The Hypochondriac's Guide to Life. and Death.

by Gene Weingarten

  Hypochondriac: My eyelid is twitching once every six point four seconds.

  Poison Control Person: (Pause) Omigod.

  Hypochondriac: OMIGOD? (Beatbeatbeatbeatbeatbeatbeat)

  Poison Control Person: Quick. You need to prepare an antidote. Do you have any anchovies?

  Hypochondriac: Yes!

  Poison Control Person: OK, now do exactly what I say. Make a drink of mashed anchovies, root beer, and tartar-control toothpaste …

  My point is that Poison Control people are shitheads. They love to have their little fun with hypochondriacs. The whole world loves to have its fun with hypochondriacs, and I am frankly tired of it.

  Listen, hypochondriacs. This book will not insult your intelligence by telling you to grow up, that it’s all in your mind. It will insult your intelligence in far more sophisticated ways. This book is going to feed your disease, symptom by symptom, chapter by chapter, until—to use complicated medical terminology—you are so gorged on your own self-pity you puke it all out. And as everyone knows, puking it all out is a great way to purge the body of toxins. Unless it leads to a rupture of the esophagus, septicemia, peritonitis, febrile dementia, and death.

  This book will also describe many rudimentary medical tests that, in the hands of the trained clinician, can be invaluable diagnostic tools. These tests are so simple that you could perform them on yourself, in the privacy of your home. Not that you should. Doctors have spent years studying the proper techniques of physical examination. No reputable writer would encourage untrained persons to engage in self-diagnosis, particularly hypochondriacs, who may be needlessly alarmed. For quick reference I will thumbnail each test with a handy icon.

  * * *

  Quick! Go to the mirror. Open your mouth. Look at your uvula, the thing that hangs down at the back like a garden slug. Is it pulsing? It shouldn’t be. When your uvula throbs in time with your heartbeat it is called Mueller’s sign, and it can indicate heart disease! You could die!

  Now insert the tips of your three middle fingers into your mouth, making a vertical stack, without touching your lips or teeth. If you cannot open your mouth that wide, you might have temporomandibular joint syndrome; worse, you might have systemic sclerosis, a grotesque progressive illness in which your skin hardens and contracts and can slowly garrote the life out of you.

  With your palm facing you, tap lightly on the very center of your wrist. You are performing the Tinel test. If you feel a radiating numbness in your hand, you might have early carpal tunnel syndrome, which can eventually turn your hands into appendages as useful and attractive as a tyrannosaurus’s.

  * * *

  In the end this book is going to present a surefire cure for hypochondria—a dramatic, natural remedy as effective as Bactine on a boo-boo. I could disclose it here, but I won’t. This is a literary technique called foreshadowing, previously employed by famous literary individuals such as William Shakespeare. In the hands of the unscrupulous, foreshadowing can be nothing more than misleading hype. The responsible writer promises no more than he can deliver. I will say only this: I am going to keep hinting at my cure for hypochondria until I finally disclose it, and you will have an orgasm.

  To find out if this book is “for you,” take this simple Grade-Ur-Self Multiple-Choice Test. There are nine questions. Score one point for each answer numbered 1, two points for each answer numbered 2, and three points for each answer numbered 3.

  THE HYPOCHONDRIA SELF-EXAM

  Carefully wash and dry your hands. Now touch your left nipple with your right hand. Knead the nipple between your thumb and forefinger, rolling it gently but firmly in a counterclockwise direction. What do you feel?

  Stupid.

  A nipple.

  Small, benign enlargements and/or impacted pores that are probably no cause for alarm.

  You feel you might have a fever. So you:

  Crank up the air-conditioning.

  Take your temperature.

  Take your temperature, and when you insert the thermometer you are pretty sure you notice an extra lump in that thing under the tongue that looks like a sea urchin, so you walk around with your tongue in the air, asking everyone if they see anything wrong, only they can’t understand you because it comes out “Arll lralll lallrhal?”

  Within 38 to 40 minutes of eating a heavy meal, do you sometimes find that your pyloric sphincter fails to relax adequately, causing excessive peptic digestion accompanied by mild-to-moderate upper gastric distress and followed 18 to 22 hours later by chalky stools?

  Huh?

  Sphincter? Wha?

  Yes.

  When did you last see a doctor?

  Two years ago or more.

  In the past two years.

  You are reading this in your doctor’s office. You are having him check out that left nipple, just to be sure.

  You notice a slight pain in your armpit when you lift your arm in a certain way. Do you:

  Stop lifting your arm in that certain way.

  Check for lumps.

  Check for lumps. Finding none, check for nodes or lesions or garfunkels. Finding none, get a brain scan. Finding no abnormalities, you contrive to have a conversation with a trusted friend wherein you casually mention that you know of a person who noticed a slight pain in his armpit when he lifted his arm a certain way, and your friend says yes, she once knew someone like that who later developed dysentery and pooped himself to death, and suddenly you have to go to the bathroom real bad.

  Do you have any moles?

  I don’t know.

  Yes. Maybe I should get them looked at.

  Yes, but they have not changed appreciably in the last 18 months. I have Polaroids.

  Systemic lupus erythematosus is a serious, debilitating, potentially fatal autoimmune disease involving periodic, episodic occurrences of some or all of the following symptoms: fatigue, muscle aches, rashes, nausea, dry mouth, chest pain, headaches, bruising of the skin, tenderness in the joints, forgetfulness. Do you think you might have systemic lupus erythematosus?

  Nah.

  Why? What have you heard?

  If it were only that simple.

  Would you marry a proctologist?

  No.

  No, unless I loved the person very, very much.

  No, unless I had polyps.

  How do you think you will die?

  In bed, surrounded by weeping children and grandchildren.

  Flying through the windshield of your car.

  Flying through the windshield of your car after suffering a “cerebrovascular accident,” or stroke, probably linked to undiagnosed atherosclerosis, thrombotic endocarditis, or hemorrhagic telangiectasia.

  GRADING

  Score of 9-10: You should buy this hook because you are entirely too cavalier about your body. Vigilance is critical to good health.

  Score of 11-19: You should buy this book to feel superior to the people in the next group. A positive mental attitude is critical to good health.

  Score of 20-27: You are a hypochondriac. If you do not buy this book, you will die.

  Score of 28 or higher: You are an imbecile. You have already bought this book and plan to use it as your family’s primary medical text.

  There are other excellent books available to those persons concerned with their health. In the interests of fairness and full disclosure, I will briefly describe these volumes and list their principal advantages and disadvantages.

  The first group consists of books with names like The Family Medical Guide, or The Home Medical Encyclopedia, or The Doctors’ Guide to Good Health, generally published by the American Medical Association or other renowned physicians’ organizations. These are helpful, responsible diagnostic books, featuring listings of symptoms in easy-to-follow flow charts, each chart terminating in a row of exclamation points urging you to see your physician without delay.

  The second group are clinical texts, intended for doctors and available mostly in medical bookstores and libraries, containing lines like
this, from page 458 of Current Medical Diagnosis and Treatment, 1995: “Disorders such as disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, hemolyticuremic syndrome, hypersplenism, and sepsis are easily excluded by the absence of system illness. Thus, patients with isolated thrombocytopenia with no other abnormal findings almost certainly have immune thrombocytopenia.”

  These books are characterized by the use of humongously scientific Latin-influenced terms such as “sternutation”1 and “epistaxis”2 and “cutis anserina”3 and “pyrexia”4 and “diaphoresis”5 and “singultus,”6 which are too important and complicated to be understood by unschooled morons such as yourself.

  Many of these medical books also contain pages of photographs, such as this one, reprinted from French’s Differential Diagnosis (1979):

  So these books can be highly entertaining, though they cost much more than my book and make you vomit.

  The third type consists of books arranged on endless shelves labeled “alternative medicine” These usually begin with solemn advice against succumbing to quackery, followed by a simple nine-step formula for curing lymphomas via the teachings of Mohammed Ibn Rajneesh and the use of beet suppositories.

  Alternative medicine books take elaborate measures to appear serious and scientific. I am right now leafing through Alternatives in Cancer Therapy, by Ross Pelton and Lee Overholser, featuring an endorsement on the cover by Linus Pauling, the two-time Nobel laureate. Alternatives in Cancer Therapy soberly evaluates treatments that include eating mistletoe, taking enemas made from strong coffee, and drinking urine.

  My book is like none of those.7 Unlike the family medical guides, this book will dispense no practical medical advice whatsoever. Unlike the alternative medical books, it will advance no mountebank cures. Unlike the medical texts, it will not be condescending to the reader.8 It will mention thrombotic thrombocytopenic purpura only for the purpose of observing that, among all diseases the author has encountered in the course of his extensive medical research requiring many, many footnotes,9 it has the second-funniest name.10

  Last, let me say that although this book will raise some legitimate concerns about health, it will not use scare tactics to inflame the public’s fears in the manner that, say, untreated appendicitis can inflame the appendix until it bursts, choking the bloodstream with deadly toxins and snuffing out your life in fifteen minutes of writhing agony. We are living in an era of fabulous preventive medicine. After all, it is not every day that some guy goes to the doctor because he is peeing a lot and learns he has a prostate the size of a bagpipe, though I personally know of two people this happened to.

  They did not buy this book either, and now they are dead.

  1 Sneezing.

  2 Nosebleed.

  3 Goose bumps.

  4 Fever.

  5 Sweating.

  6 Hiccups.

  7 It is also unlike Hystories, a popular 1997 book by Elaine Showalter suggesting that many trendy diseases of the modern era-such as chronic fatigue syndrome—are not real, but hysterical reactions to the tensions of modern life. This book led to strong opposition by CFS sufferers, who claimed it belittled them and their affliction. Their opposition dramatically increased sales of Hystories, an obscure scholarly treatise, because chronic fatigue syndrome sufferers kept showing up to picket Ms. Showalter’s public appearances. I wonder if they wore bunny rabbit slippers and Dr. Denton’s pajamas, with the little tushy flap in the back. I hereby express my solidarity with CFS sufferers and other whining nutcakes, including victims of “seasonal affective disorder.” I will fight to the death for their right to picket my book.

  8 “Condescending” is a great big word that means “talking down to.”

  9 Some of my footnotes even have footnotes.11

  10 The funniest name: “beer potomania.” See Chapter 12, “Are You an Alcoholic?”

  11 Like this one.

  Relax, Hypochondria Never Killed Anyone. Oh, Wait. Yes, It Did.

  People have always been worried about their health, and some people have always been more worried than others. The ancient Greeks coined the term hypochondrion to indicate the part of the torso beneath the rib cage, which is where most early hypochondriacs imagined their pains. Typically, the sufferer never got better, attributing his condition to what the ancient Greek doctors considered fanciful, even laughable causes.

  Think about that. These were primitive times. If you had a real case of, say, influenza, the finest medical minds in the world would consult on your case and decide you had an evil salamander dwelling in your spleen. What could the hypochondriac possibly have imagined that seemed bizarre to these people?

  First Greek Doctor: I’m at my wits’ end with Eucalyptus. He blames his sore throat on-get this-teensy invisible creatures that entered his body through the nose when someone else sneezed!

  Second Greek Doctor: Har har har. What a bozo. But he does seem to be ill. Just to be safe, I would follow established medical procedure.

  First Greek Doctor: Agreed. We shall flay him with the tailbone of an ass.

  Thousands of years later, hypochondria still poses a diagnostic dilemma for the medical practitioner. On the one hand, taking seriously the brooding of an obvious hypochondriac compromises the noblest tenets of medicine and, by giving credence to his complaints, may even aggravate the poor wretch’s condition. On the other hand, the poor wretch is a potential source of tens of thousands of dollars in fees over many, many years.

  Faced with this dilemma, most doctors have adopted the following checklist for evaluating a suspected hypochondriac and deciding whether to treat him:

  Does this person have medical insurance?

  The fact is, attention from a doctor may make a hypochondriac feel better, but it won’t cure him. Over the years, well-intentioned physicians have tried everything, to no avail.

  In his 1961 book, Minds That Came Back, Dr. W. C. Alvarez reports on the case of a man who was convinced he had a frog in his stomach: “We gave him an emetic, and while he was vomiting, we slipped a frog into the basin. The man was thrilled; he felt so justified, and he was grateful. The only trouble was that he returned the next day to tell us we had been a bit too late—a dozen baby frogs had hatched out and were hopping about in his stomach.”

  Many famous people were hypochondriacs: Molière, Voltaire, Jonathan Swift, Rudyard Kipling, Ludwig van Beethoven, Immanuel Kant, Robert Burns, Jesus Christ.1 Enrico Caruso used a dentist’s mirror to examine his vocal cords every day, convinced against all medical evidence that he was subject to alarming growths and swellings. John Adams, our second president, predicted his own death at thirty-five, and then again at forty, because he felt himself afflicted by ill humors. He somehow survived his fifties convinced he could not possibly make it into his sixties, so infirm was he. He lived through his seventies with the chill of death’s gnarled hand upon his rheumy shoulder. He spent his eighties with one foot in the grave and the other in a pot of Epsom salts. At last, his fears proved sound. Adams died midway through his ninety-first year and remains the oldest ex-president ever.

  During a journey in which he shared a coach compartment with a woman with swollen legs, the poet Percy Bysshe Shelley2 imagined he had caught elephantiasis. For months afterward, he would examine himself for signs of the illness, which causes grotesque enlargement of the legs and, in men, the scrotum. He policed his acquaintances scrupulously to make certain no one could possibly transmit the illness to him. Shelley’s biographer Thomas Hogg reports this singular event:

  When many young ladies were standing up for a country dance, he caused wonderful consternation among these charming creatures by walking slowly along the row of girls and curiously surveying them, placing his eyes close to their necks and bosoms, and feeling their breasts and bare arms, in order to ascertain whether any of the fair ones had taken the horrible disease. He proceeded with so much gravity and seriousness, and his looks were so woebegone, that they did not resist, or resent, the extraordinary l
iberties.

  James Boswell, the eighteenth-century Scottish essayist and biographer, would lie in bed at night unable to sleep, convinced his testicles were swelling. Once, he ordered a doctor to bleed him to relieve him of the poisons he felt were making him ill and causing him nightmares. He confessed he enjoyed watching public hangings because it distracted him from the fear of contracting venereal disease.

  Hypochondria afflicts the famous and the obscure alike, though most of our best anecdotal evidence concerns celebrities. That is because there is no shortage of jealous, petty ingrates hanging around famous people, willing to betray their privacy for a couple of bucks or a cheap laugh. There are name-droppers everywhere.

  This reminds me of the day I personally drove Dick Cavett and his producer to an event in the South Bronx. It was 1972. I was twenty-one. Dick sat in the backseat of my car. His producer sat next to me. Doggedly, I tried to engage the famed talk-show host in conversation. I asked him something suitably sophisticated, such as, “So, Mr. Cavett, what do you think about the state of stand-up comedy in America?” and he answered, “Mrphrprm.” This surprised me because Dick Cavett’s diction is ordinarily quite elegant, as anyone knows who has ever heard those old ads for Hormel meat products, in which he makes processed hog snouts sound like boeuf bourguignon.

  I tried again with a less boring question. Something about underpants.

  “Mrphrc,” he said.

  Finally, I looked in the rearview mirror. Dick Cavett, the master TV interviewer, was talking with a handkerchief clapped over his nose and mouth. He looked like an actor endlessly rehearsing his great vomit scene.