30 Becoming a Patient
established through years of rigorous professional training, and com-
pounded by psychological defenses of denial. Revealingly, Roxanne re-
ferred to ‘‘the spleen’’ rather than ‘‘my spleen,’’ as if it were someone
else’s. She illustrated, too, the vast gap between knowledge of pain and
experience of it. Though she had treated many patients with abdominal
pain, she was astonished at just how horrible it could be.
Such resistance to switching roles led to many physicians continuing
to work full-time, despite their early symptoms. For example, Frank, a
surgeon, developed a heart attack while rushing a patient into the op-
erating room (OR). He continued to operate even though he began to
experience chest pain.
Minimizations can continue not just in making a diagnosis, but after-
ward. Lou, in remissio n from cancer, hung on his wall a plaque awarded
to him by a professional organization. The plaque included a framed
photo of him taken when he was receiving intensive chemotherapy. The
picture showed him bald, emaciated, and weak. He debated whether to
keep the plaque on the wall—the award gratified his ego, but the photo
reminded him of how bad his disease had been. The cancer could return
at any time. ‘‘Every bone in my body told me I should not meet with you
today,’’ he immediately said as I entered his office. He did not want to
reopen psychic wounds by discussing his disease. Several times he pointed
to the plaque on the wall.
They put this award with the picture in a frame and gave it to
me—it just happened that the photo was in it. It doesn’t bother
me. It doesn’t bother me at all! Yet it is a reminder. Somebody else
would say, ‘‘Who needs it?’’ But they wanted to give it to me. If the
illness was depressing me, I might take it down.
Lou’s repeated protestations of not being troubled about the illness
seemed to belie underlying conflict about it, and the insult to him that
the disease represented. In part, he and others felt that to adopt a new
role, as a patient, would necessitate giving up the other, as a doctor—as if
individuals had a zero-sum identity.
Rationalizations and magical thinking could foster denial, too.
Mathilde and her husband danced around the possibility of his being
HIV-infected. They both employed magical thinking: because he was
exercising, he must be fine. In addition, she believed, irrationally, that
because they continued to have unsafe sex, he must be uninfected.