The Hypochondriac's Guide to Life. and Death. (3 page)

It is easy to make fun of hypochondriacs. The hypochondriac is at war with his own body. The ordinary person will notice a slight spastic tugging on his eyelid, that rhythmic twitching we all feel from time to time, and go, “Hmm.”

That doesn't happen with the hypochondriac. A hypochondriac would not go “Hmm” unless you told him there was a new fatal disease whose first symptom is the inability to say “Hmm.” Then he would say “Hmm” 1,723 times a day until he got laryngitis and could no longer say “Hmm” which would of course constitute proof he is dying.

No, if a hypochondriac gets an eyelid tic, his mind will instantly race through everything he knows about twitching—health textbooks he has read and articles he has downloaded from arcane medical databases—and he will eventually focus on the most frightening evidence he can think of, no matter how dubious its authority, such as the scene in the movie
Airplane!
in which Leslie Nielsen, playing a doctor, describes the symptoms of fatal food poisoning, which begins with twitching, and the pilot, played by Peter Graves, dies farting.

So the hypochondriac will
know
he has been poisoned. He will call the Poison Control Center.

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

1. 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?
   

   1. Stupid.
      

   2. A nipple.
      

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

2. You feel you might have a fever. So you:
   

   1. Crank up the air-conditioning.
      

   2. Take your temperature.
      

   3. 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?”
      

3. 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?
   

   1. Huh?
      

   2. Sphincter? Wha?
      

   3. Yes.
      

4. When did you last see a doctor?
   

   1. Two years ago or more.
      

   2. In the past two years.
      

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

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

   1. Stop lifting your arm in that certain way.
      

   2. Check for lumps.
      

   3. 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.
      

6. Do you have any moles?
   

   1. I don't know.
      

   2. Yes. Maybe I should get them looked at.
      

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

7. 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?
   

   1. Nah.
      

   2. Why? What have you heard?
      

   3. If it were only that simple.
      

8. Would you marry a proctologist?
   

   1. No.
      

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

   3. No, unless I had polyps.
      

9. How do you think you will die?
   

   1. In bed, surrounded by weeping children and grandchildren.
      

   2. Flying through the windshield of your car.
      

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

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.”