R had been my patient for over a year. She was referred to me by a colleague. She had 38 symptoms. All tests and imaging studies failed to find any demonstrable medical disease; I considered her to have “symptoms of unknown origin”.
I had little information on R’s personal and family history. I did know she was 43 years old and was 7 years into her second marriage. Her first marriage ended in divorce from a severe alcoholic husband. She had no children. She dwelled on her many symptoms and avoided all my attempts to gather more personal or social information.
Before I can share my full experience with R, I need to provide some back ground on my clinical thinking.