Case 4 - Wally Graham

"The news is good," announced Wally Graham's clinician. "Your x-rays and the other tests show nothing wrong - no cancer, no ulcer, not even gastritis."

Wally Graham did not look pleased. "I don't understand it."

"I mean I don't understand why I'm still having the pain and why I'm throwing up nearly every morning." He slowly began to put on his shirt.

The clinician leafed through his chart. "I checked with your previous HMO. They said you'd had the same set of tests done there six months ago. And the year before that."

"Yes, I told you all about that, last time I was here. I haven't held anything back." Wally had begun to sound angry. "This has been going on for four or five years now. I don't like being this way, you know."

"No, of course not," said the clinician. "I didn't mean that. I meant that for years you've had stomach pains, nausea, vomiting, and diarrhea, and for years you've been afraid you have cancer. You've had at least four workups by excellent clinicians; they've all reassured you that nothing is wrong. Only you don't feel reassured. Last week you were even gastroscoped by our gastroenterologist. That's the most definitive test you can get. There weren't even enough findings to diagnose an upset stomach! I'm not saying you don't have pain, but I think your problem is somewhere besides your stomach. I'd like to check out some other possibilities, to see if we can get to the bottom of this."

"I hope so." Wally Graham was less angry, but he still sounded unconvinced. Fully dressed now in his tie and sports jacket, he looked somehow smaller than he had before. He was a 42-year-old, unmarried accountant who worked for a branch of one of the large national firms that advertised on TV. He liked his job (except during tax season, which nobody liked). but several days a month he had to stay in bed with abdominal pains. His supervisor was becoming restive.

Of course, Wally had been worried, maybe even a little depressed. He had felt this way occasionally throughout his ordeal of the past several years, but his concentration had been good and his interest in work and leisure activities had been high. Any problems with sleep or appetite had been due to the abdominal distress, which only lasted for a few days each time. He had never had suicidal ideas.

Wally had never tried street drugs; for years he avoided alcohol in any form. Except for his abdominal distress, his health was good. He denied everything on an impressively long list of symptoms that included headache, dizziness, chest pain, painful urination, and musculoskeletal and neurological complaints. Over the years he had quite a lot of anxiety about having cancer, but he never experienced a full-blown panic attack. He had never heard voices or seen visions, nor did he believe that people were plotting or talking about him behind his back.

The first few times a clinician told Wally that he did not have cancer, he felt relieved, but after a few days, the symptoms would start again and he would worry. "What if the lab had switched somebody else's tests with his?" "Suppose the radiologist had misread the film." "Or perhaps, I didn't have cancer then, but I've developed it since the last tests were made. How's anyone going to reassure me about that?"

*Note, You are looking for an Axis I diagnosis. Also, how is this case different from that of Jason Bird in Case 3?