Tuesday, April 11, 2006

Takes One To Know One

That's what they say, right? Well, today I began a Freaky Friday-like switcheroo from almost-doctor...to almost-patient.

It all started with a headache. Not my normal monthly migraine, or the underacknowledged bulging-pocketed-white-coat neck muscle tension headache. Those I know. I wouldn't say we're good buddies--but to me they are familiar, and expected--like two neighbors who exchange the same nod and wave every single Wednesday night while taking out the garbage, but would never think of inviting each other over. Known, albeit unwelcome.

But this was not that kind of headache. This was a new neighbor, who moved in suddenly and started playing a loud, incomprehensible cacophany in my sinuses. I tried caffeine and water, to no avail. Exercise seemed like a good idea, if not because I hadn't done any in a few days, then because it's worked for me in the past as an endorphin-mediated cure for headaches, knee pain, and other minor ailments. The good news is: it worked, and by the end of my elliptical endeavors, my headache was gone. The bad news is: while shoveling legs and arms in furious synchrony on the machine, my throat started burning something awful. It was the burn of an out of shape body sprinting to catch the train--but I'm not *that* out of shape these days, and I wasn't doing any sprinting. So it seemed unusual. But overall I felt better after the workout, so I figured maybe I was just coming down with something, nothing a good night's sleep (ha) couldn't manage.

The next day, which was yesterday, all was going smoothly until after lunch, when I felt a scratchiness in my throat. Being the good medical student that I am, my hands immediately flew up to my neck to where I imagine my lymph nodes to reside. BUMP. Before I could get to the lymph nodes, my fingers had hit a smooth, bulging bump. A lump, to be more precise. Or, I guess to be really precise, a soft, tender mass in the anterior neck. It has to be my thyroid, I thought as the lump figuratively got stuck in the very throat it was literally feeling stuck in. I grabbed a classmate and told her that I thought I had an enlarged thyroid. She gave me a look--the same look that the three doctors I've seen in the past year have all given me (when I came in claiming to have, in chronological order, axillary lympadenopathy that I was sure indicated metastatic disease, migraines that I was sure indicated a space-occupying brain tumor, and symptoms that I was sure indicated severe hypothyroidism--all diagnosed conclusively as normal anatomy and physiology, of course), a look that says, "oh, you poor hypochondriac medical student, you always think you're dying of something awful and rare and there's not a lick of anything wrong with you, you healthy paranoid freak." Then, she (my classmate) put her hand on my neck and popped her eyes open with a gasping "oh!". Yup, she felt it. It wasn't just me.

Then, she grabbed another classmate, said, "hey, feel Rachel's thyroid", and he gave the same look, and the same eye-popping 'oh, wow!' as soon as his hands touched my neck. This was repeated with one of my residents, my chief resident (who gave the most disbelieving look of all pre-'neck touch', then immediately became the most supportive and helpful post-'oh wow'), and several other med students who happened to pass by. I felt like the more legitimate cousin of Chicken Little.

By nightfall, my left thyroid had been manhandled by more medical professionals than a little old lady with a doctor for each body part; and it had become quite tender. I talked to two close yet non-medical friends before bed, and both reassured me with excellent "bedside manner" that it was probably nothing and I would be fine. I slept fitfully.

This morning, I changed into scrubs and waited outside a certain operating scrubroom at just the right time to catch one of the major endocrine surgeons before her next case--which was, ironically, a partial thyroidectomy. Even more ironically, I know particular surgeon largely because of her lecture to us med students on surgery several weeks ago, during which she picked me--yes, me!--to come up in front of everyone else and demonstrate the physical exam of the thyroid on a classmate. I felt nervous waiting for her to come out of the OR, where she was setting up the next patient. When she emerged, all I could muster was a plaintive "feel my thyroid? I think it might be enlarged..." This time, my claim was once again met with a look; but this time, for the first time, the eyebrow raise was one of concern, not doubt. And upon palpation, Dr. R gave a reassuring 'ahh, yes', not the disconcerting 'oh, wow!' of previous palpaters. What a relief. "I guess you could say I take the term experiential learning very seriously," I said, trying to make light of the situation. "Don't panic, you're going to be fine," she said, seeing my underlying anxiety clearly through my veil of humor and intellectualization.

Within minutes, Dr. R scored me an appointment with an endocrinologist tomorrow; within hours, I got blood drawn to check thyroid function. As she and some of my residents helped me use inside connections to navigate speedily through the maze of healthcare acquisition protocol, I realized how lucky I am to be on the inside of the system. How long would I have waited to see someone if it took me days to get around to calling for an appointment, weeks to get the appointment, days to wait for the lab results, and weeks more until the followup? And what if I worked equally crazy hours, but not at the hospital where I'm literally surrounded by doctors? Or what if I didn't know that what I have is most likely a small hemorrhage into a thyroid cyst, a benign and common condition that will resolve without difficulty--what if I thought I might have cancer, and was scared of finding out, so I postponed going to the doctor because I preferred the ignorant bliss of not knowing? I began to think about all of the ways that people don't get timely appropriate healthcare for reasons that have nothing to do with insurance coverage.

Outside of those larger issues, I also felt the anxiety that every patient must feel before a diagnosis has been named. Knowledge is truly power when it comes to diagnosis; the uncertainty of "what's wrong with me?" is almost worst than even the gravest diagnosis. To live in uncertainty is like floating in a sensory deprivation tank: there's nothing to go by, nothing to hold on to, nothing to feel. Which, in a sense, is a denial of what it is to be human--we are by nature and design sensory gluttons. We live for sensual experiences, and they provide motivation and support for much of what we find meaningful in our lives. Without certainty, we are stuck holding our breaths indefinitely, flying in a holding pattern, stagnant as a grimy pond sitting under a thick blanket of late summer heat. In some cases, uncertainty can be a good thing--it can be infinite possibility. That's exciting! But here, uncertainty only breeds ickiness. And I hate ickiness.

So...um, yeah, I think I have some sort of thyroid disease. More tomorrow.


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