It started years earlier, the older woman told her. Almost every night, she would get these crazy fevers. First came bone-rattling, shaking chills; she couldn’t get warm even under a pile of quilts. Then suddenly she would be roasting hot, with sweat pouring off her. Her temperature would spike to 102 or 103. And her whole body would hurt, right down to her bones. She popped Tylenol constantly just to keep her fever down.
Then an hour after the fever hit, she would start to feel sick and throw up until she had nothing left in her. This happened almost every night.
During the day, she felt weak and tired, and her bones hurt. It made any movement painful. Her doctors called it fibromyalgia. She also had a rash. Hives, the doctors told her. It didn’t itch, but no one could figure out why she had it. And, her daughters added, she had no appetite. The very thought of food made her want to vomit, the older woman told May. She’d lost over 80 pounds this past year.
A Deep Dive Into the Records
May could see how the patient’s clothes, eyes and even skin looked a couple of sizes too large. Otherwise her exam was uninformative. She didn’t have a fever, and she didn’t have a rash. May told the patient she would go through the stack of records and come up with a plan.
Reviewing them, May saw that the patient had a persistently elevated white-blood-cell count. Normal is under 10; the patient’s was at nearly 20 — and had been for a couple of years. CT scans showed enlarged lymph nodes throughout her body. These findings could be from a chronic infection. Or from a cancer. But her hometown doctors found neither.
May decided to think about illnesses that her first doctors hadn’t tested for. The woman needed to be checked for H.I.V.; patients over 55 are thought to make up a quarter of all cases — diagnosed and…