The Hypochondriac's Guide to Life. and Death. (11 page)

Nosebleeds.
If you go to a doctor complaining of nosebleeds, he will first make vague, discreet inquiries, using big, dignified words like “extrusion,” and it will slowly dawn on you that he is asking you if you pick your nose. The fact is, the capillaries in the nose are a threadwork of vessels easily damaged by, say, a pinkie.
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After ruling this out, and ruling out obvious
other genetic causes you will probably know about—hemophilia, for example—the doctor will begin looking for diseases you don't know about: These include a series of things with very long names. One is an esoneuroblastoma. Another is a nasopharyngeal angiofibroma. These are nasal tumors, and they tend to debut as nosebleeds.

If these immediate causes of your nosebleed are eliminated, the doctor will consider systemic causes, diseases that affect your whole body but first show as nosebleeds. One would be an inflammation of the right side of the heart. Or the doctor might suspect Waldenström's macroglobulinemia, a blood disease that is terrifying not only because it turns you weak, pale, and blind, and then tends to kill you, but because it involves the use of an umlaut, which makes everything sound worse than it is. Try it. Settle a few umlauts atop the most benign thing you can imagine, and watch what happens: Sänta Claüs. The jolly patron of Nazi children.

But a more likely explanation for nosebleeds would be cirrhosis. You don't have to be a drunk to get cirrhosis. Liver disease can sneak up on you, and sometimes you can be near death before you notice anything is wrong. One warning signal is that the liver stops doing what it is supposed to do, including helping the body absorb vitamin K, which helps blood to clot. If there isn't enough, you bleed. It can start with the capillaries in your nose. This is the early stage. Eventually, you cough and vomit up huge gobs of cherry red, clumpy blood the consistency of rice pudding. Sometimes it will be darker and look like chicken livers or coffee grounds. This stage of your disease is called “hematemesis.” People with terminal cirrhosis don't get invited to many parties.

Snoring.
You snore at night and feel tired during the day. You are a man. You are middle aged. You are at least somewhat overweight. You might have obstructive sleep apnea, a serious sleep disorder in which the pharynx collapses and prevents you from breathing. This can last up to two minutes without waking you. Your heart rhythm is impaired. Your body is starved for oxygen, a condition called hypoxia. The brain hates
this; it degenerates, and so do you. Your family notices changes in personality; you get cranky and irritable and, according to medical texts, you “show poor judgment at work.”
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Untreated, this can lead to cor pulmonale, a condition that destroys the heart's right ventricle. You become impotent. You look sort of purple. The veins in your neck pop out, resembling a hangman's rope. By then, you want to die. Sometimes you do.

What can be done? First, a doctor will have to determine whether you actually have sleep apnea; some people are just fat, cranky boors with bad judgment. If the diagnosis is sleep apnea, there is an operation called uvulopalatopharyngoplasty (we'll just call it “Bob”), in which the whole back of your throat is sheared off. Usually this solves the problem. Sometimes it doesn't. You still snore and choke, only it hurts more because some idiot sheared your throat open.

Toothache.
Get a bunch of dentists together in a room. Get them talking. Then get the hell out of there; there is nothing quite so stultifying as a room full of talking dentists. However, if you leave a tape recorder in the room, you can later fast-forward to the good parts. If he has practiced long enough, every dentist will have a story of a patient who complained of a toothache in the lower jaw. The teeth will look fine. But the patient won't. He will have clammy skin. The dentist will send him to the emergency room. That is because an emergency room is a better place than a dentist's office to have a massive coronary.

At other times, a patient will come in complaining of pain in the molars. An X-ray will reveal an ameloblastoma, a tumor of the bone in the lower jaw, in the wisdom tooth area. This is what is known as an “insidious” tumor. It grows slowly and causes no pain until it is quite large and crowds against the root of a tooth. By that time, the only solution may be removal
of all or part of the lower jaw. A prosthesis is inserted. It is usually part metal and part bone shaved from your hip. Depending on the skill of the surgeon, you might look pretty good, or you might look like Grover Cleveland. Cleveland had a jaw tumor; doctors removed a portion of the jaw and replaced it with vulcanized rubber. He was an excellent president but resembled a warthog.

Stiff Neck.
“I probably just slept on it wrong.” Yes, yes. Probably. In the last half century, the simple stiff neck has lost most of its cachet, due to advances in modern medicine. In the absence of other symptoms, waking up with a stiff neck used to be a first sign of polio or tetanus. But these days everyone is inoculated against polio. Also tetanus. You
have
had a tetanus shot, and a booster in the last five years, right? Not sure? You may wish to call your doctor. Ask him. If you sound like Thurston Howell IV, you may be in trouble. Doctors call this initial stage “trismus,” or lockjaw. It will be rapidly followed by a ghastly grin that makes you look like the Joker. Doctors call this “risus sardonicus.” Then your body bends backward, taut, like a crossbow. Doctors call this “opisthotonos.” Doctors have a term for everything. If treatment is delayed, the final symptom can be “cessation of vital signs.” Doctors call this “death.”

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Of course, if you are mentally confused, you might not
realize
you are mentally confused. That is the nature of mental confusion. You could be mentally confused right now. You could be thinking you are reading this book, but in fact, you are
remembering
having read this book in your youth. It could be the year 2049 and you are ninety-five years old in a nursing home, rocking back and forth in your own incontinence. If you suspect this may be the case, here is a way to test: Remove your pants. If someone comes to help you, you are probably in a nursing home. If people sort of shrink away from you, you are probably on the subway or something and everything is OK.

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Note the somewhat jarring use of the female pronoun. This is a brilliant preemptive strike against those who will later question the author's gender sensitivity, such as in
Chapter 16
, when he describes a colleague's hooters.

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True fact: The official medical terminology for having lice is “lousiness.”

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Speaking of seizures, I cannot forbear mentioning the story, recently reported in the
Emergency Physicians Monthly,
of the attractive couple in dinner attire who came into an emergency room in Spokane, Washington, he with his loins wrapped in bloody towels, she wearing what appeared to be a bloody turban. The man's penis had deep lacerations, and the woman's head had many severe puncture wounds, in odd cluster patterns. Initially reluctant to discuss what had happened, the couple eventually fessed up: After a romantic candlelit dinner and some excellent merlot, the woman decided to perform an exceedingly friendly service to her companion, under the table. Midway through, she suffered an epileptic seizure, clamping down the way a terrier might attack a rat. That is when he reached for the fork …

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Carol Scheman, Philadelphia, Pennsylvania.

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I bet you thought I was going to give you the punch line here.

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Why do you suppose we have a name for each of our fingers, but not for each of our toes? It seems wrong. I propose that the toes be named as follows, from the largest to the smallest: Big Wally, Shitkicker, Old Number Three, Gruntcakes, and Thor.

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The medical books do not specify the nature of the poor judgment you might exhibit in the workplace. For the sake of medical accuracy, we will hypothesize that you wear only a cummerbund and a sombrero, conduct animal sacrifices in the employees' lounge, and address the boss as Puny Mortal.

Headaches: Don't Worry, They're All in Your Head

For some reason
we tend to impart profound significance to a person's final words, as though God chooses to speak through the mouths of those He is about to summon. There have been some splendid deathbed pronouncements (Oscar Wilde is reputed to have said, “Either that wallpaper goes, or I do”), but alas, exit lines tend to be banal (“Shit!”), incomprehensible (“Gaack”), or memorably idiotic. Who can forget the immortal last words uttered by Civil War general John Sedgwick as he ridiculed his troops for taking cover from Confederate fire: “Come, come! Why, they couldn't hit an
elephant
at this dis—”

For hypochondriacs there is only one final line worth remembering, and it has given them the willies for more than a half century, On April 12, 1945, in Warm Springs, Georgia, Franklin Roosevelt turned to a friend and said: “I have a terrific headache.” Then he slipped into a coma and died of a brain hemorrhage, which normal people call a stroke but doctors call an “accident.”
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“I have a terrific headache” remains the anthem of the
hypochondriac, who knows in his heart that headaches can and sometimes do signal the presence of a brain tumor or a stroke. Here is where an unfortunate irony of human anatomy comes into play. The brain is made of nerve tissue, but, perversely, it has no pain receptors. So, chances are you won't feel a stroke or a tumor when it first arrives; you will have to wait until it kicks off its shoes, reaches for the remote, and starts porking up on Doritos. Eventually it gets so fat it presses on vascular nerves, which causes a headache, or presses on other brain tissue, which can cause seizures, partial paralysis, or some of the weirdest danged things you ever saw. Tumors or bleeding can create personality changes ranging from irritability to confusion to confabulation, a strange state in which you compensate for memory loss by inventing an entire, elaborately detailed, improbable history for yourself. Asked, for example, if you have ever been married, you might say, “I was married for a time to Queen Fredericka of the Netherlands. She has three nipples.”

Headaches are the single most reported medical symptom, and they have always been related to environmental stresses; headaches have gone hand in hand with the march of civilization. In prehistoric times, they were caused by persons hitting you on the head with the femur of an ox. During the Dark Ages, they were caused by being hung upside down in dungeons. In the Renaissance, people got headaches because they were tormented by anguish over the beastly unfairness of life. During the French Revolution, people got headaches because their hair weighed two hundred pounds, plus they wore quarts of perfume to disguise the fact that, as French people, they never bathed. In the Industrial Revolution, people got headaches because they were breathing air made from vaporized rubber and despair. In the 1920s people got headaches because they drank gin made in toilets from any available source of carbohydrates, such as corncobs, maggots, and pumpernickel. Through the 1950s, women got headaches because they did not wish to have sex with their husbands. (Thankfully, this artifice is no longer necessary, since conjugal “duties” are now an antiquated notion. Today, if a woman chooses not to have sex with her husband, she is no
longer required to come up with an excuse. She can simply cut off his penis.)

Nowadays, doctors specializing in the treatment of headaches will tell you that most headaches are minor matters. Then their brows will furrow with professional concern; they will get a faraway look in their eyes and they will say, “Of course, there are exceptions. Notable, grave exceptions.” You think doctors who specialize in headaches want you to walk out the door?

The hypochondriac doesn't have to be told that headaches can be related to tumors or strokes. He knows this. He also understands that headaches can signal encephalitis and meningitis, serious infections of the brain. There are some things he doesn't know, however. A crushing headache can be the first sign of cysticercosis. That is a parasitic disease in which the brain is infested by the larva of an intestinal tapeworm,
Taenia solium,
which can grow to twenty feet long.
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In your brain, though, these worms are only a half inch long. Some people have both at the same time: huge ravenous worms in their guts, and small brain-burrowing worms in their head, which happens to throb quite a bit, just like with an ordinary headache, at first.