Doctors Don't Always Bury Their Mistakes

Introduction

RSDS is a mysterious disorder of the sympathetic nervous system. S. Weir Mitchell and his colleagues first isolated this unusual complex of symptoms during the Civil War. Another name, causalgia, was given to this syndrome, meaning heat and pain—describing the peculiar burning sensation characteristic of the disorder. A network of nerves located alongside the spinal cord controls certain functions in our bodies, such as the opening and closing of blood vessels and sweat glands.

The syndrome can affect anyone, from children as young as two to some documented cases of people up to a hundred years old. There are an estimated 5.5 to 7 million women, men, and children with this disease, but women are more likely to become victims of the syndrome.

RSDS often follows an injury from a fall, an accident, an infection, radiation therapy, heat, electrical burns, heart disease, surgery, or broken bones. But in 30 percent of cases the cause is unknown. It often affects the hand or foot but may also involve the knee, hip, shoulder, or other sites. The main symptom of RSDS is severe pain, often burning in nature. The disorder eventually results in weakness or wasting of the area. Usually, in the first acute stage, which lasts three to six months, it is characterized primarily by pain, tenderness, swelling, and vascular disturbances. Changes in the temperature and color of the skin may occur, along with sweating. Other symptoms may include rapid hair and nail growth, edema, or loss of ability to move the affected joints normally.

As the syndrome reaches a second stage, the dystrophic stage pain is often made worse by changes in temperature or by other stimulation, such as breezes, air conditioning, or touch. The skin becomes cool and the nails become brittle. The area may become swollen and look pale and waxy. X-rays show thinning or damage of the joints or bones. Pain may spread, usually moving toward the center of the body, from the foot to the hip or the hand to the shoulder. Often the spreading pain affects the muscles, producing painful spasms. During the third atrophic stage of the disorder, the pain may remain severe, although some people may notice less discomfort. The skin becomes drawn, shiny, and cool, with the muscles and other tissues becoming wasted and tight.

By then the tissues have started to atrophy and reversal is rare. Joint movement is greatly impaired. Bilateral involvement is generally thought to be present in 18 to 50 percent of patients. This supports the idea that the syndrome is reflexive and is mediated by central neurological workings.

1

A Simple Twist of Fate

Suddenly, in one split second, my life changed forever.

One day in August 1988 shaped the course of my destiny—a day that would steer me into unfamiliar, uncharted territory, sending me into a world of pain and darkness for many years to come.

It was an ordinary day, one of those days I usually took for granted. Little did I know my life was about to change drastically. This unremarkable day would have a profound effect on me and would alter my life forever. Strange how unforeseen events sneak up on you when you least expect it.

It was a busy day. My mind and body were going full speed ahead, a hundred miles a minute, and in thirty different directions! There was just no time to stop and smell those roses I kept hearing about. This unbelievable day would be etched in my brain, body, and memory forever.

That afternoon I walked into my kitchen, oblivious to what would happen next. A large green trash bag with one empty bottle of Thousand Island salad dressing attacked me, or so it seemed. A little detail like this shouldn’t have a lot of impact on anyone, but it sure did on me. It would haunt me for the rest of my life.

The truth of the matter was I was a klutz. I had never thought of myself as a klutz until that day, though. As I walked past the trash bag on the counter, my clumsy fingers accidentally bumped it onto the floor and smack-dab into my right foot. I would spend many years of soul-searching asking this question: Was it an accident or a simple twist of fate?

There were no words to explain the intensity of the pain I felt. Hot, searing, sharp lines of pain started at my toes and rose through my knee. The pain shot into my thigh, through my spine, and into my brain.

It felt as if someone had taken a hunting knife—one of those big ones with serrated edges—and placed it into a fire with hot coals, then jammed it deeply into my foot, dragging it through my body. I immediately felt dizzy. The room started spinning, and I almost fell to the ground. My pain was agonizing, and I could barely apply any pressure to my foot. It was impossible to walk even a few paces with the pain I was experiencing. It was unlike any sensation I had ever felt in my life. At the same time, the agony engulfed my body, and I thought, How can one small glass bottle hurt so much?

At that moment my life spun totally out of my control. The aching became fiercer with each passing second. The throbbing was so strong that my heart beat rapidly. I was confused and frightened by its intensity, and my state of increasing agitation produced a severe anxiety attack. The more I panicked, the worse I hyperventilated. I could not stop quivering from the adrenaline surging through my body. My pulse raced, and my breathing became shallow and irregular. Sweat poured down my brow and my face flushed.

Suddenly I became sick to my stomach. I almost vomited from the aching discomfort my foot was producing. For an instant I became dazed and lightheaded. I was so dizzy I was afraid I would pass out. The room was so quiet. In my panicked state of mind I fell to my knees and clutched my chest.

I was unable to catch my breath because the pain had enveloped my entire body. I knew if I didn’t regain control of the situation immediately I would totally freak out. I needed immediate medical attention—something, anything, some kind of pill to make my pain just go away!

I dialed my trusted family doctor’s phone number in sheer desperation. The nurse answered the phone and acknowledged the panic in my voice. Finally my physician picked up the telephone. He told me to come down to the office. For one brief, shining moment I breathed a sigh of relief.

At the doctor’s office, once in the examination room, I mournfully wept. My agitated nervous system was working overtime because of the excruciating pain in my foot. Suddenly the doctor came in. He was a tall, distinguished-looking gentleman in his early forties. His wavy blond hair had a slight touch of gray at his temples.

His blue eyes stared intently at me through his wire-rimmed glasses. Dr. Granger had a strange sneer on his face as opposed to a friendly smile. He was short-tempered with me and pressed for time. His attitude was sarcastic, and his voice had a harsh tone. His demeanor was more abrupt than usual. Dr. Granger did not seem to be the slightest bit interested in my cry for help or my predicament.

After completing his examination on my foot, he prescribed painkillers, acetaminophen with codeine. Unsatisfied with that solution, I told him my pain was unbearable and constant, and it was impossible for me to function with the agony I was enduring. He took out his pad once again and wrote me another prescription for a muscle relaxant called Soma Compound.

Your problem is merely a sprained foot, he said. I was naive and trusting at the time, but I had the distinct impression that he was trying to get rid of me as quickly as possible.

After leaving his office, one thought puzzled me. How could he make a diagnosis of a sprained foot without an X-ray? Then I thought, Why should I question him? He was the doctor, and I believed he was a medical god. Wrong!

After a few days of agonizing torment increasing with each breath, it dawned on me that the time had come to seek out a specialist. The pain felt like a toothache. It was a constant pulsating feeling, but there was a strange icy coldness to it. My foot had turned the most interesting shades of black and blue. It was so cold, you would have thought I had immersed it in a bucket of ice cubes or kept it stored in a freezer for weeks! Pain was the only sensation I felt. I obsessed and panicked over what was happening to my body.

I decided to let my fingers do the walking through the Yellow Pages to find a specialist. I talked myself into believing that if these doctors were skilled enough to get their names in the Yellow Pages, it was all the referral I required. I didn’t realize just how crazy that notion was at the time. I was desperate for some sense of relief from the tortuous pains. The pain was in my foot, so why not find a foot specialist? I needed instant relief without delay.

After telephoning a few different physicians, I finally found a podiatrist who was willing to take me on as his patient. I was thrilled that Dr. Dalton could see me immediately! I got into my car as quickly as I could hobble to the door and drove to his office.

I painfully limped into the examination room to await the new doctor’s arrival. A tall blond gentleman with deep blue eyes walked into the room. After recounting the story of my bizarre mishap with the trash bag, the doctor with his warm bedside manner and charming smile examined my icy cold black and blue foot.

He had a pleasing personality, and it was truly a welcome relief to be treated with kindness and concern for a change. Dr. Dalton took a series of front, back, and side X-rays to determine a diagnosis.

Upon reading these films, I believe your foot is suffering from a fracture to the sesamoid bone in your right great toe.

Personally, I saw nothing great about the toe. It was wreaking havoc upon my nervous system and causing my body to suffer excruciating pain.

After finishing his examination, the doctor placed my broken foot into an ugly brown bunion shoe specifically designed for a fractured toe. The shoe was wide enough to fit over my extremely swollen black and blue extremity.

I am sending you home with a prescription for hydrocodeine with APAP 500 milligrams, to be taken as needed.

I began to wonder if doctors purposely overmedicated their patients to shut them up so they would stop complaining. I wondered if there were enough painkilling drugs in the pharmacy to make my insufferable discomfort go away.

The thought of experiencing a fantastic release of discomfort was a blessing to my tired mind and body. If these pills could put me in a state of La-La Land and knock me out, my body could experience a few moments of relief and much-needed rest. And if one of these drugs actually worked, being high on pain pills would have a few other benefits as well.

The word relief sounded beautiful and blissful. My brain had forgotten what lovely sensations peace and calm were. I longed for those wonderful pain-free days of the past—the days when I felt great, the ones I had taken for granted.

My weeks from hell continued. The medication didn’t work. With each passing second, the pain in my foot increased with a vengeance. The emotionally and physically draining discomfort throbbed nonstop. My foot remained icy cold. There was a stinging and burning sensation inside, as if someone had lit a match to my foot, setting it up into a roaring blaze of fire.

I became confused and agitated because of the severity of the aching. It was difficult to believe a fractured toe could cause so much horrendous discomfort. As the days went on and the wretched spasms in my foot continued, I became incensed and utterly frustrated.

One distressing thought troubled me. Was there no end to my suffering in sight? It became painfully clear that I had to make a decision quickly. But where and to whom would I turn next? My ordeal had turned into a nightmare. The piercing, stinging ache in my foot was intense and unbearable.

The annoying anguish increased with a vengeance and was now overpowering me. Its constant pulsating forced my body and brain to become crazed and frustrated because of the maddening sensations. My nerves were frayed. I was a woman on the edge, with my body ready to collapse at any second.

My circuits were overloaded from the agony, and I wanted my suffering to stop! But I also discovered a new side of myself. Total survival instinct kicked in. I weighed my options. A decision needed to be made immediately. Would I stay with Dr. Dalton or find a different physician?

I opted for another search through the Yellow Pages, but this time it was for an orthopedic surgeon, in the hopes that he would have the magic healing potion, or at least an explanation as to why the aching in my foot was so relentless.

I was plagued with increasing fear and dread in the examination room. I shut my eyes, silently saying a prayer. My apprehension was building and cruising higher with each second. Questions replayed in my head. Would the doctor have any kind of solution to my problem or a pill to miraculously heal me?

Abruptly the door swung open. A slightly rotund older man with curly gray hair and intense dark brown eyes entered the room and sat down on a nearby stool.

Hello. My name is Dr. Aston. Where is your pain located, and what are your symptoms?

He listened to each of my complaints and glared at me with a curious stare. After some brief conversation, Dr. Aston examined my right foot.

You have moderate tenderness in the area maximal through the mid-arch and also over the distal first metatarsal. These bones are between the toes forming the instep.

He took new X-rays and confirmed Dr. Dalton’s diagnosis of