Aliens from Outer Space, Part 1

After nearly dying from an anaphylactic reaction to penicillin in 1980, I stayed allergic.

I was allergic to everything I encountered.

The ER episode was on a Saturday or Sunday night. On Monday, I was sent to a Chicago clinic run by the allergy department at Northwestern, a highly regarded medical school. The professors running the clinic were considered a bit radical at the time.

When I got to the clinic, I was told the doctor was very busy and seeing another patient. I knew it was a teaching facility that saw people like me a lot - ones who couldn't pay, but had something interesting for the docs to treat. There were always a good five or six high-grade post graduate medical associates there. Full doctors learning a specialty.

After waiting for quite some time - and unaccustomed still to my new status as poor and insignificant and expected to wait uncomplaining - I started walking around looking. I found Dr. Zimmerman, identified by his name tag, sitting in a little corner somewhere, resting and having a cup of coffee.

--Hi. I'm your next patient, been waiting a long time. Interesting *patient* you've got there.

In a heavy German accent he replied, --Vell, efen busy doctors haf to haf some rest and coffee sometimes, no?

--Sure. In fact that's so important, it should be scheduled into your day. But not at the same time a patient is scheduled to see you.

I got my exam room assignment, and soon Dr. Z came in, followed by a troop of eager-looking students. Their faces wore such a hopeful, interested, vulnerable look, and I felt so much like a long-waiting bug under a microscope, I - well, I just couldn't help myself there - I said a bit sarcastically, --Ah! Here to "practice" our medicine today, are we?

As a younger woman, I must confess, I had a big mouth sometimes. In my defense, I really did keep it shut almost all the time.

Almost.

Their poor little happy faces fell and I was sorry. Still, I hadn't figured on the price I'd have to pay for that crack later on.

Just as he was when I caught him on his coffee break, Dr. Z was totally unfazed. He began talking in his heavy accent. The students were startled by his voice, but then looked back at all the things he was pointing out on me. He was quite excited by my display of allergic rashes, so many different kinds all at once, very unusual, we're lucky to see this today. Nearly rubbing his hands in glee.

Fife disstinct rrashes - and can you describe vut is different in each, and vy? Vut's de name of dis one? Dat one?

Vy de brrilliant red patches in de palms and elsevere, you read about dis from de ER report, traces still remain. Is it purpura? No, purpura iss darker and defelops differently, can be palpable too. Dis is an indication dat de blood vesssels had veakened and vere no lonker containing de plasma and other blood constituents; and vut is de name and mekanism for dat, pleasse? De palmss ve can expect, yess? But vy to see dem elsevere only on dose joints vere de patient hass rrhematoid arthrritis?

He was clearly a very good teacher. I had some questions of my own, but I saved them for later. Not wanting to interrupt, you see.

At the age of 22, I looked much different than I do today. I was smack dab in that phase of our lives I call *Youthful Gorgeousness,* as opposed to my *Old Crone* status of today. The rashes and lingering signs of angioedema (huge blue-white cone-shaped hives) and erythema (the brilliant blood red patches on my palms and joints) were strikingly noticeable.

Dr. Z went over the angioedema, erythema, itching - I was still covered head to toe in tiny scratches from my fingernails - and the chest pain and throat pain. The finger that had started to split apart, swollen beyond containment from an angioedema hive. He discussed why my tryptase was normal, even though I displayed classic hallmarks of full anaphylaxis. (Tryptase tests to identify anaphylaxis are no longer used much, these days, apparently being inaccurate too often.)

The docs explained to me then and in later exams that sometimes, after anaphylaxis, a patient continues to be allergic to most everything they come in contact with. They didn't know why this happens. There was no official name for it yet. They themselves sometimes called it "idiopathic allergy syndrome," but not everyone called it that. They told me that I'd need to get an Ana-kit and stay on antihistamines (Benadryl and Atarax) for as long as this continued.

Because it might not be a permanent condition, I was instructed on how to test to see if I was recovering from it. If, in my daily life, I seemed less reactive, then after time I could try to decrease my doses of antihistamine. Very slowly and carefully please! If the symptoms reappeared, if I saw hives, rashes, itching, breathing problems, then I must immediately return to the original dose. Go to the ER if it didn't get better right away.

To be told that a patient could not only take part in diagnosing the severity of a condition, but actually even watch for symptoms and adjust meds accordingly, was absolutely radical at the time. Patients were NEVER directly involved in their treatment like this. Almost universally, they were considered by the medical community to be ignorant, emotional, illogical, impulsive, histrionic hicks that had no business participating in their own medical treatment in any way, shape or form except for taking meds. All else was the doctor's job, and his alone.

The reasoning went like this: If patients learned anything about diseases or symptoms, then they'd be hypochondriacs and think they had every illness described to them. And how did docs know this was true? Because they'd done the same thing themselves in medical school. So they had A Responsibility to prevent this from happening to the foolish unwashed masses they saw.

Back then, even asking the doctor a simple question usually got a shocked and hostile reaction. If they deigned to answer, the reply would often come in baby-talk or dumbed-down words, and dismissive in the extreme. A doctor was God, and the little lamb did not question Him.

Old school. Little did I know that medical treatment would take such a turn over the next fifteen years, that having patients ask questions and learn something about their medical care would be considered desirable and beneficial - and very much within the patient's rights.

The visit then turned to Patient Question time. Dr. Z had already introduced the student docs, who were all men; and one of them had proved it by politely leering at me, --The good news is, you don't LOOK that bad!, accompanied by a standard-issue playground bully wolfish grin. As an attractive young woman, the only woman present, sitting half-naked in a roomful of men, this was more an unsafe feeling than a friendly one.

Dr. Z wanted to know if I had any questions. Yes. How long might I be sick? He said he had no idea. For some, it was lifelong. For others, it went away in a few months or a couple of years. Even at that, it might return after being in remission.

The best way to get better was to avoid common allergens. I would remain in a state of constant allergic reaction for some period of time. The underlying condition was fairly static that way. However, certain allergens might increase the reaction quite noticeably - the more changeable or dynamic half of the equation. Avoid those substances! Learn about common allergens and avoid them too - shellfish, peanuts, etc. Watch yourself and learn what specific items you react more to than others.

My last question was about the red patches on my palms and joints. How did that work? I was just curious, could they explain it, please, in terms I might understand?

Probably not - it required highly detailed medical terminology, that one.

Try, please?

By then we'd gotten up and were all going through a doorway.

And one student doc, one who had not smiled at all when I'd said, --practicing our medicine?-- took up the challenge. Putting his face up close to mine and staring hard into my eyes, he began an A to Z rundown on how this worked, using twenty ten-dollar medical words in each sentence. After a minute or two his face began turning red. His fellow students started tugging gently on his sleeve, muttering hey, guy, that's enough; and Dr. Z, motionless and seemingly unaware, was actually watching him carefully. The other students noticed Dr. Z and upped their efforts to shut up their buddy. By then he was literally spitting with fury into my face, spewing angry medical words at me like they were pointed darts.

They gave up being unobtrusive and pulled him away, back through the door we'd just walked through. I heard him saying, --It's the fucking tail wagging the dog, why the hell am I supposed to take that shit from a --

Dr. Z turned back to me, his face now a mask of gentleness and kindness. He wanted to know if I needed anything else he could help me with. No thank you. He set up my next appointment, loaded me with scripts, and I went home, alone, to learn to deal with my radically changed existence.

Fast forward twenty-three years later, to 1993. Seeing Dr. C, an allergist in Ft. Lauderdale, I told her about my anaphylaxis experience in Chicago. As it happened, she knew a Dr. Zimmerman! A fabulous, brilliant, world-class allergist by now. Was it really the same doctor? We talked about him, and yes, it had to be the same one. Oh, she regretted not having him in medical school, she knew him from seminars and things she'd attended...

But, she wondered - why the German accent? He didn't have an accent. He was born and raised in America and sounded like any one of us.

Now, Dr. C and I had our differences, and her complete lack of a sense of humor didn't help. I use it and I need it, and a person without one can have difficulty communicating with people like me.

She said even putting on an accent for fun wasn't something she'd ever expect of Dr. Z. Did he only do it on that first appointment, where I'd been So Rude?, rude and demanding with this great respectable renowned allergist? --No, he talked that way every visit after that too.

She shook her head. I had a feeling she didn't quite believe me. A great doc does not do something silly like that, a childish little private joke. No matter how funny it is.

Dr. C and I, we didn't last. Just too incompatible. We saw things in life very differently from each other. In the long run it couldn't work out, and it didn't.

But I'd see Dr. Z again. In a heartbeat.

I'd tell him I found out about him, too. And grin.