For the past few weeks I've been obsessed with rashes. Found every article I could and read about the differentials, examined for hours the images of each rash, read more than once about varicella, scabies, PLEVA, and a few others on the differentials. I'd wake up in the middle of the night from the itch, reached out to my phone and looked up other causes of rashes, or read up on one of the many skin diseases. I really shouldn't be going down the rabbit hole when I should be studying for boards, but I can't help it!! I can't stand not knowing what it is and why it's getting worse when it should be better! Arggghhhhhhwwarrrrghhhuuuurgggh!!! [That's me turning into Hulk, in my head.]
So. As you can tell from the title of this post, turns out the rash wasn't chicken pox after all. Here's what happened.
About two weeks after it started, when it didn't get better as expected for varicella, but in fact got worse, I started questioning the diagnosis. I would've got to the bottom of it all sooner if I wasn't so reluctant to see a doctor, or if I didn't hold on so tightly to the wishful thinking that it is the easier, simpler diagnosis. Because even though it's absurd that one could get varicella twice, it's still a shorter course of disease, self-limiting, and- I was banking on the probability of it being milder since it'd be a recurrent infection. I was really hoping it was "just" that, and be done with it. So when the rash started to spread, I convinced myself that I'm seeing things, that it's all in my head. Sigh. "For someone who studied so much, this type of reasoning was downright stupid," I can almost hear my dad say that to me. :(
And so it got to a point where I just couldn't lie to myself anymore and had to go to the university health center to get it looked at. The doctor being uncertain of what it was, referred me to dermatology. And with just two words, a huge portion of my anxiety melted away: pityriasis rosea. UGHHH. Really? I never thought bout it because there's no herald patch! And no christmas tree pattern as well! Here's another lesson learned, just because something is pathognomonic of a disease doesn't mean the absence of it precludes the diagnosis. I guess my frustration was noticeable, when I asked the dermatology resident: "How on earth did I get it?!" To which he calmly responded, as if trying to placate me, "It's nothing that you did or could've done to get this. It's a really common disease and a lot of people get it, but we still don't really know why it happens or what causes it." Great. Just great. Isn't this the majority of the case for almost 80% of the diseases out there?! That we don't know what the heck we're dealing with most of the time. If I weren't in the medical field and could understand the unpleasantness of having to tell a patient that, I'd have rolled my eyes and stopped listening. But I get it, so I didn't pursue further. Yes- I get it now, more so than ever, because now I don't only understand it from the physician's point of view, but also from the patient's. I know how it feels to be on the receiving end of that statement- and it sucked.
Sure, I understand that a lot of medicine is still in the grey area, and that there are a lot that have yet to be discovered. But the simple truth is that logic never does make anyone feel better. It also makes me realise something about myself, which is probably also the nature of most human beings: that we always attempt to explain everything that happens to us (that's how the age-old adage of "everything happens for a reason" reasoning came along, isn't it? To make us feel better?), and we also try to do so in a way that attribute the cause upon something other than ourselves. In other words, we're always inclined to blame it on something else, anything but ourselves or our own deed. But when push comes to shove, we'd take the blame too, as long as there's a logical reason to it. We don't handle the "unknown" very well though. Indeed, it's the shrugged "I-don't-know-why-it-happened-it-just-does-and-I'm-sorry" explanation that makes us feel the worst. But why??? Why did it happen to me? What have I done to deserve this?! Those are the thoughts that would plague one's mind, because one usually cannot fathom how a bad outcome could befall oneself when one has done everything by the books. Think of all the people who got lung cancer but never smoked a cigarette or anything in their entire lives. Or substitute it with any cancer that happened without a known risk factor in someone who had lived a perfect life up till that point. Think about the 30-something neurosurgeon who was about the complete his decade-long training only to find out he had terminal lung cancer. It's atrocious! How vile to have been sentenced to such fate when a 90-year old man a stone's throw away was probably happily puffing his cigarette celebrating his 70th-pack-year! But what can one do but throw up his hands and surrender to this thing called Life??!
And when the initial emotions has passed and the dust settled, how does one cope with this kind of horrible outcome? Ironically, one tends to circle back to the "everything happens for a reason" argument to cope with it, or chose to accept and entrust one's faith to the higher beings. That, or one could go into self-destruction mode and start hating everything and everyone with the "fuck god, fuck the disease, fuck the world" mentality.
Now I'm not being melodramatic, I don't have a terminal illness, I just have a skin condition that is also self-limiting, albeit one that will last 6-8 weeks. In the bigger scheme of things, I am thankful for being alive, for having "just" a skin disease. But being unwell is hard, especially for someone who's spent most of her adult life working towards being the person who provides care. Now that table has turned, it's a hard pill to swallow. I don't want or like to be reminded that I too am mortal, that I'm completely susceptible to any disease, and that the medical degree earned is not an immunity to any or all sickness at all. Alas, I, and all the other physicians who may share my sentiments, are just humans too. We too can die, can get heart attacks, dementias, stroke, or [insert your disease of choice here]. It's a silly, not-worth-mentioning known fact, but we don't really think about it until we have to. (One could argue that some deliberately avoid thinking about it, but that's a topic for another day.) The truth is, we all have to face mortality at some point, and we will all do so on our own terms. One way or another, eventually. (Unless you happened to be in a plane that miraculously disappear into thin air. Then sorry, no time for you to think about dying and death because your brain cells and every bit of you will be blown up into ashes before you could even conceive of what just happened.)
I write this before I had the chance to read Atul Gawande's Being Mortal, or Paul Kalanithi's When Breath Becomes Air (that's the neurosurgeon who had terminal lung cancer I mentioned above), even though those books are just sitting on the shelf two feet away from me. When I'm done with exam, I'll read them. Perhaps I will have additional thoughts on mortality then. But at this moment, as I'm writing this pondering upon mortality, grateful that I'm alive yet slightly (only slightly) resenting the cards I'm dealt with, I still think it's a good thing over all. I see some good coming from it, not because I'm a masochist, but because through this ordeal I had a taste of being a patient, of being unwell, without having to go through chemo or radiation (or worse- to die!). Empathy and compassion often grow exponentially from first-hand experience. So hopefully this experience will help me be a better doctor. Then again- one could only hope, eh. :P
Peace. xoxo.
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