One of the most difficult tasks that confront patients is finding the "right" way to be sick. It's easy to be too sick-to become preoccupied, frightened, and overwhelmed. It's also tempting to be not sick-to deny illness, run away from the demands of the body, and pretend that everything's fine. The trick is to be "just sick enough"-to walk the line between obsession and neglect, paying the necessary attention in order to find the space and freedom to live well, despite illness.
Cathy, a woman with chronic pain, came to my office swamped with anxious thoughts, alert to every passing sensation, and aggrieved by her previous doctor's inability to make it all go away. Though I could help with her kidney problem related to taking pain medications, I couldn't make it all go away, either. Given that no doctor was able to treat her pain successfully, Cathy inevitably became more and more focused on it, leaving her "too sick" to live fully. In contrast, Bill O'Malley, a former cop, was a textbook example of "not sick": he never acknowledged his kidney disease and brushed off my suggestions for changes-less beer, fewer Doritos-that might have slowed its progression. Instead, he'd spend office visits telling me hilarious tales of his wild days (lots of beer, many Doritos) with his buddies at the station house. When dialysis became necessary, he refused to sign on, telling me, "Never mind, doc, I'm happy with my choices. I don't need to be on the machine."
