She was involved in a minor car accident three months earlier. Could that somehow be the cause?

“I feel just horrible, and no one knows what to do,” the 21-year-old woman sobbed to her father. In one hand, she held her phone, in the other, a red Solo cup. The pungent smell from the vomit-filled cup wafted through the room. Despite her best efforts, the strange lightness she felt when standing told her that she was dehydrated. And why wouldn’t she be? Everything she ate or drank came back minutes later in terrible heaves that tore at the aching muscles in her chest and abdomen. She filled the cup more than once during this call with her father. And maybe a dozen times earlier that day. And the day before. And the day before that.

She paced around the room as she listened to her father. “You need to go to the emergency room,” he told her. She didn’t want to go. She already went seven times over the past three months since this vomiting became part of her daily routine. Most of the time they just gave her IV fluids and sent her home. They thought it was her anxiety. She was admitted twice. Both times they ran countless tests, then sent her home to vomit there — without any answers.

Nevertheless, the woman took her father’s advice, and her roommate drove her to the Emory University Hospital emergency room in Atlanta. After getting some IV fluids and the anti-emetic Zofran, which hadn’t helped her in the past, she was discharged. She called her father as soon as she got back to her apartment, and he told her to come home to Cleveland. It was the week before Thanksgiving, and lots of flights were full, but she finally found one for that afternoon and packed her bag.

Just days after arriving in Atlanta that August to start her junior year at Emory University, she was in a car accident. Another car made an illegal turn and sideswiped hers, and she whipsawed against the door. She felt fine, though, and after they exchanged insurance information, she just went on with her day. But by the next day, she had started throwing up. Everything she ate or drank caused her to retch and vomit. She went to the E.R. Because the vomiting started right after her accident, the emergency-department doctor thought she had a concussion. He gave her some fluids and a medicine to stop the nausea. It should get better in a couple of days, he assured her. But it didn’t. She’d been vomiting every day since then. She felt fine until she ate or drank something — anything. Then, within minutes, she would have an overwhelming sense of nausea, and the wrenching spasms and vomiting would start.

The flight to Cleveland was quick. Her father picked her up at the airport and drove directly to the Cleveland Clinic Children’s hospital. Her regular doctor, Ellen Rome, the head of the Center for Adolescent Medicine there, wasn’t in the office that holiday week but arranged for the young woman to see a pediatric gastroenterologist. She immediately admitted her to the hospital.

The doctor who admitted her that night considered the possible causes of this kind of unremitting vomiting. The patient was taking medications for anxiety, so maybe the doctors in Atlanta were right — maybe this was psychogenic vomiting, caused by her longstanding psychiatric disorder. But there were other possibilities. Regular marijuana use could cause persistent vomiting. Hyperemesis gravidarum — excessive vomiting in pregnancy — was also possible. Those were easy to test for. Hyperthyroidism can cause this kind of vomiting as well. By the next morning results from the testing began to trickle in. She was not pregnant and had no evidence of marijuana in her system. Her thyroid was normal. So were the rest of the more routine studies.

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