The sword of Damocles

The waiting room offered the usual collection of magazines. Well, usual for this postcode. In the specialist rooms you can almost guarantee a Vogue Living, or a House and Garden at the very least. The well-worn editions of New Idea that clutter up the GP’s foyer, with their missing covers and half-completed crosswords are conspicuous in their absence. I pass time imagining the receptionist furtively removing these lower grade rags from the neat stacks of interior and travel tomes to be read at home. I see her simultaneously flicking through their creased pages and the free-to-air channels on TV, seeking a distraction to settle on.

The reason I am there, and so often in waiting rooms is that in 2015, on one of the happiest days of my life, I sustained a life-changing injury. It is not an injury you can see. To the observer I appear to be a healthy, if somewhat ragged woman entering her middle age. The injured area of my body is in fact so small that you could swallow it without noticing. Normally less than the size of a pea, the anterior pituitary gland that sits at the base of my brain and smack-bang in the middle of my head is now even smaller, having almost disappeared on the day my second son was born.

“Are you familiar with the Sword of Damocles?” the old man with friendly eyes and sinking cheeks asks me. I am not.  My suburban education did not take in the classics. It’s not the kind of question I usually get from the old men who I see at the ends of the waiting room corridors. He goes on to recount the tale, told by Cicero, of King Dionysus II, who in teaching Damocles a lesson on the perils of power, hung a razor sharp sword by a horsehair above his head, inviting him to enjoy the pleasures of court whilst imminent death swung lightly in the breeze above him. No prizes for guessing that Damocles wasn’t so keen on the throne after that. “Oh, yes, I see what you mean” I say. But truth be told, it’s a knowing I withhold from fully basking in the light of my consciousness. The beauty of myth is its ability to keep our greatest fears and desires at arms-length. Living through them is another story.

The pituitary gland, whilst only weighing half a gram has a weighty reputation. Known as the master gland of the endocrine system, it controls the activity of most other hormone-producing glands, acting as listener and instructor, it keeps everything in balance. When a woman is in labour, it doubles in size, stepping up to the symbolic rostrum as master and conductor in the symphony of giving birth. Made up of delicate folds of hormone-secreting tissue, when unsupported by sufficient blood volume and essential oxygen supply (hello hemorrhage), it collapses on itself. It’s called pituitary necrosis. When I first heard these words my suburban education was good enough to know what this means. It means death.

The syndrome, like most others is named after the person who first described it, Harold Sheehan. For the person living with it, it may as well be called the autumn lament. For while the body can get by with artificial hormones, it cannot escape the reality of weakened immunity and susceptibility to infection. Which means that every April, the change of season game begins. For some it brings colds and flu, for me it brings a complicated dosing dance with that most powerful and duplicitous hormone, Cortisone.

Every other hormone I ingest, apply or inject is delivered in a regular dose. Nothing changes from day to day, four times a day, every day for the rest of my life. But cortisone is different.  Well known as the major stress hormone, it is central to the body mounting an attack against an invading enemy. So every time I have a little sniffle or cold, I need to increase the dose. If the sniffle turns into a chesty cough, increase it again. If a fever is present, increase it again, and so forth. Sounds simple enough, and if my body were a better communicator, it might be. But as with most relationships, there is a communication gap. By the time I’m aware of the problem, It’s usually too late, and I’m left playing catch up to keep from sinking into the state I’ve come to call, with begrudging familiarity, the deflating balloon.

It starts with the eyes. Vision becomes just slightly blurry. Then the dizziness strikes. Time to sit down. Somehow, the speech of everyone around me speeds up, going faster than my brain is able to process. My body starts to feel, well empty somehow. Like it is looking for something that isn’t there. Soon enough my presence on the couch seems to be diminishing, like all the air inside me is escaping through an unseen hole. Like my body has gone into an interminably slow shut down, waiting for the correct amount of cortisone to reboot. The deflated balloon state can last for minutes, hours or days, depending on the severity of the infection and how much cortisone I have taken. The goal is to take enough to achieve a ‘natural’ state of resilience, but not so much that the negative effects of excess cortisone start to show.

In the short term, vanity is the best adjudicator. A puffy and flushed face, thinning skin, increased bruising, some extra padding around the middle, all easily identifiable and motivating factors to hold back on the wonder drug. In the longer term, the effects are more insidious. Heart disease, diabetes, high blood pressure, osteoporosis, anxiety, depression, the list goes on. With each addition the sword of Damocles seems to hang heavier on that horsehair thread. But that is not the worst part.

The central message contained within the myth, if my suburban education should grant me such enlightenment, is the fragility of that single strand of horsetail. The razor sharp sword it holds may fall, or it may not. Is time alone enough to weaken its bonds? Or would it take an act of outside interference? Perhaps a fly may come to land on it, snapping it in half. Or a gust of wind may create enough momentum in its swing that it finally submits to gravity. The challenge is in sitting with the not-knowing. Living with the not-knowing if it will fall, or if it will, when?

In my case, any extreme physical stressor - trauma, severe infection, or I don’t know, a deadly crown-shaped virus could be enough to send the mythic sword crashing down upon my head. Without the master conductor front and centre, the orchestra could be playing its final song. Or it could play its divine symphony again, and again, and again. We don’t know. For people living with chronic illness, this is an everyday reality. One that is largely shouldered in silence, but the distraction of that sword is ever-present. Humming away below our conscious minds, playing tricks in our dreams and keeping us from looking squarely at Damocles and his sword, for fear the meaning in the tale becomes incarnate.

Life in the age of Covid can teach us many things. How to look after each other, how to value scientists, frontline workers and the caring professions, how to bake and break bread. For those of you who are new to that experience of old Damocles, his haughty indifference to the perils of living well so swiftly obliterated by the threat of that sword, please take note. Half of all Australians are living with a chronic illness. For them, the sword hangs that much lower, the horsehair that much thinner. The prospect of a long and fruitful life is not a given to everyone in society. Pandemic or not, please don’t take your good health for granted, and please don’t assume that there is a relationship between good health and virtue, for as Damocles was wise enough to know, your fate is only as certain as the thinnest, barest thread is strong.

And please, stop taking the New Idea magazines from the waiting rooms. Even the oldest, most tattered editions provide enough pop mythology to distract us from the things we’d rather not think about.  Like that fly circling above.