Samuel Johnson Is Indignant

Thyroid Diary

Tonight we are going to a party to celebrate my dentist’s wife’s graduation from college. All these years, while the dentist has been working on my teeth, his wife has been earning credits at the college, just a few at a time. Every semester, along with her other courses, she has been studying painting with my husband, who teaches painting and drawing at the college. She has been studying with him in a tutorial situation. She is an enthusiastic flower gardener and paints mostly flowers. She has written texts about her flower gardens, to go with her paintings. My husband told me that a flower painting of hers that was hanging in the Art Building at commencement time was stolen — by a student, he thought, or a student’s parents.

I didn’t know she was actually earning a degree until we received the invitation to this party to be given by her friend, who is a faculty secretary at the college. A few days after the invitation arrived, we received another one from the same woman, but for a different date. I was sure there had been a mistake. But in fact she is simply giving two parties, and we are invited to both.

Now I have to wonder why my serious and extensive dental work ended — which it did — just a couple of months before the dentist’s wife’s graduation. When the dentist said I didn’t need any further work, I thought I still had at least two more crowns to go. I can’t remember a time when I haven’t had more work to be done on my teeth.

I have always been puzzled, anyway, by the economics of the thing, because I would pay the dentist, and he would presumably give his wife the money for her courses at the college, she would pay the college, the college would pay my husband a separate fee for her tutorials, and then my husband would give me money for the dentist, I would pay the dentist, the dentist would give money to his wife, and so it would continue. I thought that if no one paid anyone, it would work out just the same, but that didn’t seem quite right, either.

This spring the dentist, who is a gardener like his wife, but grows vegetables and grapes, and has a small apple orchard, made the transactions a little more complicated by proposing to my husband that they share certain shipments of bedding plants which could be bought more economically in large quantities. He said they might share two varieties of tomatoes as well as some onions and peppers. My husband thought it over and then agreed. In general he is wary of the obligations of any sort of partnership, but he is also interested in saving money, and in this case he appreciated the gesture of goodwill and trust.

The party we are going to tonight will be at the home of the faculty secretary in a small town on the other side of the river. But as soon as I say that, I realize I have made a mistake. This is not the party in honor of the dentist’s wife, but the other one. This one is for the faculty secretary’s nephew, who is going off on a long sea voyage. After many years of living sometimes on land and sometimes on the water, he has sold his house and will be living on his sailboat, though he still has a girlfriend here on land. I should have remembered this, because my husband and I were just discussing at lunch what to give him as a going-away present. We were considering three choices: a copy of Richard Henry Dana’s Two Years Before the Mast, or a book that my husband saw about tying knots, or a bottle of wine. My husband also suggested a bottle of good brandy, but I thought that would only encourage our friend to drink alone on his boat.

If I’m confused about all this, it may be because of my underactive thyroid. Slow thinking is one symptom of an underactive thyroid, but I can’t tell if I’m thinking more slowly than I used to. Since my brain is the only thing I have for observing how I am thinking, I can’t be truly objective. If it is slow, it will not necessarily know that it’s slow, since it will be moving at a rate that seems appropriate to it.

And then, there have always been days when my mind does not make connections very fast. There are always days when my mind is cloudy, or I forget things, or I feel as if I am in a different town or a different house — that something around me or about me is not normal.

When the doctor was explaining my condition to me, I took notes. I had to stop her once or twice and ask her to repeat something so that I could write it down. I told her it helped me to remember. She said I would not have to take notes if my thyroid were more active. That made me a little angry, but I did not try to defend myself. I did not answer her that for one thing, the self-help medical books always tell you to take notes during a meeting with a doctor, and for another I have a habit of taking notes anyway, especially when I am on the telephone, and even during conversations when it is not at all necessary, when the information I am hearing is something that does not have to be remembered. I take notes on things I have just said to someone else. I write down words I have just used myself, like nice guy or responsible. I write down names of people in my family, and my own telephone number.

I did notice, one evening when I was playing a board game with my family, that over and over again I could not remember whose turn it was or see where my piece was on the board. This could have been due to my underactive thyroid.

I thought I wasn’t worried about my thyroid, because I believed I could correct whatever problem there was with a strategy involving diet. But maybe I am worried after all, because for the past week, ever since my doctor called me, I haven’t been sleeping well. My trouble sleeping, though, may be due to the underactive thyroid.

My doctor is not actually a doctor, as my husband is quick to say: she’s only a physician’s assistant. He says this as though she may not know what she’s talking about. He says this in my defense, as though to protect me from her or from my condition. But I think she’s careful and competent, and I believe her. Now I’m eating only vegetables for dinner, preparing to begin my dietary strategy. I truly believe the body can cure itself of whatever is wrong with it, given the right diet and other treatments. I am only waiting for some more tests, which I will have this week, before I make a plan for my care. I’m sure that whatever diet I choose, I should not drink any alcohol, but I have already planned to make an exception for the party tonight.

My physician’s assistant told me the thyroid gland controls every part of the body — not only the brain but also the heart, the digestion, the metabolism, the circulation, and other things I may be forgetting. In the case of a significantly underactive thyroid, everything slows down. I have a slow heartbeat, slow digestion, possibly slow thinking, a low temperature, cold hands and feet. Sometimes my heart rate goes down to fifty or below. I never knew what a thyroid gland did. Now I find out it is so important that if it were allowed to continue functioning poorly like this, I would eventually die — die early, I mean. I have never associated myself with such an unexpected part of the body as the thyroid, so it feels as though my body is suddenly strange to me, or I am strange to myself.

Now I have learned more about what is wrong with me, and I do not think the body can always cure itself of whatever is wrong with it. Or rather, I still believe this as a general principle, but I don’t think my body can cure itself in this case, because no one seems to know enough about this particular disease, which is an auto-immune disease. It is called Hashimoto’s disease, though my husband keeps calling it Kurasawa’s, or Nagasaki’s.

By now I have also been to the first party, given for our sailor friend, as well as the second party, given for our dentist’s wife. The parties were very different even though they were at the same house. In the perennial beds, different flowers were in bloom. The first party was informal, as was appropriate for a going-away party for a sailor. Neighbors wearing casual clothes came out onto the lawn from shortcuts through the woods. At the second, there were trays of catered hors d’oeuvres and a uniformed serving woman. At that party I learned that not one, but two, of the dentist’s wife’s paintings had been stolen at commencement time. I learned that the paintings were much smaller than I had thought. One from the same series was hanging on the wall in the faculty secretary’s house. It was small enough to put in your pocket or your purse. The dentist was sitting in a wicker chair on the screened porch. I did not find it strange to see him there instead of in his office, but I also couldn’t smile at him socially in quite the same way I would at anyone else, since he knows my teeth so well, particularly my upper left incisor.

A corkscrew willow grows by a tiny stream in the front yard of the faculty secretary’s house. At the first party, she cut a shoot of the corkscrew willow for me to take home and plant. I forgot to take it. From the second, I took several more shoots, but at home I put them in a bucket of water in the garage and forgot them for a few days. I then offered them to a friend, but forgot to give them to her, and the water in the bucket evaporated and they withered.

I have also been up to see a specialist in Albany several times, more often than was necessary, my husband believes. My husband thinks the specialist could simply read the numbers and look at the results of the blood tests, and that like other doctors he schedules extra office visits to make more money. But a friend of mine said, “With gland problems, they like to look at you.” I do not remember which friend it was.

And yet this specialist seemed to avoid looking at me. At least he avoided it when he first walked into the room — he looked down at my file instead. He did eventually look at me, with his head cocked a little to one side and a slight smile on his face that seemed to express a private amusement that was not completely unfriendly. But he looked at me only when he was ready to deliver his opinion, which he had already formed by reading the numbers in my file.

Meanwhile, my husband has been having trouble with his tomato plants. The dentist gave him four or five healthy, well-grown plants, neatly potted in peat pots, and they are doing well. In return, my husband is supposed to give him four or five of another variety. But most of these arrived in the mail half dead. Some died, two are doing fairly well, and the rest are not dead, but are not growing, either, at least not visibly. My husband does not want to give away the only two that are thriving. He also does not want to give the dentist spindly and sickly plants. He is waiting, time is passing, but the plants that were not growing well are not growing any better.

I have been trying to see if I am thinking more slowly than before. In my translation work, for instance, I see that I sometimes try to find an equivalent in English before I really understand the French. Then I realize that I don’t understand the French, even after trying several times, and I cast my eye rather listlessly here and there within the paragraph hoping the meaning of it will fall into place by itself, which it sometimes does. But today it does not, and then my mind wanders. I go back to work on it, look in the dictionary again, reading every word of a very long entry, but there’s nothing in the dictionary that helps me. I want to put something down, anything at all, just to mark the place so that I can go on translating and come back to the problem later. I need to put down something noticeably wrong, so that later I will see that the spot needs work, but everything I think of is so poor that it is embarrassing. I don’t know why I should be embarrassed, if there is no one to see it, but I am embarrassed and will not go on until I put down something decent, though wrong. At least, this morning, as I was studying the dictionary carefully in order to see if I really wanted to use the word, I learned more about embarrassment and its earlier, concrete meaning of encumbrance or obstruction.

But then, even though I had been awake since six o’clock and had been working for an hour already, someone who didn’t know me, in fact someone from the doctor’s office, said to me on the phone, “Sounds like you’re not up yet. Can you call me back when you are?” I was not insulted, but I was a little worried. I apparently sounded very slow on the phone, even if I did not think I was very slow. Now, if I do this whole translation, which is an important job, with my mind not working very clearly, but not knowing that my mind isn’t working very clearly, then the translation may not be very good — though I may not know that. And if it isn’t very good — that would really be unfortunate, since some of my future income may depend on it.

Actually, what the receptionist or nurse took to be slowness may be something else, an attitude I now have that is more casual toward health-care professionals. I used to be very respectful of them and slightly intimidated. Now I have noticed that I want to make fun of the men and joke with the women, or I should say, joke with both men and women, but rather more aggressively with the men.

I first noticed this a few years ago with my oral surgeon. I liked him and respected him, but I noticed after a while that I would not deal in a straightforward, courteous way with him, but had to make some kind of a joke. That shocked me, because all my life I have been so respectful of health-care professionals, or have at least behaved with respect, whatever I thought of them privately. The jokes just popped out as though someone else had taken over for a moment. Once, for instance, I saw a skull in his office and made what was no doubt the obvious joke — that it must be a former patient. He was startled, but did not seem to mind. Another time, when he had just hurt me badly by giving me a long injection in my gum, I bit down hard on his index finger. That was not a joke, and I did not do it on purpose. His two female assistants were amazed but also delighted. Although he frowned in pain and shook his finger in the air, the doctor took it very well and said it happened from time to time, that it was actually a reflex. I slightly antagonized my present doctor, or physician’s assistant, by saying that I did not like taking medicine because I did not like being dependent on any drug. What if I were lost in a jungle without my thyroid medicine? I asked her, and it is true that I always believe that some day I may be lost in a jungle, even though we do not call them jungles anymore, and we are losing them anyway, so that the word jungle is becoming just an idea. She said I would get along well enough without it until I could find my way out of the jungle.

There was a small emergency situation quite recently, though, in which I was not tempted to make fun of the doctor. He was a young doctor, I admired his decisiveness and his technical skill, and I was also quiet because of my pain. I had bruised my finger badly, and what he had to do was to release some of the pressure under the nail. He did this in what he said was the best way, but also the old-fashioned way, using nothing but a candle and a large paper clip.

The receptionist or nurse this morning thought I wasn’t “up” yet because I didn’t know the exact dose or the full name of my thyroid medicine. But I was careless about that information because of my skeptical attitude toward the health-care profession and because I do not try to conceal that attitude. I did not mean to be disrespectful to her in particular. But after she said this, I noticed two other possible signs of poor functioning: a real estate dealer I called on the phone later in the morning thought at first that I was another real estate dealer. I asked her why she thought this. She had trouble answering, but I guessed that it might have been my lack of enthusiasm, or a coldness in my tone of voice. Then, still later, when I was talking to my husband on the telephone, I was so confusing, contradictory, and long-winded that he compared me to a legal brief he was reading. This document is fifty pages long and concerns a possible class action against an insurance company for misrepresentation.

After wondering for some weeks what to do about the tomato plants, my husband told me he was going to explain to the dentist that none of the plants was good enough to give him, though that is not strictly true. Then, just hours later, he told me that he had changed his mind. He was going to patch the soaker hose and give the plants a little more time.

But on the other hand, it occurs to me that maybe my brain is working well enough but simply more slowly than usual. Maybe the quality of my work will be good but I will take longer than usual to make it good. Or maybe the dose of thyroid supplement I’m taking, which has been increased once without much effect, will be increased to the proper level soon enough so that by the time I reach the final draft of this translation I will be thinking sharply and quickly again. Then I wonder if I will think even better than before this whole condition began, because my brain will have been trying so hard in the meantime, without adequate support from my thyroid, that maybe it will have developed new cells. But I don’t know enough about the brain’s anatomy to know if that is possible.

Or maybe some of the time I go ahead quickly enough but without producing very high quality work, while some of the time I go ahead slowly and produce better quality work, so that it is a choice: either go slowly and do good work, or go quickly and do poor work. But then, those have always been the two options in translation, I see, so I should say that now the choice is: go even more slowly than before and do adequately good work, or go more quickly and do really poor work.

But with any luck, the dosage will gradually be raised high enough so that in a couple of months I will be able to do work that is both quick and adequately good or quite good. The dosage can’t be raised too abruptly or my heart will suffer.

I had thought at first, If my brain is working this well with inadequate amounts of thyroid hormone, how well my brain will work with the proper amounts of thyroid hormone! But then I began to distrust the thought, because what seemed like good working of the brain seemed good to that very same brain that was lacking the proper dose of hormone, and that brain could be quite mistaken.

Another question I had recently was this: is the rather pessimistic turn that my thoughts have taken these days due to the state of the world, which is bad and which gets worse more quickly than one can hope to save it, so that I become quite scared? Or is it due simply to the low level of my thyroid hormone, which would mean that maybe the world is not really in such a frightening state and seems that way only to me? So that I could say to myself: Remember your low thyroid hormone level and have faith that the world will be all right?

What an insult to the mind, I think then, that the chemicals of the body and nothing else are causing my thoughts, which I take so seriously, to move in a certain direction. What an insult to the amazing brain that such a simple thing as a level of chemicals should point it in a certain direction. Then I think, No, it’s not an insult, I can think of it not as an insult, but as part of another fascinating system. I can say, I would prefer to see it as part of a single, interesting system. Then I think, And, after all, it is this amazing brain that, in thinking this, is being so magnanimous to the dumb body. Though of course maybe it is the chemicals of the dumb body that are permitting the amazing brain to be magnanimous.

Now I have been to the dentist again for a cleaning and checkup, and he has found a large cracked filling in a tooth that he said should really have a crown or a cap. He said he had predicted this years ago. But when I objected to more major work, and asked for a postponement, he consented to treat it with a bonded filling that might or might not last for a long time. I was a little surprised that he agreed to this. I wondered if he was losing his enthusiasm, or losing the conviction — which all my dentists seem to have had — that all work on my teeth should be as extreme and as complete as possible. I also noticed that he was curiously silent about tomatoes, saying nothing, either, about the other vegetables in his garden, or about his harvests. We talked instead about crowded holiday spots and the westward expansion of the United States during the nineteenth century. His grandfather had actually lived in the days of the westward expansion and used to talk to him about it. He said it was surprising how recent that time was.

Our talk extended out into the reception area while I paid my bill and took a pencil from the box of gift pencils. Considering the rapid population growth, he said, he did not want to come back after he died. I agreed that I would not want to come back either, at least not as a person, adding the qualification, which I believe, that if we have to come back we may be safer coming back as cockroaches. The receptionist and dental hygienist, who were listening, looked surprised at this.

Now that the fall semester has begun, the woman who gave both parties is back at work at the college. Nearly every day, I read notices that she sends out to all the faculty. She has a very sharp and funny mind, a good education, and an interesting background, but her notices are deliberately neutral in tone and strictly practical. Some are about empty cardboard boxes free for the taking, some about stray cats on the campus, and a great many about misuse of the Xerox machines. Only now and then can I detect from something she says about a page of sonnets left in her office, or from her rhetorically balanced sentences, or from her use of the word criterion, how sharp she is.

Since the dentist’s wife now has her degree, she is no longer studying with my husband, but I do not remember what she is doing, though I was told, probably by my husband.

We have been eating the tomatoes from our garden, though the harvest is not as good as it has been in other years. A woodchuck has dug a hole down under the fence and up among the tomato plants and has been eating the tomatoes as they ripen. My husband puts heavy stones in the hole, but during the night the woodchuck moves them.

I thought this was the end of it, that I would hear no more about the dentist and the results of the season’s planting. I thought there was a slight embarrassment all around. But last week my husband came home from his three-month cleaning with a bag of onions and told me that the issue had been tacitly resolved, that he and the dentist had talked about the long dry spells coming at the wrong times and how the summer had been a poor one for tomatoes. Even the dentist’s plants had not done well. And yesterday, during the insertion of my bonded filling, the dentist told me how he makes grape jelly. I am relieved that there are apparently no hard feelings. The dentist’s onions are pretty, small and fresh. I will want to think of some way of preparing them so that they will be particularly noticeable as we eat them.

My heart seems to be beating a little faster now. If it is true that I have been thinking more slowly, I have still been able to learn new things and remember them, in the past few months. I forget what we actually gave to our sailor friend, and there are other things I know I have forgotten, and still others that I must have forgotten, but I have learned the history of the word embarrassment and many other word histories, I have been introduced to the corkscrew willow, I have learned the term bonded filling, and many other new definitions from the dictionaries, for instance that the verb flense means to cut up a whale, and that the adjective next is the superlative of nigh. I have learned two new terms for familiar things: in music, the Alberti bass, and in grammar, the Oxford comma. I have had new thoughts about the westward expansion of the United States. I have heard the expression dead soldiers twice in two days and learned that it means empty bottles. Maybe it also means anything that is no more use to anyone, since I first heard it from a woman at a plant nursery who was looking through a bin of gourds and tossing out the rotten ones. I learned from the dentist that if I make grape jelly I should heat the sugar in the oven before adding it to the grape juice. I have learned more about the Kennedy family and particularly Edward Kennedy from a magazine in the dentist’s office. I had no trouble, after a few minutes, recognizing Dvoák’s “New World Symphony” on the radio while I was having my bonded filling put in. After reading the introduction again, having read it years ago and forgotten what I learned from it, I have learned yet again how Richard Henry Dana’s Two Years Before the Mast came to be written, that when Dana was a student at Harvard he fell ill and could not continue his studies, went to sea to recover his health, and subsequently wrote about his experiences, so that it is the book of a young man, whereas I had thought of it as the book of an older man just because it has been a classic for so many decades. What I don’t know yet is why I see it so often in secondhand bookstores and at library sales.