Transcript of 7th Session between Charles Balis, M.D. and Ms. Cassandra Evans, Tuesday, September 10, 1996 at 1 pm.

Ms. Evans: Hi Doctor.
Dr. Balis: Good day Cassie. How are you doing?
Ms. Evans: Gosh, I don't know. There is so much swirling around in my head. I saw Dr. Halsey again. Did he speak to you?
Dr. Balis: Yes. Why don't you tell me what happened?
Ms. Evans: I don't know where to start. Let's see...he went over some of the medical reports and his findings. A lot of that medical technical mumbo-jumbo that doctors are so fond of using, half of which I just drone out after time. Then he told me he had a diagnosis. I was so shocked and surprised! I mean, I have only seen him a few times. I have spent so many years seeing so many doctors, it seemed hard to believe that he could find an answer so easily and quickly. Anyway, I didn't know if I should cry or be happy or scream. After all these years to finally have a diagnosis--a name to put to all this stuff my body goes through! Of course, it's a relief. But I was almost scared to hear what he was going to say. As he probably told you, I have something called "Chronic Fatigue Syndrome." He promised me he would get some literature on it so I can learn more. He suggested I find a support group as well, so I can talk to other people who are going through the same thing. It's all so weird and overwhelming.
Dr. Balis: How much of the diagnosis do you understand? How do you think it will affect your life now that you have a diagnosis?
Ms. Evans: Oh, I don't know. There was way too much to absorb all in one sitting. Now that I have this, I want to know what I can do to fix it, to be better. I don't know what it means in terms of planning out my life goals. I don't even know if it is contagious. Or how I got this in the first place. I'd rather just know how to get rid of it. It seems I have more unanswered questions than when I started.
Dr. Balis: I think the idea of finding a support group is excellent. From what I understand, Dr. Halsey is doing some research into disease. I am sure you will get some of those questions answered quite soon.
Ms. Evans: I am so grateful that for all of his support, knowledge, and patience. I am confused about the name of this illness, though. Chronic Fatigue. Does that mean I just need more sleep? I know there are days when I feel like I can sleep forever, but it doesn't seem to get rid of my symptoms. Actually, I wouldn't even say fatigue is my chief complaint. Sure, it's annoying, and I am always so tired and wiped out. But there is so much more.
Dr. Balis: Well, Cassie, all three of us are new to this and will learn more as we go along. From what I understand, the fatigue is only one component of the illness. You also have some immune problems. Did he discuss this with you at all?
Ms. Evans: Yes, a little. But quite honestly, I don't recall very much. Shell shock, I guess. He said something about my white blood cell count being irregular. Is this related to AIDS? Isn't that the problem in AIDS patients?
Dr. Balis: In advanced forms of the disease, AIDS patients do have very low white blood cell counts. The virus slowly kills them off. I do not know if the mechanism works the same in CFS.
Ms. Evans: CFS? Is that an abbreviation for Chronic Fatigue Syndrome?
Dr. Balis: That's correct.
Ms. Evans: Hmm. Well, how will this affect my work? I got a letter from Ms. Bows the other day. I guess the office has noticed my absences. Now there is a letter in my file. I can't believe it! I do so much around there. I try so hard to do well at work, and now I have this haunting me. What if I need to take more time off from work in the future? I can't tell you how many times I have covered for people. Jeez! I wonder which rat squealed on me. I don't think Ms. Bows has that much of a problem with my work. When she does, she usually is up front about it. She will say something right then and there. Oh my! That reminds me. Did you hear she was in the hospital? I couldn't believe it! In the maternity ward, no less. Wow. I stopped by the hospital to visit her and bring her some flowers. She has always been kind to me, and I know what it is like to be ill. I couldn't get in to see her, but they said she had been admitted into the maternity ward. That is pretty cool. But she sure wasn't showing or anything. I can't imagine why she's there, but I just hope everything is okay with her pregnancy if she's pregnant. I wonder if she will take leave and for how long. I'm sorry Doctor. I am rambling and jumping all over the place with my thoughts, aren't I?
Dr. Balis: That is quite all right. Let's backtrack a bit. Have you had the opportunity to discuss the personnel letter with any of your supervisors?
Ms. Evans: No. Do you think I need to tell them about this CFS business? Come to think of it, I don't know how to tell anyone about it. What do I say?! "Hi, how are you doing? Things are pretty much the same. Oh, by the way, I have this disease called Chronic Fatigue Syndrome and the doctors don't know much about it...?"
Dr. Balis: I am sure we can work out some way to make revealing the news easy on you. Have you discussed your diagnosis with anyone yet?
Ms. Evans: No. I almost called Michelle, but she is due to visit during the last weekend in September. I would rather discuss it with her in person than over the phone. I don't know what to tell Brian. And my parents have been out of town this past week.
Dr. Balis: I would suggest you get an information packet on CFS from Dr. Halsey, or the Centers for Disease Control. That is the agency that Dr. Halsey contacted to get information on CFS. They monitor studies, research, track illnesses, etc. The more information you have, the easier it will be to discuss.
Ms. Evans: Okay. I guess I need to learn more. I'm almost afraid of what I might find out.
Dr. Balis: What is it that you fear learning?
Ms. Evans: That there is no hope. That I am going to linger like this forever. Weird, but I don't fear dying. Maybe because it seems so simple in comparison to the suffering. Not that I am considering suicide, Doctor. I want you to know that.
Dr. Balis: That's good to hear. Did Dr. Halsey explain to you this is a physiological problem and not a psychiatric illness?
Ms. Evans: Yes. It's nice to know that this is not "all in my head." I can't believe it. I'd love to take him around to every idiot who claimed I was making all this up!
Dr. Balis: Your knowing is the most important thing. We can worry about others later. Nonetheless, it is not uncommon for a patient with a chronic and disabling illness to suffer from some depression. It doesn't mean that it is a causative problem. It is quite natural--a normal response to an overwhelming situation.
Ms. Evans: I guess that is one thing that is normal about me! I have been doing a lot of crying lately. I can't help but feel a sense of helplessness when I think about my life. Do you remember that woman who used the assisted suicide doctor not too long ago? The one who I spoke to you about and had similar symptoms? She had this thing--this CFS. God, that is so scary! What kind of message does it say about this disease, my future, what I have to look forward to? What is to become of me?
Dr. Balis: I think she had some other problems on her plate. Besides, suicide is not a solution to your problem. Life will be difficult and challenging for you, Cassie. I won't kid you nor lie to you. Things may get worse, get better, or never change. It is a hard reality to face. But I can teach you many different coping mechanisms, and both Dr. Halsey and myself will do whatever we can to give you relief and support.
Ms. Evans: Can I have a moment... I think I am going to start crying again.
Dr. Balis: Of course. I don't know if Dr. Halsey spoke to you about anti-depressants, but I would like to try you on one. It should help you cope better.
Ms. Evans: Does it have any side effects?
Dr. Balis: Any drug or chemical you put in your body has the potential for causing problems. The package insert should describe the possible reactions and side effects. Look it over before you take it, and if you have any questions, you can always call me. I will start you on a very small dose and we'll see how you do.
Ms. Evans: Okay. That seems reasonable. Will it also help this nagging fear and impending doom I have?
Dr. Balis: It should enhance your mood, make you feel more upbeat.
Ms. Evans: Oh good. As much as I hate taking pills, I hate feeling this way even more. I'm sorry I have been such a pain in the butt.
Dr. Balis: You are just trying to come to terms with everything. That is not being a pain in the butt. Give yourself a break; cut yourself some slack, Cassie. This is a tough thing to deal with, especially at the beginning of your life as a woman.
Ms. Evans: I guess that is one of those "easier said than done" bits of advice, huh Doc? I can't wait until the weekend. I need a break from everything. I wish I could just run away and escape! Leave all my problems behind. I guess I'll get my chance when Michelle is in town. Meantime, I am going to soak myself in a nice long Epsom salt bath. Dr. Halsey said the Epsom salt helps to soothe aching muscles and joints. And I think I will play some cool music in the bathroom. A real "Calgon take me away" kind of night!
Dr. Balis: Sounds refreshing and relaxing. I hope it helps. You will have to let me know. Here is that prescription that we talked about. We'll see how you are doing next week, okay?
Ms. Evans: Is there some way we can talk without me having to come in every week? I think talking things out with you is really helpful, but now that I have to be more careful about work...
Dr. Balis: Tell you what. Why don't we make next week a telephone consultation at this same time. That should free up some time for you. How does that sound?
Ms. Evans: Very agreeable. But can we make it later on in the evening? That way I don't have to call from work.
Dr. Balis: That's fine. I usually work pretty late. How about 5:30 on Tuesday?
Ms. Evans: That's perfect. Thanks Doctor.
Dr. Balis: You are welcome. And since you're starting on a new drug, I want you to be especially aware of any changes in your physical symptoms, either good or bad. Always feel free to give me a call and talk about them, okay? Even if it's late at night or something.
Ms. Evans: I understand. I'll give you a call if I notice anything strange.
Dr. Balis: Good. Take care Cassie. We'll talk next week. Goodbye.
Ms. Evans: Bye.
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Button to Dr. Balis' Notes Doctor Balis' Notes on this Session
Button To Absenteeism Letter Letter re: Absenteeism

Button to Cassandra Evan's Transcripts Transcripts of Cassandra Evans' Therapy Sessions
Button to Cassandra Evan's Patient File Cassandra Evans' Patient File

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