Scare yourself silly, but the Real Terrors Are at Your Feet:
"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.
