Read The Hypochondriac's Guide to Life. and Death. Online
Authors: Gene Weingarten
The Hypochondriac's Guide to Life. and Death. (13 page)
Other medical terms are designed to hide the significance of bad symptoms.
| What They Say | What It Sounds Like | What They Mean |
| “Exquisite” | Wonderful | Horrible. Describes pain that is incapacitating. A patient in “exquisite” pain is often whimpering and drooling. |
| A “bruit” | Fat guy. Beats up Popeye. | An unexpected sound when doctors listen to an organ. it is usually bad. Heart bruits, for example, can indicate CK leaks. |
| An “adventitious” sound | To your benefit | To your detriment. Adventitious sounds are bad lung sounds. |
| “Ronchi” and “stridor” | Star Wars characters | Specific adventitious lung sounds; they can signal anything from a cold to a tumor. |
| A “deficit” | A little red ink | A big red flag. A deficit means an insufficiency of something, often signaling serious illness. An “oxygen deficit” in the body is sometimes followed by coma, brain injury, a vegetative state. |
| A “vegetative state” | Kansas | Brain death |
| An “accident” | Oops. Ha ha. | Oops. Bye-bye. A grave event in your body. A cerebrovascular accident is bleeding in the brain. |
| “Decompensated” | Docked | Decked. It means the failure of a systemâwhatever ails you has reached the point that the organ in question is no longer able to maintain basic body functioning. If you have compensated liver disease, your liver is functioning well enough to sustain life. If you have decompensated liver disease, it is not. |
| “Discomfort” | Discomfort, as from an itch | Pain, as from insertion of a penis catheter |
| An “embarrassment” | A faux pas | |
| A sudden, dramatic problem caused by an interruption to circulation or a drop in blood pressure, occasionally produced by bad diagnostic technique. Feeling for a pulse on the carotid artery on both sides of the neck at the same time, for example, can sometimes cause unconsciousness, as if the patient were being hanged. (See “syncope” below.) | ||
| A “dissection” | Something bad that happens to a frog | Something bad that happens to you. It's a spontaneous ripping and rending of tissue, as though it is being unzipped by God. When it happens to your aorta, you often die. |
| An “event” | A party | No party. A bad thing. A thrombotic event, for example, is a stroke. |
| “latrogenic” | A play by Aristophanes | Describes an illness or injury caused by medical treatment or diagnostic procedures. For example, sometimes a spark caused by a colonoscope will accidentally ignite intestinal gas, causing an explosion in the body. It can be fatal. And disgusting. |
| “Idiopathic” | Duh | Duh. When doctors diagnose an illness as idiopathic, it means they have no idea what is causing it. |
| An “insult” | Injured feelings | Injured flesh, often grave damage. In the autopsy report, for example, JFK's head wound was described as an “insult.” |
| “Palliative treatment” | Some sort of treatment | No treatment. Doctors have given up on a cure. At best, they will do something final and dramatic, like amputating a gangrenous limb or creating a permanent colostomy. Usually, though, palliative treatment means doping you up until you die. |
| “Precocious” | Mozart | Mozart did not have huge hairy genitals at the age of four, so far as we know. Medically, a precocious development occurs unnaturally early, and is usually a very bad sign. Precocious puberty, for example, occurs in pineal hyperplasia syndrome, or tumors of the hypothalamus. Kids get adult-looking genitals at age four. No, it is not cool. |
| “Progressive” | Modern, forward-thinking, socially conscious | Deadly. A “progressive” disease is one that is progressing, inexorably, despite treatment. Multiple sclerosis is often described as “progressive.” |
| “Resection” | Restore, put back, fix | Cut away. Amputate. |
| “Tamponade” | Women's personal hygiene procedure | Restrictive pressure on the heart, causing reduced blood flow to the body, breathlessness, and sometimes syncope. |
| “Syncope” | Thelonious Monk | Thelonious Monk OD's. Syncope is fainting, unconsciousness. |
| “Prodrome” | A dirt-floored stadium in some toilet of a town, outfitted for tractor pulls and demolition derbies | The early stage of a disease. It is often deceptively mild. Prodromal symptoms are sometimes described as “premonitory.” |
| “Premonitory” | You may already be a winner! | You lose. If a symptom is premonitory, it seems trivial, but isn't. You know: Hiccups. Cancer. |
| A “bad result” | A bad result | A very bad result. This is universal DocSpeak for “death.” |
Maybe It's Just Nerves (Uh-Oh)
On virtually every level,
I am unqualified to write a medical book,
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but if simple incompetence prevented people from getting publishing contracts, John Grisham would be pushing a broom at Jiffy Lube. My ignorance is particularly overwhelming on the subject of the brain and the nervous system.
Fortunately, I had an ace in the hole: Dr. James Prokop, an eminent neurosurgeon I knew in Greenwich, Connecticut. I was counting on Dr. Prokop because of his humor and graciousness, because of his encyclopedic knowledge of his field, and because he was my wife's uncle. I was going to supply Dr. Prokop with various minor symptoms, such as eyelid twitching, and he was going to tell me how these symptoms could signify frightening neurological deterioration.
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Privately, we would chortle over how alarmist we were being, how the human body is not so delicate a
machine that sudden death awaits us all, any minute, without warning. Then, three days before I was to talk with Dr. Prokop, he suddenly died.
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So I am feeling a little shaky right now, trying to write about neurology. Fortunately, neurology offers the ignoramus a toe-hold, since much of it can be reduced to terrifying case studies and simple diagnostic exams that scare the bejesus out of you.
Reach into your pocket or purse. Feel for a quarter. Don't take it out, just explore its surfaces with your fingertips. Can you tell which side is heads and which is tails? You should be able to. This is called “stereognosis” and it is a basic test of the functioning of the parietal lobes of the brain. Failure to distinguish heads from tails can sometimes herald the presence of a parietal lobe tumor or an oncoming stroke.
Fear of strokes and brain tumors is what most frequently brings hypochondriacs to neurologists' offices. Hypochondriacs know that strokes and tumors can cause unusual symptoms, that virtually any blip or jiggle of sensation, any failure of memory, can sometimes signal something dire. My friend James Lileks, a writer who is a ferocious hypochondriac, once read that hallucinating the smell of a burnt match can mean an impending stroke. He began noticing this smell all the time, and suffering paralyzing panic attacks. It did not occur to James that the reason he was smelling burnt matches all the time was that he was lighting matches all the time. Me is a cigarette smoker. This is how hypochondriacs think.
I have news for hypochondriacs. It is much worse than they think. Incipient strokes or tumors can create astonishing havoc in the pathways of perception, in ways hypochondriacs never would suspect, until this very moment. Yes, tumors or strokes can lead to so-called uncinate fits, which cause hallucinations of smell, but the smells are not limited to burnt phosphorus; people
detect the odor of garbage, lemons, banana oil, wet asphalt, acrid fumes, dirty diapers. In general, perception can be wickedly distorted: A stroke victim once woke up screaming because he saw a human arm in his bed, right next to him. In fact, there was an arm. It was his own. He did not recognize it.
A stroke or tumor in the visual processing center of the brain can announce itself in something called the Alice in Wonderland syndrome, in which the victim sees an object and then hallucinates the same object repeatedly. Dr. Hal Blumenfeld, a neurologist I know in New Haven, Connecticut, had a patient who was looking at a potted plant in her home. A few minutes later, it reappeared. It was growing out of an omelet.
A stroke or tumor in certain areas of the cerebral cortex can make you feel as though you have been transported to a parallel universe peopled by evil impostors. This phenomenon is called “reduplicative paramnesia.” You will be talking to someone who looks exactly like your brother Vincent, and sounds exactly like your brother Vincent, and still seems to have that scar from the day you launched a pushpin at him with a soupspoon, but he can't fool
you.
You are onto his little game.
A stroke or tumor in the brain's temporal lobe can result in a condition known as “jargon aphasia.” The person with this condition understands what you are saying and speaks fluently in his ordinary voice, and he knows exactly what he wants to say, but the words come out all wrong. He becomes Norm Crosby, that annoying comedian who says things like “Greetings and salivations, I was expectorating you to come.” No one understands the person with jargon aphasia. He is trapped in a Tower of Babel nightmare. Sometimes he commits suicide.
Parietal lobe tumors can cause a bewildering sense of spatial disorientation. You might get lost between your mailbox and your house. Or you might have difficulty putting on a shirt because you keep trying to fit your head through the armhole.
But the niftiest symptom of a stroke or brain tumor is a rare disorder called Lhermitte's peduncular hallucinosis; this was disclosed
to me by Dr. Anthony Reder of the University of Chicago. Dr. Reder solemnly assured me he was not inventing this just so he could share a giggle with his graduate students by getting a preposterous fiction printed in an actual book; I assured him I did not for one minute suspect that a man of his stature and integrity would engage in such infantile behavior. Then I spent the next day searching doubtfully through neurology texts until, to my astonishment, I found it. In Lhermitte's peduncular hallucinosis, a strangling of the oxygen supply to the base of the brain causes people to see cartoonish little characters in the room, about three feet tall, often dressed in what appear to be military-type uniforms, gaily colored in pastels. They are friendly critters, completely unthreatening, and they generally go away when the cause of the oxygen deprivation is relieved, whether by drugs, surgery, or death.
