Anne Dodge had lost count of all the doctors she had seen over the previous 15 years. She guessed it was close to 30. Now, two days after Christmas 2004, she was again driving into Boston to see yet another physician. Her primary-care doctor had opposed the trip, arguing that Dodge's problems were so long-standing and so well-defined that this consultation would be useless. But her boyfriend had stubbornly insisted. Dodge (a pseudonym, used here to protect the patient's privacy) told herself that the visit would mollify her boyfriend and that she would be back home by midday.

Dodge is in her thirties, with sandy brown hair and soft blue eyes. She grew up in a small town in Massachusetts, one of four sisters. No one had had an illness like hers. Around age 20, she found that food did not agree with her. After a meal, she'd feel as if a hand were gripping her stomach and twisting it. The nausea and pain were so intense that occasionally she vomited. Her family doctor examined her and found nothing wrong. He gave her antacids. But the symptoms continued. Dodge lost her appetite and had to force herself to eat; then she'd feel sick and quietly retreat to the bathroom to regurgitate. Her general practitioner suspected what was wrong, but to be sure he referred her to a psychiatrist, and the diagnosis was made: anorexia nervosa with bulimia, a disorder marked by vomiting and an aversion to food. If the condition was not corrected, she could starve to death.

Over the years, Dodge had seen many internists for her primary care before settling on her current one, a woman whose practice was devoted to patients with eating disorders. Dodge had also been evaluated by numerous specialists—endocrinologists, orthopaedists, hematologists, infectious disease doctors, and, of course, psychologists and psychiatrists. She had been treated with four different antidepressants and had undergone weekly talk therapy. Nutritionists closely monitored her daily caloric intake.

But Dodge's health continued to deteriorate, and the past 12 months had been the most miserable of her life. Her red blood cell count and platelets had dropped to perilous levels. A bone marrow biopsy showed very few developing cells. The two hematologists Dodge had

consulted attributed the low blood counts to her nutritional deficiency. Dodge also had severe osteoporosis. One endocrinologist said her bones were like those of a woman in her 80s, due to lack of vitamin D and calcium. An orthopaedist diagnosed a hairline fracture of the metatarsal bone of her foot. There were also signs that her immune system was failing; she had suffered a series of infections, including meningitis. She was hospitalized four times in 2004 in a mental health facility so she could try to gain weight under supervision.

To restore her system, her internist had told Dodge to consume 3,000 calories a day, mostly in easily digestible carbohydrates like cereals and pasta. But the more Dodge ate, the worse she felt. Not only was she seized by intense nausea and an urge to vomit, but recently she had also suffered severe intestinal

cramps and diarrhea. Her doctor said she had developed irritable bowel syndrome, a disorder associated with psychological stress. By December, Dodge's weight had dropped to 82 pounds. Although she said she was forcing down close to 3,000 calories a day, her internist and her psychiatrist took the steady loss of weight as a sure sign that Dodge was not telling the truth.

Trained at Dartmouth
That day Dodge was seeing Dr. Myron Falchuk, a gastroenterologist trained at Dartmouth (where he was in the Medical School Class of 1965) and Harvard. Falchuk had already seen her medical records, and her internist had told him that Dodge's irritable bowel syndrome was yet another manifestation of her deteriorating mental health. Falchuk heard in the doctor's recitation of the case the implicit message that his role was to