Time Bomb

Last Friday night was a dark and stormy one. Late in the afternoon a patient called in turmoil asking if he could possibly see me that night. When he called, I was booked until 9:30pm and I doubted my brain could function effectively for another hour, so I scheduled him for Saturday morning. I wasn't pleased about coming in on my day off but I didn't think it would be wise to put off seeing him until next week. We have worked together for many years and it was rare for him to need an emergency hour. Due to an impending ice storm, the patient who would have kept me until 9:30 wasn't able to come in, so I handled her appointment by phone. I could, then, see the emergency at 8:30. And I'm so glad I did.

He was swirling and sinking in a whirlpool of paranoia over an incident at work. I listened as he told me about the crisis. He really handled it fine and it was all over. I commented that what puzzled me was his extreme reaction to an event that he managed well. I knew before he came in that whatever the overt crisis, that it most likely had to do with his fear over the tumor in his pituitary gland.

Every year he goes into a panic as he approaches his yearly visit to the endocrinologist. As the appointment date nears, his anxiety goes through the roof. Knowing this, I have him set the date for his appointment early each year so we can skip the waiting period which is analogous to listening to the ticking of a time bomb. This year, however, has been different because this was the first year he was taken completely off medication. He has done so well that his endocrinologist has released him to be monitored by his family doctor. I picked up in early December that his anxiety over the annual pituitary checkup was beginning to build. I recommended then that he get his prolactin levels checked asap. Alas, the patient did not heed the advice of his analyst.

Since then, there have been a plethora of dreams with death themes. He has also developed a whole host of psychosomatic symptoms as well. Then came the incident at work and now his world seems to be imploding. As he talks, his mood starts to lift. He admits he has been avoiding having his pituitary checked like a small child who hides under the covers so he won't see the monster in the closet. His wife has been difficult too. I mention that some women start nit-picking when they are scared and women get frightened when their men aren't functioning well. Her Mom died six months ago, so she's scared silly that she will lose her husband too.

He starts to tell me about the day many years before when he first learned he had the pituitary tumor. He had consulted a specialist. After the tests were completed, the specialist called him and said "You have a brain tumor" and hung up. He was in total shock. His father called the doctor back and got more information. He stops mid-sentence and looks at the calendar on the wall. He said that was in the middle of January. The actual date is two days hence. He tells me about his fear that the tumor has begun to grow, of losing sexual function, of going blind, and of dying. He stops again mid-sentence and says the day he learned about his tumor was a dark and stormy Friday... just like today.

At the end of the hour, he jokingly invites me out for a beer and then seriously adds that on Monday he will ask his family doctor to order the appropriate tests. The tick-tick-ticking will be ending soon.