The Unculture of Internal Medicine - Rolf H. Fricke - ebook

The Unculture of Internal Medicine ebook

Rolf H. Fricke

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Opis

The author was born in 1963 and is a psychiatrist and psychotherapist. For several years he has suffered from a rare and severe illness, during the course of which he experienced the behavior of several consulted internists as ignorant, illogical and callous. The author himself had to arrange for the necessary diagnostics, which led to a lung operation. Without self-medication, he would have suffocated. While conducting research in order to save his own life, he discovered shortcomings in internal medicine which significantly reduce patients' chances of survival. These shortcomings involve invasive fungal diseases, cancer and diabetes. He explains how the theoretical concept of type 2 diabetes is based on a semantic confusion. He recommends replacing the phantom of 'insulin resistance' with the concept of glucose resistance, which cells use to protect themselves from an overabundance of the cell toxin glucose. He proposes the diagnosis of type 2 diabetes be replaced with that of an eating disorder or eating addiction that leads to chronic glucose poisoning. He regards epidemic obesity as an addiction phenomenon and cultural failure. The author bases his structured argumentation on more than 220 scientific publications. His shocking personal experiences and the insights gained from scientific literature are summarized in The Unculture of Internal Medicine.

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Contents

Acknowledgment

Foreword

A few biographical anecdotes

Johanna and other interesting women

Fatigue in study

Sylvana

Family doctor 1, Dr. Jardinier

Fluconazole and Sylvana

Internist 1, Dr. Faulhaber, May 2011, Zwiesel

Internist 2, Dr. Bakker, June 2011, Molln

Internist 3, Dr. Visser, November 2011, Zwiesel

Sodium bicarbonate and invasive fungal infections

Stress, ketoacidosis and lactic acid

Dr. Visser, second appointment

Urologist 1, Dr. Bolt, November 2011, Molln

Dermatologists 1, 2, and 3, December 2011, Molln

Itraconazole

Internist 4, Dr. Bankmann, February 2012, Geneva

Fury at the internists

Biofilm, Pheromones

Urologist 2, Dr. Maurer, May 2012, Amsterdam

Posaconazole

CT, Dr. Engelbert, November 2012, Mödling, lung tumor

The Delusion, Psychiatrist Dr. Deichbogen

Zygomycosis

Surgeon Dr. Antonius, December 2012, Geneva

Lung surgery, January 2013, Geneva

Internists 5 and 6, Professor Becker, Dr. Wendysh, Geneva

Mycobacterium kansasii

Dreams

Occupational health physician

PET-CT, Dr. Lohmeyer, April 2013, Mödling

Green tea

Dermatologist 4, Dr. Jovanovic, Molln

Coffee

Internist 7, Dr. Lamprecht, 24 May 2013, Kent

Guidelines for invasive fungal infections

Mucormycosis in detail

Internist 8, Professor Montematto, Novara, August 2013

"Cheese" from the paranasal sinus

Internist 9, Professor Dalton, January 2014, Helling

PET-CT, Dr. Lohmeyer, February 2014, Mödling

Internist 10, Professor Callister, May 2014, London

Psychiatrist, August 2014, Zell am See

Urologist 4, Dr. Drake, late 2014, Grünfeld

Dermatologist 5, Dr. Blond, Grünfeld, January 2015

Internist 11, Professor Dock, Grünfeld, February 2015

Sylvana and the psychopaths at Hiccup.com

Dermatologist 6, Professor Ehling, end of 2016, Amsterdam

Chocolate, lecithin

Achievements of the internists

Strange experiences with diabetes mellitus type 2

Etymology Diabetes mellitus, Glycosuria

Definition Diabetes

Hormone insulin

Definition of insulin resistance

History of the treatment of diabetes type 1 and 2

Current status of treatment Diabetes type 2

First semantic confusion: the symptom diabetes mellitusbecomes the diagnosis

Second semantic confusion: insulin resistance versus insulin sensitivity

Third semantic confusion: diabetes types 1 and 2

From insulin resistance to glucose resistance

Glucose as a toxin: Glycation

Oxygen radicals

Methylglyoxal

Apoptosis

Fats as a toxin

Metabolic syndrome

Fat people should become fatter

Bariatric Surgery

Traditional lifestyles and overweight

Obesity and the brain

Physical activity and the brain

The Daily Mile

New concepts for diagnosis of diabetes and metabolic syndrome

Sodium bicarbonate and cancer

The Unculture of Internal Medicine

Epilogue

Bibliography

Acknowledgment

I would like to thank my parents for their support and help over the past six years – especially my mother, whose quiet and caring presence in recent months, has contributed significantly to the creation of this book.

I would also like to thank everyone who, wittingly or unwittingly, has helped me survive the past six years.

Foreword

Most of the names of people and places in the biographical chapters are fictional. Any similarities with living persons are in principle coincidental. Actual names are marked with an asterisk. In the biographical section, I describe my personal experience as well as the results of medical examinations. Names of persons in the medical chapters are original as far as they are the authors of the cited publications.

The reader may wonder why the book cites more than 220 scientific publications, largely from internal medical journals. The internists have encouraged me to do so. I am a medical doctor myself. The internists who I consulted over the last six years because of my illness told me so much nonsense and dismissed my concerns at the same time that I am now letting the scientific publications speak for themselves.

By chance, I have found three areas in internal medicine in which essential facts are ignored or not understood due to a particular culture within internal medicine. This has likely had drastic consequences for the mortality and quality of life of the affected patients as well as the medical costs of the treatment. In order to present my findings and conclusions based on profound evidence correctly, a sufficient number of relevant quotations from scientific publications are indispensable. The bizarre problem starts with the fact that internal medicine fails to deal with the concept of the hormone and chases the phantom of hormone resistance. I was frightened by the logical aberrations in internal medicine, the extent of which I could not have imagined in my worst nightmares, especially in the area of "type 2 diabetes".

An attempt to discuss the scientific publications with internists would inevitably fail for various reasons. First, I do not know whether I still have the time for a scientific publication. Secondly, it is unlikely that a journal of internal medicine journal will accept the hypotheses of a psychiatrist regarding an internal issue. Thirdly, there is a high probability that a single article that calls into question essential parts of the theoretical concept of type 2 diabetes will be lost in the flood of thousands of other publications.

At first sight, it seems peculiar to describe a biographical history together with critical considerations of the concepts from three different groups of diseases in one book. I have united them for several reasons. First, the individual little stories would have addressed at most only very small groups of readers. Combining the stories thus seems to me to have a bigger chance of gaining a much wider readership. Secondly, each of the individual stories described in this book is an expression of the very specific culture of internal medicine that I had to learn.

The purely medical chapters are certainly not interesting for every reader. For this reason, a very accessible section entitled "Summary and Interpretation" is included at the end of each chapter. For the sake of clarity and legibility, medical terms have been replaced by simple terms.

A few biographical anecdotes

This book seems crazy. It's not crazy; the circumstances are crazy. I am a psychiatrist and a psychotherapist. In the psychotherapeutic training, an older, more experienced colleague said to me: "Rolf, if everyone is crazy, you are the last one who is still sane." I did not know then what he meant. Over the last few years I had to learn it.

I need to write down my story, I guess because it is so insane that you probably won’t believe it. This all seems outside the realm of possibility. I should have been dead a few times. Maybe my story will enable others to have a better experience than mine. And this book contains more than my story, it is part of a survival strategy.

Since the end of 2011, I have been so sick that I cannot work. I felt better sometimes, sometimes worse, and sometimes I was almost dead – as if I was dissolving. I had to prescribe the drugs myself. Filling prescriptions is a bureaucratic act, so it helps to survive being a bureaucrat. Without drugs I would have been dead since 2011.

A few times I have written down some of my experiences. I should have kept a diary but I could not; I did not have the energy for it. I escaped from the reality with computer games, thus killing time. I also sat in front of the computer eating, as I could not stand to think about reality. I have to go a little further back in time to explain how everything is related.

My life has been marked by contradictory experiences. It was only in the last few years that I understood the cause of the contradictions. My mother had told me at some point that I was a chubby, healthy baby until I was one and a half years old. Then it was very hot in the summer and I got very sick. From that moment on I was skinny and often pale. My mother said I looked like the suffering of Christ.

At the age of five I was examined in the children's clinic because I was sick and vomiting so often. One doctor suspected meningitis, but could not detect any infection. They concluded that I had acetonaemic vomiting. When one is hungry, the body's glucose stores are sometimes quickly emptied, and then only fats are burnt, leading to an excess of ketone bodies, one of which is acetone. If one has too much acetone in the blood, it leads to long-lasting vomiting. The acetone smells like cider vinegar. The reason for my hunger was fungi in the intestine. At that time, nobody knew it, I understood it just a couple of years ago. The fungi had eaten the carbohydrates in the intestine or the glucose in the blood.

Before I even started school I had taught myself to read. I had asked my parents what the individual letters meant and then put them together. When we went on vacation, just before my sixth birthday, I read the road signs and the names of the hotels and shops in the holiday resort. My parents had never encouraged me to learn to read, and they were themselves surprised. I was simply curious about the world and could better satisfy my curiosity and participate in the secrets of adults by reading the world.

I did well at school and sometimes was the best pupil. I did not have any problems, except for memorizing poems. It was a disaster every time and it lasted forever. At home I read a lot, mostly several books at the same time, which I could strangely remember. I read so quickly that my brother could not believe someone could read so fast. Other children who had lent me books of fairy tales when I was on holiday with my grandmother were quite amazed when I said I had finished them all

A few anecdotes from my childhood are still told by my parents at family celebrations today. My father was always an avid skier, so I first skied when I was 4. I sped down the mountain, crashed, and disappeared into a great snow cloud. My father feared there would be loud whining, but as the snow settled again, I looked at him and asked: "Dad, can I take pictures with the camera?" My grandmother liked to watch funny movies with me with Louis de Funès, because I laughed so hard.

Johanna and other interesting women

Puberty came very late for me. I was the last with fluff on the upper lip. At 14 I was nearly the shortest in the class, but at 16 I shot up to 6 feet. Unfortunately, I remained scrawny. Around that time I talked to a girl from my school at a disco. She stood out because of her long blonde hair that went down to her hips. I brought her home that evening, although it was quite far. I was constantly trying to see something in her face, which was hardly possible because of the quantity of hair. We met a few times afterwards, and she invited me to her place. She had big, curious, and alert blue eyes that looked directly at me, a slightly curved nose, heart-shaped lips, and cheeks that accentuated her round face. She was called Johanna.

I was proud. I thought that I had my first girlfriend. We met a few times over a couple of weeks. I was overwhelmed by her. She was too much for me: emotional, creative, fast with her feelings and thoughts, then sober and pragmatic, and extremely talented. She was like from another star. I just staggered about her and admired her although she was almost two years younger than me.

There were no kisses, no sex. She was playing the guitar; I sometimes only sat with her and listened to her playing the classical pieces perfectly. She was excellent, the best guitar player of her age class far and wide. She had a special talent to create closeness. I felt comfortable with her, and the music she played was a revelation. During the holidays, she ended the relationship by letter, writing she had not yet experienced anyone who was so intelligent and at the same time so empty. I had always only listened to her, and had not brought anything to the relationship myself. This is not a mutual relationship.

We had only been seeing each other for a few weeks. I was concerned, but felt that she was right in part. I could not describe it further, but I would have liked to have known why I was often so tired and empty. When I was with her, I was passive all the time, and had no ideas about what to do.

I still went to her house. Her parents liked me and let me in. Her father George even invited me to play a game of chess. I checkmated him in the middle of the chessboard. He was completely perplexed – he was a practiced club player. He looked at the board and said several times: I didn't see that. This must have been a special event in the family. Twenty-five years later I met Johanna’s younger brother Patrick at a family event. He was still impressed by the fact that I had won against his father.

Johanna was irritated by my visit, perhaps afraid of me, of the drama. She did not want anything from me. But I did not cause any drama. I left the apartment after the chess game with her father. I did not speak to her, only to briefly say bye.

George invited me to his chess club after the lost game. I went there for a few months. Sometimes I won with bravura, but then I sat completely uninspired before the board. Once the chairman of the chess club had noticed how I had won against a regular player and he was excited. Until then, I knew very little about chess theory, and I had only played at home from time to time against my brother or father. After a few months, I gave up; I was too tired in the evening. For me, my winnings were not that special at the time. I saw it as just a game; sometimes you win, then sometimes you lose.

Johanna and her father both had something striking in common: they moved with measured movements. No movement was superfluous; they moved like dancers, perhaps gymnasts, without ever actively practicing. They moved like trained martial artists, gymnasts, or ballet dancers, without any superfluous movement. Few people are able to learn to move in such an extraordinarily precise way.

Later, I went there perhaps once or twice a year. She was no longer afraid of me, and I became someone with whom she chatted. Once in the summer, it was warm, and we lay together on her bed. Yes, that actually happened. She lay with me on her bed and we chatted. I did not touch her. I was glad I could be with her, and I did not want to ruin it. I also knew that she did not want a relation with me.

Then, all of a sudden, she sat down on me. I was completely taken aback, and she obviously was too. She stood up and said to me, "You have to go now" and pushed me to the door grinning. It all happened too quickly for me to do anything but obey. Of course, I understood what had happened; it was warm, and as were side by side she suddenly became aroused. But she did not want to have sex with me. The next time we saw each other, we did not talk about it.

Once when I visited Johanna, her mother opened the door and let me in. Johanna had a migraine and was lying in bed in her darkened room. There was not much to talk about. I sat next to her bed, and wanted to do something to help her. Spontaneously I began to massage her face with two fingers, slowly, gently, and with tactile pressure. She closed her eyes, said nothing, and did not move. When I stopped, she said, "You could do anything with me now." There was only amazement in the low voice. I sat a few minutes beside her before I left.

At school the pictures painted during the art lessons were regularly hung up on the wall. Regarding one of my paintings, a teacher said that I would have a painting style like Caspar David Friedrich. I then looked up Friedrich to see who he was. When I saw the pictures of his work in the art books, I felt the teacher's remark was a huge compliment. My painting meant more to me than chess because such a picture is mine, it remains. Others can see the picture, and I am visible in it. A chess match is quickly forgotten. I saw Johanna by chance as she looked at the picture I had painted with two of her friends. I did not address her, but went out in the dark hallway. I had not even finished the picture; I was too slow. We were no longer together at this school, as she moved to a school closer to her flat.

Beside my passivity and sometimes lethargy, I had another problem that hit me while I was studying: after eating I was often in a state that could best be described as vegetative. I could still orient myself, move and do simple tasks, but I could no longer conceive of complex connections, let alone flirt, make funny comments, or show creativity. It was as if I were drunk, without being swayed or loosened. It was like I was in cotton wool. I went to see a doctor about this, but he could not find anything.

Because of this physical and mental incalculability, a very important date with Anne went wrong. She was a schoolmate from a parallel class during secondary school. She had very long black hair, big interested brown eyes, and an open and lively face. She was always friendly, open, and attentive, and she was undoubtedly intelligent. She was exceptionally attractive and had a very feminine appearance. I spoke to her at school and invited her to a classical music concert. I suppose I was relatively calm during the invitation. She looked at me directly and accepted, without thinking for a long time.

I like it when a woman looks into my eyes. This creates closeness, and I feel that she is focusing on me. It shows that she is self-confident and not frightened. When a woman looks past me towards somewhere else in the room, I feel like this is a refusal.

Before the concert I ate a lot because I did not want to sit beside her in the concert with a growling stomach or not be able to concentrate because of hunger. There were no problems in the beginning, but then she asked me a question during the break and for the rest of the evening I was silent. My head was empty; I could not think.

The question was: "What else do you do?" It was an easy, simple, normal question for such an evening, something to start conversation. I could have answered that I read a lot, play chess, go sailing on the weekends in the sports club. I could have mentioned that you can sail well in Geneva. It should not be hard to give a proper answer. But, I could not say anything and I did not know why. My head was empty. All night. I was excited, of course, but not so excited that I should have had a blackout.

I was not shy or anxious. If necessary, I could also be stubborn or challenging. Until then I had thought that I would decide how I would make contact with someone. I remembered that a similar thing happened to me a few years ago. One evening we had a small program at school for the parents and I had suddenly forgotten my poem. I could not understand it, just like the emptiness in my head that evening with Anne. She was annoyed that evening, of course. The next morning when we met in the school, she was still troubled.

I had learned that there were situations in which I could not rely on my body and mind, and I did not know why.

A few months later, our class performed in the auditorium. A classmate had adapted a book for the stage. There was a male lead and a chorus. I played the lead role, but in the rehearsals I was not good. I had trouble remembering my lines. I saw the doubts in the faces of my classmates.

At home I tried to put myself into the position of the main character. It was about a man in his late thirties who had just lost his great love during childbirth. I was 17 and, of course, had not experienced anything like this. I felt despair, pain, emptiness, and fear. I wanted to play such a role quietly, with restraint.

The auditorium was full and Anne was sitting in one of the first rows. When we started, it was quiet. Then it was very quiet. Out of the corner of my eye, I could see some people had pressed their backs nervously into their chairs, holding their breath. I had no problems with the text. I sat on the stage and felt like a man twice my age who had just become lonely. Everything else was unimportant. And it worked. The performance was a success.

The classmates congratulated me, saying "such shit rehearsals and then this performance..." Over the next few days I was approached by other pupils, who were all impressed. What I did not know then is how I could thrill 500 people but fail on the date with Anne. It had something to do with the fact that the performance was in the late afternoon, a few hours after lunch, while the date with Anne was shortly after dinner, which made me "blackout". The answer to the puzzle follows.

In the 12th grade, I was in an advanced art course. We were to make a bust of clay. Anne presented herself as a model. I was reserved and did not speak to her It was like a superstition; if I were to speak to her, I might "blackout" again, so I was completely quiet. She did not speak to me either. I met her years later at the end of my studies at the university. She came with her daughter who was perhaps four years old and inquired about the examination dates. I greeted her kindly, and she greeted me, looking embarrassed. This did not fit in with her usual even-tempered charisma.

A few months after the flop with Anna, I began talking to Henriette. This time I did not experience any blackout. Henriette was not as sophisticated as Johanna, and I was enough for her as I was. However, at the time I felt a bit better than I had a year and a half before. Henriette had long blonde curls, green eyes, was funny, creative, and made jewelry from wire and small shells. We had fun together, and the sex was good, passionate and long. Nevertheless, I ended the relationship. I did not feel close, did not want to continue the relationship just because of sex. I had the feeling I would exploit her, that she would merely be filling the gap until I met the next woman with whom I would feel this closeness.

During my military service, Johanna visited me once and I was glad. I thought that she had changed her mind about me and now wanted a relationship. She said her mother had sent her and that made me go silent. She was in a stupid situation, as was I. We spent the remaining hours until the evening train silently walking through the city.

When I began my medical studies, we met again in the same lecture theater. She came near me, and talked to someone beside me. I did not speak to her. I tried to avoid her, remembering the last meeting. I was still in love and did not want to get rebuffed again. At some point, an informal contact arose; unknowingly we both accepted a temporary job at a convention.

For the first New Year's Eve during medical school, I had a party and invited Christine, her sister and a few friends. Christine was a classmate of Helena. Helena had learned guitar together with Johanna, so she was almost family. The New Year's Eve party was a complete success. Christine stayed with me overnight, which astonished both she and her sister. I had not asked her if she wanted to stay. She was not drunk. In fact, no one was drunk at the party. That was not our style.

There was more than just one night. Christine studied in London, which was a few hours’ train ride from Geneva. After a few months, the distance was too tiring for me. I did not want it any longer. I would rather have had a girlfriend where I was studying. However, I quickly realized that – apart from Johanna, who did not want me – I wasn’t really attracted to anyone in my environment. The weekend relationship with Christine then went well until the end of my studies. She did not feel much of my tiredness, as I had no stress on the weekends. Only sometimes I had a weak episode after a meal. I must have looked quite bad because she was also frightened.

We got married in the summer of 1989. She was just finished with her studies. I still had to complete my internship at the hospital to get my license to practice. She was five-months pregnant and was showing. A fellow female student came to the celebration. She said she who would like to be my slave. At the time I rejected the serious offer, which I did not like. She came together with a friend; they had fun, it was nice, and there was no jealousy.

And Johanna came. I was surprised, I had not expected her. She was also pregnant, just as far along as Christine. She came alone. She was curious about Christine and talked to her. They were standing in front of me, stretching their pregnant bellies and chatting. Christine had a tomato in her hand, bit into it, and spattered Johanna with the tomato juice. Johanna took it well. I had the impression that Christine felt unsure about Johanna, and that I was better off. Christine was not as creative and lively as Johanna, but that's why Christine was a better fit for me. I just had too little energy for very lively women.

She knew the story of me and Johanna certainly from Helena. I had also told her about Johanna but really only briefly. Yammering to one’s girlfriend about a former partner is foolish. I had no problem presenting my former girlfriends; there was no reason to hide them. Christine had also seen a large photo of Henriette. She had only looked at it briefly, looked at me and said "Yes". It was approved and granted, so to speak.

And then I saw how Johanna was sitting on the sofa next to my mother, talking to her excitedly and saying she had to come alone because sometimes it was a bit difficult with her husband. I did not want to hear that now.

Johanna visited me and Christine soon after she had her son Jörg. Just barely a year later, she and her husband Olof and Jörg came around. Her husband was extraordinary, intelligent, fast, and played several instruments. Physically he matched petite Johanna, as he was medium-sized and lean. And he doted on Johanna; he could not be without her. Johanna probably thought that a friendship could be established between the couples. It did not work, however, not between her and Christine or between Olof and me. After a few years, they separated. I do not know why, and did not ask her. I thought that was not my concern. Olof died in 2016.

I was sure that I wanted to become a psychiatrist before I graduated. At the age of 18, I asked myself why people did things that contrasted with what they said and they thought. I thought that I would best be able to understand this as a psychiatrist; the alternatives of physics, philosophy, psychology, and acting appeared to be less productive ways of answering this question. I believed that psychology, in practice, neglected the biology of man.

I realized at the end of my studies how strange it was that Johanna also had became a psychiatrist and had chosen courses similar to my own in the postgraduate studies. I have read the reviews that patients have written about her on the Internet. They correspond with my experience of her: she can listen well and creates a sense of closeness, familiarity.

After my separation from Christine in 1997, I saw Johanna perhaps a few times. One of those times was when I was looking at whether I could open a practice in Geneva. Her mother had provided me with many tips concerning the organization of a practice. I then gave up the idea of having a practice. I thought I could have a career in a clinic.

After the separation from my wife, I was alone. I had sex only two times in a short and superficial relationship. I had been chronically tired for years and I did not know why. I had just enough energy so that it was possible for me to do my job; a relationship with a woman was not possible. At least not with a woman I would have liked. They are not attracted to inert and tired men.

I had tried it in 1999. A few days after a one-night stand, however, I was called by the boyfriend of Franziska in the middle of the night. He asked if I would not help him look for her because she had not come home in the evening and he was afraid that she would attempt suicide. I had some doubts about my competence as a person and a psychiatrist. I had seen nothing that seemed suicidal about her. It was clear to me that she was not suicidal. She was curious, and had talked to me for two hours, which would be very unusual for someone with suicide intentions. It was only when I wrote this book that I realized that he had probably found my phone number in her mobile phone. He had probably learned from her that I was a psychiatrist and had tried to lure me out on a pretext.

I met Franziska for the first time at the city opera, the Rocky Horror Show was shown, a small sensation for the remote, provincial town. Tickets were hard to get and the room was packed, of course with a full program, toilet paper, popcorn, etc. I spoke with Franziska during the break, as she was alone. We arranged a meeting after the end of the play. I offered to drive her home, but we stopped on the way and talked for quite a while. I had the impression that she did not want to stop talking to me. She had not told me where she wanted to go.

So I asked if she wanted to come home with me. Yes. It was peculiar. She wanted proximity and sex, but her skin remained cold. Occasionally, she would mention her boyfriend, which I found strange. She seemed uncomplicated and there was no sadness. I felt rather like I was being curiously observed. She did not stay too long. We met a second time, but then never again. There was no emotional connection.

After that, I had contact with some women superficially. A few were clearly interested at first, but then it did not work. I was too slow, sluggish even. I had no idea what was wrong with me.

I met Johanna for the last time probably in late 2008. I do not recall it exactly anymore. She had been with Folke for a couple of years and they had a daughter. Folke had a reddish beard. He was above all calm, cozy, and kind, someone who was immediately sympathetic and unpretentious. With him one could surely survive several months on a mountain tour. Johanna had met him as a colleague in a clinic during the training. I guess he was not very musical, which seemed to be very important for her with former partners. In the meantime, Johanna had also played the piano and the cello.

I had told her that I had problems with a fungal infection in the bowel. I was doing so poorly that I would not eat anything of the chocolate I had brought with me. I still thought at the time that it would be over in a few months. And then I said that I would just have to find a woman who would accept a half-sick man. I looked at her longingly, while Folke sat next to her.

I knew immediately that I had made a mistake, but I was so weak that I could no longer control my words and facial expressions. I said that was never very lively anyway, so nobody would notice when I was a little quieter because the force had left me.

I watched as the anger rose in her. She sat straight up, her back was taut, her shoulders pulled back, the corners of her mouth were dropping, her eyes narrowed. Then she told me something that she hoped would hurt me. It was like a code for both of us, but for Folke it was a casual remark that was totally unrelated to what I had just said. She wanted me to go, and told me in this way, indirectly. She started practicing cello with her daughter, and then I lef

Fatigue in study

In the afternoon, I often felt bad during my studies. I was like I was wrapped in cotton wool after lunch, but had no idea why. I had the impression that it was particularly bad after potatoes or noodle soup. I fell asleep in the library on the books. It took all of my energy to stay awake while doing training in a laboratory. I did not dare to sit down. I failed some tests completely and had to retake them. Fellow students thought that something was not right with me, as I sometimes appeared sparkling in conversation, witty, and intelligent, while at other times I seemed to be pretty dumb. They were amazed that I sometimes failed spectacularly an examination. I therefore went to a doctor, which changed nothing.

After finishing my studies, I wondered why I was so tired after eating. Moreover, I was always hungry. Although I ate a great deal of food, I was still thin and had diarrhea. I had the idea that I might not have enough enzymes of the pancreas to digest the food and that therefore my bowel movements were regularly so plentiful because there was hardly anything digested in my gut. After I became a doctor, I wrote a prescription for myself and took pancreatic enzymes. The effect was overwhelming. I gained 5 kg within a short time. I was less tired after meals and the diarrhea was only after drinking coffee. I went to a gastroenterologist and told him about it. He looked at me sharply and said there was something wrong, as I was taking more of the enzymes than patients without a pancreas. There really was something wrong.

I noticed that I had constantly tense abdominal muscles, which was causing my entrails to collapse. This was still a reaction from the acetonaemic vomiting as a child. Maybe the diaphragm was cramped too and I had not noticed it because I did not know otherwise. And this muscle tension was still unconscious. Over the next few days, I did some relaxation exercises. After 14 days, I had thus reduced the tension in the abdomen so that my guts were now no longer under pressure and the digestion was closer to normal. I no longer needed the extra enzymes and I continued to gain a few kilograms. I was less tired after eating. It was not clear at the time that this had been the reason for my frequent blackouts over the years, during my examinations, with Anne, and at the poetry recitals at school. I only realized the connection when writing this book.

From then on I had a few good years and I could work relatively normally. In the previous state, I would not have been able to spend the years as an assistant physician with the frequent services and regularly putting in 50 to 60, sometimes 80 hours of work a week with two children.

Because I wanted to know if my dizzy moments might have a psychological cause, I took a personality test, the PF-16 with 16 personality factors. With 14 factors I was in the normal range. In the areas of abstract thinking and openness to change, I was far above the norm. This did not explain the blackouts at all.

At this time I usually fell asleep with my children when I put them in bed, reading stories and cuddling. The oldest son was born in 1989, the youngest in 1993. For me it was important that my children went to bed on time. I loved it when they woke up cheerfully without alarm clocks in the morning. I cannot stand it when children have tired eyes because they have gone to bed late. Tired children are unfocused, inattentive, irritable, and distraught. I regard this as neglect and child maltreatment.

I had a lot of fun with my sons in the years up to 1996. Grandma asked the older one when he was five, who is more fun at home, mom or dad. It came spontaneously with an enthusiastic look to me: Daddy. That was nice.

The reader may by now be wondering why I had not gone to the doctor immediately, without trying the enzymes. The reason is that I had too often had the experience that physicians could not find out what was wrong with me or drew conclusions that later turned out to be incorrect. That is why, before a doctor's visit, I attempted to narrow down the problem as much as possible in order to achieve a result with little effort. Many previous medical visits had been unsuccessful and I don’t know why I got well. It is frustrating to be in the hospital several times for two weeks and then be dismissed, without the doctors knowing what the reason for the health problems actually was. Ultimately, I had found the solution with the help of the gastroenterologist. I did not tell him, though as I did not think he would care, and he seemed to be reserved at the appointment.

Sylvana

In the fall of 2002, I moved from Onedom to Twodom, as I hoped to have better working conditions and better pay in Twodom. I also had the impression that there were certain legal regulations in Onedom that were particularly detrimental to psychiatric patients. Since I wanted to build a social life quickly, I signed up for a volleyball club after a few weeks.

This was not tolerated by my Achilles tendon, which tore and had to be operated on. After that, my general performance slowed down. It got so bad that by about 2007 I had difficulties following meetings at work. It was all too fast for me. I became more and more silent in the discussions and only did what was absolutely necessary. I could follow talks with patients. It was not so stressful, as it was just me and the patient.

I had a job as a psychiatrist in Twodom, where I was employed by a foundation that had several branch offices for inpatient and outpatient psychiatric treatment in the government. In September 2008, a psychologist joined our team for one year of training. On the first day I could only see her from a distance. She was slim with long blonde hair. Her body language was striking. It was the first time in my life that I was so overwhelmingly surprised by the karma of a person. Even though her facial features were hidden by shadows and barely recognizable, she impressed with her energetic forward steps. The power of her balanced body posture exuded a feeling of satisfaction and self-assurance.

When I saw her two days later in the team meeting for the first time close up, I was frightened. The first idea that ran through my mind was: I'm too old. I did not want a relationship in the company. I had noticed on several occasions that the dangers of a relationship at work are bigger than the emotional gain. But this woman was so impressive, beautiful, and lively that I thought for the first time in my life that nothing would happen between us just because I'm too old.

She introduced herself as Sylvana Serra. She had a round, almost childishly naive face and thus innocent-seeming expression. Her bright blue eyes curiously looked at the assembled people. She knew that she was the main person at the moment. She knew in these moments that one was flabbergasted by her beauty, but she smiled the amazement away. The immediate expression on her face was fascinating. It seemed as if her feelings were directly visible from her face. It was as if her soul could be an open book for everyone. I thought that someone who shows her feelings so openly cannot lie. This face lived. It told stories. I could have watched for hours and it would not have bored me. I tried to look away because I was afraid to stare at her. I wanted to spare us both the embarrassment.

In addition, her resemblance to Johanna was astonishing, with the proper elegance of her moves, her blue eyes and long blonde hair. She was just as slender as Johanna. After 30 years, and about 15 years younger, here was a woman who was so damned like Johanna, sitting in front of me. And was at the same time she was the gentlest woman I ever met. That was too much for me. I could only deal with her by avoiding her. In the meetings I looked at her as little as I could. I did not address her.

I did not want to be in danger, or make myself ridiculous because I found it unsuitable to bother a twenty-year-younger colleague with my emotions when I was 46 years old. She was supposed to be training with us, not solving my loneliness. Also I felt that flirting with female colleagues during training was abusive. Fortunately, I was not responsible for her education; the psychologist Manuela was responsible for her. At a team meeting when Sylvana was absent, the others talked briefly about her extraordinary beauty. I did not say anything. I thought they would immediately notice my amorousness. I did not want to betray myself. That would have been embarrassing to me.

Besides, I was plagued with my own problems. I was busy with the fungal infection I had mentioned earlier. I've suffered had anal itchiness for years, especially at night when I lay in a warm bed. During the day I had no itch. It disturbed my sleep terribly; sometimes I lay awake for a long time. I had tried many things against the itching without success, including creams. Then I came up with the idea that it could be a fungal infection. So then I used Canesten, a cream that fights against fungal skin infections, and it got better. As a student I once went to a dermatologist because of the itch (it was then less disturbing), who said only with a resigning and commiserative shrug, without throwing a glance at my butt: "Oh, I cannot help you at all."

I had already informed myself and had read stories online about people with fungal infections whose doctors had ignored their problems. So they had helped themselves with diets and had gone better. I started the diet, which was mainly about avoiding carbohydrates that are easily digestible, such as sugar and noodles and soft potatoes. I had eaten mainly harder rice, which slows the release of the carbohydrates into to the blood stream. It did not make me much better. On the contrary, after a few weeks I became weak, jogging was no longer possible, and during the day I was sometimes so weak that I began to tremble. So I stopped the diet.

Family doctor 1, Dr. Jardinier

Because of the anal itchiness I had used Canesten for a few months and the itching had disappeared. But it only worked as long as the cream was on the skin. Normally the treatment is finished after three weeks of application of Canesten. By then the skin has completely renewed and all fungi and fungus spores have been killed by the antifungal cream with the outgrowing skin. This did not work for me. Each time after the cream was discontinued, the itching resumed. My conclusion was that the fungus had to be coming out of the intestine. How else would the inflammation flare up again every time?

I went to the family doctor, Jardinier. He first thought of examining my stool for parasites, worms and such things. But I was free of parasites. After the parasite search was unsuccessful, Jardinier contacted a microbiologist. He said that he could no longer detect fungi in the intestines because I had a diet which would work against the fungi, so a test would be useless. And, according to the microbiologist, I must be healthy.

But I was not healthy. The itching relapsed all the time. For Jardinier, however, the issue was solved. He had heard it personally from the microbiologist that the case was closed. But if the itchiness come back despite the long-term use of anti-fungal cream, then I must have fungi in the intestine. Where else could it come from? Since I did not want to smear my butt with cream forever, I decided to take antifungal drugs, tablets or medicinal juice.

I knew nothing about the treatment of fungi with medicines, except for the treatment of the skin infections with Canesten. But what else should I do, since for the family doctor the case was finished and he did not want to do anything else? In the meantime, I moved and therefore I had to find a new family doctor, Dr. König. However, I saw no chance of influencing her so that she would take further action.

The antifungal drugs nystatin and dactarin had no effect, none. Nystatin is in principle not absorbed by the body, as well as dactarin (myconazole). It occurred to me that the fungus might not be directly in the intestine, but perhaps in the intestinal wall. Therefore it was necessary to find a drug which is absorbed by the intestines of the body. It should also cause as little side effects as possible.

Fluconazole and Sylvana

Fluconazole is just such a drug. One should take a maximum of 400 mg per day. Fluconazole belongs to the group of triazoles, whose active principle is to inhibit ergosterol synthesis in mold fungi. Fungi need ergosterol to build their cell wall. In bacteria and animal cells, cholesterol has the same function as ergosterol. It serves to stabilize the cell walls. As they do not have any ergosterol, bacteria and animal cells are not affected by Fluconazole.

After a few days, I was surprised by the improvement in my condition. The anal itching was gone, I felt more alert, and I could think more clearly. After work I could do several things in one day. For example, I could go food shopping and afterwards go to the computer shop. Previously that would not have been possible. I had to plan shopping trips several days in advance, as only one action was possible on a work day. I noticed that at the checkout I was not completely absorbed with the packing or paying. I could chat with the cashier a bit at the same time, without losing the overall control.

I had not experienced this for years. At work I got faster. I once again understood what my colleagues were saying during the meetings. After a few weeks I could tell jokes that would make my colleagues laugh. That was new. My last humorous remarks had been made within my family more than ten years ago. When I talked at work, I seemed to have mutated into a kind of lame ghost. Even Sylvana once said to me that she thought I was new because I hardly said anything when she started working with us.

I began taking fluconazole around the time that Sylvana arrive. So the change was noticeable for her – but of course she did not know the reason for my awakening. Therefore, without fluconazole, she never would have even noticed me and all the things that were still to come would not have happened. I thought that a few weeks of fluconazole would be enough. This is generally also the case with bacterial infections. So I took the fluconazole for a few weeks and noticed a steady improvement in my condition. The diarrhea was gone, just gone. Each time the fluconazole was discontinued, however, it became worse again. So I continued to take it, stopping a few months later again because I hoped to be healthy. I was not.

Sylvana had been working with us for three months, and so far I had been able to avoid her. Until one day she was standing behind me in the doorway. She asked if she could disturb me. I was busy writing on the computer, said briefly, "Yes, no problem, sit down" and finished the sentence. She sat down at the small table, I turned my chair toward her, and was startled – at least the top three buttons of her blouse were undone and her bra was pushing her small breasts almost out of the plunging neckline. I wondered how she could even do therapy with her male patients, because no man could focus with such a view in front of him.