The DO Book Club, Nov. 2026: ‘The Mystery in the Room: A Physician’s Journey Treating Patients with Rare Diseases’

Like many contemporary authors, Chuck Radis, DO, takes his readers back and forth in time. The disorganized and well-meaning family physician once lived and worked on Peaks Island, Maine.

He went back to fellowship training to become a rheumatologist and now writes as a highly trained consultant on all forms of joint disorders and autoimmune conditions. His expertise in diagnosing mysterious maladies is often sought in the Portland, Maine, community.

His latest book, “The Mystery in the Room: A Physician’s Journey Treating Patients with Rare Diseases,” is written in the easy and self-deprecating manner of his previous books, “Go by Boat” and “Island Medicine,” which I previously reviewed for this column.

“The Mystery in the Room” introduces readers to a whole cast of characters who have painful and puzzling medical problems. We get a bird’s eye view of how the diagnostic process works.

First, the most likely diagnosis is made by the primary care physician and treatment is started. For the purposes of this type of mystery disease story, the first and second diagnoses are both always wrong. If it were easy, the case would not be written up by Dr. Radis as one of the chapters in this book.

An old-fashioned physician in the best way

Dr. Radis delights in being an old-fashioned physician, taking his time with every patient. He prides himself on paying attention to the person in front of him, not on the computer screen of the electronic medical record. The doctor takes a thorough history and does a detailed physical exam. In every case, he makes particular note of the person’s posture and how they walk. Additionally, he comments on the patient’s demeanor and attitude.

“From time to time, I consult on a patient with severe, sometimes untreated mental illness which may also have rheumatic symptoms,” he writes. “This complicates the picture. Unexplained, life-altering pain is common in patients with mental illness. In some cases, the symptoms are related to anxiety or depression or post-traumatic stress disorder. In others, the pain may be due to unexplained autoimmune disease or cancer. The challenge is to sift through the symptoms and determine a diagnosis. These are difficult, complex visits.” (p. 61)

Sometimes the patients improve for a while, even if the primary diagnosis is incorrect. Why? Two illnesses can occur at once. The lady with the very rare type of vasculitis, an inflammation of the blood vessels, also has some spasm in the bronchioles of the lung. She responds to respiratory treatments in the short-term, but her underlying problem of undiagnosed vasculitis looms far larger. The team needs to stay on her case.

The chapters line up as the greatest hits of the specialty of rheumatology, if such a list ever existed. We’ve got lupus, rheumatoid arthritis, ankylosing spondylitis and gout.

Refusal to accept a diagnosis or the physician’s recommended treatment is a common theme among the author’s patients who have complex cases. Dr. Radis brings us into his office while treating a patient who refuses to agree with his diagnosis of a specific and treatable disease. She clings to a binder of evidence for chronic Lyme infection.

Unusual cases

One chapter goes back decades to the days of Dr. Radis’ fellowship at Presbyterian Hospital in Pittsburgh. We meet and get to know a woman with advanced scleroderma. Dr. Radis has an easy way of getting to know his patients as people with very complex problems.

At a research center with experimental protocols available, the woman begins treatment of this stubbornly progressive disease. These scleroderma cases do not end well, but the physicians keep trying new protocols and learning from their experiences.

Another interesting case begins with a Maine pig farmer beset with fever, sweats, joint pain, weight loss and an awful malaise. The fellow’s case progresses badly despite the best efforts of a team of concerned physicians and nurses.

With the man in the intensive care unit looking like the end was near, Dr. Radis remembered another possible infection so rare that he had never seen it in all of his training or private practice. With a simple change of medication, he saves the day and the man gets well.

In addition to the interesting case presentations, Dr. Radis discusses many of the systemic problems that plague society and the practice of medicine. One chapter introduces readers to the opioid crisis and demonstrates the elaborate deceptions people will go through just to get another Vicodin or OxyContin prescription. And yet another chapter explains why frustrated patients sometimes think their physicians dismiss their reports of pain.

Dr. Radis shares his own struggles

The author also discusses overseas medical missions, the frustrations of obtaining prior authorizations for much-needed urgent treatments and his own skiing accident that left him with significant injury, anxiety and panic attacks. As so many physicians will attest after going through their own medical and mental health challenges, Dr. Radis shares how the experience taught him to be a better doctor.

Reflecting on his traumatic event, “there are benefits,” wrote Dr. Radis. “Putting on my physician’s hat, I now realize that before my accident, I didn’t truly understand the challenges my patients faced with chronic anxiety, depression or panic attacks. Sure, I tried to listen and identify emotional problems—particularly if they were a barrier to effective medical management—and I ticked off the usual bromides: exercise, counseling and medications, but inwardly, I was frustrated by my patient’s inability to Just. Get. Better. Now that I suffer from my own mental illness—PTSD—I think I understand. We all have something. None of us gets through this life unscathed.” (p. 114)

Working with patients who respond poorly to treatment

Dr. Radis has many patients who challenge their medical team and get labeled as “difficult,” a topic I found especially of interest. None are more challenging than the lady he diagnoses with fibromyalgia syndrome, a chronic pain processing issue of the central nervous system. Dr. Radis offers these suggestions for understanding fibromyalgia and his tailored approach for patients who respond poorly to treatment.

“Working with these patients may be frustrating for both the patients and the healthcare providers … It’s particularly important in this group to avoid polypharmacy—prescribing multiple medications to manage mental health disorders, insomnia and pain. Unfortunately, because of the intensity of their symptoms, it’s this subgroup that is often prescribed narcotics for pain, which are ineffective or paradoxically may make their pain worse … This isn’t a condition you can manage by following a computer-generated list of recommendations.” (p. 161)

Even the very empathetic and resilient Dr. Radis said that he dreaded his half-hour visit with this particular woman with fibromyalgia because she always reported that her symptoms were worse. He felt like he had nothing new to offer. Eventually, her condition did improve when some of her life stressors changed and she was compelled to exercise more.

Each chapter teaches some of the principles of medicine and illustrates the best lessons of narrative medicine. Physicians who enjoy medical mysteries in the tradition of physician authors Oliver Saks and Lisa Sanders will enjoy this well-written gem of a book.

Related reading:

The DO Book Club, Aug. 2026: ‘A Month in the Country’

The DO Book Club, Sept. 2026: ‘Let Me Lead: Escaping The Experience Bias And Excelling As An Early-Career Professional’