New Haven Independent

Her new book, Every Patient Tells a Story: Medical Mysteries and the Art of Diagnosis (Random House), brims with the kind of compelling, puzzling, obscure conditions and diagnoses that television’s House and staff confront every week.

House, played on the Fox series by British actor Hugh Laurie, has the same fascination with taking an apparent muddle of symptoms and matching the pieces together like a puzzle.

Sanders, an assistant clinical professor of medicine at Yale, does that in real life, with real patients, and aspects of some of her more interesting cases could end up on the show. She is a medical advisor to the series.

Most of the mordant medical drama is fantastically unrealistic, Sanders said Wednesday evening at a book signing at the Yale Bookstore. But House, the sardonic, misanthropic, drug-addicted contrarian character, takes the “absolute right approach” to diagnosis, she said.

“Of course, the TV hospital has no nurses, and we don’t break into people’s houses. At least I don’t,” Sanders said.

Doctors also do not begin toxic courses of treatment until they are certain of a diagnosis. Patients on House keep receiving new treatments as the harried team of residents inches closer to a diagnosis.

Sanders, who lives in New Haven with her husband, author Jack Hitt, also writes a medicine column for The New York Times Sunday magazine.

Sanders’ serpentine route to the Yale School of Medicine faculty started as a TV producer for CBS and ABC. Sanders’ main focus was on medicine.

One day, during a piece on whitewater rafting, the crew was preparing for the “talent,” Dr. Bob Arnot, to whoosh around a corner and speak his first lines. The raft whooshed by, but there was no sign of the correspondent.

Sanders said she caught sight of him performing CPR on an elderly woman on the river bank. He saved the woman.

“I became a doctor because of that moment,” Sanders said. “It was an ‘Is there a doctor in the house?’” moment.

Sanders completed two years of pre-med studies at Columbia, and was accepted into the Yale School of Medicine.

When she started medical school, she planned on pathophysiology, which involves finding the causes and effects of disease.

However, she became captivated by doctors’ stories about their diagnostic adventures.

Diagnosis is under-examined and under discussed in medical schools, Sanders said. In earlier centuries doctors could so little but physically examine patients. The accuracy of their diagnoses made little difference.

Now physicians have CT scans, MRI scans, blood analysis, and a far deeper understanding of the human body.

However, many doctors now dismiss the physical exam, taking a history instead and sending the patient to be scanned in a machine.

Gregory House, she pointed out, rarely, if ever, actually touches a patient. “He works off of the basic story,” she said.

“Medicine is a narrative art, making facts into a story,” she said.

Often doctors will create stories that they can understand, but do not correspond well with the patient’s symptoms. Frequently, health care personnel will latch onto a certain symptom, while ignoring other results that they cannot understand or do not make sense to them.

For instance, a 44-year-old woman came to Waterbury Hospital with hot and cold flashes, a fever and a sore throat. Doctors diagnosed a case of Streptococcus.

Then the woman’s neck developed a bulge and white patches appeared on the back of her throat. She was treated with antibiotics and steroids, but the symptoms reappeared. Now her neck was swollen, she had a fever, and her right side was sore.

One of her doctors ran into a friend, who is also a physician, and described the woman’s symptoms.

“Oh,” the other doctor quickly replied, “I think she has Lemierre’s disease.” Bacteria from a previous case of inflamed tonsils migrated to the woman’s jugular vein and clotted. She spent two months in the hospital, but survived.

Then there is Crystal, a 20-year-old woman with a fever of 103 degrees and bright yellow skin. She was declining rapidly.

“She was dying for a diagnosis,” Sanders said.

Another doctor was consulted and he took a new history from the fading girl.

Crystal, the doctor realized, must have Wilson’s disease, in which the liver is unable to regulate copper. Instead the element builds up and is then released, attacking all organs. Crystal needed, and received, a new liver.

The symptom that confirmed the diagnosis? Crystal had thin, barely visible copper circles around the outer edges of her irises.

Sounds like an episode of House.

Hugh Laurie was kind enough to produce a blurb for the cover, and is really reading the book, Sander said with surprise.