Love,
Well this complicates things… Sorry for telling her to leave you. I don’t know what a therapist or doctor will do with the information you provide, but it can’t hurt to share your concerns with them as well as a couple of trusted family members. I will add that, whether she made herself sick or not, she was actually sick and you should have helped her get to the hospital. If your suspicions are true, I hope she can get help but in the meantime, you should make it a priority to respond to her very real illness and suffering, despite your belief about its origins.
no subject
Regarding the advice for LW2 to speak to LW1's doctor or therapist (if she has one): I definitely agree with other folks who've pointed out that that has the potential to be really harmful by leading a doctor to discount her symptoms as psychosomatic. On the other hand, if there is a psych issue here (Munchausen's or otherwise), LW1 might not be in a position to recognize an issue herself: depending on the condition, psych symptoms can often be hard to notice in oneself, especially when someone hasn't been diagnosed and therefore isn't on the lookout. If LW1 does see a therapist, I wonder if LW2 telling his concerns to the therapist, but not to LW1's primary care doctor, would be an appropriate way to thread that line?
Initial comment:
Both of Prudie's responses strike me as somewhat inadequate. ("Sorry for telling her to leave you" cracks me up!) But I think it's a good example of why letters that seem to have an immediately obvious answer, especially when the answer is "LW, you are 100% justified," might not actually be so easy.
The initial letter is missing a lot of information – all we have is that she had a stomachache and was throwing up, and he wouldn't take her to the ER for...a stomachache and throwing up? Which doesn't strike me as something one would usually go to the ER for, especially since there's no mention of a fever, or that the chronic medical issues the LW references make throwing up particularly worrisome? If I were Prudie, I think – or like to think, as it's easy to be an armchair critic – that I'd've passed on answering the first letter because it's just too light on the details, and seems like it might be glossing over things that don't favor the LW.
Not that I'd've sided with the boyfriend on the facts presented in the letter! If your partner says they need to go to the hospital, take them to the hospital!!! But it does read like something's being left out, and for that reason I'd have been hesitant to call it "a relationship-ending, unforgivable sin."
As for the response to the second: If I'm recalling correctly, Prudies old and new, as well as other Slate columnists, not infrequently reach out to experts about issues that come up in letters. This seems like it would've been a great time to do it! Asking "Hey, Dr. So-and-so who reads Slate, how would you react if the spouse of a patient told you he was worried the patient had Munchausen's, and gave you a list of the reasons he was worried?" and giving the answer in the response would have made it a lot more helpful than just "I don't know, but it can't hurt!"
no subject
all we have is that she had a stomachache and was throwing up, and he wouldn't take her to the ER for...a stomachache and throwing up? Which doesn't strike me as something one would usually go to the ER
I dunno, this seems sufficient to me if it's a particularly exceptional case of discomfort. Going to the ER for stomachache & nausea are how I discovered I had a kidney stone, and I wasn't even throwing up yet.
no subject
(I'm sorry to hear about your kidney stone! That sucks.)
no subject
Ahahaha, do you know what this reminded me of?
A discussion I read once about whether it was "less bad" to beat one's kid with a wide belt vs a narrow belt, which made me think about my carefree (/s) childhood. Having Been Hit With Both I can say the wide belt is "less bad" in that it's broader so it inflicts bruises rather than ripping the skin open. But they are both sufficiently bad. Obviously, kids shouldn't be hit with belts (or anything except the occasional pillow when equally armed). Similarly it's worse to refuse to take someone who's having layman-evident symptoms to the ER than someone who is complaining of non-layman-evident symptoms, but both refusals are sufficiently cruel that they should not happen in an allegedly loving relationship, so it's rather a distinction without a difference
(Oh, I nearly forgot -- thank you about the kidney stone. Hydration is important.)