Once I Was a Patient

I actually missed this #hcldr chat last October 29, 2013 when Dr. Gia Sison (@giasison) was the guest. The chat was entitled “The Jekyll-Hyde Experience – When the Doctor Becomes the Patient.” Check out the pre-chat blog post by Lisa Fields (@PracticalWisdom) here. Gia is a breast cancer survivor. She talks about her experience in her blog Sand and Stone.

Once I was a patient too. I diagnosed myself to have a prolactinoma in the year 2000. I was then serving as Chief Resident in the Department of Medicine at the Philippine General Hospital. I began having irregular menses in medical school. I even consulted a gynecologist in the 4th year of medical school and was told that I was probably just stressed. I was given oral contraceptive pills in an attempt to make my menses regular. That worked – only if I took them properly! And being busy with my studies and clinical work, I often forgot to take my pills.

After a while, my gynecologist said I should try to wean myself off the pills. And I did! But every time I stopped, my menses would stop too until I resumed taking the pills again. At this time I was already in internal medicine residency training. In my third year of residency training, I decided to stop the pills altogether and wait it out. As a result, I did not have menses for ten months!

After finishing my training, I was asked to stay on an extra year to be Chief Resident. I became worried about my menses but I did not want to go back to my gynecologist as I felt she would only recommend resuming the pills. I set out to diagnose myself. I opened our textbook Harrison’s Principles of Internal Medicine.

Looking at this algorithm, I decided to get a prolactin level. I got so busy after this (or so I told myself, I think I was also afraid to find out), I delayed getting the result until a week after. When I passed by the lab to finally get my test result, I saw a fleeting look of alarm on the clerk’s face as she was about to hand it to me. She then asked if the lab test was mine. I remember saying “Yes” and feeling rather annoyed since obviously my name was on it. She didn’t hand me the result just yet which I found very strange. She then asked me, “Are you pregnant?” And I said, “Of course, not!” She then asked me to wait and disappeared inside the inner office in the lab still holding my lab result. After ten minutes, she came out with my lab test and asked me to sign for it.

In that lab, the normal for a prolactin level was 90-500 IU/mL. My result simply said >500 so I knew it was abnormal. I decided to go to the endocrine clinic and ask C, an endocrine fellow about my result. C took a look and told me my result was peculiar since it only said my prolactin was above normal – she was expecting to get an actual number. She called up the lab. Apparently, the lab had been afraid to give me my result since I was chief resident and had wanted to re-check the test. My prolactin level was actually 19,000 IU/mL! I knew then I had to get a pituitary MRI.

I proceeded with the MRI at another hospital since the Philippine General Hospital did not have one at that time. I remember feeling strange filling out the patient form – I was now a patient! I filled in my history and then continued on with the working diagnosis and some medical data. Out of habit, I had filled up that part of the form reserved for the doctor. That surprised the rad tech on duty as he had not known I was a doctor. The MRI felt interminable and I was starting to get claustrophobic inside the machine when finally, it was done. The rad tech told me that since it was a Saturday, I can expect to get the MRI results the following week since a radiologist was not on duty that afternoon. I requested him if it wouldn’t break any rules if I could take a look at the images on the computer monitor since I was a doctor anyway. I wonder now if I was brave to do this because I honestly felt it was going to be a normal MRI. It wasn’t! I saw plainly for myself that I had a macroadenoma. The report would later say it was 1.9 cm in its greatest dimension. I knew then that I had a prolactin-producing pituitary adenoma.

Even before this diagnosis, I had already decided to train further in endocrinology. And here I was with an endocrine condition!

I’ll write about what happened next in another blog post.

I wrote this post because of my involvement with #HealthXPh. I think it adds value to the conversation we’re having in #HealthXPh, knowing that I, a doctor, was once a patient too!

Read more about #HealthXPh and how to join here.