96 Becoming a Patient
Weight gain as a symptom can cause enormous psychological distress, in part because it is stigmatized in both medicine and broader society. For example, Ernie found his change in body shape more disturbing than either his Huntington’ s disease( HD) or depression.‘‘ There are no obese doctors,’’ he observed. He felt that both colleagues and patients viewed overweight doctors with suspicion: Why had these physicians not taken better care of themselves, given the health risks involved?
Similarly, ill doctors realized more fully the extent of difficulties associated with nonspecific symptoms( e. g., of fatigue): the extent of the burden of decreased energy from disease. For Suzanne, on lithium,‘‘ everything is a hump to get over.’’ She added,‘‘ My therapist said,‘ The first thing you should do at home is put your gym stuff on. Don’ t even go home— go right to the gym.’’’ But she felt she simply couldn’ t.
For physicians, decreased energy can be particularly hard, given the profession’ s competitiveness and ethos. Suzanne continued:
I run out of gas more quickly— not just energy-wise, but everythingwise. I tolerate life less— don’ t get as much done as everyone else. I’ m just not as functional. Everybody else’ s car has a larger gas tank.
Many become more sensitive not only to patients’ complaints of‘‘ minor’’ symptoms such as‘‘ tiredness,’’ but also to how hard these feelings were even to describe. Paul, an internist who lost a job offer due to his HIV, said,‘‘ I now have a huge respect for people when they say they’ re tired. You have no way to define it, but getting to the end of the day is really a challenge.’’
Lack of mental and physical energy, and feelings of being overwhelmed can profoundly impede professional and personal lives in unexpected ways. Roxanne said,‘‘ I realized that nothing is simple when you are sick. Any little thing isn’ t little.’’
Organization and planning take mental energy more than one imagines. Suzanne added:
I require a lot of support to have a life. I don’ t go to the market because you have to pick everything out, pay, make sure you have the money, bring it home, put it away. That takes a lot of patience. Organizing meals is a lot— just too much.
Yet physicians may discount patients’ reports of these frustrations. For example, Jeff could no longer jog because of illness. His physician, however, trivialized this problem.