Anatomy of an Illness as Perceived by the Patient Page 5

  The decency and goodness within Don Pablo were clearly evident. But there were other resources—purpose, the will to live, faith, and good humor—that enabled him to cope with his infirmities and to perform as cellist and conductor well into his nineties.

  Albert Schweitzer always believed that the best medicine for any illness he might have was the knowledge that he had a job to do, plus a good sense of humor. He once said that disease tended to leave him rather rapidly because it found so little hospitality inside his body.

  The essence of Dr. Schweitzer was purpose and creativity. All his multiple skills and interests were energized by a torrential drive to use his mind and body. To observe him at work at his hospital in Lambarene was to see human purpose bordering on the supernatural. During an average day at the hospital, even after he turned ninety, he would attend to his duties at the clinic and make his rounds, do strenuous carpentry, move heavy crates of medicine, work on his correspondence (innumerable letters each day), give time to his unfinished manuscripts, and play the piano.

  “I have no intention of dying,” he once told his staff, “so long as I can do things. And if I do things, there is no need to die. So I will live a long, long time.”

  And he did—until he was ninety-five.

  Like his friend Pablo Casals, Albert Schweitzer would not allow a single day to pass without playing Bach. His favorite piece was the Toccata and Fugue in D Minor. The piece was written for the organ. But there were no organs in Lambarene. There were two pianos, both uprights, both ancient. The one in the staff dining room was the more battered of the two. The equatorial climate, with its saturating humidity, had vanquished it almost beyond recognition. Some of the keys had no ivories; others were yellowed and cracked. The felt on the hammers had worn thin and produced harsh, twanging sounds. The instrument hadn’t been tuned in years; even if it had been, the improvement would have been short-lived. On my first visit to the hospital, I wandered into the dining room, sat down to play, then drew back abruptly at the caricatured tones. Yet the amazing thing was that Schweitzer could play hymns on it at dinnertime each evening and the piano somehow lost its poverty in his hands.

  The other piano was in his bungalow. It was in far better shape than the one in the dining room but it was hardly what one would call playable for a performer of Schweitzer’s worldwide reputation. It had an organ footboard attachment that was engineered into the hammer action, but this footboard had the infuriating habit of becoming detached in the middle of critical passages. Even a phantom footboard, however, provided him with an opportunity to work his feet.

  In an earlier book, I wrote about my experience at the Lambarene hospital when, one night, long after most of the oil lamps had been turned out, I walked down toward the river. It was a sticky night and I couldn’t sleep. As I passed the compound near Dr. Schweitzer’s quarters, I could hear the rapid piano movement of a Bach toccata.

  I approached the doctor’s bungalow and stood for perhaps five minutes outside the latticed window, through which I could see his silhouette at the piano in the dimly lit room. His powerful hands were in total control of the composition and he met Bach’s demands for complete definition of each note—each with its own weight and value, yet all of them intimately interlaced to create an ordered whole.

  I had a stronger sense of listening to a great console than if I had been in the world’s largest cathedral. The yearning for an architectured beauty in music; the disciplined artistry and the palpable desire to keep alive a towering part of his past; the need for outpouring and catharsis—all these things inside Albert Schweitzer spoke in his playing.

  And when he was through he sat with his hands resting lightly on the keys, his great head bent forward as though to catch the lingering echoes. Johann Sebastian Bach had made it possible for him to free himself of the pressures and tensions of the hospital, with its forms to fill out in triplicate. He was now restored to the world of creative and ordered splendor that he had always found in music.

  The effect of the music was much the same on Schweitzer as it had been on Casals. He felt restored, regenerated, enhanced. When he stood up, there was no trace of a stoop. Music was his medicine.

  But not the only medicine. There was also humor.

  Albert Schweitzer employed humor as a form of equatorial therapy, a way of reducing the temperatures and the humidity and the tensions. His use of humor, in fact, was so artistic that one had the feeling he almost regarded it as a musical instrument.

  Life for the young doctors and nurses was not easy at the Schweitzer Hospital. Dr. Schweitzer knew it and gave himself the task of supplying nutrients for their spirits. At mealtimes, when the staff came together, Schweitzer always had an amusing story or two to go with the meal. Laughter at the dinner hour was probably the most important course. It was fascinating to see the way the staff members seemed to be rejuvenated by the wryness of his humor. At one meal, for example, Dr. Schweitzer reported to the staff that, “as everyone knows, there are only two automobiles within seventy-five miles of the hospital. This afternoon, the inevitable happened; the cars collided. We have treated the drivers for their superficial wounds. Anyone who has reverence for machines may treat the cars.”

  The next evening, he passed along the news that six baby chicks had been born to Edna the hen, who made her home near the dock. “It was a great surprise to me,” he said solemnly, “I didn’t even know she was that way.”

  One night at the dinner table, after a particularly trying day, he related to the staff an account of his visit to the Royal Palace in Copenhagen some years earlier. The invitation was for dinner, the first course of which was Danish herring. Schweitzer didn’t happen to like herring. When no one was looking he deftly slipped the herring off the plate and into his jacket pocket. The next day, one of the local newspapers, reporting on the life at the Royal Palace, told of the visit of the jungle doctor and of the strange eating habits he had picked up in Africa. Not only did Dr. Schweitzer eat the meat of the fish, the newspaper reported; he ate the bones, head, eyes and all.

  I noticed that when the young doctors and nurses got up from the table that evening, they were in a fine mood, refreshed as much by the spirit of the occasion as by the food. Dr. Schweitzer’s fatigue, so palpable when he first came into the dining room, now gave way to anticipations of things that had to be done. Humor at Lambarene was vital nourishment.

  The Bible tells us that a merry heart works like a doctor. Exactly what happens inside the human mind and body as the result of humor is difficult to say. But the evidence that it works has stimulated the speculations not just of physicians but of philosophers and scholars over the centuries. Sir Francis Bacon called attention to the physiological characteristics of mirth. Robert Burton, in his Anatomy of Melancholy, almost four hundred years ago, cited authorities for his observation that “humor purges the blood, making the body young, lively, and fit for any manner of employment.” In general, Burton said, mirth is the “principal engine for battering the walls of melancholy … and a sufficient cure in itself.” Hobbes described laughter as a “passion of sudden glory.”

  Immanuel Kant, in his Critique of Pure Reason, wrote that laughter produces a “feeling of health through the furtherance of the vital bodily processes, the affection that moves the intestines and the diaphragms; in a word, the feeling of health that makes up the gratification felt by us; so that we can thus reach the body through the soul and use the latter as the physician of the former.” If Kant was intimating in these remarks that he never knew a man who possessed the gift of hearty laughter to be burdened by constipation, I can readily agree with him. It has always seemed to me that hearty laughter is a good way to jog internally without having to go outdoors.

  Sigmund Freud’s fascination with the human mind was not confined to its malfunctioning or its torments. His researches were directed to the supremely mysterious station occupied by the brain in the universe. Wit and humor to him were highly differentiated manifestations of the
uniqueness of the mind. He believed that mirth was a highly useful way of counteracting nervous tension, and that humor could be used as effective therapy.

  Sir William Osler regarded laughter as the “music of life.” His biographer, Harvey Cushing, quoted Osler as having advised doctors who are spiritually and physically depleted at the end of a long day to find their own medicine in mirth. “There is the happy possibility,” Osler wrote, “that like Lionel in, I think, one of Shelley’s poems, he may keep himself young with laughter.”

  Current scientific research in the physiological benefits of laughter may not be abundant but is significant nonetheless. William Fry, of Stanford University, has written a highly illuminating paper, “The Respiratory Components of Mirthful Laughter.” I assume he is referring to what is commonly known as belly laughter. Like Immanuel Kant, Fry finds that the entire process of respiration is benevolently engaged by laughter. Another paper worth consulting on the subject is “Effect of Laughter on Muscle Tone,” written by H. Paskind in the Archives of Neurology and Psychiatry in 1932.

  Some people, in the grip of uncontrollable laughter, say their ribs are hurting. The expression is probably accurate, but it is a delightful “hurt” that leaves the individual relaxed almost to the point of an open sprawl. It is the kind of “pain,” too, that most people would do well to experience every day of their lives. It is as specific and tangible as any other form of physical exercise. Though its biochemical manifestations have yet to be as explicitly charted and understood as the effects of fear or frustration or rage, they are real enough.

  Increasingly, in the medical press, articles are being published about the high cost of the negative emotions. Cancer, in particular, has been connected to intensive states of grief or anger or fear. It makes little sense to suppose that emotions exact only penalties and confer no benefits. At any rate, long before my own serious illness, I became convinced that creativity, the will to live, hope, faith, and love have biochemical significance and contribute strongly to healing and to well-being. The positive emotions are life-giving experiences.

  Scientific research has established the existence of endorphins in the human brain—a substance very much like morphine in its molecular structure and effects. It is the body’s own anesthesia and a relaxant and helps human beings to sustain pain. Exactly how the endorphins are activated and released into the bloodstream is not yet fully known. Nor is it known whether they might be activated by the positive emotions. But enough research has been done to indicate that those individuals with determination to overcome an illness tend to have a greater tolerance to severe pain than those who are morbidly apprehensive. Chinese medical scientists contend that the highly successful use of acupuncture instead of anesthetic is made possible because the insertion of needles in the “meridians” of the body activates the endorphins.

  In any case, the human mind has a role to play in the control of pain, just as it has a key role in combating illness. We need look no further than the phenomenon of the placebo to recognize that, both on the conscious and subconscious level, the mind can order the body to react or respond in certain ways. Such response involves body chemistry and not just psychological reactions.

  In the first chapter, I wrote about the ability of laughter to reduce the inflammation in my joints, confirmed by a reduction in the sedimentation rate—both sustained and cumulative. Did this mean that laughter stimulated the endorphins? An interesting experiment in this direction was undertaken by a Japanese doctor in Tokyo, who incorporated laughter into the treatment of tuberculous patients. The account of the experiment said that he was able to demonstrate to his own satisfaction that laughter was therapeutic and figured in the improvement of his patients.

  Other and more comprehensive research studies and experiments will be designed. As a result we will learn a great deal more than we know about the role of the positive emotions and of creativity and of the will to live. Before long, medical researchers may discover that the human brain has a natural drive to sustain the life process and to potentiate the entire body in the fight against pain and disease. When that knowledge is developed, the art and practice of medicine will ascend to a new and higher plateau.

  FOUR

  PAIN IS NOT THE ULTIMATE ENEMY

  Americans are probably the most pain-conscious people on the face of the earth. For years we have had it drummed into us—in print, on radio, over television, in everyday conversation—that any hint of pain is to be banished as though it were the ultimate evil. As a result, we are becoming a nation of pill-grabbers and hypochondriacs, escalating the slightest ache into a searing ordeal.

  We know very little about pain and what we don’t know makes it hurt all the more. Indeed, no form of illiteracy in the United States is so widespread or costly as ignorance about pain—what it is, what causes it, how to deal with it without panic. Almost everyone can rattle off the names of at least a dozen drugs that can deaden pain from every conceivable cause—all the way from headaches to hemorrhoids. There is far less knowledge about the fact that about 90 percent of pain is self-limiting, that it is not always an indication of poor health, and that, most frequently, it is the result of tension, stress, worry, idleness, boredom, frustration, suppressed rage, insufficient sleep, overeating, poorly balanced diet, smoking, excessive drinking, inadequate exercise, stale air, or any of the other abuses encountered by the human body in modern society.

  The most ignored fact of all about pain is that the best way to eliminate it is to eliminate the abuse. Instead, many people reach almost instinctively for the painkillers—aspirins, barbiturates, codeines, tranquilizers, sleeping pills, and dozens of other analgesics or desensitizing drugs.

  Most doctors are profoundly troubled over the extent to which the medical profession today is taking on the trappings of a pain-killing industry. Their offices are overloaded with people who are morbidly but mistakenly convinced that something dreadful is about to happen to them. It is all too evident that the campaign to get people to run to a doctor at the first sign of pain has boomeranged. Physicians find it difficult to give adequate attention to patients genuinely in need of expert diagnosis and treatment because their time is soaked up by people who have nothing wrong with them except a temporary indisposition or a psychogenic ache.

  Patients tend to feel indignant and insulted if the physician tells them he can find no organic cause for the pain. They tend to interpret the term “psychogenic” to mean that they are complaining of nonexistent symptoms. They need to be educated about the fact that many forms of pain have no underlying physical cause but are the result, as mentioned earlier, of tension, stress, or hostile factors in the general environment. Sometimes a pain may be a manifestation of “conversion hysteria,” as mentioned earlier, the name given by Jean Charcot to physical symptoms that have their origins in emotional disturbances.

  Obviously, it is folly for an individual to ignore symptoms that could be a warning of a potentially serious illness. Some people are so terrified of getting bad news from a doctor that they allow their malaise to worsen, sometimes past the point of no return. Total neglect is not the answer to hypochondria. The only answer has to be increased education about the way the human body works, so that more people will be able to steer an intelligent course between promiscuous pill-popping and irresponsible disregard of genuine symptoms.

  Of all forms of pain, none is more important for the individual to understand than the “threshold” variety. Almost everyone has a telltale ache that is triggered whenever tension or fatigue reaches a certain point. It can take the form of a migraine-type headache or a squeezing pain deep in the abdomen or cramps or a pain in the lower back or even pain in the joints. The individual who has learned how to make the correlation between such threshold pains and their cause doesn’t panic when they occur; he or she does something about relieving the stress and tension. Then, if the pain persists despite the absence of apparent cause, the individual will telephone the doctor.

  If i
gnorance about the nature of pain is widespread, ignorance about the way pain-killing drugs work is even more so. What is not generally understood is that many of the vaunted pain-killing drugs conceal the pain without correcting the underlying condition. They deaden the mechanism in the body that alerts the brain to the fact that something may be wrong. The body can pay a high price for suppression of pain without regard to its basic cause.

  Professional athletes are sometimes severely disadvantaged by trainers whose job it is to keep them in action. The more famous the athlete, the greater the risk that he or she may be subjected to extreme medical measures when injury strikes. The star baseball pitcher whose arm is sore because of a torn muscle or tissue damage may need sustained rest more than anything else. But his team is battling for a place in the World Series; so the trainer or team doctor, called upon to work his magic, reaches for a strong dose of butazolidine or other powerful pain suppressants. Presto, the pain disappears! The pitcher takes his place on the mound and does superbly. That could be the last game, however, in which he is able to throw a ball with full strength. The drugs didn’t repair the torn muscle or cause the damaged tissue to heal. What they did was to mask the pain, enabling the pitcher to throw hard, further damaging the torn muscle. Little wonder that so many star athletes are cut down in their prime, more the victims of overzealous treatment of their injuries than of the injuries themselves.

  The king of all painkillers, of course, is aspirin. The U.S. Food and Drug Administration permits aspirin to be sold without prescription, but the drug, contrary to popular belief, can be dangerous and, in sustained doses, potentially lethal. Aspirin is self-administered by more people than any other drug in the world. Some people are aspirin-poppers, taking ten or more a day. What they don’t know is that the smallest dose can cause internal bleeding. Even more serious perhaps is the fact that aspirin is antagonistic to collagen, which has a key role in the formation of connective tissue. Since many forms of arthritis involve disintegration of the connective tissue, the steady use of aspirin can actually intensify the underlying arthritic condition.