Medical Secret: 1 + 1 = 1

After you finish medical school classes, the night before graduation, they take you to a dark, quiet room.  There, among leather bound tomes 300-years-old, diseased skeleton trophies swinging behind glass, as you sip 50-year-old Port in ancient crystal, they tell you the secrets.  This is the wisdom passed not in lectures, rounds or at the operating table; it is the hallowed legacy of thousands of healers over the millennia; the bedrock of medicine, the soul of the profession.  And here, right now, I will give you a small peak, a tiny glimpse of that great light.  The deep insight, that marvelous truth is; watch the wife.

Let us be honest, men lie.  I mean of course, male patients. They do not mean to lie; they simply cannot help it.  Whether it is a macho thing, a denial of reality or perhaps simply that their brains do not fully connect to the body, they often do not seem to have a clue about how they really feel.  Have you been eating well?  “Absolutely,” says the guy that lost six pounds in a week.  Taking your meds?  “Of course,” with a blood pressure of 190/112.  “I’m ready to go back to work,” as he barely navigates the exam table.  Clueless.

So, one of the great tricks, which doctors learn, is watch the wife.  I am not saying, ask the wife whether he is telling the truth, check his answers.   If she wants, she will tell you.  Alternatively, she may feel the need to temper her words, in order to preserve domestic peace.  I am saying watch her body language, gestures and especially her eyes.

If, when you come into the exam room, you note that the wife is tired, then he is not doing well; she has been up all night worrying.  She has been cooking meal after meal that he says he wants, but does not eat.  She may be exhausted fighting, trying to get him to take care of himself.  If her cloths are a mess, makeup crooked, let alone eyes puffy from crying, he is in big trouble.

When he swears that he is having no pain, and her eyes widen, and she glances briefly at his face as if they have never been introduced, then he is in agony.  When he describes brisk walks around the neighborhood and her mouth opens so wide you can see her tonsils, he is spending most of his time on the couch.  If he says, “I quit smoking” and her hands clinch tight, you wasted that prescription for Chantix.

It is not just that a loving wife can be an excellent gauge of a man’s condition.  The lesson, passed down from healer to healer over so many years, is that when a man, or a woman, gets a disease, they both get sick.  Just as if that tumor is growing in both of them, the spouse suffers deeply in the mind and often in the body.  It is the nature of people that love each other to connect, not only in joy, but also in pain, loss and disease.  Soul mates mean more than walking the same path; it means walking in the same shoes, the same steps, driven by the same heart.

In general, women have better connection between body and mind, so that husbands are not as vital to measure their wife’s suffering.  Even the most loving husband may not be a good measure of what is happening to his wife, but this is not because he is insensitive.  The pain of the one he cares most about and is not able to protect, often overwhelms a man. Still, both men and women move through difficult times as one and suffer together.

One plus one equals one. To ignore that reality, to think you can treat one, without being aware of the one, is to risk confrontation, confusion and failure.  We are each different, each strong, and each weak, but together we heal.  When we remember the bond that makes two into one, we gain a powerful tool.  This lesson, the power of love, the power of togetherness, can serve all of us, no matter on what side of the stethoscope we stand.


  • Janet Visokay
    How absolutely true. You nailed it on the head! I wish that I was able to read this years and years ago. Also the next to last paragraph clears up a problem I had been feeling for so long. As I have said before, you are a great inspiration to all.
  • Gerda
    Agreed - SO true! I too was in that position as the monkey in the middle in trying to give honest answers to the doctor and not have my husband uncomfortable. Even though I'm no longer in that position - your blog is quiet inspiring. Thank you.
    • James Salwitz, MD
      Thanks very much. The tough side of love. jcs
  • D Someya Reed
    You have said so much here. Maybe more than you realize or initially intended. You have described, too, what for my wife was the “getting us” (not just her) requirement she held for all of her doctors. Due to long held cultural differences from a culture with which she was very far removed in time but not tradition, she was more like the man you describe but for different reasons. Even with her doctors, she would say she was feeling better than she was so they wouldn’t feel bad. Her doctors’ discomfort would be her responsibility to bear as her lack of improvement could be interpreted as an insult to their skill as physicians. Though it makes no logical sense to us (doctors are not mind readers) it was ingrained nonetheless. Alternatively, one of my best friends (a man) will tell you all of his infirmities, aches and pains to the point you may think he suffers from hypochondria (he doesn’t…he really has a long list of medical issues and openly talks about them). The “getting us” was her recognition of a limitation she had that I could fill (and vice versa). A “patient team” approach to medical care, if you will, and how we approached everything…together. What you say is very true for Western society perhaps even 98-99% of the time. But, today, we live in a global society. The burden on doctors is now even more immense. A patient can be inadvertently made to withdraw (misinterpret or lie) by a poorly chosen word, a look or a even a commonplace action much the same as your description of clues the doctor must be looking for from his patients. Doctors must be intuitives but how do you teach that? Of greatest concern and danger is that the doctor must not misinterpret the exchange (visual or physical) between husband and wife. Ever. Sometimes it may have to be ignored and the doctor must go with what can be proven from test results, physical examination, etc. Just as with ailments, this misdiagnosis can lead you on the wrong path and waste precious time. By the way, did they really take you to a dark, quiet room deep in the bowels of the building? From your description, I can’t shake the image of a Dr. Van Helsing.
    • James Salwitz, MD
      Your thought about the global community and the tremendous added communication problems is very relevant. An added complication is the number of societies that deliberately hide the "truth" from the patient and sometimes their spouse. Makes it hard to give good care. The dark room? Maybe. Perhaps the real medical moto is, as in that movie's words of Cardinal Jinette: "We have kept mankind safe since time immemorial, we are the last defense against evil. An evil that the rest of mankind has no idea even exists." Or maybe not. jcs
      • D Someya Reed
        That is true; as well as, those with such a strong familial hierarchical structure that the patient will obey family over the doctor's orders. There are so many variations that it makes it hard to imagine how anyone can be (or would want to be) a doctor today. I was actually thinking more of Edward Van Sloan playing Van Helsing in the Bela Lugosi version (much more atmospheric, don't you think?) but I did enjoy the Hugh Jackman version. My hat's off to you (if I wore one) if you recited that line from memory. One quote and one exchange from that film struck a cord with me (but I had to look them up to correctly add them here): Van Helsing: To have memories of those you have loved and lost is perhaps harder than to have no memories at all. and Anna Valerious: We Transylvanians always look on the brighter side of death. Van Helsing: There's a brighter side of death? Anna Valerious: Yes. It's just harder to see. The first is definitely true. I hope one day we'll find the second to be true, as well. Oh, you recently inspired me to give Becker's 'Denial of Death' another try. Should I get bogged down perhaps I can run it past you (offline)?
        • James Salwitz, MD
          Interesting ... what we have a a falure to clearly communicate ... thanks for straightening me out. I am a giant fan of Becker's. I will be interested to hear your comments on my blog this Friday. jcs
      • I found this to be sexist...and narrow. The personality variations of individuals cross sexual, cultural and personal life experiences as well as individual 'family' traditions. The quote from the cardinal...repugnant. The religious communities sheltering of criminal offenders, sexual etc. does not imply protection. I go for honesty at all times. The person dealing the cards in charge has to have a clean unmarked deck, so to speak. Some of mankind has been kept safe..I still have problems with absolutes when it comes to human behavior. None the less I enjoy your writing immensely!
        • James Salwitz, MD
          Hmmmm ... thanks for your thoughts ... did not mean to express sexist thoughts, rather relaying a very common observation of how men and women interact in the medical environment. The cardinal is a charector in a movie, and the comment meant to be facicious (as it is). jcs
          • Thank you! The variety of couple types and individual family issues..I recently met a young man with a mother in several relationships and whose dad, biological Dad ,died not too long with him at his side supporting him. This young man has a chronic bone disease.. A really great guy. My parents are still alive and married..90 and 89, But I rarely come across this situation these days. Gay couples..cross gender individuals in relationships finally receiving legal binding rights...the breakdown of traditional 'families' somehow made this seem a narrow perception. I am always in shock..but have had relationship issues as a result of discrimination against non traditional lifestyles and the religious communities inflexible standards that are hypocritical at the least. Thank you again. The Cardinal in the movie represents a facsimile or stereotype. Facetious....I have to watch the movie..I saw Hugh Jackman's name somewhere..a must watch if he is in it! :)
          • women can be terrible liars too!
  • meyati
    I can't imagine having my husband go with me, or me with him. we never had to do it. I'm old and single now. Unfortunately, I'm having problems with modern medicine. My temp is 96. My son and a grandson have learned to stare threateningly at the doctor. They've learned to say that I'm allergic to acetaminophen and NSAIDs, and ask the doctor what they're going to do for pain while they clench their fists. I had part of my nose, lip and tissue in between cut out. They used lidocaine, but I was sent home without anything for pain. All I had to use for pain control was sherbet and self-hypnotism. Even the inside of my mouth was swollen up and nothing. I'm not scared of going alone, I'm scared of how doctors practice medicine now. I had strep for 3 months-I finally found an 80 year-old doctor at an Urgent Care that ran a strep test. Very few doctors practice medicine 101 anymore, so now I need an offensive lineman.
  • Liz
    The other side to this is the doctor who cuts off communication (either by accident or on purpose). The verbal cues a doctor sends out can encourage or discourage communication. If a doctor needs his/her feet nailed to the floor to stop and listen they are likely to get a different amount/type of information than the one who is warm and encouraging.
    • nicely put Liz. I think of some of my own experiences that fostered avoidance. And I think of someone else's experience which fostered avoidance. The 'surprise' it will only hurt for a moment...etc.
  • Mike A.
    Shouldn't we lie, when telling the truth has consequences? Lectures from docs and nurses on how to live and what to ingest (or more frequently, not), insurance premium increase, big brother employers, etc. Not to mention what will happen to our jobs, insurance, and continued ability to receive treatment, should we choose to be up front with our employers. Anyone who thinks the laws are there to protect them is a bit naive, imho. Then there are health professionals, overworked as everyone else these days, who will either (1) dismiss our symptoms and side effects--- OR--- (2) freak out and throw us in the hospital instantly.
    • James Salwitz, MD
      Excellent point ... the consequences of "telling the truth" can be scary ... it's just that it may be hard to actually "live" with a lie. jcs
    • So true! I worked in the financial area...being a "somewhat of a never say the word to the employer" situation...bad situation. After surgery I not only had equilibrium social equilibrium was messed up too! My family..the same. One should not have to lie. I was almost fired when I was leaving work to go to radiation treatments. I was not to tell anyone...but someone noticed my absence for periods in the morning and marked me absent for the day many times. Guy was a real creep. When my new and later supervisor found out..he asked me to talk about...great guy! I broke down and cried once and was made fun of and called mentally unstable. After axillary direction and re-excised wider area..lifting 40 pound journals and positioning them on a copier during regular normal auditing of funds records...very painful! If you knew how many times I told someone something and they said "that is against the law!" and I had to laugh...

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