How I saved my patient's job, marriage, and life

The patient was obviously sick. But what wasn't obvious was the cause of her symptoms.

Within 30 seconds of meeting a 35-year-old patient I'll call Debbie, I knew it wasn't going to be an easy visit.

Her speech was pressured, machine-gun-like: "I just don't know what to do. I wake up angry each morning. I yell at my kids, I yell at my husband! Then I get to work, and my boss tells me that if I don't stop yelling and cussing at her, she may have to fire me, even though I do my job really well. Then, I get to my therapist and nothing she says really makes sense. She said that I need some kind of medication! I just can't concentrate when we talk."

My first thought was that she was either having a full-blown manic episode or a thyroid storm. As I went through the rest of the history and exam, however, the only thing that stood out was that she was congested and sounded nasally. She mentioned in passing that she had been blowing her nose a lot. A detailed review of systems and her family history showed nothing unusual.

I told Debbie that I wanted her to get lab work done before I came to any conclusions. Then, almost as an afterthought, I added that I could treat her obvious allergy symptoms. She left with a lab slip, a sample of a nasal steroid spray, and an appointment to return in a week.

When I saw Debbie for her follow-up, I was stunned. In an enthusiastic but much calmer voice, she thanked me: "Doctor, you've saved my job, my life, and my marriage. I started the allergy medication and three days later realized that I had slept through the night for the first time since I was in junior high school! For years, I had been waking up every hour to blow my nose."

"The other day," she continued, "I woke up and didn't yell at my husband or kids, I didn't get angry at work, and my therapist made sense to me! That nasal spray saved my life!"

As an allergy sufferer myself, I've known that the symptoms can be very tough to deal with. Medical school and residency taught me that sleep deprivation can have a significant effect on mental and emotional functioning. But, I never thought that something as "simple" as allergies could have such a profound effect on someone.

As a family physician, it's always rewarding to have a patient tell you that you saved her life, her job, or her marriage. But it's a rare day to get all three!

Ralph Harvey. How I saved my patient's job, marriage, and life.

Medical Economics

Jul. 23, 2004;81.