Scare yourself Silly
- From: "Lance" <lachenicht@xxxxxxxxxx>
- Date: 25 Oct 2005 05:05:48 -0700
New York times
October 25, 2005
Essay
Scare Yourself Silly, but the Real Terrors Are at Your Feet
By ABIGAIL ZUGER, M.D.
Just in time for Halloween, the usual yearly ritual of terror by
headline is now playing itself out in medical offices everywhere. Last
year it revolved around flu shots; a few years ago it was anthrax and
smallpox; a few years before that it was the "flesh-eating bacteria";
and before that it was Ebola virus, and Lyme disease and so on back
into the distant past. This year it's the avian flu.
"I was crossing Third Avenue yesterday and I was coughing so hard I had
to stop and barely made it across," a patient told me last week. "I'm
really scared I'm getting the avian flu."
I just looked at him. What could I say? He has smoked two packs of
cigarettes a day for the last 50 years. He has coughed and wheezed and
gasped his way across Third Avenue now for the last 10 years. His
emphysema is not going to get any better, but it might stop getting
worse if he were to stop smoking.
He made it clear long ago that this is not going to happen. When it
comes to the whole cigarette/health question, his motto, apparently, is
"What, me worry?"
But the avian flu - now there's a health scare a person can sink his
teeth into. So scary and yet, somehow, so pleasantly distant. So
thrilling, so chilling, and yet, at the same time, so not here, not
now, not yet. All in all, a completely satisfying health care fear
experience. Unlike his actual illness.
Scary movies give children nightmares. Scary health news gives adults
the extraordinary ability to ignore the immediate in favor of the
distant, to escape from the real (and the really scary) into a far
easier kind of fear.
A few years ago, a young woman waited patiently to be seen in our
office after hours. She was a patient of one of my colleagues, but she
couldn't wait for their scheduled appointment; she needed to see
someone right away.
"I'm worried I have Lyme disease," she said. "I have all the symptoms.
I think I need to be treated."
"But you have AIDS," I said.
"I'm tired and weak and I have fevers and sweats. I've lost my
appetite. I can't think straight. I'm losing so much weight!"
She had seen a TV news report on Lyme disease, and then she had checked
the Internet. All her symptoms were right there.
"But you have AIDS," I said. "And you don't want to take meds. That's
why you're feeling so bad."
"I'm really scared about Lyme disease," she said. "I really need to get
treated."
"If you want to be scared, how about that untreated AIDS of yours?"
We looked at each other. It was an impasse. The fact that logic was on
my side mattered not at all: evidently the real was just a little too
real for her. How much better to find another illness to be scared of,
obsess over, get treated for, get rid of.
Eventually she coerced my colleague into testing her for Lyme disease
and treating her despite negative tests. Then she decided her symptoms
might actually be due to a brain tumor, instead. And so it went, until
she died of AIDS.
Of four patients I saw in a single hour last week, three announced how
scared they were of the avian flu. I reassured them, but there was
quite a bit I did not say, and here it is.
I did not say: If you want to be scared, then how about that drug habit
of yours you think I don't know about? How about the fact that you are
100 pounds overweight and eat nothing but junk? How about the fact that
in a few short months Medicaid is going to stop paying for your very
expensive medications and no one knows how just high that Medicare Part
D deductible and co-payment are going to be? I did not say: If you want
something to be scared of, how about the drug-resistant Klebsiella that
is all over this very hospital, an ordinary run-of-the-mill bacterial
strain that has become so resistant to so many antibiotics that we've
had to resurrect a few we stopped using 30 years ago because they were
so toxic.
That Klebsiella is one scary germ. It's in hospitals all over the
country, and by now it's probably killed a thousandfold more people
than the avian flu.
But you don't hear much about our Klebsiella. Like our bad habits and
our dismally insoluble health insurance tangles, our
antibiotic-resistant bacteria are with us, right here, right now.
Apparently they all lack the drama, the suspense, the titillating
worst-case situations that energize our politicians and turn into a
really newsworthy health care scare.
They're all just too real.
.
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