The Hypochondriac's Guide to Life. and Death.

by Gene Weingarten

  To summarize: Fifteen hundred dollars. No pubic hair.

  No X-ray Specs.

  What is that pink thing in the corner of the eye? Why, in old people, does it look like worm larva?

  It is called the “lachrymal caruncle.” It is one of those organs whose function is to go unnoticed for years and years until one day you really look at it, and it totally grosses you out. Another one of these is the uvula. Most people never think about the uvula, dangling in the back of the throat, bobbling back and forth unnoticed, forgotten, until some idiot makes you aware of it. Then some people become obsessed with it. They imagine they can feel it all the time, whapping against the throat, stimulating the gag function, interfering with the swallowing of food, a constant, malignant presence that CANNOT BE IGNORED AND MUST BE ELIMINATED EVEN RIGHT NOW, WITH ANYTHING YOU CAN FIND INCLUDING TOENAIL CLIPPERS OR A STAPLE REMOVER. Fortunately, this rarely occurs.

  1 It is a little-known fact that during eye surgery, doctors often take your slit eyeball and flap it open and shut while talking in little squeaky voices, to relieve tension.

  2 A reputable organization that cooperated with me because I implied I was researching a serious medical book. Ha ha.

  3 Despite its name, there is nothing funny about the vitreous “humor,” except, possibly, the fact that it is odorless. So it is without any scents. No scents. Of humor. Then again, perhaps this is not funny.4

  4 On the other hand, the humerus, which is the bone extending from the shoulder to the elbow, ends in the “funny bone.” Doctors find this hilarious. In general, doctors have unbelievably lame senses of humor. Their concept of cutting-edge comedy is Reader’s Digest’s “Laughter, the Best Medicine” page, featuring jokes such as: “Patient: I have a pain in my upper-arm bone. Doctor: That’s ‘humerus.’ Patient: You wouldn’t think so if it was you.”

  5 Karl is not renowned for his superior judgment. He has done other dumb things. He is the only person I know who once slammed a car door on his own head.

  6 Worms cause all sorts of diseases, and they enjoy the eyes. Loiasis, for example, is an infestation of the loa loa worm. It spreads throughout your body but is often not diagnosed until the worms are seen migrating across your eyeball.

  7 Do not do this if the person is clearly not forty-two. Do not do this if the person appears to be, say, eighteen, especially if this person is a woman.

  Oh, Crap (Diagnosis by the Process of Elimination)

  I work at The Washington Post, which is a great and powerful news organization that will boldly publish stories that infuriate potentates, put people in prison, provoke multimillion-dollar libel suits. But certain subjects scare it half to death. Like every big, respectable newspaper, it fears being labeled “tabloid.”1 And so it is that several months ago, Post editors killed a story by one of their finest foreign correspondents because the subject matter was considered vulgar.

  Fulfilling my duty under the First Amendment to eradicate censorship and suppression wherever it arises, I am now going to disclose for the first time the contents of this story: Women in Japan suffer from terrible constipation because they are embarrassed to move their bowels.2

  This is true. They won’t leave their desks at work because people will watch them, calculate the amount of time it took them to return, and surmise what they have been up to. Constipation during honeymoons is epidemic because women are worried about what they might reveal of themselves to their new spouses in the close quarters of a hotel room. Once married, Japanese women typically will wait for their husbands to leave for work before they use the toilet. A hot-selling item in Japan is a bathroom accessory for women delicately called the Sound Princess, which produces pleasing nature sounds3 to cover up distressing body noises.

  Now, what can we learn from this?

  First, stories like this one provide a valuable cultural lesson. Every time we think we have finally figured out that the earth is one great big comfy living room filled with people exactly like us and we should all be nice to everybody because they are our siblings united in the blissful commonality of humanity, we read that in, say, Yemen, jaywalkers are beheaded.4

  The second lesson is that the human body has astonishing control over its bowels. If you can induce constipation as an act of will, then you can do almost anything. A hypochondriac’s playground!

  Before proceeding, let me say that it is easy to find adolescent humor in normal bodily processes, and this is a good time to, heh heh, rectify the situation. There is nothing funny about hawking up a loogie or making foof-foof noises from the rump hole.5 The fact is, bodily secretions are so natural that some of them have even been commemorated in song. One example is eye crud (“Mr. Sandman,” by the the Chordettes, 1954). Another is vaginal discharge, and it is a perfect example of how one might go “a little too far” in the pursuit of humor. In his song, Frank Zappa advocated stealing women’s panties and wearing them on one’s head as “discharge party hats.” God was as appalled as you are. Mr. Zappa is dead.

  I had Zappa’s demise in my head the day I went to interview one of Washington’s most distinguished colorectal surgeons, Dr. Bruce Orkin. I resolved to approach the topic of pooping with all the restraint and reverence one might associate with an ecumenical council.

  Dr. Orkin arrived fresh from surgery, in a white lab coat. It was very clean. I had many things that I wanted to ask Dr. Orkin, things that had been bedeviling me my whole life, such as why toilet paper comes in squares so small no one can use only one.6 But I did not ask this. I was asking very mature questions, and Dr. Orkin was answering in a very mature fashion, both of us hewing maturely to the notion that there is nothing remotely funny about the colon, or the rectum, or human intestinal function. Dr. Orkin was going on about the need for roughage (it is very, very important) when I suddenly interrupted to ask him about something I could not get out of my mind. I did not know how to broach the subject in an appropriately stately fashion, so I just handed him a copy of a 1987 medical abstract from the American Journal of Forensic Medicine and Pathology. This story had made the rounds of the Post. It had stains on it, drool marks from where coffee was launched out of people’s noses, etc. The article described a case in which a man came into an emergency room complaining of rectal pain. Doctors discovered a huge, hard mass in his rectum. The man initially claimed he did not know how this object got there, but in time he admitted he’d had his boyfriend pour wet concrete into his anus with a funnel, and (surprise!) it hardened, forming a rocklike object that doctors had to remove, like delivering a baby. The object was six inches long, four inches thick, and contained, imbedded at the far end, perfectly intact … a Ping-Pong ball.7

  Dr. Orkin scanned this article. “Oh,” he said.

  He looked at me dourly. I sensed I had made a terrible mistake. I sensed the interview was about to be terminated.

  “Let me show you something,” Dr. Orkin said.

  Abruptly, his demeanor changed. Rising from his desk with new animation, he went to a file cabinet and extracted a set of keys from his pocket. Then he pulled from the wall a large vertical slide cabinet, the type doctors on ER use to display X-rays of hearts and lungs and broken bones. It was entirely filled with small slides. There were perhaps seventy-five of them.

  On almost every slide was something that Dr. Bruce Orkin, eminent colorectal surgeon, had personally removed from a rectum. Usually there was a “before” and an “after”: objects photographed in situ, through an X-ray, and then again after extraction. There were photos of bottles, vibrators, and light-bulbs. One was of a gigantic, realistic black rubber penis roughly the dimensions of a meatball sub. One showed a delicate French glass vase. (In the “after” picture, a yellow rose had been placed in it. An elegant touch.) “Actually,” corrected Dr. Orkin, “that one was removed by my colleague Dr. Sackier.”

  One photo showed a bottle of Suave roll-on deodorant. That patient had come in with his wife, Dr. Orkin recalled. She grumped that the bottle had been too smooth, offering n
othing to hold on to.8

  One photo showed someone with two lightbulbs in his butt.

  “Why would you put two lightbulbs in you?” I asked.

  “If one is good, two is better.” Dr. Orkin shrugged.

  I am not an expert in anatomy, but one of the pictures appeared to be of a penis, not a rectum. Inside the penis, quite clearly, was a chicken bone9 broken in two. Dr. Orkin is a rectum man.

  “A friend gave me that one,” he explained.

  “You like this stuff?” Dr. Orkin asked a little unctuously, like a playground dope pusher. I nodded; at this point, I was speechless. Then the doctor produced another key. He opened another drawer. He extracted from it an object swathed in a towel, and handed it to me. It appeared to be about the size of a railroad spike. It appeared to weigh about as much as a railroad spike. “It has been cleaned,” Dr. Orkin assured me.

  I unwrapped it.

  It was a railroad spike.

  It was ten inches long, an inch and a half thick, with a sharp end. “I took it out of the descending colon,” Dr. Orkin said.

  Dr. Sackier walked by. I complimented him on the vase, and he blushed and stammered, and said that really, it was nothing compared with the fine work Dr. Orkin has done.

  “Did he show you the railroad spike?”

  Jonathan Sackier is a Brit, and so everything he says sounds dignified and magisterial, which is particularly entertaining when he is discussing his study entitled “Management of Colorectal Foreign Bodies.” In this, Dr. Sackier follows up on forty-nine selected cases of foreign objects up the gazoo, including fourteen vibrators, eight dildos, three wooden dowels, three vegetables (type unspecified), three bars of soap, three deodorant bottle tops, two deodorant bottles, one porcelain teacup, one television vacuum tube, one glass bottle, one marble egg, five ballpoint pens (apparently inserted together), one chicken bone (!), one handle of garden shears, one screwdriver, one cigar tube, one Lucozade bottle, and one “packet of white powder.” The range of objects inserted, Dr. Sackier notes, “is not limited by the imagination, but by the size of the rectum.”10

  All of this carries a valuable object lesson: Don’t try to stick any object in your rump that is smaller than an unabridged thesaurus, or you might wind up on your belly in a room full of giggling people with forceps.

  This is not to suggest that intestinal specialists spend all their time extracting items from people’s behinds. Every few weeks they apparently take a break to treat someone else, often someone diagnosed with “irritable bowel syndrome.” Irritable bowel syndrome is the cash cow of the gastrointestinal industry. Victims report intestinal pain coupled with alternating bouts of diarrhea and constipation. There is no obvious cause. Irritable bowel syndrome is one of those modern diseases that can best be described by what they are not rather than what they are. Other examples are “noncardiac chest pain” and “nonulcer dyspepsia.” All three conditions cause vague symptoms that are not clearly linked to organic problems, that seem related to stress and anxiety, and that don’t seem to show up in ordinary chemical tests, which implies that either (1) medicine has not yet determined the cause of these conditions or (2) these conditions are horse potatoes. As it happens, there is a dramatic overlap of patients who have irritable bowel syndrome and those with nonulcer dyspepsia or noncardiac chest pain. I personally draw no conclusions from this. I hereby declare irritable bowel syndrome to be a real, live, genuine, terrible scourge, mostly because I do not want to be picketed by angry persons with gas.

  Diseases in most bodily systems can cause a wide array of symptoms. This is not true with the intestines. Intestinal disorders tend to show up as either constipation or diarrhea, which greatly simplifies things for the hypochondriac.

  Constipation. Everyone knows prolonged constipation can mean a tumor of the colon, which can be cured with surgery if caught early enough. But did you know constipation can also be a sign of a tumor of the lower spinal cord, which can eventually cause paralysis or death? Sometimes spinal cord tumors will prevent the colon from increasing its motility after meals. This causes constipation, sometimes as an initial symptom.

  Diarrhea. Prolonged diarrhea can be caused by food poisoning or colitis, or by infectious and parasitic diseases such as dysentery, shigella, or giarclia. But it is also the primary symptom of cholera and Whipple’s disease. With cholera—which has been showing up recently in North America—you experience explosive diarrhea, firing out as much as a quart of scorching, watery feces every hour, until you either recover or die of dehydration in a half day of unbearable frothing-at-the-butt agony. People with Whipple’s disease envy cholera victims their cushy life. Whipple’s disease is a dreadful bacterial infection that occurs mostly in middle-aged white men. It generally shows up as fatty diarrhea. Then it can infiltrate the heart, lungs, brain, spleen, liver, and pancreas. Your joints ache. Your heart gets weak. Your eyesight gets blurry. Sometimes you become spastic, and then you go crazy, and then you die. If it is caught early enough, you can be saved with a lifetime regimen of antibiotics, but sometimes the drugs don’t work on the neurological problems. So you feel well enough to entertain, but you serve your guests boiled gophers.

  My point is, you might wish to keep an eye on your stools.

  Whether we admit it or not, we all sneak a peek into the toilet bowl, at least briefly. It is human nature. The hypochondriac will linger a bit. The human body does not offer too many opportunities for people to examine their biological exudates; a hypochondriac would pass up this chance about as often as a paleontologist would walk past a fibula sticking out of a creek bed.

  I asked Dr. Orkin for his advice on what to look for in stools, and he said: “Blood.” Then he added, “Also, little squirming things.”11 Other signs are subtler:

  Pencil-Thin Stools. A bad sign if they persist over time. If they are unaccompanied by other symptoms, this suggests a narrowing of the intestine, possibly caused by cancer of the rectum or sigmoid colon.

  Black Stools. If they are the color and consistency of tar and smell kind of metallic, this can mean bleeding in the upper gastrointestinal tract. Suspect stomach cancer, duodenal ulcers, inflammatory bowel disease, or embolisms or thromboses in the blood vessels of the gut.

  White Stools. Often described as being the color of aluminum, persistent pale stools suggest your body is not secreting bile, which gives poop its brown color. You want white stools to be accompanied by pain, because that would probably mean you have gallstones causing an obstruction of the common bile duct; that is treatable by simple surgery. Persistent white stools without pain can mean pancreatic or duodenal cancer, or cancer of the bile ducts.

  Maroon Stools. Particularly if they are of pasty consistency, maroon stools suggest bleeding in the lower intestinal tract, possibly caused by colon cancer or diverticulosis. Diverticulosis can sometimes require a colostomy or, in serious cases, removal of the entire large intestine.

  Sinkers Becoming Floaters. Yes, there is medical significance to this preschool obsession. If your stools used to sink and now tend to float, it could be a problem. Stool that floats has more fat in it than stool that does not float. Something is causing malabsorption of fat. If you are in pain, it could be an obstructed bile duct or pancreatitis. Without pain, suspect early pancreatic cancer or a diffuse lymphoma of the small intestine.

  Gargantuan Stools. This can be one sign of megacolon, in which the large intestine swells up like the Graf Zeppelin. The rectum becomes a stern sentry; nothing passes without a struggle. Constipation can be profound, the stools large and hard. Megacolon with constipation tends to indicate a neurological disorder or possibly Chagas’s disease, caused by infection by a protozoan. Chagas’s disease can eventually cause a total body breakdown, affecting the heart and brain. A final symptom, as listed dispassionately in medical texts after “fever” and “myocarditis” and “ischemic chest pain,” is “sudden unexpected death.”

  No chapter on pooping would be complete without a passage on the passage of gas,
and no chapter on the passage of gas would be complete without an interview with Dr. Michael D. Levitt. Dr. Levitt is chief of research at the Veterans Affairs Medical Center in Minneapolis and professor of medicine at the University of Minnesota, and he is the world’s leading expert on the subject of farting. I got him on the phone. The very first thing Dr. Levitt told me is that he is famous, and so I worried that he would be a little stuffy, especially when he began listing his credentials.

  “I took a fellowship in gastroenterology with Dr. Franz J. Ingelfinger, which is a good name for a gastroenterologist, if you see what I mean. We called him ‘the Finger.’ He was famous. I realized no one was studying intestinal gas, so you didn’t have to do anything particularly good to get published.”

  I stopped worrying about Dr. Levitt being stuffy.

  In a long and distinguished career, Dr. Levitt has published dozens of articles on intestinal gas, including “Floating Stools: Flatus vs. Fat,” and what some might consider his masterwork, “Studies of a Flatulent Patient,” which chronicles the gas output of one twenty-eight-year-old man who averaged 34 flatulations a day, plus or minus 7, with a standard deviation of 1.12 A gas chromatograph was used to do detailed chemical analyses. This article was published in the prestigious New England Journal of Medicine and includes many footnotes and citations of the work of distinguished doctors, including Michael D. Levitt and Hippocrates.

  Dr. Levitt was the first person to figure out a foolproof way to measure the chemical content of intestinal gas: “This is how I got famous,” was how he put it. He figured out that since gas is absorbed by the large intestine, and the blood goes into the patient’s lungs, “if you sample someone’s breath, you can analyze the gases in his intestine.”

  In other words, we breathe what we fart?

  “Well, yes.”

  Wow.

  Dr. Levitt is also the inventor of the Mylar pantaloons, which are baggy, airtight pants that may be worn for purposes of analyzing flatulence. They were sewn by Dr. Levitt’s wife, Shirley, who is the Betsy Ross of intestinal gas research. Dr. Levitt’s Mylar pantaloons were used to spectacular success in one test of a commercial product, a fart-absorbing seat cushion. Dr. Levitt’s tests proved conclusively that this product worked as advertised.