58 Becoming a Patient
Walter, the political activist with lymphoma, looked from a great dis-
tance at himself as a patient. His medical conceptualizations helped him
cope, providing him a framework through which to view his illness and
telling him he could survive, based on the statistics.
My medical self said, ‘‘A lot of people survive Hodgkin’s. You can
get through that.’’ But when I was told I had a very malignant
non-Hodgkin’s lymphoma, that was a shock. My sense of mortality
and vulnerability—that I could really die from this—was much
more heightened.
Walter felt he had a ‘‘medical self’’ observing himself. This self re-
sponded to medical facts, and was separate and distinct from other, emo-
tional aspects of himself: his fears and worries. The contrast between his
physician-self and patient-self astonished him. Heretofore, he and others
had not recognized or appreciated the depth of this divide.
This prognostication of one’s own death, leading to discontinuity in
one’s identity and sense of self, was so threatening that at times it re-
vealed itself only i n flipness or ‘‘gallows humor.’’ For example, Eleanor’s
husband’s curt comment on seeing his X-rays (‘‘Yup, I’m a dead man’’)
suggested irony, resignation, and distance all at the same time.
A few physicians recognized this discontinuity and self-distancing,
even if still perplexed about it. Stuart, now teaching at the university, for
example, felt he spoke about his illness as if it affected ‘‘a third person’’—
not himself.
It’s easy to talk about now—almost as a third person. Before, I was
not connecting much of the emotional—the darkness that was
definitely there. That came to me later. When you say ‘‘hurt,’’
there’s almost a certain amount of nonchalance, as I proceeded to
say this happened and that happened.
In talking about himself, Stuart switched here back and forth from the
first person to the third person to the second person, hinting at this
separation from part of himself.
Some physicians viewed themselves as though they were ‘‘a case,’’
barely a full person. Sally, who brought her laptop to the ICU, went so far
as to consider writing up her own case for publication in a medical journal.
The fact that her physician raised this possibility with her did not wholly
surprise her.