A Doctor’s Clinical Diary Episode 41-The Noise That Wasn’t the Heart: A Story of Psychogenic Chest Pain

 

A Doctor’s Clinical Diary Episode 41-The Noise That Wasn’t the Heart: A Story of Psychogenic Chest Pain

By SangBock Lee

Copyright

Copyright © 2026 SangBock Lee
All rights reserved.

This work is based on real clinical experiences.
Identifying details have been altered to protect privacy.

This book is not intended as medical advice.

Author’s Note

Why This Story Matters

Chest pain is one of the most terrifying sensations a human being can experience.
For patients, it means death.
For doctors, it means responsibility.

This story is about a patient whose heart was structurally normal,
yet whose pain was real, relentless, and life-altering.

In medicine, we are trained to rule out disease.
But we are rarely taught how to stay
after nothing is found.

This episode is about what remains
when the tests come back normal.

Prologue

When the Heart Is Innocent

Chest pain arrives without warning.
It interrupts conversations, meals, sleep.
It does not ask permission.

In fifteen years of clinical practice,
I have learned that chest pain is never “just pain.”

It is fear with a pulse.

Patients do not come to the hospital
because their chest hurts.
They come because they are afraid
they might not wake up tomorrow.

This is a story about a heart
that did nothing wrong,
and a life that nearly stopped anyway.


Chapter 1

“Doctor, I Think I’m Dying”

The emergency department was unusually quiet that night.

A man in his early forties sat upright on the bed,
one hand pressed firmly against his chest.
His breathing was shallow but controlled—
the kind that comes from fear, not collapse.

“My chest hurts,” he said.
“I think it’s my heart.”

I introduced myself and sat down.

“When did it start?”

“An hour ago.
Out of nowhere.”

The pain was sharp, squeezing, radiating to the left arm.
Textbook words.
The kind that activate protocols.

We moved quickly.

EKG.
Cardiac enzymes.
Chest X-ray.

Everything was normal.

And yet, the man was shaking.

Chapter 2

Normal Tests, Abnormal Suffering

His name was Min-jae.

He was healthy by every measurable standard.
No hypertension.
No diabetes.
No family history of heart disease.

The repeat EKG was normal.
Troponin levels were negative.

“Your heart looks fine,” I said.

He stared at me, confused.

“Then why does it hurt so much?”

This is the moment medicine often fails.

Because “normal” is not relief
when pain is still present.

Chapter 3

The Diagnosis Nobody Wants

I asked questions that were not on the checklist.

“Has this happened before?”

“Yes. Three times this month.”

“Any recent stress?”

He laughed bitterly.

“My company laid off half our team.
I haven’t slept in weeks.”

I nodded.

The body keeps its own records.

Psychogenic chest pain.
Somatic symptom disorder.
Panic-related pain.

Clinical terms that sound dismissive
to those who suffer from them.

“Are you saying it’s all in my head?” he asked.

“No,” I said.
“I’m saying your body learned fear very well.”

Chapter 4

Pain Without Permission

Psychogenic chest pain is not imaginary.
It is pain generated by a nervous system
locked in survival mode.

Muscle tension.
Hyperventilation.
Autonomic dysregulation.

The heart becomes the stage
for a much older story.

Min-jae listened quietly.

“So I’m not dying?”

“No,” I said.
“But you are exhausted.”

For the first time,
his shoulders dropped.

Chapter 5

The Treatment That Isn’t a Pill

There was no prescription
that could undo months of fear.

We talked about therapy.
Breathing techniques.
Sleep.

“These aren’t consolation prizes,” I told him.
“They are treatment.”

He nodded slowly.

“Why didn’t anyone explain it like this before?”

Because explaining takes time.
And time is the rarest resource in medicine.

Chapter 6

The Return Visit

Three weeks later, Min-jae returned.

“I still get pain,” he said.
“But I don’t think I’m dying anymore.”

That mattered.

Pain without terror
is survivable.

Epilogue

What Remains After Normal

Before he left, Min-jae said something I still remember.

“I wish someone had told me earlier
that fear can sound like a heart attack.”

Medicine saved his heart.
Listening saved his life.

That night, I wrote:

Not every normal test is good news.
Sometimes, it is an invitation
to stay longer.

Medical Notes for Readers

  • Psychogenic Chest Pain:
    Chest pain caused by anxiety, panic disorder, or somatic symptom disorder.
  • Key Features:
    Normal cardiac tests, recurrent episodes, strong association with stress.
  • Treatment:
    Education, reassurance, cognitive behavioral therapy, stress management.

  • Return to the first page

Comments

Post a Comment

Popular posts from this blog

[MHS: Episode 74] Part I: The Genesis of an Invisible Enemy: When the Body’s Silence Speaks

Image
  [MHS: Medical Human Story]-Episode 74   Prologue | Part 1 | Part 2 | Part 3 | Part 4 & Epilogue Part I: The Genesis of an Invisible Enemy: When the Body’s Silence Speaks   "The human body is a masterpiece of communication, but we are experts at misinterpreting its signals. We call it fatigue. We call it stress. We blame the encroaching years. Yet, beneath the skin, a silent storm can be brewing." We All Think, "It Will Pass" Park Jun-ho, forty-five, was a man who lived by the clock. A routine of morning coffee, the same jazz playlist on his commute, and weekend market walks with his wife defined his existence. His medical history was mundane—a touch of fatty liver, a doctor's recommendation for more fiber. He was a man who rarely saw the inside of a hospital, which made his dismissiveness toward a dull, persistent abdominal ache all the more dangerous. "It’s just a stomachache," he told himself, sipping lukewarm tea. "It will pass by t...
Read more

[Medical Human Story - Episode 64] Shadows of the Retroperitoneum: 72 Hours on the Brink of Life and Death_2

Image
    Part I: A Gathering Storm Behind the Silent Peritoneum   Cold Night Air and the Mechanical Heartbeat Every time the emergency room’s automatic doors slid open with a harsh, metallic rasp, a gust of sharp night air bit into the room.  That chill mingled with the piercing scent of disinfectant and the metallic tang of blood, weaving a strange, palpable tension.  The station was a sea of monitors, their screens blinking incessantly with vital signs and spitting out sharp beeps—a cacophony that sounded like the rhythmic heartbeat of a massive, living machine.  It was a battlefield where those clinging to the edge of life collided with those determined to pull them back. The Stalker in the Dark: The Radiologist I sat in the deep shadows of the reading room, anchored only by the cool blue glow of the monitors.  People often imagine a doctor wielding a scalpel under brilliant surgical lights, but for a radiologist, darkness is the ultimate weapon—the ...
Read more

[Medical Human Story - Episode 64] Shadows of the Retroperitoneum: 72 Hours on the Brink of Life and Death_3

Image
    Part II: The Tightening Noose of Time and the Invisible Infiltrator   At the End of the Cold Corridor The LED lights in the hallway leading to the Emergency Room felt exceptionally cold and pallid that day. A faint blue glow stretched across the floor, and the entire hospital was enveloped in a dry scent, reminiscent of crisp dawn air. I walked slowly, hands buried deep in my white coat pockets, but my mind was racing. The CT images of Ms. Park Soon-ja that I had just reviewed played on a continuous loop in my mind. It wasn't merely a matter of "inflammation." The real issue was where that inflammation was spreading. Anatomically, the retroperitoneal space is incredibly deep and complex—a labyrinthine tangle of organs, blood vessels, fascia, and adipose tissue. Once bacteria invade this space, they proliferate at lightning speed through invisible channels. I mentally traced the potential paths of infection: Had it descended along the right psoas muscle? Had it...
Read more