Inside Out: The Things You Can See and the Things You Can't

TW: Mention of overdose, self-harm, and suicidal thinking

Them: You don’t look sick.

Me: This may shock you but most of my body is on the inside, where you can’t see it.

— Anonymous

I received an envelope in the post a few weeks ago. Inside was an invitation to attend an abdominal aortic aneurysm screening (also called an AAA screening). I’d never heard of this condition let alone worried about contracting it. It’s an age-related thing, apparently. The scan is “offered free of charge by the NHS to all men during their sixty-fifth year.” I reach the age of sixty-five two days after the appointment so they got in just under the wire.

I wasn’t sure I needed to attend. Other than age I don’t rank highly for the risk factors. I’ve never smoked, I don’t have high blood pressure, and as far as I know there’s no history of AAA in my family. On the other hand, although rare the condition has a high mortality. According to the letter, “around 85 out of 100 people die when an aneurysm bursts.” The procedure itself is painless and non-invasive. “We use a simple ultrasound scan, similar to that offered to pregnant women. This is very quick and usually lasts less than ten minutes.” I’ll attend the appointment. It’s a day off work and I dare say there’s a coffee shop near the health centre.

My thoughts turn to other scans I’ve seen. The printout a friend showed me recently of her ultrasound, excited and proud to be newly pregnant. I’m so happy for her! The portable ultrasound machine a hospital doctor used to find my friend Aimee’s vein after various professionals had failed to get a needle in to administer pain relief. I felt helpless but it was fascinating to watch the procedure on the machine’s display. I was no less fascinated watching my colonoscopy play out before me on a huge screen while simultaneously regaling the doctor with news of our book’s imminent publication. I remember thinking that you know you’re a writer when you find yourself promoting your book during a rectal examination.

My checkup to rule out prostate cancer was less fascinating but no less important. I wrote it up in two blog posts — here and here — in the hope my experience might reassure someone uncertain about the procedure. It was my first visit to a doctor in more than three decades. I left a dozen years between eye tests before finally attending Grey St. Opticians in Newcastle in 2023. I wrote up my experiences as To See and Be Seen and I Can See Clearly. Eye examinations check more than vision and can detect underlying health conditions such as diabetes and high blood pressure.

There are other types of checkups, of course. Fran recently had a bone densitometry scan. This non-invasive procedure uses low-dose X-rays to measure mineral content in the hip and spine to diagnose osteoporosis and assess fracture risk. She has regular blood tests to monitor her general health and check for adverse side effects from the medications she takes for bipolar disorder and other health conditions. Another friend monitors her blood glucose to help manage her diabetes. Blood tests are also used to assess the severity of paracetamol (acetaminophen) overdose and the progress of antidote treatment.

These procedures are valuable and can be life-saving. They’re also interesting, offering insight into what’s going on inside our bodies. I’m only half joking when I tell friends it’s very educational being their friend as they share with me their latest scan or test results. I’ve never needed an X-ray but Aimee shares hers with me. This usually follows a fall caused by the epileptic seizures she’s lived with for years. X-rays show the physical state of her bones and catalogue the progress of any damage over time or following surgical repair. There’s a limit, however, to what can be shown on a screen or printout. They cannot image the pain, discomfort, and frustration such injuries bring her. There’s no light or dark spot she can circle (“There! That’s how much agony I’m in right now!”) so that I can understand.

As I write this a friend posts on social media about “running out of spoons.” Spoon theory is something I recognise. It’s helped me appreciate a little of what Fran and others live with on an ongoing basis. But it’s an analogy. An approximation. A form of words that only hints at the reality of living with chronic illness and fatigue. There’s likewise no scan to show the psychological impact of trauma and abuse. No test results that express how it feels to go months without a decent night’s sleep. Nothing to evidence the crippling weight of depression; the careering thoughts of a manic episode; the hallucinations, delusions, and disordered thinking of psychosis; or the perils of suicidal thinking and self-harm.

What would it be like if there were? If invisible illness or trauma could be made visible, demonstrable to someone like me who has no idea what it’s like to live with things that can’t be materially evidenced. Would people be believed more readily? Would diagnosis be improved and treatment more effectively targeted? And if so, if a scan result or an out-of-range value on a scale made such a difference, why? It doesn’t seem right to me that validation, treatment, and support depend on a piece of paper or an image on a screen.

Medical science may find markers for some currently invisible symptoms and conditions but there’s something more fundamental here. It’s impossible to reduce lived experience to a photograph or graph or sequence of numbers. We’d do better to listen to people and believe them when they say “This hurts,” “This happened to me,” or “This doesn’t feel right.” Not every story is objectively true or diagnostically significant but scans don’t always capture what they’re meant to and can be misinterpreted too.

I’ll attend my ultrasound and hope for a clean result. But I’ll pay attention to my mind and body in the meantime and speak up if something doesn’t feel right. Maybe I’ll draw a picture.

 

Photo by Rene Böhmer at Unsplash.