This was written for a physician audience originally and appeared and is courtesy of the magazine I edit, The Medical Post. 

The behaviour of patients can be mind-blowing. As one doctor said to me, “How do you fail to come in when your wounds are dripping with pus but you come in routinely with a scratch? Why do people put jade eggs up their vaginas? I have no idea.”

Sometimes we can see the rationale for the odd things patients do, but the other things that are clearly and directly bad for them are more difficult to understand. What is one to make of that? The advice is often limited to “Don’t laugh out loud” or “If you have to gag, leave the room.”

John Green’s Turtles All The Way Down was recommended to us by a physician because it offered new insight into hard-to-understand patient behaviour. Green is the king of young adult (YA) books and though they’re ostensibly aimed at teenagers, it’s one of the few categories in book publishing that is growing. Surveys show that more than half of YA readers are adults.

Green himself has had his own struggles with OCD and this novel illustrates some of those experiences. Turtles All The Way Down is the story of 16-year-old Aza Holmes as she tries to find out what happened to a billionaire who went missing in her town (and, oh yes, she starts to date the billionaire’s teenage son—there’s almost always romance in YA novels). But really the story is mostly about understanding Aza who has “invasive” thoughts that pop into her head. “For some people, the ‘invasive’ can kind of takeover, crowding out all the other thoughts until it’s the only one you’re able to have, the thought you’re perpetually either thinking or distracting yourself from,” writes Green.
turbles

For instance, Aza is creeped out by her own microbiome. She lives in irrational fear of C. diff. She’s constantly looking at online articles about it and when she reads about rare ways patients get it, she thinks those are likely to happen to her. After she kisses the billionaire’s son, she learns that about 80 million microbes are exchanged, on average, per kiss. From then on, she begins swallowing hand sanitizer after each time.

Green works hard to describe Aza’s thought processes, like there’s two people in her head:

“Ingesting large amounts of hand sanitizer is very dangerous.”

“Do you want to die of C. diff?!”

“No, but this is not rational.”

“You will put the hand sanitizer foam in your mouth, swish it around your filthy teeth and gums.”

When Aza is like this, her thoughts spiraling, she can’t participate in life. She’s out with her friends smiling and shaking her head at funny things they say but is always a moment behind. “They laughed because something was funny; I laughed because they had,” she says at one point.

Aza’s doctor spends a lot of time with her, gently challenging her misdirected thinking and educating her. It seems like the kind of work that takes a lot of patience. (Green thanks his own doctors in the acknowledgments.)

But I think this kind of weird thinking affects many of us at some point in our lives. When I was in my 20s, after a guy and I broke up, he found out he was HIV-positive. We’d always had safe sex but I was convinced I had contracted HIV and this continued for almost a year despite getting multiple test results showing I was HIV-negative. I’d toss and turn at night and think it was the dreaded “night sweats.” I obsessed over the research on just how long a small percentage of people go without seroconverting. I did a bit of cognitive behavioural therapy. About a year later I got another HIV-negative test result which I finally accepted. I haven’t had any similar periods of anxiety since then.

We’re all a bit insane in our own ways. It’s incredibly hard to truly understand each other’s thought processes. But Green gives you a sense of how thinking like this happens. The book definitely boosts one’s sympathy for those whose thoughts can be self-destructive.

Colin Leslie is the editor-in-chief of the Medical Post.