The Hypochondriac's Guide to Life. and Death. (12 page)

Cysticercosis is relatively rare in the United States. So, relax: Your headache is probably not caused by worms in your brain. It is more likely to be related to your consumption of mouse urine. (See chart below and follow-up questions.)

And finally, some answers to commonly asked scientific questions about headaches.

I have a splitting headache and my muscles hurt and I feel kind of stoned and confused. It is possible I have been drinking mouse urine?

Yes. You are exhibiting symptoms of Weil's disease, or leptospirosis. It is spread by the urine of pigs and rodents, particularly mice and rats. You can pick it up from unclean food or water. Most people recover, but some will first turn a pale yellow. This is particularly unnerving, under the circumstances.

What is the stupidest official medical name for a headache?

There are two. The first is “Chinese restaurant syndrome headache,”
linked to consumption of monosodium glutamate. The second is “ice cream headache,” caused by the sudden ingestion of very cold food, which aggravates the trigeminal nerve. These conditions are so dumb and harmless they do not have more technical, Latin names. And so “Chinese restaurant syndrome headache” and “ice cream headache” are listed soberly in the indexes of some eminent medical texts, right near “chickungunya hemorrhagic fever” and “ichthyosis.”

What is the cruelest headache?

Some people get a splitting headache every time they get an orgasm. “Not tonight, dear, I have a headache” can be a self-fulfilling prophecy.

1
See next chapter, on ridiculous medical euphemisms.

2
To get a mental picture of a twenty-foot tapeworm, imagine eating pasta by sucking a single strand noisily through your mouth. Now imagine that the strand turns out to be so long it takes you a full minute of nonstop sucking to get it down. Now imagine that when you get to the end you discover a face, with little feelers and a pair of googly eyes on stalks. There's your tapeworm! Worms have been turning up in surprising places since the worldwide sushi craze began ten years ago. In a case recently reported in the
New England Journal of Medicine,
surgeons performing an emergency appendectomy on a patient with abdominal pain were chagrined to find a perfectly normal appendix. Then a ten-inch pink worm slithered out from the body onto the surgical sheets.

3
The pineal gland, in the brain, appears to have no clearly defined function other than to develop tumors. We will hypothesize that the pineal gland is the brain's highly efficient storehouse of annoying, obsolete information, such as the American Dental Association's declaration that Crest has been shown to be an effective decay-preventive dentifrice that can be of significant value when used in a conscientiously applied program of oral hygiene and regular professional care.

Interpreting DocSpeak (Hint: “Good” Means “Bad”)

There are ways
of delivering disagreeable news so as to make it palatable. For example, when flight attendants discuss using your seat as a flotation device, they do this in the context of a “water landing,” not in the context of the plane becoming a “plummeting sarcophagus.” And in the seat-back compartment in front of you, the illustrations of persons experiencing a “water landing” or an “unscheduled landing” look like this:

They do not look like this:

Every profession has its conventional euphemisms. Butchers sell “chopped sirloin,” not “ground cow.” Even journalism, which is supposed to be about truth telling, occasionally resorts to bull hockey. Newspapers will write about a “developing nation” even when the nation about which they are writing is not developing at all, inasmuch as it has a rooster-based economy. Euphemism is the driving force behind the classified ad:

What it says:
“Cozy starter home.”
What it means:
House is size of men's room in Exxon station.

What it says:
“Attractive benefits package.”
What it means:
Janitorial salary.

What it says:
“Runs good.”
What it means:
Owner is idiot.

The language of medicine is similarly deceptive. When doctors say a test result was “positive,” that means it is bad. “Negative” test results are good. A “thrill” sounds cool, but if a doctor hears one when listening to your heart, you might keel over at any minute. An “ecchymosis” sounds revolting, but it is only a black-and-blue mark.

Among themselves, however, doctors tend to speak plainly. Surgeons will refer to a “peek-and-shriek,” which is, literally, an open-and-shut case: Look in, blanch, close him up, let him die. Doctors will say a patient belongs to the Hi-Five Club, meaning he has HIV. Doctors can be real cards.

But when they are speaking in front of patients, doctors have learned the opposite skill—creative euphemism. They learn it as interns, when they are making “rounds.” Rounds occur when a learned doctor in a teaching hospital goes from room to room trailed by a pack of lickspittles in lab coats who leave behind them an oily trail of sycophancy. Everyone must discuss each case in the presence of the patient. The lickspittles want to show off by exhibiting intuitive diagnostic skills, but they must do so in a manner that does not alarm the patient. They cannot say, for example, that Mr. Achenbach is “decomposing faster than a pile of fish heads in the Kalahari.” They would say Mr. Achenbach is “an excellent candidate for palliative treatment” (see below).

Doctors never lose this tendency to obfuscate in front of their patients. Most people will ignore this, figuring that if there is something the doctor needs to tell you, he will get around to it in due course. Some people might even be grateful for the doctor's delicacy and diplomacy. This is not true of the hypochondriac, who is constantly looking for validation of his fears. He will assume everything the doctor says is a subterfuge to hide the ghastly truth about his condition.

Doctor: Good morning, Mr. Achenbach.

Patient: I am dying, right?

Doctor: I haven't examined you yet.

Patient: But it looks bad, doesn't it, Doc?

Doctor: We are talking on the telephone.

This sort of suspicion causes needless worry for the hypochondriac. There are only a handful of terms doctors routinely use to disguise bad things, a few dozen terms that are really, really scary but that you might not recognize. Here they are.

Yes, cancer is the leading cause of medical euphemisms; but it is not the only terrible thing that medical language is designed to hide.