So I am sitting in a treatment room in the Nephrology Clinic at Upstate Medical Center when Dr. W. Clayton Elliott walks in and introduces himself. He is a late-middle-aged man who used to be known as Dr. William C. Elliott, and he used to work at Oswego Hospital, which is close to the end of the known medical universe.
He asks me if I know who he is.
‘God?’ I wonder. ‘The latest in a long line of medical assholes?’ I wonder. “You’re a nephrologist,” I say, puzzled by the question.
He asks me if I know where I am.
This son of a bitch is doing a basic psych evaluation—is the patient oriented to place and person! It is unnecessary, inappropriate and fucking rude. Any good physician begins the new-patient interview with one minute of social courtesy, then says “How can I help you today?” The patient begins to tell her story and—according to research studies—12 seconds into her story, the doctor interrupts for the first time. They do not listen.
Dr. Elliott goes way beyond not listening. He doesn’t even ask. He sits down and states “You don’t have diabetes insipidus.”
WTF? Shocked speechless, I mumble and mutter something indistinct. Elliott repeats: “You do not have diabetes insipidus.”
Back around 1991, I was peeing all the time. I told my psychiatrist, who did nothing, so I demanded a second opinion. She sent me to another psychiatrist who actually knew what he was doing, consequently I got sent to a primary care physician who ordered a 24-hour urine and blood tests. When the results came back, she told me I had diabetes insipidus. I cheerfully replied, “You can fix it can’t you?”
“Um, no,” she said. “It’s permanent.”
Then I went to a nephrologist who admitted me to hospital and did a dehydration test, which consisted of denying me liquids for 12 hours, starting around 8:00 p.m., and weighing me every hour all night. I lost ten pounds, just from producing large quantities of urine. Imagine losing ten pounds overnight! My grandma always said “A pint’s a pound the world around” so ten pounds is more than a gallon.
A healthy person excretes less than two liters of urine in 24 hours; I was putting out twice that amount just overnight. I had diabetes insipidus. “Diabetes” means large quantities of urine; “mellitus” means sweet-smelling; “insipidus” means odorless and colorless. Diabetes mellitus is a disease of the pancreas; diabetes insipidus is a kidney disease. Diabetes insipidus means that you are basically excreting clear water and not concentrating urine.
My next stop was Dr. Arnold Moses at Upstate Medical Center who said that the overnight dehydration test was “barbaric” and no longer much in use. Dr. Moses is an endocrinologist and an internationally acclaimed expert on diabetes insipidus. He put me in one of his research programs and reported that my 24-hour urine output was 9.6 liters—about five times normal.
Diabetes insipidus comes in three forms: neurogenic, nephrogenic and psychogenic. Neurogenic means that the posterior pituitary gland in the brain is not putting out enough antidiuretic hormone (ADH). Nephrogenic means that the posterior pituitary is putting out ADH but the kidneys are not responding to it. Psychogenic means you’re crazy, therefore you drink too much, therefore you produce too much urine. Dr. Moses did some horrific test (talk about “barbaric!”) and reported that my diabetes insipidus was exclusively nephrogenic. My kidneys had been damaged by lithium, prescribed by a bad psychiatrist, which is the most frequent cause of diabetes insipidus.
I went on to nearly a quarter of a century of treatment by various endocrinologists, nephrologists and emergency medicine specialists, usually DDAVP—which cost about $10,000 a year—and the diuretic hydrochlorothiazide (HCTZ). About every six months, I would dehydrate into the Emergency Room. Then I stopped taking physician-prescribed pharmaceuticals and I stopped dehydrating.
I had to urinate about every two hours, including all night, and was dying from lack of sleep after ten years of this so about three years ago Dr. Tucker, chief of hospitalists at St. Joseph’s Hospital, prescribed an indwelling catheter so I could get some sleep.
And Dr. Elliott, the idiot du jour, has just informed me that I don’t have diabetes insipidus. He comes from the medical backwater of Upstate New York and probably has never seen a case of diabetes insipidus in his 35-year career. The incidence of diabetes insipidus is 3:100,000; Oswego County has a population of about 120,000.
I ask Elliott on what he bases the judgment that I don’t have diabetes insipidus and he says—wait for it [drumroll]—“I read your lab reports.” He did not interview the patient. He relied entirely on what tests other physicians, such as the rheumatologist, had seen fit to order.
A 24-hour urine collection is where you start if you suspect diabetes insipidus. There is no 24-hour urine lab report in my file.
Back in the 1990’s an internist, a nephrologist and an endocrinologist each independently did testing and arrived at the same diagnosis. It was before Upstate Medical Center began to put test results on computer. No 24-hour urine collection has been done on me in this century. Neither has there been any ADH test.
I sputter, “Bu—bu—but, Dr. Moses! This hospital . . . international expert . . . tests!”
The asshole du jour repeats that I do not have diabetes insipidus.
I leave the room, and the hospital, probably forever.
And here’s what I believe: I believe that the asshole du jour read my psych history and, based on multiple fallacious notes by psychiatrists—whose “diagnoses” are based on opinion, not any objective tests—he decided I was crazy and, since he is fundamentally incompetent, he did no testing to validate his opinion, which is that of a bigot.