the downside of doctoring

 

 

 

 

One of the perks of being a physician is the fact that you get to live in a state of perpetual awe. It starts with the first pass of the scalpel on your first day in the anatomy lab. It continues as you tease out every organ, blood vessel, and nerve in the body you've been assigned to dissect. A sense of wonder punches you in the gut the first time you hear a beating human heart and realize that your own heart has been pumping steadily and predictably without any effort on your part since before the day you were born. 

You'd have to be a toadstool not to be mystified by the anatomy, physiology, and psychology of your very own body. You'd have to believe in miracles if you understood the way a broken bone heals, what it takes for an open wound to close, how a lifeless heart can pick up the beat again.

Don't even ask what happens during sex.

I studied medicine for seven years and practiced it for over three decades, so I understand how the body works. I know what it takes to keep it up and running, and most of the time, I know how to fix it when something goes wrong. Most people don't. They get out of bed in the morning and expect their bodies to cooperate with their plans for the day. They have to get their children off to school and get to their jobs. They don't have time to be sick.

But what if you woke up in the morning and you couldn't move the left side of your body, and your speech was garbled so you couldn’t tell anyone what had happened? What if you woke up to find the infant you rocked to sleep the night before pale and lifeless in her crib? What if everything that was familiar and predictable to you changed in a heartbeat?

We expect our bodies to work, but sometimes they don't. We think our children are safe, but we can't guarantee it. We take health and happiness for granted until something goes wrong. The cancer comes back. The paralysis is permanent. The depression won't lift. Sometimes the afflictions of the body go beyond its ability to heal, and beyond the physician's ability to help.

What then?

When a patient under his care gets worse and there is nothing he can do about it, a doctor feels helpless. When he has tried everything he knows and nothing has worked, he feels like a failure. So not-God as is sometimes still expected of physicians.

And that's the problem. The downside of doctoring is that sometimes the patient gets worse despite your noblest efforts. The cancer spreads. The heart fails. The wound won't close. There is nothing more you can do. You concede it would take a miracle for the patient to recover. All you have left is prayer.

But what if you don't believe in miracles and you've given up on prayer? Your sense of awe comes into question. Your sense of wonder falters. Hope fades away. Where do you turn? 

You might try this. Study the night sky. Watch for the first signs of spring. Check for the pulse in your own wrist.

jan

 



 

 



take this pop quiz

  





This is a pop quiz. It won't take long, and it shouldn't be hard. It's just one question, and the answer is multiple choice:

 

Q: What should you do if you think you could be having a stroke?

 

This issue came to mind one day last week when a friend called me in the middle of the afternoon, and this is exactly what she said to me: "I think I had a small stroke." She said it as calmly as if she had said, "I think I'll bake up some cookies."

 

She went on to tell me that when she woke up that morning, the side of her face was a tiny bit droopy and she had a hard time speaking clearly. Her left arm and leg felt weak...but not bad. Because she has a "pre-existing condition" that can cause neurological symptoms, she didn't think much of it...until her husband got home and immediately noticed her facial weakness. I told her she needed to go to the emergency room immediately for evaluation. In fact, she should have gone hours earlier, as soon as the word "stroke" crossed her mind because time is critical when it comes to a stroke. If you go right away, you may be a candidate for treatments that can reverse the symptoms completely, or at least, prevent them from getting worse.

 

So, the question is, what should she have done?

 

Answer (select one): 

 

1. She should have gotten into the car immediately and had her husband

 take her straight to the nearest hospital.

 

2. She should have packed a bag (in case they made her stay overnight)

and grabbed a bite to eat on the way to the hospital

because the drive takes almost an hour.

 

3.She should have called 911.

 

To my surprise and dismay, I learned later on that my friend opted for #2. She packed up some toiletries, her slippers, and a robe just in case they wanted to keep her overnight. On the way to the hospital, they stopped in at MacDonald's for lunch. When they got to the hospital, they parked the car, found their way to the emergency entrance, and waited in line at the reception desk to register.

 

Wrong choice! The correct answer, of course, is #3. She should have dialed 911 and taken an ambulance straight to the ER, no matter how trivial her symptoms seemed to her. They'd have been ready for her arrival, meaning they would have had a doctor there waiting to assess her, and she'd have been rushed in for a stat CT scan of her brain. What if her stroke worsened on the way to the hospital and she slumped over, unresponsive, in the seat next to her husband? What could he have done, except to panic?

 

The point is that the earlier a stroke patient can be evaluated and treated, the better the outlook for recovery. Even if the symptoms are minor, you should seek immediate care. You don't know if you're going to get better or worse in the time it takes to get to the ER. If you're lucky, the symptoms may resolve completely on the way to the hospital, in which case you'll feel like an idiot when you get there...but, trust me, you won't feel as stupid as you'd feel if you couldn't pronounce your own name...or remember your age.

My friend's story is not unusual. Too often people who are experiencing the onset of a mild stroke hesitate to seek care. They say they couldn't be sure it was a stroke so they didn't want to make a big deal of it. Or the symptoms were mild so it wasn't bad enough to require treatment. Or they were waiting to see if it went away by itself...all of them risking a major stroke that might leave them forever paralyzed on one side or unable to ever speak again.

 

This is what you need to know:
 

~American Sleep Apnea Association~



 

...because treatment is possible:



 

~Management of Acute Ischemic Stroke from SlidePlayer~



...but time is critical:

 

~The National Institute of Neurological Disorders and Stroke~







Luckily, my friend has done well despite the fact that she would have failed my little quiz.

 

How would you have done??



 jan

 

 

 

 

 



an outpouring of stories

 

If you want to hear an outpouring of stories about medicine, start a conversation about childbirth with a gathering of women or about sports injuries among men. Ask a group of doctors about their most difficult cases. Listen to any cancer survivor describe her diagnosis and treatment. Ask a child about the band aid on his knee. You’ll find a story there.

These stories serve us in several ways:

•  By narrating our experience, we organize our thoughts about it. No longer are we plagued with a vague sense of fear or dread or uncertainty. We come to understand what our fear is based upon. The pregnant woman confesses, “I thought I did something wrong to cause the bleeding.” The basketball player says, “I thought I’d never play again.” The doctor admits, “I had no idea what to do next." 

• Storytelling is an attempt to understand the cause and timing of an illness. Why me? Why this? Why now? What did I do, or fail to do, to bring this on?

• It enables us to understand the role illness plays in our lives. How it affects our family and friends, our team, our job, our finances. Our future. It all comes out.

•  It forces us to ask some difficult questions. What could I have done differently? How much pain can I bear? Who will take care of me? How long do I have to live? 

www.emaze.com

This is a big deal. Illness disrupts our lives at the same time it grounds us. It forces us take a good hard look at what we value. Shared stories of recovery and healing dispel fear and give us hope. Stories of loss deepen empathy and help us confront denial. Stories of courage and faith strengthen us for our own battles.

The importance of storytelling in medicine cannot be overestimated. Most of us are bursting with stories, about to explode with the untold narratives we stuff inside because no one invites us to tell them.
 

"One of the most valuable

things we can do to heal

one another is to listen to

each other's stories."

~Rebecca Falls~

 jan

 

 

time out for a commercial message

 

 

 

 

 

True story:

 

On my way into church yesterday I ran into a woman I've known for over thirty years. I greeted her, but she didn't respond with her usual sunny smile, so I knew something was wrong.

 

"I have to have part of my colon removed," she said. Then she proceeded to tell me her story.

 

She'd recently undergone a routine screening colonoscopy. Her last one, ten years earlier, had been clear. But, as a nurse, she was aware that she was due to have another one this year. That's what the experts recommend for low risk patients like her...of a certain age with no symptoms, and no personal or family history of colon polyps or cancer. Well, maybe she had seen one spot of bright red blood a while back, but she blamed that on a hemorrhoid...like we all do.

 

Nevertheless, she signed on for her colonoscopy. To her surprise and dismay, her doctor found eight polyps this time around. Seven of them were easily removed during the procedure, and all tested negative for cancer. But they had to leave one behind, a large, flat polyp deep in the proximal colon, near where the appendix is. These polyps are notoriously difficult to anticipate. They don't cause symptoms until after they spread. If they bleed, you don't see it. Patients are more likely to present with a profound anemia from an imperceptible leak of blood over a long, asymptomatic period of time, so they tend to present in a more advanced malignant stage. They definitely don't cause bright red rectal bleeding. Although that's what prompted my friend to proceed, it was a red herring in her case, so in a way, she lucked out...if a partial colon resection can be considered lucky. Her polyps were detected early because she followed the rules. Her prognosis is excellent. Undetected, these polyps can be killers.

 

"Once colon cancer becomes symptomatic,

nine times out of ten

it is too late."

~Kevin Richardson~



 

The message here is that colon cancer is preventable with early screening. These cancers grow slowly and seldom cause symptoms until they are fairly advanced. The goal is to detect and remove them before they become cancerous. But the guidelines for colon cancer screening are complicated:











 

 

Recommendations take into consideration your age, the presence or absence of symptoms (which can overlap with many other conditions), a family history of colon polyps or colon cancer, whether the polyp is benign, precancerous, or frankly malignant on biopsy, its size, the depth of penetration into the wall of the colon, and whether or not it has spread to nearby lymph nodes. All these factors affect risk, prognosis, and treatment. It's all pretty complicated, and as new technologies are developed, the guidelines change frequently.

 

The best advice I can offer is this:

 



 

 

Yes...talk to your doctor. Let him figure out when it's time for you to be screened and what kind of testing you should have.

 

Don't be embarrassed. Don't be shy. If you're afraid, call up a friend and go together. He/she is probably due for screening, too. Most of all...don't be stupid. The life you save may be your own.

 

For more information than you probably want or need, go to:

 

https://www.nejm.org/doi/full/10.1056/NEJMsr1714643

 

jan