What is the Worst Illness in the World?

What is the worst illness in the world?

I was reminded of that rhetorical question this week when I examined a patient rapidly losing her vision from retinal hemorrhages and a central retinal vein thrombosis. She had struggled with poor vision in one eye and now has lost almost total vision in both eyes, only being able to perceive shapes and light. Amazingly, although 86 she has no other chronic illnesses and has never taken any prescription medicine.

Naturally this patient is overwhelmed by the sudden development of this affliction. Now she must become reliant on neighbors and friends for her daily activities, and her security and independence have been permanently changed. She humorously pretends to consider suicide but wouldn’t be able to ascend the Brooklyn Bridge on her own.

As a physician, I am repeatedly faced with the difficult task of giving consolation and courage to people such as this wonderful woman. What can you tell them? Throughout 30 years as a doctor and a healer, I have had the singularly unpleasant responsibility to tell family members that a grandparent, relative, friend, lover, spouse, or child is dead. My training for this terrible task came from years of exposure to humanistic psychology, not from medical textbooks. One needs to be especially empathetic because we will all eventually be on the receiving end of such news.

When I lay recuperating from ulcer surgery in 1991 at St. Claire’s Hospital, tubes everywhere, I began to feel sorry for myself. That lasted about ten minutes when I realized that I was in a hospice unit and my neighbors were terminal patients. I imagined going to their bedsides and asking if someone would want to trade places with me. You know the answer: anyone dying of cancer or another frightening illness would welcome the opportunity to erase their disease and substitute a totally healed gastric ulcer. I stopped this foolish and selfish thinking immediately.

Illness brings out our worst fears and challenges our inner strength and stability. Personal myths such as “I never get sick” can be shattered in seconds. Yet, I have seen patients with pancreatic cancer accept their fate. In contrast, I have seen a young patient newly diagnosed with mild asthma commit suicide in his hospital room.

Physicians are not merely diagnosticians, clinicians, tradesmen, or surgical technicians. We deal not only with human bodies but diverse reactions to bodily trauma and incapacitation. Interestingly, a given individual may have multiple different responses to illness at different times. Elisabeth Kübler-Ross discusses this eloquently in On Death and Dying. Even seemingly mundane illnesses such as diabetes or hypertension can elicit diverse reactions ranging from denial and depression to total loss of self-control.

What did I tell the lovely 86 year-old who was now confronting a future of darkness? I recycled my own experience at St. Claire’s and told her to visit a nursing home or hospice and ask patients if they would trade places with her. After a moment of reflection, the patient smiled and decided instead to visit the Lighthouse and the Jewish Home for the Blind. They would be able to provide the necessary support system for her daily activities and routines. She will supply her own courage.

I often ask patients and myself: “What is the worst illness in the world?” The answer is the same every time: “It’s the one that you have.”