There is a pain in my side. It is transient and subtle. The untrained observer might even go sometime without noticing it. But I notice it. Between clear muscle spasms in my lower back, and a feeling that part of my abdomen has been pulled a bit too tight, there is a general dull aching. Never mind that it seemed to be alleviated when I was working out regularly for a span of a few months, or that its most recent incarnation has coincided with a family vacation in which I spent most evenings with a 2-year old strapped into a baby carrier that hung around my neck and hips like a drooping Orangutan. Or that it mostly goes silent after a few Ibuprofen. These are just coincidences, intended to lead even the most skilled practitioner to conclude that I suffer from mere muscle aches.
I know better, though. I happen to know that these pains are symptoms of a deeper sickness: a cancer growing deep inside my body. How do I know?
Consider, if you will, the preponderance of evidence:
Fact #1: If you look up pancreatic cancer, bowl cancer, stomach cancer, prostate cancer, to name just a few, you will find in every single case pain in the back or abdomen as a symptom.
Fact #2: I feel quite confident that I’m dying of cancer.
I will spare you the tedium of continuing down the list of reasons.
To be honest, every few months, or at least a few times a year, I’m quite convinced that I’m dying of something – typically its cancer, but I’m not opposed to falling back on more conventional ailments like life threatening blood clots, aneurysms or even the more pedestrian ‘heart-attack’. I’ve also, from time to time, been known to suffer from a rare condition known as Total System Failure – which is not well known to western medicine (or eastern medicine for that matter) and has as its single symptom an instantaneous and permanent shutdown of the brain. There aren’t any warning signs. One minute you may be fine and then, poof, your consciousness has suddenly been snuffed from the space-time continuum. No cases of TSF have been officially documented, but I’m convinced TSF is seriously under reported.
If what I have just described sounds more like I suffer from Hypochondriasis – making me a hypochondriac – well that is also true. Who says I can’t be a hypochondriac and be dying of an undiagnosed cancer? By the way, hypochondriac is so DSM-IV-TR (DSM is the Diagnostic and Statistical Manual of Mental Disorders used by psychiatrists to define and diagnose mental disorders). In the DSM-5 lingo I likely suffer from Illness Anxiety Disorder, to go along with my other likely diagnoses of Generalized Anxiety Disorder and Panic Disorder. My therapist suggested that this might be a distinction without meaning, but I always like to pile on another disorder to my resume.
Here is the thing though, knowing that one is a little crazy is not sufficient to change ones behaviors or even ones beliefs – though it may be a nice start. How many people know they are overweight and yet seem unable to change this condition? I know I’m a little chunky and I’m also devouring a giant chocolate chip cookie right now – what exactly is the contradiction here? You often hear people say ‘knowing is half the battle.’ Really? Because it seems like it would be more genuine to say ‘knowing is between 1 and 30% of the battle, depending on the battle’ though I suppose that’s a bit more of a mouthful.
Anxiety and other disorders of the mind aren’t something you can just solve with an Italian uncle’s worth of advice: ey-a, dont-a worry so-a much! To be sure, knowing helps. But it’s just a prerequisite for coping with anxiety. It’s like taking biology 101 as a requirement for med-school. No one shouts out in a panicked crowd, Did Anyone Take Biology 101 as a Pre-med major?! Necessary is not sufficient.
Over the years (I had my first panic attacks when I was 25) I’ve gone through an assortment of imaginary ailments. I’ve learned clever ways to disarm my anxiety. You can’t have a heart-attack every day for two weeks in a row and live to tell the tale – so on day 14 I can cross ‘heart-attack’ off the list of reasons for my ongoing chest pains. Aneurysms, I’ve learned, are usually sudden and without much in the way of warning signs (much like TSF) – so those spasms in my head must be of the garden variety kind – due to dehydration or probably just random muscle twitches. But my anxiety is quite clever and over the years it too has learned. I rarely feel tightness in my chest, or constricted airways (turns out you can’t be actively suffocating for an hour). My anxiety knows better now. Instead, it probes deeper into sicknesses and diseases that can’t be written off with a few days of self-observation or even a quick trip to the doctor. Only costly diagnostic scans and elaborate blood tests could rule out the rarer diseases that I’ve suffered from of late. Cancer is in fact the most diabolical of things to be dying of, because who can completely rule it out without opening you up? Is my lower back pain most likely due to our attachment style of parenting? Sure it is. But can anyone say for sure that the pain isn’t due to pancreatic cancer? No? I didn’t think so.
Anxiety 1, doctors 0.
Of course that doesn’t stop me from seeking the advice of professionals from time to time. And so recently I went to see a doctor about the pain in my side. I figured my odds of having terminal cancer were about 50/50 and so I only needed the doctor to help me get closer to 80/20 (for or against), or maybe 90/10. So I went in to get a second opinion.
It was about halfway through my examination that I started to have second thoughts. Describe the pain, well, it’s mild. Yes, I’d say it’s pretty mild. And transient. Does it hurt more when I eat? I’d say, yes sometimes it does, but other times it does not. Sharp? Oh no, it’s pretty dull. More like a mild cramp. Nope, nothing else. No diarrhea, vomiting, fevers, blood or any of those things. Just a really mild and dull muscle-like pain. Say, do you think it could be muscular?
Just to be on the safe side, the doctor ordered up an ultrasound for my upper right quadrant. And so for the next twelve hours I actually felt a little bit of relief, for the doctor himself had said I probably have gall stones (he wasn’t buying my theory of liver cancer). To be fair, that isn’t quite what he said, his words were more to the effect of ‘I see a lot of gallbladder pain, liver not so much’ – but it was clear to me that he meant to say ‘you do not need to worry, the pain you have is probably just from this dumb organ that we can remove lickety-split. You go tell your wife and kids you have a long life ahead of you.’ Thanks doc, you just gave me a new lease on life.
The next day, I had arrived at the hospital’s radiology department a new man, one who was more than ready to part with a gallbladder that he hadn’t even known was a thing twenty four hours before. I wondered, should I just pop on by the general surgery clinic and let them know that my primary would probably be contacting them later that day to set up the surgery? At this point, wasn’t doing the scan sort of a formality?
Thirty minutes later the scan was over, and I was back to planning what I would do with the last few months of my life. Should I work or quit my job? I could see the upside to both.
“What happened – how are you so sure the test results are bad? Did someone talk to you about them?” my wife asked, almost charmingly ignorant of the grueling road that lay before us.
“It wasn’t what she said,” I responded, speaking of the young radiation tech that had performed the scan. “It was how she acted. When she was done, she kept the towel on my stomach and told me ‘I’ll leave this here for now in case someone else wants to take a look.'”
“Isn’t that probably routine?”
“Well it was the way she said it. It was clear she saw something on that scan that was haunting her. She put the towel over my exposed belly, still warm with the ultrasound goop, and gave me this look – like I was a deadman walking. ”
“And then someone else came in,” I continued, as though expecting my wife to finally understand the gravity of the situation.
“No, another tech. She did more scans. More scans!” I could picture the scans on the screen, which was turned just at an angle so that I couldn’t look at it. The two techs standing there, trying to keep a straight face, wishing for all that was right in the world that they could avert their eyes from the dozens and dozens of tumors that they were seeing on every organ in my upper right quadrant. Their only saving grace the knowledge that I would go quickly. He won’t have to suffer too long.
What I didn’t appreciate, when they ushered me down the hallway to the waiting room, my own personal Green Mile, was how long it would take them to break the news to me. For although the technician had said I could expect a call from my doctor later that day with the results, the results failed to arrive that afternoon. And the day after. And the day after that.
On Monday, five full days after the original scan, including at least six conversations with my doctor’s scheduling staff asking about my results and a few voicemails for the doctor’s nurse to boot, the doctor finally called me with my diagnosis.
“Sorry about the delay, looks like we didn’t get the electronic files last week, but the hard copies arrived today,” he said. Enough with the small talk doc, I think we can both agree this little administrative oversight will not feel like such a big deal once you give me my terminal diagnosis.
“Anyways,” he continued, “your scans look normal. Nothing in the gallbladder. Other organs look good. Maybe take some of that antacid your primary prescribed, see if that helps?”
Modern medicine had bought me a bit of relief.
Anxiety 1, Doctors 1.
Now a visit to the doctor is a double edged sword. Doctors, unlike, say, me, don’t start with the worst case scenario. They are trained to check for the most common ailments first. So within a few days of my clear scans it began to occur to my anxiety that doctors don’t know shit. Or at least, they don’t do shit when it comes to people with very misunderstood and serious symptoms like my mild and transient pains.
What was it that my doctor had said at the very end of our call? Something about how even though he was suggesting I take antacids he couldn’t say for sure that the pain was definitely related to indigestion? In the exhilaration of hearing that my organs were not in fact riddled with tumors, I’d overlooked this curious uncertainty. Luckily for me, my anxiety had not. It was only waiting for me to settle down a bit before breaking the bad news to me. Turns out, the doctor hasn’t actually ruled out cancer. May be best if we dust off that two-month bucket list you’d started writing.
Anxiety 2, Doctors 1.
And this is the real reason why anxiety is so hard to defeat. No one is more confident than it. Not your doctor or your wife or even the part of you that should know better. No one screams as loud or makes it so hard to focus on anything else. Anxiety is like the Donald Trump of your inner voices. I’m not convinced the person you just saw was even a real doctor – did you ask to see their diploma?
And of course there is the real Trump card (not the Donald) that anxiety can always play, when all else fails. You are going to die. Maybe not today or tomorrow, but some day. I’m just here to remind you of that fact. Be prepared. Be vigilant. Don’t be distracted by your kids or your career. You are going to die. And who is to say it won’t be today or tomorrow? That quack you just saw? Please…
At this point, there is only one thing for reasonable people to do with their anxiety: Get into its head. Toy with it like Kaiser Soze did with that detective in Usual Suspects, or like the writers of Lost did with viewers for six seasons. What the hell do those numbers mean?!?! Because hey, if you may die today or tomorrow anyways, why not have a little fun on your way out?
Anxiety: I think you may have colon cancer.
Me: Colon. That’s one of those funny words you don’t think about until you hear it. Co-lon, co-lon, co-lon.
Anxiety: Wait, what? I said I’m concerned you have colon cancer. You are 36 and you really should have been getting a colonoscopy every year at this point. Unfortunately, I think it may be too late.
Me: Co-lon, co-lon, co-lon…
Anxiety: I said I think you are dying!
Me: I wonder what color the word ‘colon’ is to people with synaesthesia. Or what smell. I bet I could guess!
Anxiety: You are crazy.
Me: Takes one to know one.
You’d be surprised how well this sort of trick actually works. Entire psychological therapies are built on it.
You see at some point dealing with anxiety comes down to realizing that it isn’t the anxious thoughts that are the real problem. You don’t get to pick and choose most of your thoughts, it turns out. No the problem is that you are listening to them. Taking them as gospel when in fact they are more like the random musings of some deranged street person. Just imagine telling your wife, honey, you know that guy who sleeps on the grate downtown and has that sign counting down to the end of the world? Well, and this is really hard to say, but he just told me he thinks my liver is failing and I don’t have much time left here on earth. I think it’s time we started talking about what kind of funeral I’d like. That is basically what I sound like to my wife on the tenth day of telling her something, something I tell you, is killing me – if I only knew what.
Could I be dying from this pain in my side? Possibly. It’s not likely, but who knows. The key though isn’t to persuade myself of how unlikely that situation is – but instead to come to terms with the fact that I should keep on living life despite this seemingly insurmountable unknown. Death is coming, but for now, there is life to be lived. At least, this is what I try to tell myself as the pain in my side continues to radiate deep inside of me. Here’s hoping that it’s just my gallbladder.