"Behind every affliction, illness, or malady, there is a story. Of course, there is the story of the affliction itself. That story tells the who, what, when, where, and how; but the story behind the story tells the why. The why is what determines whether you get sick or become ill. I will show you what I mean. First I will tell you my story; then I will tell you the story behind the story. First the what, then the why.
I have been sick before, obviously. I have had colds, coughs, runny noses, fevers, sinus infections, flus, and chicken pox, just to name a few ailments. I have been taken to the emergency room for choking on a peanut (if that counts). I have even gone under the knife for an inguinal hernia repair when I was ten. However, only one time have I actually been afraid. I had never dealt with uncertainty before in sickness, and a visit to the emergency department two years ago was my first encounter with fear.
I first started feeling poorly on a Tuesday. I felt fatigued walking around campus, my throat was scratchy, and I developed a cough and runny nose. It felt like the usual January cold-weather cold, so I did not think much of it until Wednesday morning when I began having trouble swallowing. I had the chills the night before, and by sunrise it was extremely painful to swallow anything, either saliva or food. So I skipped classes that morning and went over to Campus Student Health. After diagnosing a low grade fever and a general feeling of “crumminess,” I was given a rapid strep test. Strep throat was showing increased incidence on campus, and I was had all the symptoms. However, the test came back negative, so I was simply told to take an antipyretic and come back next week if the symptoms continued.
Two extra-strength acetaminophen tablets every six hours kept the fever low, just over 100 °F throughout Thursday night and Friday. I even got a call Friday morning saying the throat culture was negative. But just before ten at night, I woke up sweating through my sheets. My fever had spiked to 104.3 °F, much too high in my estimation. I had taken two pills a couple hours earlier, but I added an extra one for insurance. I stayed up for another half an hour, waiting for some relief. I got so hot that I took an ice cold shower to try to bring down my core temperature (I had seen House put a patient in an ice bath once and it brought down the fever, so why wouldn’t it work for me? Plus, one of my best friends was a fourth year med student and he confirmed Dr. House’s treatment.). About a quarter to eleven I took my temperature again, just after getting out of the freezing cold water, and this time it was 105.0 °F. At this point, I knew more than one thing was amiss. One, if your temperature gets too high, it can cause brain damage because of protein denaturation. Two, my fever was now running for over 24 hours. And three, I could not control the virus at home. It was time to head to the hospital since urgent care was closed at this hour.
My roommate drove me to the Emergency Department at UNC-Hospitals. I was scared, but I figured it would be faster to drive than call 911 since I was living on-campus. On the way I called my head swim coach’s wife, who was an ER physician at UNC. She told me I was doing the right thing, and that she would monitor my situation from home. Within minutes I was in triage. I was sweating so hard that I started taking off clothing; the lady sitting next to me in the waiting room told me she was hoping I’d go all the way. While being evaluated by the nurse, my hands and feet went numb. Apparently I was breathing so rapidly that the nurse had to tell me to calm down and breathe slower. Feeling came back quickly.
Soon, however, I was whisked over to “Minor Trauma,” an area for less serious sicknesses and injuries. I was seen by the resident within minutes and the attending no more than ten minutes later. Dr. Harrigan walked into the room, shook my hand, asked me how I was doing, and definitively asserted that I had strep throat. I recounted again, just as I had to the resident, the nurse, and everyone else, that both the rapid and the long strep tests had come back negative. Coolly, Dr. Harrigan told me that can happen, but he could smell the strep on my breath. He ordered a bunch of pills for me to take, slapped me on my shoulder, and sent me on my merry way. I was in and out in less than an hour, a miracle in itself. I felt better as I left, even before popping one pill. The uncertainty and fear slipped away…
Mundane and anticlimactic as this account may be, the story behind the story shows how lucky I was to be the right person in the right place at the right time. Implicit in my narrative are some important facts. First, I had ample access to health care. I went to my primary care physician immediately because I was not feeling well. I did not have to worry about the cost of the visit or the tests. It was all covered by my insurance plan through the University. I did not have to worry about the cost of missing work either; I simply emailed my professors. My life and my job did not depend going to work that day. And when all was said and done, after the hospital visit, tests, drug costs, and doctor’s fees, I owed less than $50 for everything. Insurance covered the rest.
Not only was I financially unburdened, but I had an incredible support structure. I was constantly on the phone with an experienced medical student while sick, receiving advice from someone inside the medical profession. My parents helped me decide when enough was enough and when it was time to drive to the hospital. An ER physician who worked at the hospital I was going to confirmed that I should go to the hospital. I even found out later that she called the Emergency Department to alert them of my imminent arrival, urging them to steer me toward Minor Trauma if possible. That way I would be in and out quickly and in a quieter environment. I also had a roommate and friend willing to drive me to the ER and wait with me. And once I was in a hospital bed, my head coach came to check up on me.
The moral of this story within the story is not that those who are financially and socially well off do not get ill. People of different socioeconomic backgrounds become very ill every day. My point is that, while sick, I was in the perfect position to get well. I did not have to worry about money, and I did not have to worry about making difficult choices. I had physicians, parents, and friends coaching me at every point, ready to spring into action if things got worse. The question is, what if things had been different? What if I did not think I could afford medical care? What if I thought I had to wait it out? Untreated strep throat can lead to very serious complications. What if I had to go at this alone? What if I had made all my health decisions by myself? In my case, the outcome may have been similar, but how much did that have to do with my education and family background? This story demonstrates the best possible health outcome in a crisis situation, but it is hard for me to imagine a similar chain of events for one of the 47 million Americans without health insurance, or one of the 3 billion in the world who live on less than $2.50 a day.
That is why this essay is not a personal “illness” narrative. I have never really been ill. I have been sick, but not ill. For me, illness implies something more serious; something life-threatening or something chronic and painful. Perhaps illness also encompasses the inability to afford to get well, or the lack of a friend to advise and help heal. Maybe we should take “illness” more seriously. I would argue that we can treat someone who is sick with a pill or a test or a procedure, but we cannot do the same for someone who is ill. The “me”s of this world get sick all the time, but rarely get ill.
This is why I came to medical school: to be the physician, advocate, and friend of the people who are not “me.” For the ill."
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