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Why life scientists make the best hypochondriacs

Ian Brooks 18 May 2008

www.lablit.com/article/381

Jumping to medical conclusions: an occupational hazard

There is a dark side to this wealth of semi-useless information: whenever I get sick, I know what's wrong to an almost atomic level

Being a scientist has some cool fringe perks: you know a hell of a lot about a lot of things. However, being a scientist has some bad fringe downsides: you know too much about too many things.

When I was younger, so much younger than today, I wanted to be a doctor. A medical doctor, not a “Doctor of Philosophy”. In the United States young people who want to enter medical school generally do a “Pre-Med” undergraduate degree, with medical school being equivalent to graduate school. In the UK, however, you go to medical school straight from high school. I think there are pros and cons to both systems, but I’m not going to go into them here. As a young man at school in the southeast of England in the late 1980s, I geared my GCSE coursework towards medical school, taking maths, biology, chemistry and physics. Later, my A-levels were also aimed at getting me into medical school, but here I took into account the fact that I suck at mathematics. Fortunately I was able to substitute English Lit. I suppose this could have led, years later, to a malpractice suit featuring a well-read doctor who couldn’t calculate drug dosages. On either side of the Atlantic getting into medical school is very competitive, and one is well advised to bolster one's application by any means possible. My mother is a nurse, and suggested I work at our local hospital to show the interview boards that I was suitably keen. So, at the tender age of just sixteen, I worked at the Hertfordshire National Health Service Trust as an auxiliary nurse. I was there every weekend and holiday for the next seven years. This was possibly the craziest, most frightening and ultimately most rewarding thing I have ever done.

I could regale you with stories of getting hazed by the nurses, but I promise you, firstly you wouldn't believe me, and secondly I doubt you'd forgive me for some of the mental images. At times being an auxiliary nurse can be described literally as a shitty job; it involves wiping a lot of arses. I stuck with it though. There was something about helping people so desperately in need that touched me deeply. As much as I didn't want to wipe your bum, I also knew that you really didn't want me doing it either, so seeing as neither of us was too happy with the situation, I might as well put a brave face on it and minimise your discomfort at much as possible. I also had the fortune of working with some real old school Ward Managers too, and one learned the benefits of hard work very quickly. There were innumerable different chores to be done throughout the course of the day, whether you worked the early shift or the late. Later we switched to a thirteen hour full day shift system, and you worked three days on and two days off. That was really hard. I think this is where my work ethic comes from: I find I have very little patience for procrastination. Being an effective scientist means being able to multitask efficiently. Woe betide the graduate student I find sitting around complaining they have "nothing to do".

I loved being an auxiliary nurse and seriously considered getting my RN. In fact, part of me still thinks about it. When I'm King of America I'm re-instituting national service for 18-20 year olds. There will be the option to do social, not just military, service. I honestly believe a period of service to others is an essential part of growing up. It certainly made a man out of me. And I still have a thing for women in uniform. (Hey – I was only sixteen!)

My experiences at the Hertfordshire NHS, as well as being the son of a nurse, have given me a more than passing familiarity with medical matters. Combine this with working in medical schools, teaching pre-medical and medical students, and earning an undergraduate and graduate degrees in physiology and its no surprise that I know a lot about your body. It also means I know a lot about it when it goes wrong too. I often find people want to talk to me about medical matters, but I love giving "pro-am" advice. Of course I'm the first to point out I'm not that kind of doctor, so one shouldn't treat anything as a physician's advice. As much as it can hurt to talk to someone about their aunt with early-stage Alzheimer's or their uncle with Parkinson's, I can be honest about the processes involved and find that often helps people. Once they have a feeling or understanding about the underlying biology, the control this imparts seems to allow a sort of peace. More tangibly, a couple of times I've been really fortunate in helping people get in touch with groups around the country who are running small-scale clinical trials and are looking for volunteers.

But there is a dark side to this wealth of semi-useless information. It means that whenever I hurt myself, or get sick, I know what's wrong with me to an almost atomic level. I can't just bump into a door frame, for example, and bruise my elbow. I bump into a door frame and induce shredded capillary beds leaching blood into extracellular spaces, crushed nerves firing antidromic action potentials, the metabolism of arachidonic acid generating bradykinin and its chemical kin to cause pain, swelling, inflammation and more pain. Now, couple all of this with my predilection for potentially lethal hobbies, pastimes and sports (or PLHOPS as I like to call them). I have a snowboard, a long-board (a kind of big skateboard) and a mountain bike. I enjoy scuba diving and Muay Thai, also known as Thai Boxing. It's a particularly brutal form of kickboxing that allows the use of elbow and knee strikes, as well as punches and kicks. In fact, I'm sitting in my study writing this with my left leg propped up on the desk. I think I have a stress fracture of my tibia. Most people would say, "Oh, I bruised my shin". Not me! Oh no, I have a stress fracture. If this sounds a little like a form of hypochondria, I'm afraid I might be inclined to agree.

A month or so ago I came down with a late season flu virus that's been doing the rounds in the Eastern US. It was nasty, like influenza is, and I was pretty much bed-ridden for a week. Imagine the increasing levels of hysteria with every new ache, pain, sneeze, fart or cough. Is it bird flu? Oh shit! I've gone and got the fucking bird flu! They study it in Memphis… I must have got it from friends at work! I'll be dead by morning…why God, why?

But then a new ache appeared. In my stomach, low down on the right hand side (all the other hypochondriacs out there are already nodding in sage approval, knowing exactly where this going). I finally went to my doctor to be told the worst, get my emergency course of retrovirals and write my last will and testament; it's a cool multi-purpose kind of place like that. The examining physician told me I likely had the same flu bug everyone else did and since there was nothing to be done about it, was there anything I wanted to complain about seeing as I was there and paying for this. I mentioned the pain in my stomach and that's when everything went haywire.

Looking back I can see where I should have perhaps volunteered some extra information during the exam…

She prodded me low down on the right side of my abdomen. I shrieked and writhed appropriately from the lancing pain this induced.

"Are you going to the toilet regularly?" she asked.

"Yes," I gasped. Except I also just started nicotine replacement therapy and I know that can kind of bung you up a bit.

"The muscles here are very tight and firm when I push," she said.

"Yes," I gasped. Except I train in Muay Thai and do about a thousand sit-ups a week.

"I'm concerned you might have appendicitis," she pronounced. "These flu-like symptoms and this pain in your abdomen are indicative of peritonitis."

"Yes," I gasped. But I’m a hypochondriac scientist and I thought the same thing about a day ago, and you have now confirmed my second worst fear. It's not the bird flu, it’s a burst appendix. I knew it!

"OK, I want you to get a CT scan. We need to be sure. It will require immediate surgery if I'm right." What she failed to mention at that point was that I would have to drive myself across town to the hospital, and that my health insurance had a $250 deductible I would have to meet before they covered the procedure.

In John Wayne fashion, like a wounded hero in True Grit, I drove my way across town to the hospital. I really was in great deal of pain and this seemed a rather unfair extra torture – but such are the vagaries of the US Healthcare system. Because I have crap (i.e. cheap) health insurance, it would have cost me around $600 to take an ambulance. At the hospital I sat through seemingly endless interviews where I had to reaffirm my social security number, address and other pertinent facts to a veritable army of brain-dead crones. Finally someone took my credit card and preemptively billed me $250. I was eventually shown to a waiting room full of old, sick-looking people. I think I managed to pull off the requisite troubled hero look, struggling manfully in the face of imminent death. I knew at any moment this useless evolutionary oversight of an organ could simply explode, leaving me to come down with septicemia and die a manful, yet tragic death. Finally a nurse came and gave me some liquid to drink.

"You need to drink this, it has something in it to help with the contrast on the scan. I'll be back in an hour."

"An hour!" I squealed.

"Yes, Mr. Brooks. It takes an hour to get in your system."

Now, I rarely use my title, but this one situation I felt demanded it.

"Actually, it's Dr. Brooks, but you can call me Ian," I added with my best winning smile. And in all fairness to her, she did only make me wait 45 minutes. Now the actual CT scan itself was rather unremarkable, the only highlight being made to take off all my body jewelry beforehand. I don’t think they were used to that. Oh, and being allergic to the dye they use and nearly loosing my right arm in the process. Another story for another day there.

After all this, I was sent back to the waiting room. Five minutes later the phone at the waiting room porter's desk rang. He answered, began nodding, as you do when the listener can't hear you. And then he burst out laughing. My third-to-last worst fear was about to be realised.

"Mr. Brooks," he asked, looking round the room. "You can go home, sir."

"That's it?" I asked.

"Uh huh. And if I were you," he added in a conspiratorial whisper, "I'd think about maybe getting some more fiber in your diet.”