Big in the head

Marvelous drawing, found here

My dear friend Olga, joined Sam and me for lunch yesterday. While I was finishing up with the salad and we were alone in the kitchen, she hurriedly told me that she thought she was dying. With tears and sighs, she recounted symptoms that proved that she was hanging by a thread: bad taste in her mouth, bloating and gas, a 22 pound weight loss in two months, grinding pain under the right part of her ribcage--it all added up to her imminent demise.

I don't mean to poke fun at Olga, because if those things were happening to me and I had no medical knowledge, I could think I was dying, too. The problem is that she has paid $300 in physician visit copayments in the last month, and is getting nowhere. Her doctor has told her that she is being hysterical, that it's all in her head, that it is gastritis, etc. When she told the doctor that many of her friends are physicians, he relented and ordered an ultrasound. "No gall bladder problems, see?" was his only comment after noting that there were no stones in her gall bladder. When Olga asks questions he acts as though he doesn't hear her. He doesn't respond to her comments and often, doesn't give her eye contact. He has in a word, grossly mismanaged her care, in addition to misrepresenting a noble profession.

I took out my 1977 medical-surgical nursing textbook and read to Olga all the symptoms of gall bladder disease. I recalled my rather straight-laced nursing teacher saying in a hushed voice, "Fat, forty and farty--the cardinal symptoms of gall bladder disease." We had cracked up to see Mrs. Reinbaum say farty.
"That's everything I have!" Olga exclaimed, after hearing the list of symptoms. "What's wrong with the doctor?" She has told him all of her symptoms, asked about various forms of treatment, and asked for a referral. She has even begun reading medical textbooks. As the problem has only increased in terms of pain, lack of appetite and bloating, she has gone back the doctor several times. She only gets responses grudgingly--nothing for pain, no anti-inflammatory, nothing for the "gastritis" she supposedly has, no concern. Since Olga is an immigrant, she is especially vulnerable to being taken advantage of. I won't stand for it.

Needless to say, I'm going with her to her next medical appointment. There is no excuse for what has happened to Olga. It is classic litigation material and I have no reservations about expressing this. This physician practices out of an HMO that has a reputation in the community for stringing patients along, taking money for needless tests, not providing good care to their patients. I anticipate a huge lawsuit one day that will shut down the entire enterprise.

The lesson I take from this is the realization that when we don't talk to other people and keep everything inside, the issues we hold close to us becomes "big in the head." That is, they take on lives of their own and become overwhelming. Since we don't have the opportunity to get a reality check from anyone else, we think the worse, assume that we are somehow to blame, and begin trotting out all of our weaknesses and propensities just that implicate us. As we circle the drain, so to speak, we recite our beliefs about the issue, our history, and all the facts because we can hardly believe what is happening. Nonetheless, we still go down the drain.

It is also at such times that people do rash things to try to relieve themselves of the angst they feel at carrying about such a story of doom and gloom in their head. People become suicidal, strike out in violence at other people, become hermits, tell someone off, begin planning their funeral service. Anything done to deal with a huge story in one's head will fail because it is no longer possible to think objectively or rationally about the facts. The response comes from the bigness of the problem, not the problem itself.

Children who grow up in abusive homes often have trouble with this. Shame keeps them from finding out from someone else how the rest of the world lives, how parents behave, and what is typical relational behavior. Instead, they develop sensitivities to anything that reminds them of the abuse. They may be people we consider "touchy" or they may be standoffish: they don't want people to think they're less than anyone else, or that they come from a dysfunctional background. Or they might become abusive themselves as a way to feel less vulnerable to being victimized again. Such people also don't know that what has happened to them doesn't necessarily mean that they're defined by it. They believe that the family issues that loom so large on their horizons--complete with all the pain and emotional blind spots--are visible to everyone else. But it is just the irrational, touchy, lashing out behavior that tells people something deeper is amiss.

Stories of where we come from can indeed become very big in our heads if we don't invite anyone else into our lives.

So Olga realizes today that she is not dying. She has epigastric pain, but she knows what it is now. The story in her head has gone from watermelon size to the size of a pea. I am revved up to take on her doctor. I imagine that she slept very well last night. I know that I did.