The Hypochondriac's Guide to Life. and Death. (9 page)

Once I had noticed my floaters, the same scene looked like this:

Hypochondria is not communicable, but it is transferable. And so it is that when my daughter began getting headaches and an ophthalmologist looked into her eyes and determined that she had an odd bulging of her optic nerves, I did some quick research and concluded she had pressure on the brain caused by a tumor. Painfully, I rehearsed how I would tell her, how I would make her final months as comfortable as possible. Tentatively, I began to write my speech for her funeral, which was to be more a symphony than a dirge—a celebration of a remarkable young life, heroically lived. Practically, I weighed the financial ramifications: readjusting what we are salting away for college tuitions. Selflessly, I resolved to inquire about whether my employer offered bereavement leave and to make it a union issue if the company did not, as a way to harness my grief for the benefit of others. This all occurred in about twelve minutes. It turned out my daughter's problem was a harmless medical condition defined, more or less, as “big fat optic nerves.”

To the hypochondriac, actual crises involving loved ones come as something of a respite, because they take his mind off his troubles. Plus, when illness does strike in the family, the
hypochondriac is
much
better prepared to handle it. He's been in training his whole life.

One winter day a lew years ago, on a dare from me, my nineyear-old son, Dan, was sledding down Dead Man's Hill. He hit a bump, rose into the air, and came down like a moose dropped from a helicopter. He bit clean through his lower lip. We took him to the hospital, where a plastic surgeon informed us he was going to operate, right then.

At times like this, my wife and I employ a careful division of labor. My wife's job is to walk away so she doesn't faint. My job, as the resident hypochondriac, is to wade hip deep into the disaster. In this case, my job was to stand over Dan and act jolly so he could not possibly guess what the doctor was doing. What the doctor was doing was gouging out a huge bubbling basin in Dan's face, making the hole much wider and deeper so the incision line would be even, as opposed to the incision line made by one's teeth, which looks like something gnawed by a starving ferret. The operation was so alarming I actually removed my glasses so there was no chance Dan might see a reflection in the lenses and puke into the foxhole that was his face.

But I remembered the lesson 1 had learned from my parents all those years before. I didn't want to lie to my son, even with a lie of omission. So I kept up a constant drone of happy, insipid, mind-deadening babble, things like, “Yo, Dan, that was a hell of a hill, wasn't it, big feller, ha ha! I'll bet Mom is plenty pissed at me, ha ha! Your lip looks like a baboon's anus, ha ha!”

Dan pulled through with barely a scar, but the experience took a toll on me. By the time I got home, I had a splitting headache.

Encephalitis, I was pretty sure.

1
Mom was wrong, actually. Asparagus contains chemicals called methyl thioesters, which make
everyone's
urine smell funny. However, some people lack the smell receptors in their noses to detect the odor. Really. This raises the fascinating epistemological paradox: If an asparagus eater pees in a toilet but there is no one around with the appropriate smell receptors, does the pee stink?

2
Did you ever wonder about the stupidity of the term “o'clock”? Americans have happily incorporated into our everyday speech a term that makes us sound like leprechauns.

3
At least one kid got further. Around this time, a teenager broke into a dentist's office in Queens. His body was found the following day with a nitrous oxide mask on his face. I considered this one of the most significant stories of my generation, even though it was buried in the newspapers. Evidently, other news was deemed “more important.” For years I remembered this as an example of the media's cowardice in dealing forthrightly with stories involving drugs and kids. Then, a few weeks ago, leafing through some old papers, I actually found the original news clipping. It was indeed buried deep in the paper. The date was November 22, 1963.

4
This was an ironic death, but it does not approach the one that befell Jim Fixx, the messianic jogging guru who had a massive heart attack while jogging. And Jim Fixx's death does not approach the most ironic demise of all time, suffered by one J. I. Rodale, the publisher of health and fitness books and founder of
Prevention
magazine. On June 7, 1971, Rodale was a guest on a late-night TV show. “I've never felt better in my life,” he bragged. “I am so healthy that I expect to live on and on.” Then he made a gurgling noise, pitched forward, and died.

5
Unless, of course, you happen to be looking at the Statue of Liberty.

Hiccups Can Mean Cancer

In many ways
the human body is like a car. Both are complex machines. Both require regular maintenance. Both will stop working if you fill them with barbiturates and applesauce.

Having a car and having a body both require adherence to a rigid servicing schedule. Let's say you own a car and you never, ever replace the oil; and when you use jumper cables, you get them mixed up and there is a spark the size of the Crab nebula, draining all the juice out of the good battery; and once, you poured windshield wiper fluid into the power steering reservoir because they really should label these things better. My point is, if you are that much of a half-wit about your car, your car is the least of your problems, because you probably also use a hair dryer in the bathtub.

The fact is, both cars and humans are designed with idiot lights, things that alert the reasonably careful person that something serious is awry. If your car's
Oil
light goes on, unless you are my wife, you probably know to stop driving and see a mechanic at once. Similarly, if you experience serious chest pains, then you probably will see a doctor. The fact is, certain symptoms
are by their nature scary. Lumps. High fever. Blood in the stool. Mental confusion.
1

This chapter is not about those common “warning signals.” This chapter is about things no sane person would ever associate with serious illness, until this very moment.

Hiccups.
The precise cause (or “etiology”) of hiccups remains a matter of some dispute among medical scientists, who have studied the phenomenon incessantly and come away with only obvious clinical observations, such as that men hiccup, on the average, five times as frequently as women. (As far as I can see, this tends to suggest, in sophisticated medical terms, an “etiology” related to beer.) There is no reliable cure for hiccups, but there is no shortage of nostrums available, each with its adherents. The rule of thumb is that the more unpleasant the remedy, the more august is the medical authority recommending it. Grandma told you to hold your breath.
Primary Care Medicine,
a text for doctors, proposes inserting a catheter down your nose into your stomach. I recommend hyperventilating into a colostomy bag.

Hiccups are harmless, except when they aren't. No other commonly reported symptom has quite so many potentially dire explanations. Persistent hiccups cross into virtually every medical specialty. Neurologists know hiccups can accompany the onset of a deadly stroke or an inoperable tumor in the medulla of the brain. Cardiologists will not rule out an oncoming heart attack or an aortic aneurysm. Nephrologists will suspect kidney failure. Gastroenterologists know hiccups can indicate an “irritation” of the diaphragm or of some other organ, particularly one that touches the vagus or phrenic nerves, which control the swallowing and breathing reflexes.

On the outside of the body, an irritation is often a minor matter. On the inside, it often isn't. On the inside, it is often a tumor. Hiccups have been associated with tumors in or around the lung, in the diaphragm, the liver, the pancreas, the stomach, and even the sigmoid colon, which is down near the butt and should not, by the grace of God, have anything to do with breathing.

Insomnia.
In the absence of other symptoms, excessive fatigue or excessive sleep can be an indication of many serious diseases, but insufficient sleep generally isn't. Most of the time, the insomniac knows or suspects why he can't sleep: He is worried or depressed, or he has a toothache, or asthma, or a goiter the size of a microwave oven. Insomnia seldom stands alone, but when it does, it is out there in the hellish regions of Things You Wouldn't Wish on Your Worst Enemy Even If He Ate Garbo, Your Dachshund.

The most dramatic of these is fatal familial insomnia. This is a disease caused by prions, which are proteins that act exactly like ice-nine, the instrument of the apocalypse in Kurt Vonnegut's
Cat's Cradle.
Ice-nine was a molecular template. If it mixed with water, it would turn the water molecules into ice-nine molecules, rock hard and useless for sustaining life. This was not good when it spread across the oceans of the world. That's how prions work. They get into your body and take other proteins and reorder their structure to resemble themselves. In fatal familial insomnia, prions take up residence in the sleep center of your brain and slowly destroy it. You start out being unable to sleep well. Then you cannot sleep at all. In desperation, you see a top neurologist like Dr. Anthony Reder of the University of Chicago.

A few years ago, a man came to see Dr. Reder. The patient was tired and grouchy—not tired and grouchy like a bus driver at the end of his route, but tired and grouchy like the people from
Invasion of the Body Snatchers
immediately before the dull-eyed pods took them over. This patient looked disheveled. His hair was askew, like Beethoven's after a night of carousing. Reder had seen this before; he is a research scientist
and had seen it in laboratory rats with sleep deprivation. He diagnosed fatal familial insomnia. There is no treatment. There was nothing that could be done. Within weeks, the patient was hallucinating, making up grandiose stories about himself. His appearance deteriorated. Beethoven lost a lot of his charm. He gave way to Dr. Irwin Corey. Then he died.

Laughing So Hard You Pee in Your Pants.
There is actually a medical term for this. Urologists call it “giggle incontinence.” It can mean nothing, or it can be a very early indication of neurologic disease, in particular multiple sclerosis.

The Sniffles.
Sometimes a cold is nothing to sneeze at. It could be the first sign of Wegener's granulomatosis, a rare, fulminant, whole-system body breakdown that often starts with coughing, congestion, and blood-streaked nasal discharge. Looks just like a cold! Then, when it doesn't go away, it looks like chronic bronchitis, maybe with an ear infection. Small wonder that Wegener's granulomatosis is sometimes not properly diagnosed until it is too late to treat. By that time it has progressed to kidney failure, lung damage, and body deformities, including “saddle nose,” in which the nose cartilage collapses like a rotted jack-o'-lantern.