An opening in my schedule allowed me to see a walk-in patient with an urgent “stomach problem.” As I entered the room, I noticed a pleasant-looking woman in no obvious distress sitting on the examination table. How-ever, her fearful voice belied her comfortable posture.

Annabelle, age 56, had been hearing a disturbing noise coming from her abdomen. She described it as similar to the sound a train makes, but very faint and brief. The symptom first ap-peared that morning, and she was understandably concerned.

As I scanned her chart, I saw that Annabelle had schizophrenia. I inquired about this, probing for any recent history of auditory or visual hallucinations. Annabelle reassured me that she was not just hearing things. I performed a thorough review, looking for any additional symptoms. She had no abdominal pain, nausea, vomiting, diarrhea, constipation, dysphagia, or fever. Other than hearing the sound, she was feeling fine.

I asked Annabelle how often the sound would occur, and she replied, “Every 37 seconds.”

“Every 37 seconds?” I asked inquisitively.

“Sometimes 36 seconds,” she said. At this point, I doubted the cause was organic. I was about to dismiss Annabelle's symptom, but since the noise occurred frequently, I said, “Let's listen. We may have been talking over the noise, but if we listen we should hear the sound momentarily.”

To my surprise, I heard the sound. And I heard it again about half a minute later. Was someone playing a practical joke on me? The sound was so faint that it was difficult to pinpoint. I auscultated her abdomen—no reproducible sound there.

I listened again to be sure Annabelle wasn't making the noise herself. I examined her clothes for anything that might make noise—still nothing. Annabelle then became concerned that she had swallowed something that was making the noise.

I scanned the room and finally surmised that the sound had to be coming from Annabelle's purse, which was on the floor. I asked for permission to inspect her purse and soon found her cell phone. We listened together, and sure enough, the sound was emanating from her cell phone. Apparently, she had had her purse next to her all morning and presumed the sound was coming from her abdomen.

Annabelle was extremely embarrassed. She confessed to me that she was worried about the possibility of having to undergo a procedure to remove whatever object was in her stomach.

I called a few days later to check on Annabelle. It seemed the battery power on her cell phone had been running low that morning, so it was making noise. Simply recharging the phone resolved the problem. Annabelle was very appreciative for the help in isolating the sound. This taught me that it pays to listen to all patients and not to make assumptions based on their history of mental-health problems.

 

Dr. Lee is associate clinical professor of family medicine at the David Geffen School of Medicine, University of California at Los Angeles.