Opinion » John Rember

Medical Writer

Sisyphus Syndrome in real life


Back in 1980, I began working as a writer for HealthData International, a startup medical information company with offices in Ketchum. My job was to research a disease and write a book about it in layman's language. If you got a disease and couldn't understand what your doctor was telling you, you could read my book. There, in plain English, would be the questions to ask, and--no small thing--some state-of-the-art answers.

I was one of a half-dozen writers. At an early meeting, our diseases were given to us. I remember high blood pressure, asthma, ischemic stroke and what might have been pancreatic cancer--I'm not sure, because the writer assigned the disease actually had the disease, and nobody much wanted to talk about it. My own disease was more of a post-disease event than a disease: I was assigned myocardial infarctions, medicalese for heart attacks.

We had trouble with layman's language. Our supervisor told us the average American reads at a seventh-grade level. When you're writing for that level, it's difficult to look at your audience as anything but seventh-graders. My working title--So You've Gone and Had a Heart Attack--illustrates the problem.

But I persisted. I read several hundred cardiology studies, then flew around the country interviewing people who had done seminal studies in the field.

My trick was to read my interviewees' books the night before interviews. Famous cardiologist authors ended interviews thinking what a perceptive young man I was, and I ended them with my notes already finished and organized in the form of their books.

One interview stands out in my memory. It was with the dean of the medical school at State University of New York-Buffalo. Previous interviews had been with people who had left an operating room to talk to me and had gone back to one just as soon as I finished.

Buffalo was different. When I walked into the dean's office, his secretary said he had cleared his afternoon calendar for me. The dean had done research on the correlation between intense, hard-driving Type A personalities and heart attacks, and I decided he had deliberately become an easygoing and friendly Type B. Type Bs never work as hard as Type As, but usually they accomplish as much because they think about what they're doing before they do it.

Sure enough, the dean looked in better shape than any of the younger physicians I'd interviewed. His desk wasn't cluttered with patients' files or telemetry data. He was relaxed. No tics or tremors. He wanted to talk about anything but heart disease.

"I was a bellhop in Sun Valley in 1950," he told me. "Best years of my life. When I saw where you were from, I agreed to the interview."

I told him I had been born in the Sun Valley Lodge in 1950, when the resort's hospital was on the third floor. We had been in the same building at the same time once before.

Sun Valley was almost as full of old people in 1980 as it is now--not the same ones, of course--so we had acquaintances in common. He told me about carrying the bags of movie stars, gangsters' girlfriends and doomed writers. I told sad stories of my time as a Sun Valley ski patrolman during the late 1960s.

He finally got around to medicine.

"The medical industry is a mess," he said. "It will get worse. My students start out determined to make a better world. Then they graduate to 70- and 80-hour work weeks, and spend most of that time reading test results. Then they figure out they wouldn't have a job without the subliminally hostile morons out there who eat too much, don't exercise and smoke. They get subliminally hostile themselves. When they finally make it a better world, it means they've bought a Porsche."

He told me cardiology relied too much on technology and not enough on human touch. He told me SUNY's teaching hospital had been in a labor dispute for six weeks and hadn't installed any pacemakers. The death rate for heart patients had gone down, not up.

I asked him about Type A personalities.

He said, "It's a diagnosis going around. Studies bear it out. But when I was still young enough to want to save the world, I came up with a less black-and-white picture of things. I found that my high-stress heart patients, even the successful ones, saw their lives as a succession of failures.

"I called it the Sisyphus Syndrome. People push rocks to the top of a mountain and when they get there, the rocks roll back down again. That's what's causing these high-powered guys to fall over --after every success, they see themselves back at the bottom, angry and disappointed and determined to crush any opposition on their way back to the top.

"But you can't design parameters for a Sisyphus Syndrome study. Failure is a subjective thing. Of course, you can identify the 11 or so definitive external characteristics of unselfconscious jerks, so we're talking about Type As instead."

I never finished my book. HealthData folded later that year. A fellow writer said he was working at his office computer one day when two repo men came in and took it.

I still have a floppy of my manuscript. If you have a Televideo TPC-1 luggable computer where you insert the system disk before the write-to disk, you can read it, but don't go looking for state-of-the-art answers.

Since that time, I've thought of Sisyphus as the bellhop of the gods. I've thought about how the results of any scientific study are skewed by the unconscious metaphors of its authors. I've thought about the deep uncertainty of scientific knowledge, and, not least, about how worldly success often masks a kind of heart failure.