Anatomy of an Illness as Perceived by the Patient (14 page)

The central question to be asked about hospitals—or about doctors for that matter—is whether they inspire the patient with the confidence that he or she is in the right place; whether they enable him to have trust in those who seek to heal him; in short, whether he has the expectation that good things will happen.

Several doctors wrote to ask whether I had been influenced in my decision to use large doses of ascorbic acid by the statements and writings of Linus Pauling. My experience with ascorbic acid occurred in 1964. Dr. Pauling's first major work on ascorbic acid (
Vitamin C and the Common Cold
) appeared in 1970. After the publication of that work, I wrote to Linus Pauling about the episode. Since that time, we have corresponded and I have followed his research in this field with great interest.

Some of the letters from doctors asked whether there had been anything in my medical history to prepare me psychologically and philosophically for the “partnership” with Dr. Hitzig in the diagnosis and treatment of my illness in 1964. There were two such episodes.

My first experience in coping with a bleak medical diagnosis came at the age of ten, when I was sent to a tuberculosis sanitarium. I was terribly frail and underweight, and it seemed logical to suppose that I was in the grip of a serious malady. Later it was discovered that the doctors had mistakenly interpreted normal calcification as TB markings. X-rays at that time were not yet a totally reliable basis for complex diagnosis. In any case, I spent six months at the sanitarium.

What was most interesting to me about that early experience was that patients divided themselves into two groups: those who were confident they would beat back the disease and be able to resume normal lives, and those who resigned themselves to a prolonged and even fatal illness. Those of us who held to the optimistic view became good friends, involved ourselves in creative activities, and had little to do with the patients who had resigned themselves to the worst. When newcomers arrived at the hospital, we did our best to recruit them before the bleak brigade went to work.

I couldn't help being impressed with the fact that the boys in my group had a far higher percentage of “discharged as cured” outcomes than the kids in the other group. Even at the age of ten, I was being philosophically conditioned; I became aware of the power of the mind in overcoming disease. The lessons I learned about hope at that time played an important part in my complete recovery and in the feelings I have had since about the preciousness of life.

By the time I was seventeen, I had completely overcome the early frailty. I had fallen in love with vigorous sports; year by year my body continued to grow and harden. This addiction to sports stayed with me. I have also had the advantage of being married to a woman who is endowed with a blessed cheerfulness and who believes deeply in the advantages of good nutrition.

The second major episode occurred during 1954, in my thirty-ninth year. With increased family responsibilities, I thought it prudent to apply for additional insurance. The company doctors turned me down, saying the cardiograms showed evidence of a serious coronary occlusion. My aunt, who was the insurance agent, was completely frank about the findings of the doctors. Despite the absence of active supporting evidence, they diagnosed an “ischemic” condition, characterized by a thickening of the walls of the heart and an erratic heartbeat. She said they urgently advised me to give up almost everything and to take to my bed for several months. I felt demolished by this report. It was inconceivable that I would have to give up my job, my travels, and an active sports life. But here was my aunt telling me that the insurance doctors said that if I became completely inactive, I might be able to stretch out my life for a year and a half.

I decided to say nothing to my wife about the verdict of the insurance doctors. When I came home that night, my little daughters came running up to me. They liked to be thrown high in the air and to dive from my shoulders onto the couch. For a split second, I looked down two roads. One was marked “cardiac alley.” If I accepted the advice of the specialists, I would never throw my girls in the air again. The second road would find me working full tilt at
SR
and doing all the other things that spelled life to me. The second road might carry me for a few months or a few weeks or a few minutes; but it was my road. It was an easy decision. I caught my little girls as they came running up to me and threw them higher in the air than ever before. The next day I played in a singles tennis tournament for perhaps a total of forty-five or fifty games.

The following Monday I telephoned Dr. Hitzig and informed him of the grim verdict of the insurance doctors. He ordered me to his office immediately, then took me to the chief of cardiology at Mount Sinai Hospital. The hospital cardiograms confirmed the insurance reports. I went back to Bill Hitzig's office. We had a good talk. I told him I intended to do exactly what I had been doing all along and that I doubted there was any cardiograph in the world that knew everything that had to be known about what made my heart tick. Hitzig patted me on the back and said he was behind me all the way.

Three years later I met Paul Dudley White, the famed heart specialist. He listened carefully to the account of what had happened, then told me that I had done the only thing that could have saved my life. He believed that sustained and vigorous exercise was necessary for the proper functioning of the human heart, even when there was evidence of the kind of cardiac inefficiency that had been diagnosed in my case. He said that if I had accepted the verdict of the specialists in 1954, I probably would have confirmed it.

That meeting with Paul Dudley White was something of a landmark in my life. It gave me confidence in my rapport with my own body. It reinforced my conviction that the human mind can discipline the body, can set goals for itself, can somehow comprehend its own potentiality and move resolutely forward.

In recounting this episode, I certainly do not intend to suggest that patients with serious heart disease should go against the advice of their doctors. I had Dr. Hitzig's backing. Besides, there were factors in my case that might not apply to others.

Has my respect for the medical profession diminished as the result of the three episodes? Just the opposite. The thousands of letters I have received from doctors have demolished any notion that physicians are universally resistant to psychological, moral, or spiritual factors in the healing process. Most doctors recognize that medicine is just as much an art as it is a science and that the most important knowledge in medicine to be learned or taught is the way the human mind and body can summon innermost resources to meet extraordinary challenges.

Some of the letters asked whether I would be able, in the event of another serious illness, to mount the kind of total response that I did earlier in my life.

My answer was that I honestly don't know how many such efforts are possible in a single lifetime. But I know I would certainly try.

I know I have been lucky. My body has already carried me far beyond the point where the medical experts in 1954 thought it would go. According to my calculations, my heart has furnished me with 876,946,280 more heartbeats than were thought possible by the insurance doctors.

It was the sheerest of coincidences that, on the tenth anniversary of my 1964 illness, I should happen to meet on the street in New York one of the specialists who had made the melancholy diagnosis of progressive paralysis. He was clearly surprised to see me. I held out my hand. He took it. I didn't hold back on the handshake. I had a point I wanted to make, and I thought the best way to do so was through a greeting firm enough to make an impression. I increased the pressure until he winced and asked to be released. He said he could tell from my handshake that he didn't have to ask about my present condition, but he was eager to hear what was behind the recovery.

It all began, I said, when I decided that some experts don't really know enough to make a pronouncement of doom on a human being. And I said I hoped they would be careful about what they said to others; they might be believed and that could be the beginning of the end.

*
The problems of improper administration are discussed later in this chapter.

B
IBLIOGRAPHY

Acupuncture anesthesia
. Translation of a Chinese publication of the same title. Bethesda, Maryland: National Institutes of Health, 1975.

Adler, H. The doctor-patient relationship revisited.
Ann. Internal Med
. 78:4, April 1973, p. 595.

Akil, H., et al. Enkephalin like material elevated in ventricular cerebrospinal fluid of pain patients after analgetic focal stimulation.
Science
201 (4354): 463–65, August 4, 1978.

Aletky, et al. Sex differences and placebo effects: motivation as an intervening variable.
J. Consulting and Clinical Psych
. 43:2, 1975.

Alexander, F.
Psychosomatic medicine
. New York: W.W. Norton and Company, 1950.

Alvarez, W.C.
Minds that came back
. New York: J. B. Lippincott, 1961.

Basolwitz, H.; Persky, H.; Korchin, S.J.; and Grinkler, R.R.
Anxiety and stress
. New York: McGraw-Hill, 1955.

Beckman, B.L. Life stress and psychological well being.
J. Health and Social Behavior
12: 35–45, 1971.

Beecher, H.K. Evidence for increased effectiveness of placebos with increased stress.
Am. J. Physiology
187:163(b), 1956.

——. The powerful placebo.
JAMA
159: 1602–06, 1955.

Bell, B. D. Cognitive dissonance and life satisfaction of older adults.
J. Gerontology
29(5), 564–71, 1974.

Benson, Herbert, et al. The placebo effect: a neglected asset in the care of patients.
JAMA
232:12, June 23, 1975.

Birk, L., ed.
Biofeedback: behavioral medicine
. New York: Grune and Stratton, 1973.

Birren, J.E., et al. Human aging: a biological and behavioral study. DHEW Publication No. (HSM) 71–9051, 1974.

Blackwell, B., et al. Demonstration to medical students of placebo responses and non drug factors.
Lancet
, June 1972, p. 1279.

Blake, K. Vitamin C: the case looks stronger, but.…
Pastimes
(shuttle edition). Eastern Airlines: March 1976.

Bloom, S.W., et al. Physician-patient expectations in primary care.
Bull. N.Y. Acad. Med
. 53(1) 75–82, January–February 1977.

Blum, R.
The management of the doctor-patient relationship
. New York: McGraw-Hill, 1960.

Bogdonoff, M.D., et al. The doctor-patient relationship.
JAMA
192:1, April 5, 1965, p. 131.

Bok, S. The ethics of giving placebos.
Scientific American
231:5, November 1974, p. 17.

Bond, M.R. Psychological and psychiatric aspects of pain.
Anaesthesia
33(4): 355–61, April 1978.

Bonica, J.J.
The management of pain
. Philadelphia: Lea & Febiger, 1953.

Bonica, J.J., et al.
Advances in pain research and therapy
, vol. 1. New York: Ravens Press, 1976.

Brand, P. Rehabilitation in leprosy (videotape recording). Washington: produced for the Bureau of Medical Services, Division of Hospitals, 1961.

Bromberg, W. An analysis of therapeutic artfulness.
Am. J. Psychiatry
114, 1958, p. 719.

Brown, B.
New mind, new body
. New York: Harper and Row, 1975.

——.
Stress and the art of biofeedback
. New York: Harper and Row, 1977.

Burch, G.E. Of bellyache.
Am. Heart J
. 94(5): 668, November 1977.

Burton, R.
The anatomy of melancholy
(1621). Edited by Floyd Dell and Paul Jordan-Smith. New York: Tudor Publishing Company, 1941.

Cabot, R.C., and Dicks, R.L.
The art of ministering to the sick
. New York: Macmillan, 1936.

Cameron, E. Biological function of ascorbic acid and the pathogenesis of scurvy: a working hypothesis.
Med. Hypotheses
3: 154–63, 1976.

——.
Hyaluronidase and cancer
. Oxford and New York: Pergamon Press, 1966.

——. Vitamin C.
Brit. I. Hosp. Med
. 13: 511, 1976.

Cameron, E., and Baird, G. Ascorbic acid and dependence on opiates in patients with advanced disseminated cancer.
J. Intern. Res. Commun
. I (96): 38, 1973.

Cameron, E., and Campbell, A. The orthomolecular treatment of cancer: II. Clinical trial of high-dose ascorbic acid supplements in advanced human cancer.
Chem.-Biol. Interact
. 9: 285–315, 1974.

Cameron, E.; Campbell, A.; and Jack, T. The orthomolecular treatment of cancer: III. Reticulum cell sarcoma: double complete regression induced by high-dose ascorbic acid therapy.
Chem.-Biol. Interact
. III: 387–93, 1975.

Cameron, E., and Pauling, L. Ascorbic acid and the glycosaminoglycans; an orthomolecular approach to cancer and other diseases.
Oncology
27: 181–92, 1973.

——. Supplemental ascorbate in the supportive cancer.
Proceedings of the National Academy of Sciences USA
73: 3685–89, 1976.

Cameron, E., and Rotman, D. Ascorbic acid, cell proliferation, and cancer.
Lancet
I: 542, 1972.

Campbell, A. Subjective measures of well-being.
American Psychologist
, 117–24, 1976.

Cannon, W.B.
The wisdom of the body
. New York: W.W. Norton and Company, 1963.

Carter, A.B. The placebo, its use and abuse.
Lancet
, October 17, 1973, p. 823.

Castiglioni, A.
A history of medicine
. Translated from the Italian and edited by E.B. Krumbhaar. 2d ed., rev. and enl. New York: Knopf, 1947.

Cochrane, A.L. Effectiveness and efficiency: random reflections on health services. Nuffield Provincial Hospital Trust, 1974.

Comaroff, J. A bitter pill to swallow; placebo therapy in general practice.
Sociological Review
24(1):79, February 1976.