If symptoms
persist . • •
WE LIVE in dark times. It is only right, therefore, that in the midst of the festive season I should spread a little medical despondency: for in dark times, there is no innocence, only guilt, and misery — as we all know — is morally superior to contentment. In short, as you swallow another mouthful of turkey against the resistance of an already overstretched oesophagus; as you pass the brandy butter, think of the homeless, the poor and those whose mothers-in-law have come to stay. Until there is no suffering in the world, no one is entitled to enjoy anything.
Fortunately, as a medical man, gloom comes naturally to me. I have only to contemplate my patients for it to sweep over me. Even now those who hardly eat a thing yet put on weight, who only have to look at food to grow fat, are expanding in girth uncontrollably, and are thinking of their consultations with me in the New Year. Somehow they will contrive to blame me. 'But surely, doctor,' they will say, 'there must be something wrong with my metabolism?' The implication is, of course, that I do not know what is wrong, and therefore am responsible for their undesired bulk.
I don't need Scrooge to tell me that the Christmas spirit is humbug; science has proved it. It is true that the general death rate goes down over Christmas — people hang on for a last mince pie — but it rebounds with the disillusion that sets in afterwards. The general consensus among the wise is that Christmas is a time of high psychological tension and that there is only one thing worse than being alone over the holiday, and that is being with one's family. I know of a family in which the mother, unable to cope with the supposed joys of reunion, retires ill to bed without fail on Christmas Eve, not to recover until the Christmas tree is safely burnt. In the meantime everyone has to tiptoe around as though at an undertak- er's for fear of disturbing her: one of the symptoms of her illness being hyper- acuisis, a morbid sensitivity to noise.
One of my closest friends, a doctor, is a wonderful cook and a most hospitable man. His in-laws, alas, are health cranks, and arrive at Christmas every year with a new idee fixe. Four years ago it was rice cakes; that year, animal protein was deadly poison, the cause of schizophre- nia, appendicitis, cataracts and emphysema, and they wouldn't eat any of my friend's meticulously prepared food. The next year it was crystals, which they hung round everybody's neck on organi- cally produced string to protect them from the electromagnetic radiation that was leaking, a la Thurber, from power sockets all over the house, causing can- cer. They also suspended crystals from the local telephone wires, using a bam- boo pole to do it. Then it was the Christmas of water: they arrived with a huge filtering device. They had per- suaded themselves that the cause of melanoma was nitrates in tap water, and they therefore had to filter the liquid for their baths.
This year (they have given advanced warning) it will be multiple immunisation in childhood — known to hypochondriacs as immune system overload — which allegedly, and almost unprovably, causes cancer 40 years later. By coincidence, my friend's wife is a paediatrician, and one of her few enthusiasms is childhood im- munistion. Christmas will therefore be tense; avoiding the subject will be like
Of course I'm disappointed,' said Alice as the Mock Turtle introduced himself, hoping it was the Mutant Turtles that lived here.' 'I was
trying to pretend one hasn't noticed that the boss is drunk after lunch. Inevitably, however, the subject will be broached, just as the children are unwrapping their presents; there will be a row, tears, a threat never to return, and a truce in the form of a syrupy reconciliation. It will all be perfectly ghastly.
I shall not go into the purely nutritional hazards of Christmas for fear of causing an outbreak of mass listeria. The list of proscribed or dangerous foods grows apace, however; carcinogens, both natu- ral and artificial, are everywhere. Truly, in the midst of lunch we are in death.
Perhaps the best, the calmest, place to be over Christmas is in hospital. Every year, the beds empty of everyone who can possibly be sent home; at the same time, they fill with the lonely, the desti- tute and the gentlemen of the road, who appear in the casualty department with tales of unlikely illnesses in order to gain admittance. For once, doctors turn a blind eye to malingering, and take the view that anyone sad enough to want to spend Christmas in hospital and risk the sweet sherry and Christmas dinner pro- vided by the kitchens should not be too closely cross-questioned.
Of course, the liberal dispensation works to the advantage of some very strange people indeed. There is, for example, a peculiar group of mothers who manufacture symptoms in their chil- dren so that they, the children, should undergo tests in hospital. I was on duty in hospital h few days before Christmas one year when a mother arrived with her child and a bottle of his urine into which, unknown to me, she had introduced some blood. Naïve and unsuspecting, I tested the urine, concluded that the child was dangerously ill and admitted him to the ward; and, since the separation of mother and child is so harmful, the mother went too.
It was only by chance that the mother's game was uncovered. A nurse asked her to take her son's temperature, and left the room; she returned because she had left her pen there, to discover the ther- mometer not in the child's mouth, but in the cup of tea which the mother had just requested. The mother was manufactur- ing a fever to alarm and confuse the doctors. I was called at once to issue appropriate recrimination and retribu- tion.
The woman was distraught at the prompt discovery of her manoeuvres. She pleaded with me to be allowed to remain in hospital till after Boxing Day. Other- wise, she said, she would have to spend Christmas at home with her husband. I agreed, on condition that she never tried to deceive us again. She was as good as her word: on subsequent Christmases, she attended other hospitals.
Theodore Dalrymple
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