Denial Is Not Just a River in Egypt

How to Save Your Own Life: The Eight Steps Only You Can Take to Manage and Control Your Health Care
by Marie Savard, M.D., Sondra Forsyth

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Now that I've given you some common warning signs and encouraged you to heed them - along with any other symptoms you suspect spell trouble - I could technically end this chapter right here. But I know better. Simply having information about what might be a red alert doesn't always push people to act. Here's a perfect example. My husband, a doctor who is an infectious disease specialist, once insisted that an infection in his leg was not a problem. I had to plead with him to let me take him to the emergency room! If a doctor can deny what is obvious, you can, too - and probably do. It's human nature not to want to face the fact that something is wrong with you. Magical thinking takes over, as in "If I ignore this, it will just go away. Anyway, I don't have time to be laid up right now, so this can't be happening." Jenny, a forty-year-old wife and mother who almost let denial kill her, talks about how her mind worked on the night she was infected with a virulent combination of the staph and strep bacteria:

"It was my daughter Sarah's tenth birthday and she had invited ten of her friends for a Friday night sleep-over. The plan was to let the girls sleep late the next day, since they would obviously be up giggling until all hours. I was going to make a pancake brunch after they woke up, and then drive them to the beach in our new van. Sarah was so excited she could hardly stand it and I wanted everything to be perfect for her. I'm a lawyer so sometimes I have to work long hours. That's why whenever I get the chance, I really go all out for Sarah. Maybe it's guilt or maybe it's just that I wish I could be in two places at once and not miss so much of her growing up. Whatever it is, I get really intense about stuff like the plans for that birthday weekend.

"Anyway, by about eleven p.m. the girls were all settled in their sleeping bags in the family room watching a video. My husband was already asleep. I was just getting around to looking at the mail. I tore open an envelope and happened to get a paper cut on my right thumb. It started to bleed a little so I sucked on it. When I finished with the mail, I went to bed.

"At three a.m., I woke up with a terrible, throbbing pain in my thumb. I turned on my little reading lamp. My thumb was all purple and swollen. My first reaction was annoyance. I had forgotten about the paper cut and just assumed that I had somehow banged my thumb in my sleep. Why would something so stupid have to happen on a weekend when I was so busy? I got up to go put some ice on my thumb. The family room is adjacent to the kitchen, and Sarah came in to get a drink of water. When she saw my thumb, her eyes got really big, and she said, 'Mommy! What happened?' But I just shrugged and told her it was a little bruise.

"By six a.m., after taking three Advil, I was still wide awake. I decided I might as well make the pancake batter. About eight a.m., my husband came down for his morning coffee. He looked at my thumb and said, 'What the hell is that?' I mumbled something about being a klutz even in my sleep. But he wasn't buying it. He insisted that I call my doctor right away. I said it could wait until Monday. He said, 'So why are you dancing around like that and gritting your teeth?' Then he picked up the phone and dialed the doctor himself.

"To make a long story short, I had a contracted a serious infection in the thumb, apparently from germs in my own saliva. Because I had let it go for hours, a potentially lethal blood poisoning called septicemia had developed. I ended up in the hospital. When the crisis had passed, the doctor asked me why I had waited so many hours before reporting something so clearly out of the ordinary and painful. I just shrugged. I was too embarrassed to say that I had been planning to drive my daughter and her friends to the beach and didn't want to be interrupted. It seemed so ridiculous in retrospect. But that is how my mind was working at the time. I like to think I'm pretty smart, but I had behaved like a total fool."

Jenny shouldn't be so hard on herself. As I've said, denial is all but universal. But you can conquer it. Here's how:

Problem: Whether you're faced with an acute symptom such as Jenny's abscessed thumb or a progressive one like a breast lump, there's a tendency to get caught in the trap of telling yourself "this isn't a good time for me to be sick." There's never a good time. Either your desk is piled with work that you were hoping to finish before the boss found out how far behind you had gotten, or your child's school play is the next day, or it's Christmas Eve, or your long-awaited vacation with the nonrefundable airline tickets is at hand, or . . . you get the idea. Dwelling on how there is no way you can be having appendicitis or a heart attack or a systemic reaction to a bee sting at this particular moment will jam your health radar. You'll miss the signals and put yourself in danger - maybe grave danger.

Solution: Get off the hamster wheel of negative thinking. Start by making actual plans for how you would manage if you found out you really were going to be out of commission for days, weeks, or months. Yes, you are unique and invaluable, but you are not indispensable at the expense of your health. Could a trusted colleague at the office go through the pile of work on your desk and minimize it enough so that the boss wouldn't think you've been slacking? Could someone videotape the school play for you? Could you send flowers to your budding thespian with a note saying how proud you are? Could your sister have your husband and kids over for Christmas dinner if you end up in the hospital? Can you change those airline tickets to a later date by paying a fairly nominal fee? The answer is almost always affirmative to each of the above. And once you've reassured yourself that people will cover for you in an emergency or that you can make contingency plans, you can let down your defenses. You can admit that, yes, you're doubled over in excruciating pain and it's no joke. Or if your symptoms don't constitute an emergency but they've been going on for some time, acknowledge that and say it out loud. You've moved from "This can't be happening!" to "This is happening, and I'm not thrilled, but I can handle it."

Problem: You engage in the magical thinking I mentioned earlier: "This will go away if I just wait awhile. In fact, I think I'm feeling better than I did a minute ago (or yesterday, or last week)." What's happening here is that you're relying on past experience. You've always gotten better sooner or later until now. Why would this situation be any different? Surely, as the old chestnut goes, this, too, shall pass.

Solution: Write down your symptoms. Pick up a pen or go to your computer and make a note such as "The right side of my head feels like it's going to explode" or "I have a mole on my chest that keeps getting bigger." Now read the note out loud to yourself. Whether this is an emergency situation or a progressive problem, the written statement will jolt you into accepting the fact that something is definitely awry. Incidentally, this exercise may be harder than you think. However, the more you resist writing down the symptom, the more likely it is that you are very worried. This is a kind of litmus test for denial. You don't want to face what's happening so you certainly don't want to see it in black-and-white. But force yourself. Your health may be at stake.

Problem: You're embarrassed to tell anyone what's going on because you're in public - maybe at work or in a restaurant or on an airplane. After all, from the time you were a little child you've been learning how to be on your best behavior when you're in certain settings. In large measure, that means overriding your body's urges. You stifle a burp, you don't pass gas, you muffle a sneeze, you control a cough, you swallow a yawn, you don't scratch yourself. A natural extension of that training is that you try to conceal anything your body is doing that wouldn't be acceptable in polite company. That stabbing pain in your gut, which could be appendicitis or an ectopic pregnancy, just isn't something you want to announce in the middle of the annual meeting of the board of directors.

Solution: Since this overly civilized reaction could cost you life or limb, correct for it ahead of time by imagining yourself in embarrassing situations. Then diffuse the bomb of false pride by learning to laugh at what's going on. Remember when President Bush threw up on the Emperor of Japan at a state dinner? The unplanned photo op resulted in front-page pictures around the world, plus endless jokes and snickers. Mentally insert yourself into Bush's place in that incident. Go ahead and laugh. Now mentally rehearse some similar scenes, always with you as the hapless protagonist. In so doing, you're preparing yourself to handle with good grace and prudent haste any threat to your well-being that might overtake you in the future.

Problem: You blame yourself, so you want to keep your condition a secret. We've all read and heard so much information on prevention by now that we've come to believe we should have been able to stave off pretty much any disease or disorder just by eating right, exercising regularly, getting enough sleep, quitting smoking, drinking in moderation, lowering stress levels, and so on. Getting sick can feel like a stigma, so you try to keep your condition to yourself.

Solution: Even if you are somewhat at fault for whatever ails you, concealing your condition out of shame or embarrassment will only make things worse. Remember, nobody's perfect. So pay attention to your symptoms. Then get thee to the doctor and 'fess up about your two-pack-a-day habit or your penchant for red meat or your couch potato status. Relax. This is about helping you get well. It isn't Judgment Day. Yet. But it could be soon if you keep putting off getting a diagnosis and treatment. Believe me, you won't be the first person your doctor has seen who has some bad health habits. The doc may even have a few of his own!

Problem: Even if you confide in someone close to you or if someone notices that you're in pain although you're trying to hide it, you don't believe the person's feedback about the possible urgency of your complaint. Jenny, for example, shut out the shocked reaction of her daughter when Sarah saw the abscessed thumb. Jenny also played down her pain when her husband pressed her. This is very common because none of us wants to worry those we love. We want to be strong for them, not vulnerable - and certainly not a burden. Consequently, we turn away from them just when we need them most.

Solution: Flip the scenario around in your head so that your husband (son, mother, maiden aunt) is the one with the worrisome symptom and you are the one trying to get through to that person. In this role, you want to be needed and heeded. You want to help. And you feel angry at this person for being so stubborn. After all, if the worst should happen, you'd be the one left to grieve. Now, do 180 degrees back to reality. You're the one who's being stubborn. You're the one who's taking a chance on your own life while your nearest and dearest is powerless to help.

So stop insisting you're just fine. Be grateful people care and that you don't have to go it alone. Let somebody be what I call your "health buddy." Whoever you pick will serve as a confidant and a coach who encourages you to do what you should to take care of yourself. If you have written about your problem, let your health buddy read your "confession." This person can also come with you to the hospital or to office visits - a boon when you're too sick or frightened to speak for yourself. And when the crisis has passed, the two of you can team up to reach health goals such as losing weight, sticking with an exercise regimen, or quitting smoking. Misery and good intentions both love company!

About the Author

MARIE SAVARD, M.D., is an internationally known internist, women's health expert, and patients' rights champion. She is the creator of The Savard Health Record. Dr. Savard is also a medical writer and seminar provider who has lectured throughout the world on the principle of taking charge. She serves as medical director of the Cabrini Nursing Home. Her past highlights include: Director of the Center for Women's Health and associate professor at the Medical College of Pennsylvania/Hahnemann University; World Health Organization's technical advisor to the United Nations Fourth World Conference on Women (Beijing); Women's Day magazine “Your Health” columnist; Philadelphia Magazine “Top Doctor” since the 1980s and a host of the popular radio show Medical Frontiers.

Sondra Forsyth is a 1999 recipient of a National Magazine Award for an article on colon cancer, as well as the winner of an award from the American Digestive Health Foundation. Ms. Forsyth has served as executive editor of Ladies' Home Journal, and is the author or co-author of seven books. She has written extensively about health and medicine as well as other topics for the major magazines.