A doctor who’s sick with worry

One problem with being a doctor is that when you are the patient you worry like crazy. For every little symptom, you use all of your medical training to make the diagnosis, and you inevitably conclude that the symptom is of the worst possible event; that is, you are about to die. You have informed worry. This sense of impending doom can be augmented by a bad doctor and dissipated by a good one. With a good doctor’s attention to worry, healing can occur. Let me give an example from my recent total hip replacement surgery.

A pain in my knee while running led to an X-ray of my knee (normal) and then of my hip. This revealed a joint which, in the words of “Dr. Hip” at a great Boston hospital: “If you told me you wanted it done today, I would do it today.” He then added that they were developing a new polymer that would make the joint last longer, so I should delay the operation as long as I could stand it. How would I know when I was ready? “It’s the Necktie Sign,” the kindly old man said, smiling. “It’s when you come in here and reach across my desk and grab my necktie and scream, ‘Now! Do me now!’ ”

Four years later I went to grab his necktie, but he had retired. He referred me to his protege, whom I will call “Dr. B.” Like many orthopedic surgeons, he looked like a day laborer -- a big guy with big shoulders and hearty hands and not much neck. He had a broad face that broke into a smile a lot, a boyish head of hair and an appealing shyness, as if he were sorry to have to do surgery on me. My wife liked him. Done deal.

Things mostly went well. Just before surgery, the anesthesia doctor came in and said I had a choice of general anesthesia or a spinal. “General” puts you totally out, so a machine breathes for you; “spinal” is the administration, into your spinal cord, of drugs that anesthetize and paralyze you from above the operative site down to your toes. You can be conscious during a spinal, although routinely you are given drugs that leave you sleepy or asleep, but there is no “hangover.”

Four days of worrying

I asked the anesthesia doctor what she would do, and she said a spinal, no question. Dr. B. came along, in a charming lime-green shower cap that made him look like a woman shot-putter on her way to the showers, and said the same thing, so I went along. Somewhat doped up, I fell asleep. I woke up only once to hear a loud noise nearby -- my surgeon hammering happily on my hip. But I didn’t feel anything and talked to him for a while and then went back to sleep. I woke up totally dead from the chest down -- unable to feel anything or move anything. My first worry was that they had severed my spinal cord and no life would ever come into my lower body again. This was the first of many worries during my four days in the hospital, witness:

When I turned out to be exquisitely sensitive to narcotics and my blood pressure plummeted to that of an amoeba (60 over 50) and I was about to pass out, I worried that the narcotics plus the beta blocker they had given me for the surgery had eradicated my normal heart action and I was going to die.

When I sat up and had the most severe headache of my life, I worried that it was a ruptured cerebral aneurysm and that I was about to die.

When I suddenly had a shaking chill -- a rigor -- in which all my muscles clenched like steel traps all at once (including the un-narcotized muscles around my hip replacement that sent a blast furnace of pain through my body), I diagnosed a septicemia from which no one recovers. I knew I would die before sunrise.

Through all these worries, the nurses helped and Dr. B. was always available. His words were always reassuring, his face sometimes not.

But I made it through and went home and, suddenly alone in my bed and unable to move much, the real worry began. All day and for great snatches of the night I had many different symptoms, each igniting a fuse of worry that I just knew would end in the implosion of death.

It was three weeks post-op. I lay in bed worrying about the pain in my calf, which I had concluded was a DVT, or deep vein thrombosis -- a blood clot that, in a whimsical break for freedom, would dislodge at any moment, travel up into my lungs and result in pulmonary embolus, leaving me dead as a doornail. For the first two weeks I had been on Coumadin, an anticoagulant used to prevent DVTs. Now I was off Coumadin, and I pictured my red cells and platelets clogging like a crowd at a South American soccer game trying to exit all at once -- with many deaths. I worried and worried and thought to call Dr. B. I had called him a couple of times before with minor stuff, but now I didn’t feel I should bother him. After all, I’d had this calf pain for a while. Why wasn’t I dead yet?

I lived with my DVT worry for a day or two. Then, one sunny summer morning as I was crutching around the garden and throwing the ball to the dog, I noticed them: There, just below the knee, were varicosities! Varicose veins! I checked the normal leg. No veins. I tried to recall if I’d ever seen them before. No. My diagnosis? Because of the DVT further down in my calf, the blood couldn’t flow through the normal deep-vein route to get back to the heart, so it was trying the superficial veins, and because they aren’t made for the load, they pop out in these purplish little pods.

‘The root of fear is time’

The dog stood there, open-mouthed, waiting for the next throw. Little did he know that if I made any kind of sudden movement I would drop, and the ball game, so to speak, would be over. Gingerly, I crutched back to the kitchen, wondering if it would be better to sit, stand or lie down -- my informed worry had no answer. I started to sweat and then I felt a chill of fear. Should I call for help? Call Dr. B.? Call 911? Call my wife? Check my will?

I did nothing, except worry. I once heard a great person say, “The root of fear is time,” and now, finally, it made sense. I was in no pain now, but I was frantic about what was about to happen. In an hour my wife came home. I decided not to worry her. She immediately saw I was scared to death, and asked what was the trouble now. I pointed to my leg.

“Yuck! What are those?” she cried out.

“Varicose veins. I’m going to die.”

“Stop it. Call your doctor.”

“He’s on vacation. Building his barn.” It was true. Like many orthopedic surgeons he chose as his hobby one that involved a lot of hammering and sawing and screwing and nailing.

“Yeah, but he gave you his home number and said to call if anything came up.”

“Not just for a little worry.”

“Call him.”

I struggled with it, then called him at home. His wife answered and said he was out in the barn and before I could say don’t bother she was going to get him. I waited, feeling like a real wimp. Here he is building his barn, and I call him because of a little pain in my leg and a varicose vein?

“Hi, what’s up?” he said in his hearty voice.

“How are you?” I asked, stalling.

“Couldn’t be better.” He always said that. I felt like hanging up.

I apologized profusely for bothering him, but then, realizing that my extended apology was keeping him from hammering and sawing on his barn, I got to the point.

“It may be from the swelling in the quadriceps,” he said, “around the knee, or maybe they were always there and you’re just paying more attention to your leg these days.”

“Yeah, maybe,” I agreed, saying to myself not. He was doing what I as a doctor often did with patients: try to think of why it is not a problem.

“It’s probably nothing.” He paused. “Hey, but if you’re really worried, we can get you an ultrasound.”

I said, no, but thanks, and we hung up.

‘It’s probably nothing’

My wife asked what he said. I told her he reassured me that it was probably nothing, but that if I wanted I could get an ultrasound. She asked why didn’t I say I wanted one. I had no answer. She suggested we go out for coffee. She went in alone, so I wouldn’t have to negotiate in and out of the car on crutches. I sat there, stewing, glancing from time to time at my little varicose veins and focused on one word he had said to me, “probably,” as in “probably nothing.” Probably? Why didn’t he say definitely? From probably I could die. I still had the pain in my calf, I still had my varicose veins and I now was even more informedly worried that death was just around the corner.

But to call him back, again, to interrupt that crucial moment in the celebratory barn-raising when the big oak beam was being hammered home into the snug oak slot? To feel like a total jerk because I couldn’t even make up my mind the first time?

My wife got back into the car and asked me -- as if she didn’t know -- what I was going to do. I picked up the cell phone. His wife was just as cheerful, and just as willing to trundle on out to the barn.

“Hi,” he said.

“Sorry to ... “

“Yeah, I know, you’re worried. I’ll order the ultrasound right now, you go in this afternoon and I’ll call you back with the result.”

“I hate to bother you.”

“Look, I’d rather you call me, ‘cause we both sleep better at night. I’ll get my secretary to call right now.”

Two hours later I went in for an ultrasound. Everything was hanging on this test. Imagine my surprise when a very young woman -- she looked like she could neither legally drink nor vote -- came in and introduced herself as “the ultrasound trainee.” My informed worry hit the roof.

I knew all too well that trainees are, well, just trainees. What I needed was experience. I gently asked Ms. Trainee if her work would be checked by the regular technician. She said it would. On she went, doing the test slowly and, to my mind, sloppily. Finally, her supervisor -- old enough to both drink and vote -- came in and repeated the test, quickly and meticulously, and announced with not a shred of doubt in her voice, “It’s normal.”

My relief was immense and transforming. My informed worry disappeared -- and it was to turn out to be the last worry, informed or uninformed, that I had with my recovery.

Doctor-patient connection

What did I learn? That worry can be crippling and self-fulfilling, and that the only reassurance is that your doctor is available and invested in not being done in by informed worry about his patients. I had a sense that he cared about what happened, not only to my hip, leg and body but to my spirits. And he knew that he couldn’t reassure me himself, but that a test could. Did he worry about the cost, about justifying it to the managed-care bandits? If he did, I never heard about it. Did he worry especially about me because I too was a doctor? Well, he told me when he called back with the test result that another patient, not a doctor, with similar pain, had come in that day, did have a DVT and could have died. Dr. B. never made me feel I was bothering him. I felt he wanted to stay in good connection with me through a rough time, that he had an authentic wish to know.

Better yet, I imagine that he understood, maybe through his own experience of informed worry -- perhaps for a loved one or for himself. What did he understand? That the way we humans grow and heal is by walking through our suffering with another or with others.

I heard later that he invites his orthopedic residents out to his place on weekends to help build the barn -- which, apparently, is always in need of more building. It’s got to be about the best training to become a hip surgeon there is.

Samuel Shem is the pen name of Dr. Stephen J. Bergman, a psychiatrist on the Harvard Medical School faculty and author of the novels “The House of God” and “Mount Misery” and, with Janet Surrey, the book “We Have to Talk: Healing Dialogues Between Women and Men.”