In The Lives of a Cell, Lewis Thomas reveals what he calls the “great secret” of medicine–known to internists, he says, but unknown to the general public: “Most things get better by themselves. Most things, in fact, are better by morning.” Of course one segment of the general public knows this secret intimately: the uninsured. Up until a couple of years ago, I had passed my entire adult life without health insurance, and I’d grown so conversant with the secret that if I found myself with a sucking chest wound, my first impulse would still be to wait and see if it was better by morning.
I have in my wallet a wad of ID cards that would prove to any passing doctor that I am no longer a wanderer in the medical netherworld, but a real person with a real HMO who may be treated without fear of liability. (Doctors must long for the old days, when they were afraid to treat patients only because they didn’t want to catch bubonic plague.) But that morning I discovered that I didn’t still believe in any of it, not really. I couldn’t convince myself that a doctor would be able to do me any good–or in fact that there was anything that needed to be done anyway. The only reason to try was a creeping, directionless panic I couldn’t figure out how to get rid of, and the growing certainty that the panic was going to get worse if I didn’t do something soon.
The appointment itself proved to be another test of my resolve–maybe doctors arrange things that way so they can weed out the malingerers. In the whirl of phone buzzings and beeper chimes and loudspeaker pages that surrounded my doctor everywhere he went, I felt like I was trying to tell my life story to somebody on a subway platform while his train was pulling in. But he did finally put in some quality time with my eye. He couldn’t tell what was wrong, but he too thought it probably wasn’t serious. He gave me a prescription for antibiotic eyedrops and told me to call him in the morning if there was no improvement.
“What have I got?” I asked.
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“Well, probably it’s a bacterial infection. But I can’t rule out a disease called iritis. It’s pretty unusual, so the odds are you don’t have it, but if you do, you’ll need to get it treated immediately. And the same thing goes if you get a recurrence while I’m on vacation–you have to promise me you’ll call my office and get that referral.”
I picked up the prescription on the way home and obediently passed the night drowning my eyeball in antibiotics. In the morning there was indeed improvement: the pain had faded into a dull ache. The eye was still swollen (though less so, it seemed to me) and my sight was fuzzy–but these symptoms seemed trivial. I decided not to call for the referral.
