Jerry insisted his eyes were yellow, but they didn't appear yellow to me. I moved in for a closer look. Fluorescent lights like those in the office where I practice internal medicine can make subtle jaundice, a sign of liver disease, difficult to detect. No, his sclerae were as white as mine and, as usual, Jerry seemed to have absolutely wrong with him.
Jerry visited my office frequently. He was in his mid twenties, handsome and well built, someone who should have felt invulnerable. Most men his age need to be talked in to going to the doctor occasionally--and talked out of taking risks with their health. Jerry needed no such counsel. He used seatbelts and a bike helmet. He took vitamins and supplements. He flossed. And, still, he felt in perpetual danger of getting something bad. For Jerry every freckle was a potential skin cancer, every cold an impending immunological crisis.
Many patients apologize to me sheepishly for being "hypochondriacs." Usually the thought hasn't crossed my mind. Coming in to see a doctor about a prolonged bout of flu or the chest pain that probably represents indigestion (but started at the very age when your father had his first heart attack) doesn't make you a hypochondriac. All illnesses are, in fact, "psychosomatic," involving both the mind and the body. The simplest sore throat brings a tide of emotion: sometimes fear (What if I miss too much work? Will I lose my job?), sometimes guilt (Will anyone catch this from me?), sometimes anger (Who did I catch this from?) And conversely, emotions, of course, often communicate in the language of the body: tension headache, stress induced upset stomach, and so forth. But true hypochondriacs, like Jerry, obsess about the possibility that they are ill constantly; an uncomfortable and even paralyzing state.
Interestingly, the ancient Greeks considered the body the source of "imaginary" illness. The word "hypochondria" comes from hypos (under) and khondros (the ribs). The Greeks believed that anxiety sprang from bilious humors in the chest. (Similarly, "hysteria" arose from the hysteros ("uterus" - as in "hysterectomy"). The Greek concept of illness integrated mind and body millennia before the terms "mind body medicine" and "integrative medicine" were coined.
I ordered some lab work, mostly to prove to Jerry that his eyes weren't really yellow and that his liver function was perfectly normal. I advised him to come back the next morning so he could have the blood drawn after he'd fasted overnight since he was also due to have his cholesterol checked. Much to my surprise, his liver tests were abnormal. His bilirubin, a breakdown product of blood that colors healing bruises yellow (and turns the whites of the eyes yellow when there's too much of it in the blood) was mildly elevated. After further investigation I was able to tell Jerry that he likely had Gilbert's Syndrome (pronounced with a rolled "r" and a silent "t" like comedian Stephen Colbert's last name), a hereditary defect in the processing of bilirubin. The condition is more likely to occur in men, more likely to manifest itself when someone hasn't eaten (hence the yellowness of his eyes, which he insisted he had observed in his bathroom mirror while shaving, had disappeared by the time I saw him in the afternoon), and doesn't affect people's health or life spans.
I worried that the diagnosis would increase Jerry's anxiety but it didn't. Actually, he felt strangely comforted by it. Finally, after all Jerry's worrying that he would develop a medical condition, he did. And it wasn't all that bad.