Deflated

I am deflated. I dont even know if thats a word, but I'm using it. My 31 year old female pt, the one who had nausea and vomiting for 2 months along with a growing liver and jaundice, has sadden me. She came in to the ED (emergency department) last week complaining of seeing yellow. With no past medical history, she denied any blood in her vomit, denied taking any vitamins, denied IV drug use, and said she rarely drank alcohol. She denied this everyday for a week. (I like to triple check) So we started working her up for hepatitis and cholecystitis.

Everything came back negative. I mean everything. She had a CT, MRI, HIDA scan, MRCP which just showed a fatty liver. We ran almost every autoimmune liver disease possible. Finally we had no choice but to take a liver biopsy (which was pretty cool---it was a transjugular IR bioposy). What were the results you ask? Alcoholic hepatitis.

At first I thought they mixed up the patient's results. But my resident said it was definite. I couldn't believe it. I had forgotten the first House, MD rule: "Everybody lies." or "I dont ask why patients lie, I just assume they do." When confronted, she said "Oh I am just so glad it was something as simple as that." She must have known the whole time. Or she is in incredible denial. Either way I was deflated. If I can't trust my patient then what is our purpose?