What is the medical significance of all this?
Passage of gas, Dr. Levitt said mournfully, “is virtually never indicative of serious disease.”
So, farting isn’t important?
“Right. I am constantly trying to find out why it is important.”
But why does he spend so much time studying the field?
“it’s a good question. Maybe on my deathbed I will wish I had studied cancer.”
The interview was going handsomely, I thought, but something was bothering me. This book is ostensibly about hypochondria, and hypochondria thrives on the fear of serious disease. If farting does not suggest serious disease, why should any of this be of interest to the hypochondriac?
Dr. Levitt tried to help. He said he has conducted studies suggesting that lactose intolerance is a lot of hooey, that people who have been diagnosed as lactose intolerant might well be hypochondriacs.
Big deal.
I could tell Dr. Levitt was holding back, so I said nothing. It’s a trick journalists use. Bob Woodward and I are particularly good at it. Sometimes if you just dummy up, your source will get uncomfortable and start babbling to fill in the silence. Sometimes, if he’s got a secret, he coughs it up.
Two seconds passed. Four.
“Right now,” Dr. Levitt finally said, “the love of my life is sulfur gases produced in the colon.” Sulfur gases are what make farts smell bad. “I am in love with the idea that overproduction of gases causes problems.”
Problems? What problems?
“It’s still theoretical,” he cautioned.
Noted.
“Well, ulcerative colitis.” Ulcerative colitis is an awful illness that burns and scars your intestines. It holds you hostage to its pain. It can make you a lifelong invalid. Dr. Levitt said that when you analyze the rectal output of people with ulcerative colitis, you find excessive hydrogen sulfide gas, “enough to kill twenty-five mice!”
And?
Hydrogen sulfide is a toxin, he said. Toxins cause disease. His voice got a little theatrical. What if, he said, the hydrogen sulfide is not a byproduct of ulcerative colitis? What if it causes ulcerative colitis?
Is that possible?
“I am working on it.”
But wait. Gas is absorbed into the blood from the intestines. He, Michael D. Levitt, established that many years ago, with the famous breath-fart experiment. Might it be possible that hydrogen sulfide is reabsorbed into the body and causes other diseases?
“It is possible,” Dr. Levitt said. “People don’t like it when I speculate on that, but I speculate on that.”
The phone line crackled. Was it a bad connection, or the electricity of the moment? “Once they are in the blood, gases go to the liver, and then to the lungs, where they are cleared,” Dr. Levitt said. Theoretically, he said, they could cause disease to either organ.
What sort of diseases?
Anything, he said, that attacks the liver or the lung.
B-but that could be …
“Exactly.”
Farts might cause cancer.
1 The editors at big, gray newspapers like The New York Times try mightily to maintain a sense of decorum and stiff formality, even at the risk of sounding hopelessly fuddy-duddy, such as by referring to Snoop Doggy Dogg as “Mr. Dogg.”
2 The story quotes a doctor who specializes in this problem. His name is Dr. Ikeshita.
3 The sounds of babbling brooks, chirping larks, etc. Wouldn’t it be great if every fifteen minutes or so the Sound Princess emitted an EXTREMELY LOUD fart?
4 The World Almanac provides a terrific antidote to sugary we-are-the-world fantasies. We are not the world. The world is dorky. In Equatorial Guinea, the two main ethnic groups are the “Fangs” and the “Bubi.” The leader of Gabon is “President Bongo.” The entire economy of Djibouti is listed as “salt.”
5 Am I the only one who has noticed that the British novelist John Mortimer, known for his urbanity, created a detective whose name, basically, is Rump Hole?
6 I recently learned there is an actual answer to this: Toilet paper squares are small not because anyone is expected to use just one but because some people use two, and some use three, and this is the only way of accommodating both types of clientele. Seriously. Entire scientific studies have been done on this by the toilet paper industry.
7 There is something about this story that propels normal, decent people into uncharacteristic excesses of sophomoric humor. When I showed it to my friend Pat, who is a Sunday school teacher, the mother of two young children, and an authority on the proper use of the English language, she said, and I quote: “Kind of gives new meaning to the term ‘shitting a brick.’”
8 Note to deodorant manufacturers: Consider handgrip.
9 Giving rise, presumably, to the term “boner.”
10 This is not a recent development. In a pioneering 1934 thesis, famed British colorectal surgeon J. P. Lockhart-Mummery dryly pointed out that any object that can be inserted in the rectum has, at some time, been removed. Lockhart-Mummery dealt delicately with the subject. Autoeroticism was not mentioned; he accepted the patients’ explanations for their predicament, including attempted relief from itching and accidents of a most unfortunate nature (“I was gardening naked when …”).
11 Want to play a great trick on a hypochondriac? Get a couple of night crawlers and put them in the toilet tank before he goes into the bathroom. The last thing he will see after flushing are two enormous worms swirling down the drain.
12 A normal output is 10 farts a day, with a standard deviation of 5, Dr. Levitt says. “So up to twenty a day can be considered normal.” The known medical record is 155 farts in a day.
Is Death a Laughing Matter? Of Corpse Not.
The meaning of life is that it ends.
You know those signs that say, “Bridge Freezes Before Roadway”? Did you ever wonder what that meant? I found out one day in 1979, when I was driving over a bridge in Lansing, Michigan, in a light drizzle just as the temperature dropped from thirty-three degrees to thirty-two. Instantly, my car was a hockey puck. It spun out and bumped to rest against the guardrail. There was zero traction. Tires wailing, I could not free myself.
I sat there, feeling stupid, when suddenly I saw over my shoulder a City of Lansing truck coming in my direction on the bridge, spreading sand. Good, I thought. Then I realized that the truck, about the size of a big-city garbage truck, was also a hockey puck. Shit, I thought. I could see the driver’s face. His mouth was agape and his eyeballs were boinging out like golf balls on Slinkys. He was moving about forty miles an hour, barreling right at me. My car was a 1978 Dodge Colt, which is approximately the size of a Saint Bernard.
I opened my car door, stepped out, and began to run. Or rather, my feet began to run. I was on ice. I was stationary. I looked like Fred Flintstone, pre-ignition, feet windmilling in a comical blur, slapping thump-a-thump against the ground, going nowhere.
And then, suddenly, I was going somewhere. I was flying. I blacked out for a moment, and when I awoke I was on my back on the ice. On one side of my body was the truck. On the other side of my body was my car, pulverized into something that looked like a large, smoking Raisinet. Witnesses later told me that the truck hit my car, then my car hit me, and rolled over my body, bouncing once on each side but missing me entirely. The front wheel of the truck was inches from my face. I had no significant injuries.
After the accident, after I realized I had defied death, everything changed. The nighttime sky shimmered with mystery and grandeur. A man could get lost in it, out there in the blackness, sitting cross-legged on the hood of his car, captivated and humbled, oblivious to the cold. A raw tomato, eaten like a McIntosh, was the finest meal a person could want. How could I have not noticed its pebbly, sweet-sour perfection before? A stranger’s cigarette butt, hurled from a car window at night, became a thing of beauty, exploding on the road in a tiny, magnificent fire shower. You could taste water, if you tried. You could taste a woman with
out touching her, if you tried.
This sense of wonder lasted about a month. I tried to hang on to it, but it was no use. Everything returned to normal. You can’t summon feelings of mortality. They visit you, stay as long as they wish, and tiptoe away.
Unless you are actually dying.
The first fatally ill person I knew well was Howard Simons, a journalist. Those of you who read the book All the Presidents Men will recognize Howard Simons as one of the principal architects of The Washington Post’s exposé of Watergate, the fearless managing editor whose wisdom and unswerving encouragement helped Bob Woodward and Carl Bernstein topple a corrupt presidency. However, those who did not read the book but only saw the hit movie upon which it was supposedly based will instead remember Howard Simons as the cringing swine who looked like Martin Balsam and whose thickheaded skepticism and cowardice almost single-handedly torpedoed the whole project.
Howard Simons was not a bitter man, but he was bitter about this movie misrepresentation, and he had hoped that someday someone would set the record straight in a book. I am sure Howard was envisioning a book with a title like Principles and Practices in the Ethos of Latter-20th-Centiuy Journalism, volume VI, The Watergate Epoch, as opposed to a book about peeing and pooping. But such is life. And death.
In 1989, Howard started suffering from heartburn and back pain. He went to the doctor, who told him it was advanced pancreatic cancer. In the pantheon of Things Doctors Can Tell You, “advanced pancreatic cancer” is very, very bad. If Things Doctors Can Tell You were, say, popular songs, “Howard, you have the constitution of an ox and should live happily into your hundreds” would be “Johnny B. Goode,” by Chuck Berry. And “Howard, I’m afraid you have advanced pancreatic cancer” would be “Muskrat Love,” by the Captain and Tennille, as rerecorded by the barking dogs.
In the weeks before his death, I went to Cambridge, Massachusetts, to visit Howard. I had dreaded the visit. What do you say to a dying person?
In real life, Howard Simons sort of looked like Martin Balsam only in the sense that a goldfish sort of looks like a banana. Howard had ice-cube eyeglasses, a nose like an ocarina, and a head of hair resembling the cotton from an aspirin bottle recovered from a plane crash. It was infuriating to me that women invariably found Howard extremely attractive, as opposed to, say, me.
It might have had something to do with the fact that Howard was a lot smarter than, say, me. Howard was one of the smartest people on the planet. He was always right. Not only was he always right, he was always right in a way that was instantly evident to everyone, rendering all previous opinions worthless.
Once, when he was running a fellowship program for writers and editors, Howard brought me and several other big-shot young journalists to interview the man who was emerging as front-runner for the Democratic nomination for president. It was Michael Dukakis. For an hour the governor of Massachusetts regarded us from beneath those flagrant eyebrows and held forth expertly on the great issues of the day. He was never at a loss for words. He never said “um.” He had a program for every problem. Once, he fielded a question from a Latino writer and answered in flawless Spanish. It was a masterly performance. We left plainly awed.
In the elevator on the way out, all the savvy young journalists babbled on about how charming and smart and impressive Dukakis had been. Howard listened until everyone else was finished and then said, “Won’t win. No sense of humor.” Four months later, of course, Dukakis’s campaign would collapse in ignominy when the American public discovered he was as dull as a butter knife that had been used to tunnel out of prison. Seeking someone with comparatively more fire and brio and naked animal excitement, the American public chose George Bush.
Howard Simons was only fifty-nine, but he always seemed to be the oldest and wisest person in a room, and this would be true even if the other people in the room were Nelson Mandela, Ruth Bader Ginsburg, and Confucius. An audience with Howard was always just a little bit intimidating. But now that he was dying, the stakes seemed apocalyptic.
There is a tendency to assume that when one is facing death one attains a higher degree of philosophical awareness. Howard Simons getting more philosophically aware would be a fairly scary and maybe even scientifically impossible proposition, like water getting more wet.
I asked Howard if he was angry, and he said, “You mean like this?”—and he looked to the heavens and cried, “Why me, and not Pol Pot?”
Then he smiled and said no, he was not angry.
So I sort of flumphered out what I wanted to know. I do not remember precisely what I said, but essentially I wanted him to show me the world from the unduplicatable perspective of one who is about to leave it, to answer what philosophers have been asking since lumbering prognathous-jawed hominids of the Pleistocene Era contemplated the vastness of the open seas. I asked him to tell me how the imminence of death had altered his perspective on the meaning of life.
This is what he said:
“Mostly, you no longer worry about flossing.”
At that moment, to me, Howard Simons was the wisest man on earth.
Two years later, I went to the doctor for a routine cholesterol test. The doctor called the next day and said my cholesterol was fine but that there was something that showed up1 and he wanted me to stop by the lab on my way to work to take an ultrasound sonogram of my liver.
I said sure, I would arrange for it the next day.
Do it today, he said.
And so I did. It was September 17, 1991, the day I was cured of hypochondria.
The medical procedure was not unfamiliar to me. I had seen it twice before, when my pregnant wife had ultrasound prior to amniocentesis. Amniocentesis is a procedure wherein, to find out if there is anything wrong with the fetus, doctors take an enormous needle and stab it into your belly. (Actually, doctors only made that mistake a few times before they got it right. Now they stab it into your wife’s belly.)
So there I was, out on the examining table, reasonably calm for a paunchy middle-aged man lying naked in front of a cheerful, businesslike, attractive twenty-five-year-old medical technician who was applying oil to my crotch.
Next she started rolling a computer mouse on my belly, and going, “Mm, mm,” and approaching it from all these different directions. Coolly, casually, I asked what she was looking for, as though I really didn’t care but just wanted to say something to be polite.
“Usually, looking for tumors,” she said.
She was squinting at a computer screen, which was visible to me, too, and there was my liver. Right in the center of it, taking up maybe a quarter of the screen, was a huge dark elongated mass.
“Um, so what do you see?” I asked, still phenomenally cool.
“I am not permitted to diagnose,” she said evasively. It was evidently worse than I thought.
Miss, I said, please, please speak freely.
“I am not allowed to diagnose.”
Miss, just answer yes-or-no questions. Do you see that big black mass?
“Yes, I do.”
Do you know what that mass is?
“Yes, I do.”
If I were your father and you saw that big black mass there, would you be concerned?
“Yes, I would be—”
A maelstrom of horror, self-pity, and ironically, wretched gratitude for this young woman’s honesty crashed through my mind. In that flash of perception, I saw my two children, grown, with families I would never know.
“—because my father has had his gallbladder removed, so it would be highly unusual and worrisome if he had grown another one.”
Ah.
Anyway, I did not have a tumor. What I had was hepatitis.
There are many types of hepatitis, but the three principal ones are identified by the letters A, B, and C. Each has its advantages and disadvantages. Hepatitis A has the advantage of being relatively mild, not much more worrisome than a cold, but it has the disadvantage that you get it by eating poop. Feces-contaminated food. I don’t k
now about you, but I think this would bother me a great deal, even years after I recovered. I would never regard a morsel of hamburger quite the same way.2 Hepatitis B has the disadvantage of sometimes turning you as yellow as a stool pigeon but the advantage of typically being transmitted by a wild, carnal lifestyle characterized by indiscriminate sex, intravenous drug use, and/or generally behaving like a rutting jackal. Hepatitis C has the advantage of not being caused by eating poop and not usually turning you yellow. Unfortunately, it has the disadvantage of being the one for which there is no vaccine, no cure, and often no recovery. That’s the one I have.
Don’t feel bad for me. Hepatitis C is a cool disease. Lots of famous people have had it. Mickey Mantle, for example. King Farouk. Many of these people are currently dead. My point is that I had something serious, which I discovered to be a fantastic cure for my hypochondria.
Actually, it is a fantastic cure for a lot of things. What I learned, basically, is that—to put it as succinctly as possible—you no longer worry about flossing. A few weeks after I found out about my illness, the contractor who built the $16,000 deck in my backyard disappeared shortly before the job was done. Just … disappeared, right after my last check had cleared.3 Prior to my discovering I had a serious disease, my reaction would have been somewhat immature. I would have begun calling this person at 4 A.M., egging his car, sticking a potato in the exhaust pipe, etc. But everything was different now. My view of life had totally changed. So I beat him to death with a baseball bat. I mean, what are they gonna do, execute me twice?
No, the fact is, I let it slide. Now, for those of you dying out there, I would like to warn you that “letting it slide” can become a bad habit. Not bothering to floss can become not bothering to brush one’s teeth, and then not bothering to change one’s clothes, then not bothering to pull down one’s underpants before one goes to the bathroom, et cetera. It is kinder to others to behave as though you are not dying.
The Hypochondriac's Guide to Life. and Death. Page 16