94 Becoming a Patient
A physician that’s not been affected personally may blow off mild
symptoms. But I understand that mild symptoms can devastate
your regular, day-to-day life, and I would probably treat them more
aggressively than somebody else. I have taken one drug, and it’s
given me mild pancreatitis—just a 100-point increase in lipases;
clinically, probably not that significant. But it’s enough to nauseate
me, and give me stomach discomfort and diarrhea. So when a
patient tells me that, I understand. Another physician might say,
‘‘It’s not high enough to stop the medication.’’ I might say, ‘‘We’ll
stop it for a few days, restart on a lower dose, and I’ll give you some
lipase supplement, and anti-diarrheal.’’
His own disease thus prompted him to treat his patients differently.
Symptoms such as physical pain, too, can in fact be virtually inde-
scribable. As suggested earlier by Roxanne, the gastroenterologist, though
she had treated countless patients with abdominal pain, she had never
fully appreciated the degree of difficulties they experienced. After all,
pain is pre-linguistic: animals lack language, but feel pain, too. Yet health
care professionals are often unaware of the impossibility of conveying
such symptoms in words. ‘‘When my spleen enlarged, I could hardly eat,’’
Roxanne said. ‘‘Appetizers would be enough for me. I’d get full. After-
ward, I would feel pain, but was still hungry in my head. . . . My spleen
crossed the midline. I realized how painful it must be for patients!’’
The quality of pain differed radically from what these doctors ex-
pected. Albert, who had an MI on the highway, described difficulty com-
municating the experience or even the location of pain because of his fears
of its implications.
When I was a medical student, we used to ask, ‘‘How far down
does the pain go?’’ We tried to get the precision we wanted, but
never really knew. My cardiac pain had a different quality than
when I’m burning my finger or itching my skin. The fact that it can
be very, very uncomfortable was a realization for me. I didn’t
have it long—only half an hour. But it was enough. You begin to
squeeze somebody’s arm, like when they put the blood pressure
cuff on, and it gets uncomfortable. But you don’t realize that if
you take it up a few more notches, it gets more and more
uncomfortable. The overtone is: ‘‘Oh, my God, is this healthy?
What’s going on?’’