Nayab Interview Essay

I interviewed my good friend Nayab at the Undergraduate Student Government Office, here at Hunter College. Nayab suffers from hypothyroidism. It should be noted that I have a mild case myself, so I am very familiar with her complaints and experiences. She felt comfortable being interviewed with two of our friends in the room, but I was worried it would influence her responses to my questions, making the atmosphere less personal and intimate. Despite my apprehension, she answered rather openly and did not seem uncomfortable at any point. Because we were in a public area, we had a couple interruptions, such as having to change rooms and being asked questions about other student’s whereabouts, but once again this did not seem to affect Nayab very much.

Nayab’s story can be traced back to a young age. She is the oldest of four children. Her parents are immigrants from Pakistan, but she was born here in New York. Her family dynamic is one of a loving, close mother and more emotionally distant, but concerned father. This dynamic is due to cultural expectations of men and women in Pakistan. Fathers are generally not part of emotional conversations or events.They want to make sure their family is healthy and safe, but leave the emotional support to the mother. As her parents care for her, she is expected to care for her younger siblings.

As the oldest daughter, she must keep her siblings happy and reassured, even when troubles arise.
Despite being a key figure in the family, Nayab has always felt somewhat out of place. It began as a child, when she was given glasses. This made her feel separate from her family members. No one else in her family has bad eye sight, causing her to question why she was the only one. This did not deeply upset her, but it is a lingering piece of knowledge that she is not as healthy as she genetically should be. Aside from her eyesight, she was perfectly healthy, although her parents have told her that as a child she often slept more than others.
Once a freshman in college, she attributed this tiredness to an erratic sleep schedule. She noticed that even when she got 10 hours of sleep, she would still be very tired and in need of a nap. Overall though, she was comfortable enough with her sleep schedule and tiredness. She believed that if it did bother her one day, all she would need to do is regulate her sleeping habits. In the meantime, she coped by taking naps towards the middle of the day, if her schedule permitted. If her schedule did not allow her to sleep around 4 pm, she would sometimes take quick naps during class.
In addition to the uncomfortable feeling of sleepiness, her tiredness also affected her social life. She was often turning down invitations or plans so that she could sleep instead. This is extremely out of character for Nayab, who is very social and works hard to stay in touch with all her friends. She also felt she didn’t have enough energy to keep up with her friends, even if she could stave off the urge to nap.
Most importantly to her, she felt a difference in her academic performance. She slept so frequently that she often didn’t have enough time to get her schoolwork done. She was reguarly behind in her classes. Her cognition was also affected, so that when she was awake doing work, it took her much longer to finish or memorize the content. This was a big problem for a freshmen Pre-Med student, who had various demanding classes.

These symptoms were in stark contrast to her personality.

Her tiredness made her dull and absent, yet she is a vibrant and energetic person. Her friends were troubled to see her acting as such. Once nearly every aspect of her life was affected by her need to sleep, she realized something may be wrong. “According to the charter of the World Health Organization, health refers not merely to the absence of disease, but to a state of physical, social, and psychological well-being” (Brown 2010). Although at this time she did not think her tiredness was a sign of illness, she did feel that it was negatively impacting her life and thus her

health.
Nayab never did make it clear if she went to the doctor because of her concerns, or if the doctor had some sense that Nayab should be tested. Regardless, she eventually went to see her general physician and the doctor decided to take blood. Nayab says the doctor saw low TSH (thyroid stimulating hormone) levels in her blood. Medically speaking, the doctor must have seen high levels of TSH, because that is the indicator of hypothyroidism. It is interesting to note though that her memory is inaccurate, considering how impactful she said the event was on her life. Anyway, the doctor told her that this diagnosis isn’t serious but she needs to go see a specialist, and so referred Nayab to an endocrinologist.
At this stage, Nayab can be said to have disease without illness, because she had “outward, clinical manifestations of altered physical function” but did not have “the human experience and perceptions of alterations in health, as informed by its broader social and cultural network” (Brown 2010). Although she was physically affected by the disease of hypothyroidism, she never thought her tiredness was a sign of illness. She attributed it to an unhealthy sleep schedule. For that reason, she did not feel she had an illness until her bloodwork told her to think so.
Nayab and her family were very alarmed by this news, despite the doctor’s reassurances. Nayab had to take on the role of older sibling and tell her brothers and sisters that nothing was wrong, even though she didn’t know for sure what would come of her health at this point. Her father was not intent on deeply questioning her about it, but he wanted to make sure she was safe and wondered if she needed him for anything. He found all this talk of hormones very uncomfortable and meant only for women. She told him she was fine and that was enough for him. Only her mom, who was present at the appointment, was not so easily subdued.

Although she showed a strong face to her family, Nayab was extremely distressed by this news. Nayab and her mother were very afraid that Nayab might die from this disease. They did not bring these concerns up with the doctor though. In addition to her fear of the diagnosis, Nayab also couldn’t help wondering what she did to cause this illness. Was she eating badly or living in some unhealthy way? If it wasn’t something she did, then was it something genetic? If it was, then why had she never heard of anyone in her family having this disease? As when she was told she needed glasses, she wondered why she was the only one.
Even though it is not logical to search for blame within ourselves, when it comes to our health, we all do it. It is a curious thing to feel guilty about an illness, and as Murphy puts it in regards to his own disability “…Why should anyone feel a sense of guilt? In what ways could I be responsible for my physical state? It could not be attributed to smoking or drinking, the favorite whipping boys of amateur diagnosticians... No, I didn’t do a damned thing to earn my tumor, nor was there any way that I could have prevented it.” (Murphy 92). Nayab is in much the same place as Murphy. She did nothing to cause her illness nor could she have done anything more to prevent it. It is something spontaneous that happened, yet like us all, she tried to blame herself in order to make sense of it.
Once at the endocrinologist, the doctor determined that Nayab has a goiter, which is an enlarged thyroid gland. Then, the endocrinologist went on to explain that her hypothyroidism results from a disfigured protein in the body. Based on my own experience and research, I cannot make sense of what this means exactly. Nayab herself does not fully understand the cause of her illness. All she knows is that a "disfigured protein" was the beginning of her illness in her body. This news scared Nayab greatly, to think that her body was producing something abnormal and it was causing her health problems was extremely alarming to her.
Nayab’s main question, concerning her hypothyroidism, was whether she was going to die. Her doctor told her that she will not die, but she will have to take a medication for the rest of her life. The medication is called Levothyroxine, and she would take 50 mg every day. Taking a medication every single day was frightening to Nayab. She was officially a chronically ill person, and “this sense of damaged self, the acquisition of what Erving Goffman called a “stigma”, or a “spoiled identity”…” had begun(Murphy 90). She was introduced to a change in identity, that she didn’t feel ready for.
After this appointment, Nayab never saw a new doctor regarding her hypothyroidism. She didn’t get a second opinion because she trusted that bloodwork and the eyes of any trained physician would be enough to accurately read her results. She also felt comfortable because she is Pre-Med, and thus had some knowledge of medical terminology. Despite her confidence, she was hesitant to ask questions because of her Pakistani upbringing. It is seen as pushy and demanding to bombard a professional like a doctor with questions. She wondered if she even wanted to know more, perhaps it would only be more bad news. Nayab feared experiencing what Murphy experienced when becoming disabled, he states, “I had changed in my own mind, in my self-image, and in the basic conditions of my existence” (Murphy 85). She was not ready to change so suddenly from a healthy person to a chronically ill person.
While she mulled over this change in identity, she also began taking her new medication. After one week of taking it, Nayab did not feel much of an improvement. Thankfully, after two weeks, she started to feel less tired after class, which was usually the time of her much needed nap. Her tiredness decreased more and more as she continued to take it. She found she could keep up socially, academically and physically now that she was not controlled by her urge to sleep.
After a month of medication, Nayab went back to her endocrinologist for a follow-up appointment. They took blood before the appointment again. This bloodwork showed she had a vitamin D deficiency, which goes hand in hand with hypothyroidism. In addition, her TSH levels looked normal, verifying her improved experience. One new discovery was of a somewhat higher level of testosterone in her blood. This she does not treat because it is mild, but it did help explain some of her lingering complaints. Of these complaints she did not elaborate.
Eventually, her endocrinologist increased the dosage of her medication from 50 mg to 65 mg. Taking 65 mg is more difficult for Nayab because the pharmaceutical companies do not make the pills in 65 mg form. Instead, her doctor has her bite a 120 mg pill in half every day. Nayab worries about taking inaccurate dosages with this method and wonders if it impacts the drug's efficiency. She also was prescribed 4000 IU of Vitamin D supplements that she is supposed to take once a week but she never consistently does. She has taken it for short stretches and didn’t feel any physical improvement, leading her to forget about the vitamin supplement altogether.
Now that the sleepiness is addressed, her main complaint is being hungry from the medication. The medication must be taken on an empty stomach and sit in an empty stomach for 30 min to an hour. Nayab always waits an hour to be safe, but that means every morning she starts her day hungry. Even worse, most days the first thing she consumes is coffee, which wreaks havoc on her digestive system. Despite this, she continues to drink coffee because even though the medication has helped her feel more awake, she still has not adhered to a consistent sleep schedule.
Although the medication is not ideal, Nayab does not suffer from any side effects. This is amazing considering hormone medications have a wide range of possible side effects, some of which being depression and wild mood swings, which I experienced when I was briefly on the same medication. Besides the levothyroxine, she does not take anything else to treat her hypothyroidism. This is interesting to note, because her parents are from a different culture, and thus likely have some differing medical practices and beliefs from those in America. This concept never came up in the interview, and so it does not seem to me that her parents considered any other method than biomedicine.
Since her diagnosis, Nayab has come to terms with her illness and the lifestyle changes it brings. Her mother though seems permanently upset by it. She becomes distressed when thinking about her daughter’s illness, and repeatedly asks Nayab if she will ever get better or be cured. Nayab must constantly remind her that her disease is for life. It seems Nayab has assented to her new identity as a hypothyroidism sufferer, but her mother hasn’t. Despite her acceptance of her disease, Nayab still has some concerns about the future. She feels anxiety when thinking about telling her future husband that she has a chronic disease. She worries that this will feel like an admission of inadequecy. In addition, because she is not visibly ill, people often assume she is in perfect health. This makes it all the more uncomfortable to break the news to them that she isn’t. This is something she will repeatedly experience, as she will always be meeting new people. She also knows that sometimes she must give in to her urges to sleep, which are better but not completely gone. Nevertheless, Nayab leads a happy and fulfilling life and does not feel her disease will keep her from achieving her hopes and dreams.