Two recent patient experiences illustrate the impact family stress has on the perception of illness. These two patients in particular are dealing with aspects of Alzheimer’s Disease in their family life and both have had physical complaints suggesting to them that their cancer was active. Both made earlier than expected visits to see me with their concerns and it was not immediately apparent to me that what was happening was really anxiety emanating from their worries about a loved one with Alzheimer’s Disease.
Phyllis came to see me last week complaining of dizziness and a rapid heart beat with some sense of inability to breath. The symptoms were episodic but because she carries a diagnosis of marginal zone lymphoma of the lungs, she understandably was frightened her disease was returning. I ran through the usual litany of questions such as did she have a fever, night sweats, weight loss, cough or chest pain. No was the answer to each inquiry. I was comfortable thinking her symptoms were unrelated to lung lymphoma but I was hoping to solve the puzzle she presented and when I asked her when the symptoms first appeared, she said the first episode happened after she and her husband had visited their accountant a few weeks before. I asked if it was a bad visit thinking they might have some financial difficulties that led to anxiety and perhaps a panic attack.
She started to cry. I was not expecting to hear what followed. She disclosed that she recognized for the first time that her husband was probably manifesting the first stages of Alzheimer’s Disease. She had previously noted that he had become forgetful and she hoped it was age alone. But at the accountant’s visit both the accountant and she became quite aware something more serious was afoot. She cried some more. She could see her future was going to be increasingly burdensome. I assured her that the lymphoma was not a concern, hoping my meager reassurance might improve her spirits. She thanked me, composed herself and made an appointment to see me in six months. I expect our future visits will be more focused on her dealing with her husband’s illness and less on her own health.
I have taken care of Doris for 15 years. She is 50 and a breast cancer survivor who works at my medical center. We have become good friends and she returns to me for professional advice when something bothers her. Lingering in her mind is the pervasive worry of cancer recurrence, an almost universal theme for cancer survivors.
Recently, she called and made an appointment. I expected a routine concern about a pain that suggested to her that her cancer might be active. I was not surprised when she started the conversation stating she felt a pain in her chest and it worried her. A few more questions led me to conclude the pain was inconsequential. But she wanted to talk more. I knew she was the sole support for her ailing mother who was in the advanced stages of Alzheimer’s Disease. So I asked how it was going.
Doris then described an interesting nexus of her mother being close to death while her daughter was about to give birth to a child. Clearly Doris was most concerned about her mother’s impending death. She related how she had come to cope with her mother’s confusion and delusions. Doris told an important story about her mother who announced some time ago that she was upset because during a war she flew a plane and she was given the task of rescuing children. She was upset she did not save enough children but she told Doris that she had earned a medal that she was going to soon receive. Doris knew this was a complete fabrication but chose to go along with it thinking that a confrontation would serve no purpose except make her mother more unhappy. Soon her mother’s birthday approached and Doris arranged to get a medal and printed a certificate of commendation. She presented them to her mother on her birthday. Her mother beamed with great pride and appreciation!
Her mother then began an accelerated process of deterioration. Clearly Doris was upset and it became clear to me that her physical pain complaint was a somatic manifestation of her anxiety. I gently suggested she spend more psychic energy looking to the future and the imminent arrival of her first grandchild. She seemed relieved and left in better spirits.
A few weeks later, I ran into Doris in the medical center and she was smiling and content. She showed me pictures of her grand daughter and she seemed so happy and relieved.
Both patients illustrate the power of emotion in magnifying somatic concerns. In cancer survivors, this typically leads to a concern for cancer recurrence. The emotional pain is immense, both with regard to the stressor and with regard to the pervasive fear of cancer recurrence. Thankfully, I was able to discern the real problem and did not have to subject the patients to expensive and fruitless tests. Reassurance and insight paved the way for them to leave the office confident that cancer was not the cause of their distress.
Pear Martini Broadside 