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CHAPTER i TheInitial Consultation The Making of a "Flbromyalgic" March 8, 1996, is a day that S. will never forget. To be sure she did not miss her appointment with Dr. D., she flew to Seattle the night before. The appointment was scheduled for 9:00 A.M. S. went into the meeting brimming with anticipation that he would have a new and better treatment for her arthritis. Sheemerged five hours later in a muddle of shock, fear, and gratitude. Shewas shocked to discover that she had four more rheumatological conditions, including fibromyalgia, a serious lifetime ailment ; fearful about the now terrible state of her health; and grateful for having found a doctor who was willing to help manage her many ills. What happened during those five hours in the examining room? The new doctor somehow reached into S.'s core being and disrupted her most deep-seated beliefs about her health. He disturbed her understandings of what was wrong with her (diagnosis), how her conditions would develop (prognosis), and what must be done to make them better or, more accurately, keep them from getting worse (treatment plan). In the process of substituting his medical narrative for hers, Dr. D. profoundly altered— indeed, jarringly rearranged—his new patient's bodily identity. Before the appointment S. thought of herself as a person with psoriatic arthritis whose disease was worrying and occasionally debilitating but in the long run no more than an inconvenience in a full and rich life. After the appointment she saw herself as a fibromyalgic-arthritic person whose diseases were serious conditions that would be with her for life and force major cutbacks in her plans for the future. S.'s comfortable sense of her self had been shattered, her plans for her life splintered like so many pieces of broken glass. How could a single doctor's visit have such a large impact? How could one's sense of self be so radically altered in such a short time? This chapter unravels that mystery. It begins by setting out S.'s raw experience of what transpired, starting with the gathering of her medical history, then moving on to the orchestration of the clinical exam, the announcement of the diagnosis and treatment plan, and finally the disclosure of the fee. 67 chapter 1 68 / Doing Biomedicine In the second half of the chapter we step back to examine the larger process by which S. was brought under the medical gaze. Dr. D. was a skillful practitioner of the discursive and rhetorical arts. Deploying an impressive array of verbal tactics, he attached a new set of diagnostic labels to S. in a way that made them seem not only plausible but also true and requiring intensive medical treatment of a sort that he was most competent to provide. Implemented through ritualized practices and wellrehearsed rhetorics, the discourses of medicalization—objedification, quantification, pathologization, and amelioration—literally transformed the person who found her way to the doctor's doorstep into "the rheumatological patient." These discourses and the larger story they compose bear close attention, for they hold the clue to everything that later went wrong. A Life-Altering Event: The Trauma of the Consultation To S., Dr. D. had the air of an earnest scientist. Ashe bustled about preparing for his new patient, she studied him carefully for clues about what might be in store for her. The new doctor was heavyset and bespectacled , with long, wavy brown hair that sat untamed on his head. Appropriate to the scientist, he was indifferent to sartorial style, wearing a bland shirt and a dull tie under the white coat of the medical man. Physically, he was unimposing—thick in the waistline, short in height—which may be why S. felt neither threatened nor intimidated by him. And he was quite young—perhaps in his mid-3os—though of course he gave no clues about his age or any other personal matters about which S. was deeply curious. Such a young doctor, she assumed without giving it a thought, would share her liberal, baby-boomer values. These first impressions put S. at ease, giving her hope that Dr. D. would be different from the male doctors she had seen in New York. The History: An Erasure of the Past S. had but a moment to register these impressions, for the medical historytaking was soon underway. She had prepared for that. For many years she had been keeping a medical diary, a computerized file in which...


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