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PROLOGUE Finding Dr. Right By the age of forty S. had a thick medical file. Pieces of her body's history could be found up and down the East Side of Manhattan, from Cornell Medical Center on Seventieth Street to New York University Medical Center forty blocks to the south. Clearly, S. had sought some of the best physicians from the best centers of academic medicine in the city. Her records were also strewn all over the medical landscape, in the offices of neurologists, orthopedists, rheumatologists, physical therapists, and even cosmetic surgeons—so many specialists had she seen looking for help diagnosing and treating the pain in her knees, elbows, neck, and fingers.That the problem was bodily or biological she had no doubt; after all, the swelling and pain were in her joints. The solution, just as obviously , was to find expert medical help: that is what people do when their bodies stop working properly. The decision to medicalize the problem was thus made without even a passing thought. This prologue recounts some key episodes in S.'s search for the right doctor to treat her ills. The story begins with the quest for a diagnosis and ends with the discovery of a doctor whose promises for treatment sounded too good to be true. It moves from New York City, where S. was employed during her thirties and early forties, to southern California , where she moved in her mid-forties to assume a new position. It is a tale of disillusion, confusion, and desire—disillusionment from encounters with thought-less doctors, confusion over a once-healthy body now out of control, and desire born of worsening health conditions that seemed to spiral ever downward. East Coast Doctors: Thoughtless Men and Empathic Women S. had begun her search for doctor and diagnosis in her mid-thirties, when the joint condition that was later to dominate her life first made itself 57 58 / Understanding Chronic Pain felt. At the age of thirty-six she had surgery for carpal tunnel syndrome, asking to have both hands operated on at the same time to avoid the necessity of two interruptions to her busy schedule. After that, mysterious symptoms began to appear. A few weeks after the surgery her left knee started to swell, growing so large and painful that shecould scarcely walk. S. felt deep in her bones that the two events were connected, that her knee was swelling to protest the surgical assault on her system. Then in her late thirties she injured her neck during a three-day home-painting marathon. The excessive strain on her neck, which had been craned back at a ninety-degree angle while she painted a low ceiling, traumatized her whole upper-back area, causing a searing, spreading pain that immobilized her for months. It was this episode that sent her on a concerted search for medical help. The process of finding a good doctor had been emotionally traumatizing . Indeed, many of her medical encounters, especially with male physicians, had been degrading and disempowering. A young doctor at N.Y.U. Medical Center had injected her knee with corticosteroids while carrying on an animated telephone conversation with a colleague about another patient. S. felt like a barnyard animal and never went back. A more senior physician, a world-famous neurologist at Cornell Medical Center, had sat her down and said, his voice dripping with scorn, "You are a very pleasant woman," as though pleasantness were a social sin. And that was her diagnosis: even after hearing her account of her neck injury and subsequent pain and conducting a clinical examination, he insisted that there was nothing wrong with her except her personality. S. cried for weeks, unable to understand how being pleasant had caused her body so much pain. And she was still in great pain. Adding financial injury to the emotional assault, he had charged her $500 for the visit. Feeling wronged, S.wrote a pointed letter to the eminent neurologist. She expressed anger at him for dabbling in psychotherapy when his expertise lay elsewhere and for charging women with somatizing their psychosocial problems while givingmen physical explanations for their bodily ills. (Sheknew three men who had consulted the doctor and received diagnoses of a physical sort.) "In short," she wrote with feeling, "I got much less than my money's worth" (Letter, October 7, 1990). The noted physician replied by offering to let her consult a colleague in his department, a specialist in the...


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