Though rooted in childhood, my hypochondria did not fully manifest itself until I was a young adult. For that I credit Dr. Katzev, my family doctor when I was a boy. Dr. Katzev was a crusty old guy who did not believe in pampering you or letting you pamper yourself. He was an ascetic. He believed absolutely in letting diseases take their natural course. Once, after he examined my brother, his diagnosis was: “If spots develop, it’s the measles.”
Dr. Katzev actually made house calls. He would barge into my bedroom, pull off the covers, and fling open the window, even if it was the dead of winter and I had a fever of 103. “The body has to breathe,” he would say. Then he would instruct me to stop that infernal tooth chattering. To the best of my recollection, Dr. Katzev’s diagnosis was always the same: I had a “bug” that was “going around.”
(I would not have been surprised if years later Dr. Katzev achieved fame in one of those news stories you see from time to time where some kindly family physician, beloved by his patients, is discovered to be a refrigerator repairman.)
Dr. Katzev viewed all complaints skeptically. He did not cotton to drug therapy or fancy diagnostic tools. Mostly he used a stethoscope and one of those triangular reflex hammers. One day when I was seventeen, I went to Dr. Katzev complaining of a pain in the eye. He said, “If I hit you on the elbow with my hammer, your eye won’t hurt so much.”
Dr. Katzev urged me to keep an eye on the eye and see what developed. I tried, though it became increasingly hard through the slime that was oozing over my eyeball. I continued watching carefully as a red rash developed around the eye, expanding into a weird, angry blotch that bisected my forehead right at the midline and ran down the center of my nose, veering off at a ninetydegree angle across my cheek. I looked like the victim of some sort of peculiar windburn, as if Ïwere Mort—that character from Bazooka Joe comics who wears a turtleneck up over his mouth—and had driven the autobahn at 120 miles an hour with my head half out the window.
Reluctantly—no doubt suspecting that he was shamefully overreacting—Dr. Katzev finally sent me to a specialist, from whom I learned I had a serious viral disease called herpes zoster ophthalmicus. It attacks the nerves in your face around the eye. After the doctor told me his diagnosis, and that herpes zoster ophthalmicus usually clears up on its own, he went into another room and told my parents the same thing, adding something he hadn’t thought wise to share with me: that herpes zoster ophthalmicus has been known to cause blindness, and there was no surefire way to prevent this.
So then my parents had to make a decision. On the one hand, being Jewish, they believed in the Talmudic principle of truth telling. On the other hand, being Jewish, they believed it is a mortal sin to cause one’s son to worry. They decided to compromise.
Me: So I guess everything is going to be OK!
Them: Yes! Absolutely!
My Mother: (whispering to my father in Yiddish) Unless he goes blind like a burrowing rodent, the poor, sweet dumpling.
Me: (to my father) What did she say?
My Father: How do I know? I’m half deaf.
I recovered fine. If anything, the experience reinforced in me an appreciation of Dr. Katzev’s laissez-faire medical philosophy. The disease had cleared up, on its own.
Then, in 1974, Dr. Katzev died of a cold.
I had loved and respected Dr. Katzev; he had always seemed wise and kind and indestructible, and in a generic, no-frills sort of way he had been a terrific family doctor. He cared about his patients. His death—caused by neglecting his sniffles and coughs until they turned into congestive heart failure4—made me aware of the importance of vigilance in maintaining good health. Profoundly aware.
I was twenty-three. Around that time I developed a pain in my jaw. I went to see a doctor. The doctor was stymied. Thinking aloud, he made an observation. It wasn’t a diagnosis; he was simply making pleasant conversation, sharing his knowledge. He should writhe in hell for all eternity. What he said was that he had just read about a study of soldiers in World War I. If they came under hostile fire, they had been trained to fling themselves forward into a prone position, with their rifles flat out in front of them, at arm’s length. Sometimes, a soldier’s chin would come down on his rifle stock. And about a year later, this soldier would begin to experience undifferentiated pain in his jaw, not dissimilar to mine. Soon after that, his teeth would begin to fall out, one at a time, until he looked like Lamb Chop.
The doctor went on to describe other, more benign possible causes for my pain, but I wasn’t hearing him. I was lost in an unimaginable terror. Had I suffered a minor blow to the chin a year before? Could be. I seemed maybe to recall something. I left his office feeling a spreading pain in my jaw, and for weeks afterward, it got worse. Night after night, I would examine my teeth in the mirror, shaking them, feeling to see if they were loose. Have you ever tried that? Try it now. Grab one of your lower front teeth and shake it. Feel that shimmy? It is normal. But you could not have convinced me of that.
I looked in the mirror, and the face that looked back at me was myself in a few months’ time. Moms Mabley. I walked around shaking my teeth, feeling the pain creep from molar to molar. It lasted for months, until I got a great new job in an exciting new city. And rather suddenly, the pain went away.
Years passed, relatively complaint free. One day, I felt an ache in the groin. It started mildly but gradually became incapacitating.
I saw a series of urologists, none of whom could find anything wrong with me. Several of them prescribed medications; one of these, Urised, has the spectacular side effect of turning your urine blue. I do not mean cerulean blue, like the sky on a balmy summer day. Bic pen blue. Once, as I was standing at one of those trough urinals in a bathroom at a football stadium, I became aware that the man next to me was staring down at me, slack jawed. An opportunity like this occurs but once in life. I zipped up, pulled a cigarette lighter out of my pocket, and spoke into it in a robotic voice: “Gardak reporting. Earth colonization plans complete. Initiating return to mother ship.”
Urised didn’t relieve my problem. Nothing did. My doctor eventually asked me if I was having stress at work or in my home life.
I said no, not really. And he just stared at me. A thunderclap of silence. And finally I said, “Well, except my girlfriend wants to get married and have a baby and I think the company I work for might be about to go bankrupt, plus I have no talent, no integrity, and no future.”
And the doctor gave me his diagnosis: “You are a young man. Enjoy your life.”
And the pain went away.
Clearly, a pattern was emerging.
Over the years, I had a rather civil relationship with my hypochondria. Each time a symptom would arise, I would consult a doctor—or sometimes two because the first guy was obviously an incompetent. No cause would be found, I would conclude the pain must have been psychosomatic, and it would go away. Each time, however, I had to first become convinced it was something dreadful, because by doing so I would be mentally prepared for the Bad News when it arrived. I think this is at the heart of hypochondria: a fear of losing control in the face of adversity. The hypochondriac resents the arbitrary nature of death. He wants control. And control comes with knowledge.
And so, when I felt light-headed for a month, I leafed through some books and determined it was multiple sclerosis. Stomach pain was an ulcer, and when it did not respond to ulcer medication it was stomach cancer. Once, the skin on my hands began to peel. This was a tough one. Medical books suggest no obvious alarming causes of skin peeling. I eventually found one. It took a little research, but hypochondriacs are not averse to research. It turns out skin peeling is often caused by excessive localized sweating, and excessive localized sweating, particularly of the hands, can in rare instances indicate a brain tumor. For days I sucked on my fingers to see if they tasted abnormally salty. This, of course, made the peeling worse. I was eventually cured of this illness by getting a raise.
My own physiology became a subject of endle
ss fascination and terror. I began noticing the floaters in my eye, those harmless, diaphanous shapes that sometimes swim around your field of vision, turning your eyes into snow globes, only without the Statue of Liberty in the middle.5
Most people have floaters, but they don’t notice them until one day they do. Then they notice nothing else. That’s what happened to me. Before I had noticed my floaters, a pastoral scene would look like this:
Once I had noticed my floaters, the same scene looked like this:
Hypochondria is not communicable, but it is transferable. And so it is that when my daughter began getting headaches and an ophthalmologist looked into her eyes and determined that she had an odd bulging of her optic nerves, I did some quick research and concluded she had pressure on the brain caused by a tumor. Painfully, I rehearsed how I would tell her, how I would make her final months as comfortable as possible. Tentatively, I began to write my speech for her funeral, which was to be more a symphony than a dirge—a celebration of a remarkable young life, heroically lived. Practically, I weighed the financial ramifications: readjusting what we are salting away for college tuitions. Selflessly, I resolved to inquire about whether my employer offered bereavement leave and to make it a union issue if the company did not, as a way to harness my grief for the benefit of others. This all occurred in about twelve minutes. It turned out my daughter’s problem was a harmless medical condition defined, more or less, as “big fat optic nerves.”
To the hypochondriac, actual crises involving loved ones come as something of a respite, because they take his mind off his troubles. Plus, when illness does strike in the family, the hypochondriac is much better prepared to handle it. He’s been in training his whole life.
One winter day a lew years ago, on a dare from me, my nineyear-old son, Dan, was sledding down Dead Man’s Hill. He hit a bump, rose into the air, and came down like a moose dropped from a helicopter. He bit clean through his lower lip. We took him to the hospital, where a plastic surgeon informed us he was going to operate, right then.
At times like this, my wife and I employ a careful division of labor. My wife’s job is to walk away so she doesn’t faint. My job, as the resident hypochondriac, is to wade hip deep into the disaster. In this case, my job was to stand over Dan and act jolly so he could not possibly guess what the doctor was doing. What the doctor was doing was gouging out a huge bubbling basin in Dan’s face, making the hole much wider and deeper so the incision line would be even, as opposed to the incision line made by one’s teeth, which looks like something gnawed by a starving ferret. The operation was so alarming I actually removed my glasses so there was no chance Dan might see a reflection in the lenses and puke into the foxhole that was his face.
But I remembered the lesson 1 had learned from my parents all those years before. I didn’t want to lie to my son, even with a lie of omission. So I kept up a constant drone of happy, insipid, mind-deadening babble, things like, “Yo, Dan, that was a hell of a hill, wasn’t it, big feller, ha ha! I’ll bet Mom is plenty pissed at me, ha ha! Your lip looks like a baboon’s anus, ha ha!”
Dan pulled through with barely a scar, but the experience took a toll on me. By the time I got home, I had a splitting headache.
Encephalitis, I was pretty sure.
1 Mom was wrong, actually. Asparagus contains chemicals called methyl thioesters, which make everyone’s urine smell funny. However, some people lack the smell receptors in their noses to detect the odor. Really. This raises the fascinating epistemological paradox: If an asparagus eater pees in a toilet but there is no one around with the appropriate smell receptors, does the pee stink?
2 Did you ever wonder about the stupidity of the term “o’clock”? Americans have happily incorporated into our everyday speech a term that makes us sound like leprechauns.
3 At least one kid got further. Around this time, a teenager broke into a dentist’s office in Queens. His body was found the following day with a nitrous oxide mask on his face. I considered this one of the most significant stories of my generation, even though it was buried in the newspapers. Evidently, other news was deemed “more important.” For years I remembered this as an example of the media’s cowardice in dealing forthrightly with stories involving drugs and kids. Then, a few weeks ago, leafing through some old papers, I actually found the original news clipping. It was indeed buried deep in the paper. The date was November 22, 1963.
4 This was an ironic death, but it does not approach the one that befell Jim Fixx, the messianic jogging guru who had a massive heart attack while jogging. And Jim Fixx’s death does not approach the most ironic demise of all time, suffered by one J. I. Rodale, the publisher of health and fitness books and founder of Prevention magazine. On June 7, 1971, Rodale was a guest on a late-night TV show. “I’ve never felt better in my life,” he bragged. “I am so healthy that I expect to live on and on.” Then he made a gurgling noise, pitched forward, and died.
5 Unless, of course, you happen to be looking at the Statue of Liberty.
Hiccups Can Mean Cancer
In many ways the human body is like a car. Both are complex machines. Both require regular maintenance. Both will stop working if you fill them with barbiturates and applesauce.
Having a car and having a body both require adherence to a rigid servicing schedule. Let’s say you own a car and you never, ever replace the oil; and when you use jumper cables, you get them mixed up and there is a spark the size of the Crab nebula, draining all the juice out of the good battery; and once, you poured windshield wiper fluid into the power steering reservoir because they really should label these things better. My point is, if you are that much of a half-wit about your car, your car is the least of your problems, because you probably also use a hair dryer in the bathtub.
The fact is, both cars and humans are designed with idiot lights, things that alert the reasonably careful person that something serious is awry. If your car’s Oil light goes on, unless you are my wife, you probably know to stop driving and see a mechanic at once. Similarly, if you experience serious chest pains, then you probably will see a doctor. The fact is, certain symptoms are by their nature scary. Lumps. High fever. Blood in the stool. Mental confusion.1
This chapter is not about those common “warning signals.” This chapter is about things no sane person would ever associate with serious illness, until this very moment.
Hiccups. The precise cause (or “etiology”) of hiccups remains a matter of some dispute among medical scientists, who have studied the phenomenon incessantly and come away with only obvious clinical observations, such as that men hiccup, on the average, five times as frequently as women. (As far as I can see, this tends to suggest, in sophisticated medical terms, an “etiology” related to beer.) There is no reliable cure for hiccups, but there is no shortage of nostrums available, each with its adherents. The rule of thumb is that the more unpleasant the remedy, the more august is the medical authority recommending it. Grandma told you to hold your breath. Primary Care Medicine, a text for doctors, proposes inserting a catheter down your nose into your stomach. I recommend hyperventilating into a colostomy bag.
Hiccups are harmless, except when they aren’t. No other commonly reported symptom has quite so many potentially dire explanations. Persistent hiccups cross into virtually every medical specialty. Neurologists know hiccups can accompany the onset of a deadly stroke or an inoperable tumor in the medulla of the brain. Cardiologists will not rule out an oncoming heart attack or an aortic aneurysm. Nephrologists will suspect kidney failure. Gastroenterologists know hiccups can indicate an “irritation” of the diaphragm or of some other organ, particularly one that touches the vagus or phrenic nerves, which control the swallowing and breathing reflexes.
On the outside of the body, an irritation is often a minor matter. On the inside, it often isn’t. On the inside, it is often a tumor. Hiccups have been associated with tumors in or around the lung, in the diaphragm, the liver, the pancreas, the stomach, and even the sigmoid colon,
which is down near the butt and should not, by the grace of God, have anything to do with breathing.
Insomnia. In the absence of other symptoms, excessive fatigue or excessive sleep can be an indication of many serious diseases, but insufficient sleep generally isn’t. Most of the time, the insomniac knows or suspects why he can’t sleep: He is worried or depressed, or he has a toothache, or asthma, or a goiter the size of a microwave oven. Insomnia seldom stands alone, but when it does, it is out there in the hellish regions of Things You Wouldn’t Wish on Your Worst Enemy Even If He Ate Garbo, Your Dachshund.
The most dramatic of these is fatal familial insomnia. This is a disease caused by prions, which are proteins that act exactly like ice-nine, the instrument of the apocalypse in Kurt Vonnegut’s Cat’s Cradle. Ice-nine was a molecular template. If it mixed with water, it would turn the water molecules into ice-nine molecules, rock hard and useless for sustaining life. This was not good when it spread across the oceans of the world. That’s how prions work. They get into your body and take other proteins and reorder their structure to resemble themselves. In fatal familial insomnia, prions take up residence in the sleep center of your brain and slowly destroy it. You start out being unable to sleep well. Then you cannot sleep at all. In desperation, you see a top neurologist like Dr. Anthony Reder of the University of Chicago.
A few years ago, a man came to see Dr. Reder. The patient was tired and grouchy—not tired and grouchy like a bus driver at the end of his route, but tired and grouchy like the people from Invasion of the Body Snatchers immediately before the dull-eyed pods took them over. This patient looked disheveled. His hair was askew, like Beethoven’s after a night of carousing. Reder had seen this before; he is a research scientist and had seen it in laboratory rats with sleep deprivation. He diagnosed fatal familial insomnia. There is no treatment. There was nothing that could be done. Within weeks, the patient was hallucinating, making up grandiose stories about himself. His appearance deteriorated. Beethoven lost a lot of his charm. He gave way to Dr. Irwin Corey. Then he died.
The Hypochondriac's Guide to Life. and Death. Page 5