anxiety's new normal
The idea for this book came to me in a gallbladder-my husband's gallbladder, actually.
I was waiting for Ronnie to come out of surgery to remove a whopper of a gallstone that had shown up during a routine physical. The doctor had said we could leave it alone and maybe nothing would ever happen, or he could operate and take out the gallbladder and Ronnie wouldn't have to worry about needing emergency surgery someday. Now, when I go to the doctor, I ask ten million questions; the more I know, the less anxious I feel. But my husband is a practical man. He needs only enough information to make a rational decision. "Why take a chance?" he asked. "It's a simple procedure; why would I want to be traveling through Europe and suddenly find myself in a foreign hospital in agony? Let's do it. When can we schedule the surgery?"
Which is how I came to be sitting in a room with about a dozen other people, all waiting to either go in for surgery themselves or hear about how their loved ones had weathered their procedures. I was mildly anxious but not overly so; I knew Ronnie's surgery wasn't risky because I had pelted the doctor with questions: "Does he need his gallbladder for anything?" (No.) "What does laparoscopic surgery entail?" (Several small incisions; very simple, very routine.) "How long will the surgery last?" (An hour; hour and a half at most.)
I like information when I'm anxious; it comforts me. It provides a framework on which I can layer facts and opinions and second opinions that enable me to make good decisions. As Ronnie's surgery approached, I learned everything I could about gallstones, gallbladders, and anything else the surgeon happened to mention. I'm pretty familiar with my anxiety (after thirty years as an anxiety professional, that's no surprise), and I know that when I'm anxious, information is my friend: not only does it enable me to understand what's going on, but it also helps me ensure that my loved ones are getting the best possible care.
I had carried with me into the waiting room a satchel containing a bundle of magazines and newspapers, a PDA full of emails that I needed to answer, a novel, a container of almonds, a bottle of orange juice, and a stack of journal articles I had to read for work. I had brought all this stuff because I didn't think I'd be able to sit and concentrate on any one thing, and I was right. I opened the novel, stared at the same sentence for five minutes, and put it back; pulled out Newsweek and then The New Yorker, read a few paragraphs, put them back; took a sip of juice; prodded my PDA, glanced at an email, put back the PDA; grabbed The New York Times, looked at the headlines, opened it, closed it, and thrust it back into the satchel. Losing myself in reading wasn't going to work; I wanted to be occupied but present, somewhat distracted but available to see the surgeon the moment he entered the waiting room.
That's another thing: I'd chosen a chair that faced the elevators so I could see whoever was coming off. From where I was sitting, not only would I see the surgeon as soon as the doors opened; I'd be able to study his expression so by the time he reached me, I would be prepared for whatever he had to say. If he looked happy, I could leap from the chair with joy; if he looked grim, I could brace myself for bad news. I could imagine either outcome, but I simply could not imagine sitting with my back to the elevators because I knew when those doors opened and the surgeon strode out, I needed to be the first one to see him.
The doors slid open; no sign of the surgeon. I checked my watch and saw that the hour was up. What was taking so long? Was everything okay? I approached the perky woman behind the check-in counter.
"Gee, it's taking longer than I thought," I said.
"The doctor reserved the operating room for two hours. Sometimes things go slower, or they may have started late." She smiled brightly.
I returned to my seat. They'd said it could take ninety minutes and only an hour had passed, so there was no reason to worry. None at all. In my rational mind, I knew that everything was probably fine, that surgery is a complex undertaking and there was no reason to think that everything would be finished after only an hour. Even so, something could go terribly wrong: an unexpected growth, a problem with the anesthesia, a hemorrhage...
I looked around the room. A middle-aged man sat near me reading The Washington Post, eyes flicking across the neatly folded panel of newsprint. Across the room a woman sat several chairs away from a boy of about fifteen, whom I took to be her son; because of his pronounced limp and wincing when they came in, I figured he was the patient. He sprawled in his chair, legs outstretched, eyes and thumbs darting about a handheld gaming system. His hair was unkempt, and his jeans looked as if they had not been washed for a month. Woman and boy neither looked at nor acknowledged the other; had I not seen them arrive, I would not have known they were together. It was obvious that they were both dealing with their anxiety in the way that adolescents and parents do when, for instance, they are watching a movie and are ambushed by a sex scene: suddenly there's an elephant in the room and everyone slouches down in his or her seat and stares straight ahead until the agony abates. This kid seemed oblivious to where he was and why he was there until a uniformed nurse approached him and he jumped up, grimacing. His mother, who had seemed equally oblivious, also leapt to her feet and stood beside him protectively.
There was a woman who had been talking nonstop on her cell phone since she entered the room; another sat silently twisting the rings on her fingers. A man in work boots pulled a pamphlet from a display, sat down, read it, returned it to the rack, then took another and repeated the cycle all over again. It was fascinating to realize that we were all in this room, waiting and anxious, yet no two people were exhibiting the same behaviors.
My gaze drifted back to the man with the newspaper. He was well dressed and seemed no more troubled than if he were waiting for a train. He held the paper the way people do on a crowded subway, folded in half lengthwise and then crosswise so it formed a neat rectangle of newsprint. I watched as he started to read a story, smoothing the paper with his hand and unfolding and refolding the pages as he read each column. Then, when he finished a story, he unfolded the paper, opened it to the next page, refolded it into a rectangle, and began reading again. His movements were deliberate and economical, and I watched him repeat them as he made his way through the news section and then on through Metro and Business.
I was amazed. How can he sit there reading? I wondered. He must be waiting to hear about someone important to him; why is he so detached? How can he concentrate? Doesn't he care? If he's so unconcerned, why is he even here?
My reverie ended as a woman in a white jacket with a stethoscope walked toward him. He looked up, set the newspaper down, and stood, smoothing his trouser legs. I was sitting there thinking, Hurry up! Hurry up and get over there! A few seconds later I heard her say, "She's fine, everything looks benign," and the man's eyes were trained on her face and he was nodding his head rapidly and saying "Thank you, thank you, Doctor" and vigorously shaking her hand. Then she walked away and the man sat back down, stared into space for about half a minute, picked up the newspaper, and resumed reading.
I thought, Thank you? That's it? Just thank you? How can he be so blasé? Does he not have feelings? Does he not love his wife? Is he having an affair and disappointed that his wife will be hanging around longer than he thought? Or does he love his wife so much that he can't allow himself to think that something bad could happen to her? Does he keep himself together by being stoic, or did he have two martinis when he woke up this morning? Is it his personality? His upbringing? His genetics? Is he religious and convinced that God wouldn't let something bad happen to a person as good as his wife? Why isn't he anxious? Why isn't he acting more normal?
I checked my watch: an hour and forty-seven minutes had passed. Nothing to worry about, but...My mind started wandering to the stories I'd heard about somebody's uncle who went in for gallbladder surgery but when they opened him up they found something else; and another man who got an infection in the hospital and ended up dying from that. My rational mind knew that the chances of this happening to Ronnie were remote, but you never know. I started planning the eulogy.
I had gotten to the part where I was saying what a wonderful guy Ronnie was, how grateful I was to have found him relatively late in life, how he had raised three wonderful kids, and how I blamed myself because maybe if I had taken him to the doctor a little earlier, fatal complications would not have set in, when a small voice inside me piped up: Your husband is having a gallstone removed and you're planning the eulogy. You think that's normal?
Sure, it was normal-for me.
I was working on how to break the news to the children when all of a sudden the surgeon emerged from the elevator and I was on my feet in an instant and then he was right in front of me saying "Everything's okay, it went just fine." And I was thinking, I need more words, more than just "okay" and "fine." And he went to shake my hand and I said, "No, I've got to hug you," and I put my arms around him and, next thing you know, I was shaking and crying and bombarding him with questions: "He's all right? No problems with the anesthesia? You didn't find anything else? He's still unconscious? When can I see him?" And I kept shaking and the doctor kept saying, "He's really okay, he's really okay," and he was looking at me as if I were a little crazy for crying so much over a gallbladder, for God's sake, and in the midst of all the relief and tears and gratitude I was thinking, This is strange: I spend so much time talking to patients, colleagues, and reporters about what's normal and what's not normal, and here I am, acting in a way that may seem overemotional or ridiculous to others and yet that's completely normal for me when I'm worried about someone I love.
That's when the idea for this book was born, because in that moment I realized that when it comes to everyday anxiety, there is no such thing as normal; rather, there is a broad spectrum of normal, within which most of us can be found. I occupy a slot on the spectrum where anxiety manifests as an eruption of raw emotion, and I know this is normal for me. Each of us manifests and responds differently to anxiety because each of us has a different relationship with our anxiety, just as each of us has a different relationship with our mothers, our fathers, our children, and everyone else in our lives. What's important is not learning the "right" way to respond to anxiety but learning how you relate to it and whether or not the relationship is working.
The mother and son who seemed so oblivious in the waiting room, the woman who talked incessantly on her cell phone, the man reading the pamphlets, the woman twisting her rings: all of them had different relationships with their anxiety and were doing something within the context of that relationship to manage their anxious feelings. They didn't necessarily realize they were doing it, but each of them was manifesting behaviors that were specifically chosen, however unconsciously, to manage their anxiety and keep it from getting the better of them.
It became clear to me that the middle-aged fellow was not engrossed in the newspaper in spite of his anxiety but because of it: I had no proof, of course, but it now seemed obvious that his systematic reading, folding, and smoothing of the newspaper were components of a ritual that helped him control the anxiety he was probably feeling. His repeated thanks to the doctor and energetic shaking of her hand were evidence of the intensity with which he received the news of the patient's well-being. The fact that he was able to sit there reading the newspaper-or appearing to read it, at any rate-was not evidence of a lack of empathy but rather a demonstration of how he related to his anxiety: as a force that could be controlled, if not conquered, by executing a series of small and manageable actions. His deliberate, measured movements were for him what my questioning the doctor and planning the eulogy were for me: a coping mechanism uniquely suited to his personality and situation and designed to keep his anxiety under control.
Each of us has a variety of coping mechanisms, patterns of behaviors that get us through the anxiety-provoking situations that life inevitably nudges our way. You may be someone who deals with anxiety by avoiding thoughts and situations that remind you of it, or you may ruminate about your anxiety in an attempt to think it into submission. Whether you avoid your anxiety or think about it will depend on how you perceive yourself in relation to the anxiety. Is it so powerful that your only way of coping is to avoid it? Or do you see yourself as playing a role in managing it? In either case, the important question is whether or not the relationship is working for you. That question may not be easy to answer. Corinna: "If the Cancer Comes Back, It Comes Back.
I'm Not Going to Waste Precious Time Running to Doctors
I have a neighbor whom I'll call Corinna.* Four years ago, when she was in her mid-fifties, she found an irregularly shaped mole on her thigh and, after much prodding from her husband, agreed to see a dermatologist. It turned out to be cancerous and was surgically removed. She did not say much about it at the time other than that they seemed to have caught the disease early and that her doctor was pleased. From the Hardcover edition.
Excerpted from One Less Thing to Worry About by Jerilyn Ross, MA, LICSW with Robin Cantor-Cooke. Copyright © 2009 by Jerilyn Ross. Excerpted by permission of Ballantine Books, a division of Random House LLC. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.