Double Lens 201
others accepted the ‘‘numbers’’ as inevitable. Roxanne felt she knew how
to evaluate research realistically, by which she meant not assuming that
she would magically overcome the odds. ‘‘I look at the literature,
whereas other people may think they will be the exception.’’ She felt she
knew better how to interpret risk. Indeed, she was brutally matter-of-
fact about her prognosis.
Still, pessimism may confer psychological advantages. Bill, the South-
ern radiologist with HIV, said that since he was always expecting the
worst, he never felt let down. ‘‘A pessimist is never disappointed, an op-
timist always is. So prepare for the worst and you’re pleasantly surprised
when it doesn’t happen.’’ He felt fortunate (‘‘pretty lucky’’), as he had
outlived many friends and patients with his diagnosis.
Nonetheless, these predilections could change, due to subsequent re-
search studies and one’s own medical course. In viewing and interpret-
ing statistics, Steven, the suburban endocrinologist with HIV, eventually
switched from optimism to pessimism:
I used to be very optimistic, but am becoming pretty pessimistic. I
thought I wouldn’t progress, but live in a symbiotic relationship
with this virus the rest of my life, and it wouldn’t destroy my
immune system. That didn’t happen. It was a real shock. So, as
much as I try, I’m just not as optimistic as I was. My counts have
fallen very quickly, and just keep going down.
Conversely, improved therapies can reduce pessimism. Jerry, the sur-
geon-lawyer, said that the first time he allowed himself to be optimistic
was when new treatments for HIV were announced. Optimism cannot
be wholly self-willed. Objective facts can also shape it.
Among these ill physicians, family histories of disease, too, influenced
perceptions of risk. To live with even ‘‘low risk’’ (as opposed to ‘‘no
risk’’) can be hard. In part, tendencies toward optimism and pessimism
may be constitutional—ingrained components of personality. Nancy, the
endocrinologist with breast metastases, had always been ‘‘fatalistic,’’ ex-
pecting something bad to happen—even though she had had a ‘‘happy’’
life.
I had this weird feeling that something bad is going to happen to
me. I’ve been too lucky. I really felt like the other shoe was about
to fall, because of how we lived. My father was a doctor; we had
plenty of money. I had a very happy family life. . . .