Hypochondria

“One’s own thought is one’s world.

What a person thinks is what he becomes.”

-Maitri Upanishads

It’s one of the most common words I hear in the office. People who are afraid that their complaints are not “real.” Husbands who think that their spouse’s symptoms are exaggerated. Parents who do not know if they need to take off work because a child has complained of belly pain, or a sore throat, or just not feeling well.

“Am I being a hypochondriac?”

“He (she) is a notorious hypochondriac.”

“My kids are such hypochondriacs.”

The term originated from abdominal pain (“hypo” is below; “chondro” stands for the cartilage where the ribs meet the breastbone). But like a cancer it has metastasized to indicate any kind of pain or malaise all over our anatomy.  Headaches; joint pains; fatigue; all symptoms known to humanity have been ascribed to imaginary causes.

It makes it difficult for doctors. I teach my students to never, ever tell a patient that his or her symptoms are not “real.” Even when it is clear that anxiety is dominating the picture. Because the worried well also get sick.  You do not want to be the one who missed the ruptured appendix during Mrs. Brown’s umpteenth visit for belly pain.

So yes, we have to listen every time. We have to palpate; hear; test. Many times to the consternation of a life partner who is very anxious to prove that this person that he supposedly loves is an unreliable whiner.

There are cases that can make you regret having chosen a medical career.  For years I saw a lady who seemed to have a relentless desire to be sick.  Our visits lasted for forty minutes, until I was forced to put her on the clock. When I walked into the exam room I told her that she had fifteen minutes, so she had to make the best possible use of them. Despite this warning she would rush from one complaint to the other, and would never leave me time to examine her. As I began to walk out of the room she always asked me to wait, that she was not done. I learned to insist that she make another appointment, and I begged her to prioritize.

One day I was scheduled to see her long-suffering husband. I was surprised to find her in the room. She had coerced him into yielding his time, because she felt that her symptoms were worse than his.

I walked out of the room without listening to her. I asked the nurse to bring her husband in. I was shocked to see that he was very pale, and that he looked like he had lost some weight. I began to examine him while she (loudly) protested that this was her time. Because he had been a heavy smoker I sent him for a chest X Ray. When he came back with the films she was still insisting that I listen to her. He had a large lung cancer in his left lung.

I explained to him that he would need to have a biopsy of this mass; that I thought this was a serious matter; that he needed to make arrangements for a family member to be available to help out.

Before I had a chance to finish she tugged at my sleeve.

“What’s going to happen to me?” she said.

He remained quiet; an already defeated man who had no chance of getting any kind of support from his wife.

This is an extreme case, but we do see a few of these. Most of the time we deal with people who’re going through stressful times, and they are not insightful enough to realize that what needs attention is their soul, not their body. More common are the cases of people who wait too long to register a complaint, because they are afraid of being labeled as anxious. I see many heart attacks, and cancers, and joint deformities that would have had a better prognosis had they been treated earlier.

Therefore in general it’s best to check things out.

Which is what I did when I developed my second case of shingles. The first one had been fairly mild, and the pain was almost nonexistent. The rash did itch a bit. I did not see my doctor, nor did I treat it. But when I developed a new rash around my left eye nine months later, I knew enough to ask for his opinion.

You see, second cases of shingles are very unusual. Most experts think that they never happen in an otherwise healthy individual. When they do occur, they may indicate the presence of a lymphoma (lymph gland cancer).

I got myself used to this possibility. I made mental notes of which doctors would care for my patients when I had to go through chemo. I tried to guess how long I’d be out of circulation. I bought a book on meditation, and I very calmly walked into the exam room where I would receive the disastrous news.

My doctor walked in. We shook hands; we spent a few minutes catching up on our practices and our families. Then he asked me how he could help.

I explained that I had made a diagnosis of shingles, and that I wanted to have a couple of CAT scans done to look for the lymphoma that was sure to be present.

He listened to every word, not betraying any emotion. I marveled at his equanimity. Then he peered at my rash.

“Paco, this is poison ivy.”

For a few seconds I resented his ignorance. I even felt a bit of regret that I wasn’t going to get my CAT scans.

“Really?”

“Classic. In fact, if the rash you had nine months ago was similar, that was probably what you had then.”

Now I was getting upset. How could this man be so cocky about making a diagnosis of a rash he had not seen? Who did he think he was? And doubt MY diagnosis?

Then reality set in. I knew he was a good doc. For all of my years in practice I had warned my (many) physician patients to leave the diagnosing and treating to me; that doctors should never treat themselves. And here I was, doing exactly what I forbade my patients to do…

I shut up. I accepted the prescription for the cortisone cream. I called my wife, whom I had carefully prepared for widowhood for the past few days, to tell her the news. To her credit she limited her comments to two uproarious bouts of laughter. She never brought it up again, which I guess is one of the reasons that I love her so much.

I cancelled my call coverage. I spent the money that was going to cover the copay for the chemo.

I promised that I would never, ever again be humiliated in this fashion. I would always see my doctor first when I became worried about a possible cancer.

But there are these chest pains that I have been getting more frequently of late. I need to make coverage arrangements for my practice in case this is my heart. What if I end up needing a bypass? I wonder if Dr. ____ would do it…