The art of self-diagnosis

For the first two or three years of residency, I knew I had a “nervous cough.” Every morning hack hack hack, this dry retching thing that would only subside by 10 or 11. Why a “nervous cough”? Because (A) I obviously wasn’t sick sick, and (B) morning rounds made me irritable as hell. You could cut the stress with a scalpel. A dull one.

By my third year, however, I should have known something was up. The stress level dips in your third and fourth years (only to jump to celestial levels in your chief year) and, for a brief time, life is good. You have medical students, an intern, and a second year resident buffering you from all the Bad Stuff. Sure, in the middle of a call night you’re technically in charge (since your chief really doesn’t want to hear from you), but that kind of anxiety passes after two or three times at bat.

Yes, third year, and I’m still coughing. Should have been a clue.

One evening, we got together with the urology team in our call room for an evening of rented movies (Robocop, IIRC) and atrocious (but cheap) Thai food. It was early enough in the evening that our chief was still hanging around. So there we were, three ENTs, two urology residents, two interns, and one or two med students, watching viddies, ready to chow down.

I took a big mouthful of white rice, dry-swallowed, and the bolus lodged somewhere below the level of my thyroid and wouldn’t moved. I felt like I was being deep-throated by a rogue elephant. No problem — I could wash it down with a swig of Diet Coke, right?

Wrong. The Coke bounced off the rice and splashed onto my vocal cords, which promptly went into spasm. Laryngospasm in this context is an emergency measure designed to prevent aspiration. In other words, my body was none too keen to see my lungs bathed in caramel syrup and carbolic acid, or whatever the hell Coke’s secret ingredient is.

In the long run, laryngospasm is incompatible with life, but in practice, folks either manage to break the spasm or pass out (whereupon the spasm breaks spontaneously — you hope). Meanwhile, however, the air ain’t going in, the air ain’t coming out.

Oh, how I wish I knew how to record and upload a wav file, because I can imitate the noise to this day. Imagine if someone were to strangle a seal. Something like that.

Picture it. I’m standing now, hands at my throat, making funny noises in a room with two other ENTs, two urology residents, two interns, and an irrelevant number of almost-doctors. And what are they doing?

Karen, what was that expression again?

Yeah, that one. I thought: I’m gonna die in a room full of doctors, including two ENTs, the self-acknowledged masters of the airway. Oh, the irony.

Fortunately, my second-year resident, Adrian Yi (now a LaserSmooth® God, whatever LaserSmooth® is), had the presence of mind to say, “Try coughing!”

I coughed, breaking the spasm and spewing the room with dozens of grains of steamed white rice.

Everyone was duly pissed at me for ruining their appetites. Alison, our intern, said, “God, how gross!” The urologists left to contemplate whatever urologists contemplate in the privacy of their own call rooms. Adrian might have asked, “You okay?” but residents on the whole are an unsympathetic bunch. Undoubtedly, my chief was thinking that if I insisted on going down to the ER, he would be stuck taking in-house call in my place.

Soon afterwards, I realized that my dry cough, esophageal spasm, and chronic throat-clearing, not to mention the hellacious heartburn which had caused me to swig through two bottles of Mylanta a month, were all symptoms of GERD. I’ve been on Prilosec (omeprazole) ever since, and I’ve only had two or three more episodes of esophageal spasm — and none as painful as the first.

Public service announcement: not everyone with GERD has heartburn. You can have the other symptoms (repetitive throat-clearing, a ball in the throat sensation, chronic dry cough, difficulty swallowing, and hoarseness) without experiencing a single bout of hearburn. This is an under-diagnosed condition — which should be evident from this post, since this particular doofus suffered with these symptoms for three years before figuring himself out.

D.