MENTAL HEALTH

What do you prescribe for a broken heart?

A set of symptoms with no apparent cause led to a brainstorming session and finally a ‘eureka’ moment

Dr Aideen Coleman, GP, General Practice, Cork

December 7, 2012

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  • Several months ago, a colleague came to me to ‘pick my brains’. She had a young lady who had come to her several times with a mix of symptoms which she couldn’t piece together or make any sense of. The colleague had tortured herself for weeks trying in vain to solve the riddle of symptoms that the teenager presented with. 

    She had consulted every textbook she possessed and searched many online medical sites, but somehow the answer to this riddle of complaints just wouldn’t come together. Her next stop in solving this mystery illness was to gather together other medical brains in a last ditch attempt to solve the case.

    So we poured cups of teas, opened the packets of biscuits and began the brainstorming session. We had a variety of symptoms to piece together and form into a nice neat little package called ‘the diagnosis’. So far we had chest pain, poor appetite, feeling weepy and broken sleep. I made several educated suggestions but they were batted back to me having all been proven wrong already by my colleague. 

    An hour later and we were no closer to an answer. We parted company with a feeling of having accomplished nothing, but with a new and determined resolve to keep mulling over the scenario in our minds.

    A mere 24 hours later I answered my phone to my elated colleague. It seemed she had had a eureka moment earlier that morning and had now had her suspected diagnosis  confirmed. 

    I waited with excitement, fully expecting to hear her tell me that her young lady had some rare and fascinating diagnosis that exists in the fine print of medical text books; the kind of illness that as a medical student you attempt to diagnose in patients who have ‘barn door’ illnesses. 

    I was already envisaging this cool rare case that she had stumbled upon being published in a medical journal as a fascinating case report... but alas, this was not to be the case. 

    I felt the bizarre combination of surprise and stupidity when it was revealed that the ‘diagnosis’ was in fact a broken heart. It was now pretty apparent that many blood tests – both basic and exotic – had been of no use and in fact, a good old-fashioned girl-to-girl chat had unlocked this so called mystery. 

    And now to our next brainstorming session – is there a cure for a broken heart? It was certainly not something that was covered in our undergraduate medical curriculum.

    Between the two of us, neither of us could recall any proven remedy for a broken heart from our teenage years. I could definitely relate to the ritual of eating Ben & Jerrys ice cream, while simultaneously bending a friend’s ear about all the annoying and unchangeable habits of the now ex-boyfriend. 

    My friend suggested of a good old-fashioned cry followed by a 24-hour diet consisting entirely of chocolate. Our good friend Google only led us to websites claiming it took a mere 15 steps to help to heal a broken heart, while Yahoo suggested a ‘burn all reminders to cleanse your soul’.

    However, my friend was pretty doubtful that she could pull out her trusty prescription pad and scratch up a repeat prescription for ice cream, chocolate and Kleenex tissues. I shared her doubts. 

    It seemed like the logical treatment in both of our eyes, but somehow we felt it would be hard to prove that this treatment fell under the umbrella of evidence-based medicine. 

    Also, how on earth could we ‘code’ this diagnosis in the patient’s electronic notes? Somehow, I was very dubious that the ICPC has a code in its repertoire to cover the emotional distress and anguish that is a broken heart.

    For the second time in as many days we parted company with a feeling of having accomplished nothing. I wished my colleague luck as we said our goodbyes and I secretly thanked my lucky stars that I was not the unlucky one to have to console a heartbroken teenager that week. 

    Fast forward two weeks later and I was listening intently to a pale-faced sorrowful looking teenage girl who was listing out various symptoms to me. 

    At first, these symptoms all seemed rather innocuous and non-specific, until suddenly they all started to fall into place just like that perfect puzzle of Sudoku that just seems to solve itself. 

    Silence descended between us and I realised she had stopped speaking and was awaiting my knowledgeable reply. The silence lengthened and she must have heard the proverbial penny drop in my brain as I realised with absolute and undeniable certainty, that I had my very own heartbroken teenager sitting adjacent to me. My own heart started pounding as I began to panic; what should I tell her to do?

    So I flipped a coin in my brain to decide on what I should do. I slowly pulled out a slip of paper and began to jot down ‘the list’: Ice-cream, tissues, chocolate... 

     
    © Medmedia Publications/Forum, Journal of the ICGP 2012