Anatomy of an Illness as Perceived by the Patient (2 page)

At 6:00, however, I found myself in open country on the wrong side of Moscow. There had been a misunderstanding in the transmission of directions to the driver, the result being that we were some eighty miles off course. We finally got our bearings and headed back to Moscow. Our chauffeur had been schooled in cautious driving; he was not disposed to make up lost time. I kept wishing for a driver with a compulsion to prove that auto racing, like baseball, originally came from the U.S.S.R.

We didn't arrive at the dacha until 9:00
P.M.
My host's wife looked desolate. The soup had been heated and reheated. The veal was dried out. I felt pretty wrung out myself. It was a long flight back to the States the next day. The plane was overcrowded. By the time we arrived in New York, cleared through the packed customs counters, and got rolling back to Connecticut, I could feel an uneasiness deep in my bones. A week later I was hospitalized.

As I thought back on my experience abroad, I knew that I was probably on the right track in my search for a cause of the illness. I found myself increasingly convinced, as I said a moment ago, that the reason I was hit hard by the diesel and jet pollutants, whereas my wife was not, was that I had had a case of adrenal exhaustion, lowering my resistance.

Assuming this hypothesis was true, I had to get my adrenal glands functioning properly again and to restore what Walter B. Cannon, in his famous book,
The Wisdom of the Body
, called homeostasis.

I knew that the full functioning of my endocrine system—in particular the adrenal glands—was essential for combating severe arthritis or, for that matter, any other illness. A study I had read in the medical press reported that pregnant women frequently have remissions of arthritic or other rheumatic symptoms. The reason is that the endocrine system is fully activated during pregnancy.

How was I to get my adrenal glands and my endocrine system, in general, working well again?

I remembered having read, ten years or so earlier, Hans Selye's classic book,
The Stress of Life
. With great clarity, Selye showed that adrenal exhaustion could be caused by emotional tension, such as frustration or supressed rage. He detailed the negative effects of the negative emotions on body chemistry.

The inevitable question arose in my mind: what about the positive emotions? If negative emotions produce negative chemical changes in the body, wouldn't the positive emotions produce positive chemical changes? Is it possible that love, hope, faith, laughter, confidence, and the will to live have therapeutic value? Do chemical changes occur only on the downside?

Obviously, putting the positive emotions to work was nothing so simple as turning on a garden hose. But even a reasonable degree of control over my emotions might have a salutary physiologic effect. Just replacing anxiety with a fair degree of confidence might be helpful.

A plan began to form in my mind for systematic pursuit of the salutary emotions, and I knew that I would want to discuss it with my doctor. Two preconditions, however, seemed obvious for the experiment. The first concerned my medication. If that medication were toxic to any degree, it was doubtful whether the plan would work. The second precondition concerned the hospital. I knew I would have to find a place somewhat more conducive to a positive outlook on life.

Let's consider these preconditions separately.

First, the medication. The emphasis had been on pain-killing drugs—aspirin, phenylbutazone (butazolidine), codeine, colchicine, sleeping pills. The aspirin and phenylbutazone were antiinflammatory and thus were therapeutically justifiable. But I wasn't sure they weren't also toxic. It developed that I was hypersensitive to virtually all the medication I was receiving. The hospital had been giving me maximum dosages: twenty-six aspirin tablets and twelve phenylbutazone tablets a day. No wonder I had hives all over my body and felt as though my skin were being chewed up by millions of red ants.

It was unreasonable to expect positive chemical changes to take place so long as my body was being saturated with, and toxified by, pain-killing medications. I had one of my research assistants at the
Saturday Review
look up the pertinent references in the medical journals and found that drugs like phenylbutazone and even aspirin levy a heavy tax on the adrenal glands. I also learned that phenylbutazone is one of the most powerful drugs being manufactured. It can produce bloody stools, the result of its antagonism to fibrinogen. It can cause intolerable itching and sleeplessness. It can depress bone marrow.

Aspirin, of course, enjoys a more auspicious reputation, at least with the general public. The prevailing impression of aspirin is that it is not only the most harmless drug available but also one of the most effective. When I looked into research in the medical journals, however, I found that aspirin is quite powerful in its own right and warrants considerable care in its use. The fact that it can be bought in unlimited quantities without prescription or doctor's guidance seemed indefensible. Even in small amounts, it can cause internal bleeding. Articles in the medical press reported that the chemical composition of aspirin, like that of phenylbutazone, impairs the clotting function of platelets, disc-shaped substances in the blood.

It was a mind-boggling train of thought. Could it be, I asked myself, that aspirin, so universally accepted for so many years, was actually harmful in the treatment of collagen illnesses such as arthritis?

The history of medicine is replete with accounts of drugs and modes of treatment that were in use for many years before it was recognized that they did more harm than good. For centuries, for example, doctors believed that drawing blood from patients was essential for rapid recovery from virtually every illness. Then, midway through the nineteenth century, it was discovered that bleeding served only to weaken the patient. King Charles II's death is believed to have been caused in part by administered bleedings. George Washington's death was also hastened by the severe loss of blood resulting from this treatment.

Living in the second half of the twentieth century, I realized, confers no automatic protection against unwise or even dangerous drugs and methods. Each age has had to undergo its own special nostrums. Fortunately, the human body is a remarkably durable instrument and has been able to withstand all sorts of prescribed assaults over the centuries, from freezing to animal dung.

Suppose I stopped taking aspirin and phenylbutazone? What about the pain? The bones in my spine and practically every joint in my body felt as though I had been run over by a truck.

I knew that pain could be affected by attitudes. Most people become panicky about almost any pain. On all sides they have been so bombarded by advertisements about pain that they take this or that analgesic at the slightest sign of an ache. We are largely illiterate about pain and so are seldom able to deal with it rationally. Pain is part of the body's magic. It is the way the body transmits a sign to the brain that something is wrong. Leprous patients pray for the sensation of pain. What makes leprosy such a terrible disease is that the victim usually feels no pain when his extremities are being injured. He loses his fingers or toes because he receives no warning signal.

I could stand pain so long as I knew that progress was being made in meeting the basic need. That need, I felt, was to restore the body's capacity to halt the continuing breakdown of connective tissue.

There was also the problem of the severe inflammation. If we dispensed with the aspirin, how would we combat the inflammation? I recalled having read in the medical journals about the usefulness of ascorbic acid in combating a wide number of illnesses—all the way from bronchitis to some types of heart disease. Could it also combat inflammation? Did vitamin C act directly, or did it serve as a starter for the body's endocrine system—in particular, the adrenal glands? Was it possible, I asked myself, that ascorbic acid had a vital role to play in “feeding” the adrenal glands?

I had read in the medical press that vitamin C helps to oxygenate the blood. If inadequate or impaired oxygenation was a factor in collagen breakdown, couldn't this circumstance have been another argument for ascorbic acid? Also, according to some medical reports, people suffering from collagen diseases are deficient in vitamin C. Did this lack mean that the body uses up large amounts of vitamin C in the process of combating collagen breakdown?

I wanted to discuss some of these ruminations with Dr. Hitzig. He listened carefully as I told him of my speculations concerning the cause of the illness, as well as my layman's ideas for a course of action that might give me a chance to reduce the odds against my recovery.

Dr. Hitzig said it was clear to him that there was nothing undersized about my will to live. He said that what was most important was that I continue to believe in everything I had said. He shared my excitement about the possibilities of recovery and liked the idea of a partnership.

Even before we had completed arrangements for moving out of the hospital we began the part of the program calling for the full exercise of the affirmative emotions as a factor in enhancing body chemistry. It was easy enough to hope and love and have faith, but what about laughter? Nothing is less funny than being flat on your back with all the bones in your spine and joints hurting. A systematic program was indicated. A good place to begin, I thought, was with amusing movies. Allen Funt, producer of the spoofing television program “Candid Camera,” sent films of some of his CC classics, along with a motion-picture projector. The nurse was instructed in its use. We were even able to get our hands on some old Marx Brothers films. We pulled down the blinds and turned on the machine.

It worked. I made the joyous discovery that ten minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain-free sleep. When the pain-killing effect of the laughter wore off, we would switch on the motion-picture projector again, and, not infrequently, it would lead to another pain-free sleep interval. Sometimes, the nurse read to me out of a trove of humor books. Especially useful were E. B. and Katharine White's
Subtreasury of American Humor
and Max Eastman's
The Enjoyment of Laughter
.

How scientific was it to believe that laughter—as well as the positive emotions in general—was affecting my body chemistry for the better? If laughter did in fact have a salutary effect on the body's chemistry, it seemed at least theoretically likely that it would enhance the system's ability to fight the inflammation. So we took sedimentation rate readings just before as well as several hours after the laughter episodes. Each time, there was a drop of at least five points. The drop by itself was not substantial, but it held and was cumulative. I was greatly elated by the discovery that there is a physiologic basis for the ancient theory that laughter is good medicine.

There was, however, one negative side-effect of the laughter from the standpoint of the hospital. I was disturbing other patients. But that objection didn't last very long, for the arrangements were now complete for me to move my act to a hotel room.

One of the incidental advantages of the hotel room, I was delighted to find, was that it cost only about one-third as much as the hospital. The other benefits were incalculable. I would not be awakened for a bed bath or for meals or for medication or for a change of bed sheets or for tests or for examinations by hospital interns. The sense of serenity was delicious and would, I felt certain, contribute to a general improvement.

What about ascorbic acid and its place in the general program for recovery? In discussing my speculations about vitamin C with Dr. Hitzig, I found him completely open-minded on the subject, although he told me of serious questions that had been raised by scientific studies. He also cautioned me that heavy doses of ascorbic acid carried some risk of renal damage. The main problem right then, however, was not my kidneys; it seemed to me that, on balance, the risk was worth taking. I asked Dr. Hitzig about previous recorded experience with massive doses of vitamin C. He ascertained that at the hospital there had been cases in which patients had received up to 3 grams by intramuscular injection.

As I thought about the injection procedure, some questions came to mind. Introducing the ascorbic acid directly into the bloodstream might make more effective use of the vitamin, but I wondered about the body's ability to utilize a sudden, massive infusion. I knew that one of the great advantages of vitamin C is that the body takes only the amount necessary for its purposes and excretes the rest. Again, there came to mind Cannon's phrase—the wisdom of the body.

Was there a coefficient of time in the utilization of ascorbic acid? The more I thought about it, the more likely it seemed to me that the body would excrete a large quantity of the vitamin because it couldn't metabolize it fast enough. I wondered whether a better procedure than injection would be to administer the ascorbic acid through slow intravenous drip over a period of three or four hours. In this way we could go far beyond 3 grams. My hope was to start at 10 grams and then increase the dose daily until we reached 25 grams.

Dr. Hitzig's eyes widened when I mentioned 25 grams. This amount was far beyond any recorded dose. He said he had to caution me about the possible effect not just on the kidneys but on the veins in the arms. Moreover, he said he knew of no data to support the assumption that the body could handle 25 grams over a four-hour period, other than by excreting it rapidly through the urine.

As before, however, it seemed to me we were playing for bigger stakes: losing some veins was not of major importance alongside the need to combat whatever was eating at my connective tissue.

To know whether we were on the right track we took a sedimentation test before the first intravenous administration of 10 grams of ascorbic acid. Four hours later, we took another sedimentation test. There was a drop of nine full points.