1 Of course, if you are mentally confused, you might not realize you are mentally confused. That is the nature of mental confusion. You could be mentally confused right now. You could be thinking you are reading this book, but in fact, you are remembering having read this book in your youth. It could be the year 2049 and you are ninety-five years old in a nursing home, rocking back and forth in your own incontinence. If you suspect this may be the case, here is a way to test: Remove your pants. If someone comes to help you, you are probably in a nursing home. If people sort of shrink away from you, you are probably on the subway or something and everything is OK.
2 Note the somewhat jarring use of the female pronoun. This is a brilliant preemptive strike against those who will later question the author’s gender sensitivity, such as in Chapter 16, when he describes a colleague’s hooters.
3 True fact: The official medical terminology for having lice is “lousiness.”
4 Speaking of seizures, I cannot forbear mentioning the story, recently reported in the Emergency Physicians Monthly, of the attractive couple in dinner attire who came into an emergency room in Spokane, Washington, he with his loins wrapped in bloody towels, she wearing what appeared to be a bloody turban. The man’s penis had deep lacerations, and the woman’s head had many severe puncture wounds, in odd cluster patterns. Initially reluctant to discuss what had happened, the couple eventually fessed up: After a romantic candlelit dinner and some excellent merlot, the woman decided to perform an exceedingly friendly service to her companion, under the table. Midway through, she suffered an epileptic seizure, clamping down the way a terrier might attack a rat. That is when he reached for the fork …
5 Carol Scheman, Philadelphia, Pennsylvania.
6 I bet you thought I was going to give you the punch line here.
7 Why do you suppose we have a name for each of our fingers, but not for each of our toes? It seems wrong. I propose that the toes be named as follows, from the largest to the smallest: Big Wally, Shitkicker, Old Number Three, Gruntcakes, and Thor.
8 The medical books do not specify the nature of the poor judgment you might exhibit in the workplace. For the sake of medical accuracy, we will hypothesize that you wear only a cummerbund and a sombrero, conduct animal sacrifices in the employees’ lounge, and address the boss as Puny Mortal.
Headaches: Don’t Worry, They’re All in Your Head
For some reason we tend to impart profound significance to a person’s final words, as though God chooses to speak through the mouths of those He is about to summon. There have been some splendid deathbed pronouncements (Oscar Wilde is reputed to have said, “Either that wallpaper goes, or I do”), but alas, exit lines tend to be banal (“Shit!”), incomprehensible (“Gaack”), or memorably idiotic. Who can forget the immortal last words uttered by Civil War general John Sedgwick as he ridiculed his troops for taking cover from Confederate fire: “Come, come! Why, they couldn’t hit an elephant at this dis—”
For hypochondriacs there is only one final line worth remembering, and it has given them the willies for more than a half century, On April 12, 1945, in Warm Springs, Georgia, Franklin Roosevelt turned to a friend and said: “I have a terrific headache.” Then he slipped into a coma and died of a brain hemorrhage, which normal people call a stroke but doctors call an “accident.”1
“I have a terrific headache” remains the anthem of the hypochondriac, who knows in his heart that headaches can and sometimes do signal the presence of a brain tumor or a stroke. Here is where an unfortunate irony of human anatomy comes into play. The brain is made of nerve tissue, but, perversely, it has no pain receptors. So, chances are you won’t feel a stroke or a tumor when it first arrives; you will have to wait until it kicks off its shoes, reaches for the remote, and starts porking up on Doritos. Eventually it gets so fat it presses on vascular nerves, which causes a headache, or presses on other brain tissue, which can cause seizures, partial paralysis, or some of the weirdest danged things you ever saw. Tumors or bleeding can create personality changes ranging from irritability to confusion to confabulation, a strange state in which you compensate for memory loss by inventing an entire, elaborately detailed, improbable history for yourself. Asked, for example, if you have ever been married, you might say, “I was married for a time to Queen Fredericka of the Netherlands. She has three nipples.”
Headaches are the single most reported medical symptom, and they have always been related to environmental stresses; headaches have gone hand in hand with the march of civilization. In prehistoric times, they were caused by persons hitting you on the head with the femur of an ox. During the Dark Ages, they were caused by being hung upside down in dungeons. In the Renaissance, people got headaches because they were tormented by anguish over the beastly unfairness of life. During the French Revolution, people got headaches because their hair weighed two hundred pounds, plus they wore quarts of perfume to disguise the fact that, as French people, they never bathed. In the Industrial Revolution, people got headaches because they were breathing air made from vaporized rubber and despair. In the 1920s people got headaches because they drank gin made in toilets from any available source of carbohydrates, such as corncobs, maggots, and pumpernickel. Through the 1950s, women got headaches because they did not wish to have sex with their husbands. (Thankfully, this artifice is no longer necessary, since conjugal “duties” are now an antiquated notion. Today, if a woman chooses not to have sex with her husband, she is no longer required to come up with an excuse. She can simply cut off his penis.)
Nowadays, doctors specializing in the treatment of headaches will tell you that most headaches are minor matters. Then their brows will furrow with professional concern; they will get a faraway look in their eyes and they will say, “Of course, there are exceptions. Notable, grave exceptions.” You think doctors who specialize in headaches want you to walk out the door?
The hypochondriac doesn’t have to be told that headaches can be related to tumors or strokes. He knows this. He also understands that headaches can signal encephalitis and meningitis, serious infections of the brain. There are some things he doesn’t know, however. A crushing headache can be the first sign of cysticercosis. That is a parasitic disease in which the brain is infested by the larva of an intestinal tapeworm, Taenia solium, which can grow to twenty feet long.2 In your brain, though, these worms are only a half inch long. Some people have both at the same time: huge ravenous worms in their guts, and small brain-burrowing worms in their head, which happens to throb quite a bit, just like with an ordinary headache, at first.
Cysticercosis is relatively rare in the United States. So, relax: Your headache is probably not caused by worms in your brain. It is more likely to be related to your consumption of mouse urine. (See chart below and follow-up questions.)
Symptom Possible Diagnosis Look For Prognosis
Headache with pain on chewing Giant cell arteritis Scalp tenderness Can cause blindness.
Headache in obese young women Pseudotumor cerebri Double vision Can cause blindness, ulcers, cataracts, breast atrophy, and diminished libido. Treatable through repeated spinal taps or oral corticosteroids, which makes the fat patient even fatter.
Headache with nasal congestion Primary amebic meningoencephalitis, spread by polluted water Vomiting; disorientation Quickly fatal. In all medical history, only two people have survived it.
Headache with inability to focus eyes upward Tumor of pineal gland3 Nausea; vomiting; clumsy, widened walking gait Can delay onset of puberty for years. Can metastasize and result in death.
Headache with malaise Bornholm disease (“devil’s-grip”) Excessive sweating; fever; stitch in side Lasts 2-6 days, but residual malaise can last for months. Men can develop swelling of testicles.
Headache with sore throat and depression Benign myalgic encephalomyelitis Numbness of legs Persists for a month, with total flaccid paralysis of legs. May recur periodically.
Headache with dizziness, fatigue, and ringing in ears Polycythemia rubra ver
a Nosebleeds; itching, especially after a warm bath Leads to ulcers, bleeding in the stomach, baseball-sized lumps at joints. Can lead to leukemia.
Sudden, sharply focused headache Saccular cerebral aneurysm Nausea; vomiting Sometimes fatal if it ruptures.
Headache with dry cough Mycoplasmic pneumonia Fever; malaise Can develop into Guillain-Barré paralysis, heart swelling, and of skin.
Throbbing headache with nausea and confusion Carbon monoxide poisoning from faulty car exhaust or home furnace Coma; seizures; cherry red lips Full recovery if source of poisoning found in time; sometimes depression lingers, with memory impairment.
Headache that is most painful in the morning then slowly abates through the day Severe hypertension Wheezing; coughing Can lead to heart attack, congestive heart failure, strokes, blindness, death.
And finally, some answers to commonly asked scientific questions about headaches.
I have a splitting headache and my muscles hurt and I feel kind of stoned and confused. It is possible I have been drinking mouse urine?
Yes. You are exhibiting symptoms of Weil’s disease, or leptospirosis. It is spread by the urine of pigs and rodents, particularly mice and rats. You can pick it up from unclean food or water. Most people recover, but some will first turn a pale yellow. This is particularly unnerving, under the circumstances.
What is the stupidest official medical name for a headache?
There are two. The first is “Chinese restaurant syndrome headache,” linked to consumption of monosodium glutamate. The second is “ice cream headache,” caused by the sudden ingestion of very cold food, which aggravates the trigeminal nerve. These conditions are so dumb and harmless they do not have more technical, Latin names. And so “Chinese restaurant syndrome headache” and “ice cream headache” are listed soberly in the indexes of some eminent medical texts, right near “chickungunya hemorrhagic fever” and “ichthyosis.”
What is the cruelest headache?
Some people get a splitting headache every time they get an orgasm. “Not tonight, dear, I have a headache” can be a self-fulfilling prophecy.
1 See next chapter, on ridiculous medical euphemisms.
2 To get a mental picture of a twenty-foot tapeworm, imagine eating pasta by sucking a single strand noisily through your mouth. Now imagine that the strand turns out to be so long it takes you a full minute of nonstop sucking to get it down. Now imagine that when you get to the end you discover a face, with little feelers and a pair of googly eyes on stalks. There’s your tapeworm! Worms have been turning up in surprising places since the worldwide sushi craze began ten years ago. In a case recently reported in the New England Journal of Medicine, surgeons performing an emergency appendectomy on a patient with abdominal pain were chagrined to find a perfectly normal appendix. Then a ten-inch pink worm slithered out from the body onto the surgical sheets.
3 The pineal gland, in the brain, appears to have no clearly defined function other than to develop tumors. We will hypothesize that the pineal gland is the brain’s highly efficient storehouse of annoying, obsolete information, such as the American Dental Association’s declaration that Crest has been shown to be an effective decay-preventive dentifrice that can be of significant value when used in a conscientiously applied program of oral hygiene and regular professional care.
Interpreting DocSpeak (Hint: “Good” Means “Bad”)
There are ways of delivering disagreeable news so as to make it palatable. For example, when flight attendants discuss using your seat as a flotation device, they do this in the context of a “water landing,” not in the context of the plane becoming a “plummeting sarcophagus.” And in the seat-back compartment in front of you, the illustrations of persons experiencing a “water landing” or an “unscheduled landing” look like this:
They do not look like this:
Every profession has its conventional euphemisms. Butchers sell “chopped sirloin,” not “ground cow.” Even journalism, which is supposed to be about truth telling, occasionally resorts to bull hockey. Newspapers will write about a “developing nation” even when the nation about which they are writing is not developing at all, inasmuch as it has a rooster-based economy. Euphemism is the driving force behind the classified ad:
What it says: “Cozy starter home.” What it means: House is size of men’s room in Exxon station.
What it says: “Attractive benefits package.” What it means: Janitorial salary.
What it says: “Runs good.” What it means: Owner is idiot.
The language of medicine is similarly deceptive. When doctors say a test result was “positive,” that means it is bad. “Negative” test results are good. A “thrill” sounds cool, but if a doctor hears one when listening to your heart, you might keel over at any minute. An “ecchymosis” sounds revolting, but it is only a black-and-blue mark.
Among themselves, however, doctors tend to speak plainly. Surgeons will refer to a “peek-and-shriek,” which is, literally, an open-and-shut case: Look in, blanch, close him up, let him die. Doctors will say a patient belongs to the Hi-Five Club, meaning he has HIV. Doctors can be real cards.
But when they are speaking in front of patients, doctors have learned the opposite skill—creative euphemism. They learn it as interns, when they are making “rounds.” Rounds occur when a learned doctor in a teaching hospital goes from room to room trailed by a pack of lickspittles in lab coats who leave behind them an oily trail of sycophancy. Everyone must discuss each case in the presence of the patient. The lickspittles want to show off by exhibiting intuitive diagnostic skills, but they must do so in a manner that does not alarm the patient. They cannot say, for example, that Mr. Achenbach is “decomposing faster than a pile of fish heads in the Kalahari.” They would say Mr. Achenbach is “an excellent candidate for palliative treatment” (see below).
Doctors never lose this tendency to obfuscate in front of their patients. Most people will ignore this, figuring that if there is something the doctor needs to tell you, he will get around to it in due course. Some people might even be grateful for the doctor’s delicacy and diplomacy. This is not true of the hypochondriac, who is constantly looking for validation of his fears. He will assume everything the doctor says is a subterfuge to hide the ghastly truth about his condition.
Doctor: Good morning, Mr. Achenbach.
Patient: I am dying, right?
Doctor: I haven’t examined you yet.
Patient: But it looks bad, doesn’t it, Doc?
Doctor: We are talking on the telephone.
This sort of suspicion causes needless worry for the hypochondriac. There are only a handful of terms doctors routinely use to disguise bad things, a few dozen terms that are really, really scary but that you might not recognize. Here they are.
What They Say What It Sounds Like What It Means
A “mass” A solemn religious event Cancer
A “lesion” A scrape Cancer
A “mitotic process” Some damn technical thing Cancer
A “neoplastic involvement” A trinket from the dollar store Cancer
An “opacification” Giving in to Hitler Cancer
Yes, cancer is the leading cause of medical euphemisms; but it is not the only terrible thing that medical language is designed to hide.
What They Say What It Sounds Like What It Means
“AMI” College where you can major in pig husbandry Acute myocardial infarction, or heart attack
A “CK leak” Calvin Klein takes a whiz A heart attack. Refers to release of an enzyme that accompanies the death of heart muscle. Cardiologists love this term.
A “calculus” Something hard that you want to pass Something hard that you don’t want to pass. This is a calcified stone in the gallbladder or kidney.
A “demyelinating process” Getting salt from seawater, saving the peasants of India Multiple sclerosis
“Secondary lues” Reserve infielder from Dominican Republic Syphilis, featuring crusty, weeping sores
; Other medical terms are designed to hide the significance of bad symptoms.
What They Say What It Sounds Like What They Mean
“Exquisite” Wonderful Horrible. Describes pain that is incapacitating. A patient in “exquisite” pain is often whimpering and drooling.
A “bruit” Fat guy. Beats up Popeye. An unexpected sound when doctors listen to an organ. it is usually bad. Heart bruits, for example, can indicate CK leaks.
An “adventitious” sound To your benefit To your detriment. Adventitious sounds are bad lung sounds.
“Ronchi” and “stridor” Star Wars characters Specific adventitious lung sounds; they can signal anything from a cold to a tumor.
A “deficit” A little red ink A big red flag. A deficit means an insufficiency of something, often signaling serious illness. An “oxygen deficit” in the body is sometimes followed by coma, brain injury, a vegetative state.
A “vegetative state” Kansas Brain death
An “accident” Oops. Ha ha. Oops. Bye-bye. A grave event in your body. A cerebrovascular accident is bleeding in the brain.
The Hypochondriac's Guide to Life. and Death. Page 7