Monday, July 30, 2012

Final Exam and The Professor

I harbor a secret obsession with medical books for laypeople.  I absolutely love the feeling of insider knowledge about what doctors do all day.  And I especially love when all this is presented in clear, interesting, unlabored prose. 

Final Exam, by Pauline Chen, explores how doctors are (not) trained to deal with the death of their patients.  In it, Dr. Chen uses anecdotes from her own medical/surgical training and practice to highlight the gaping hole in medical education that is "How to Manage Patient Death."  It is thoughtful, honest, sad, and a lovely read.  It is also a bubble-wrapped softball thrown at the center of that gaping hole.  Somehow, after reading this book, I didn't feel so bad about doctors who can't acknowledge death.  Maybe because the doctor who wrote the book had clearly learned so much. 

Back out here in the real world, though, I'm stuck looking at medical professionals who daily fight to beat back any shadow of patient death.  And I admire them for it -- especially when our most recent losses are of patients who are so young.  It's such a strange balance, which The Professor brought into crystal clear focus in a 30-second exchange today:

"Is there a reason why you can't massage my abdomen?"

"Well, in this medical setting, I need to take extreme care with what I do so that I don't tax your body, but rather support it through your treatment.  'Do no harm' applies to me as well."

"And yet the doctors who 'Do no harm' are the ones ordering noxious chemicals for me to take." 


The Professor, restarting his treatment after a particularly nasty go-round with side effects, had a point.  But he wanted his doctors to do this calculated harm, for now. When he stops wanting it, though, how hard will it be for his doctors to accept?  And how hard will they fight to convince him not to die?

Tuesday, July 24, 2012

The Yellow Rose of Texas

The Yellow Rose of Texas is not doing so well.  When I first met her, she would marvel at the ease of her treatments "this time around."  No side effects, just a little tired.  Unbelievable how good she was feeling.  Those supplements must really be working -- and did I know how good grapeseed oil is for your hair? 

The Yellow Rose looked ten years younger than I do, even though she is five years older.  She smiled often, showing one pointed snaggle tooth.  Her skin was clear and soft.  Then somewhere along the way she got a bad scan result.  Progression of disease concerning enough that she paused her chemo to have radiation treatments. 

Now, the Yellow Rose is fading.  Her grapeseed-oil soft hair is straw-dry, gathered back into a ponytail thinner than her pinky finger.  She is in constant pain on one side of her body.  Nothing helps.  She can't even get some respite through sleep.  (Although today she pulls down into the deepest wells of her endless optimism to tell me she slept last night -- four hours.)

I learned today the pain is cancer.  Cancer and more cancer, findng the weak spots in her body to live.  An insttructor once told me cancer is just aberrant life, not a cause for war.  The instructor was trying to express that our violent metaphors for cancer treatment often do not allow us to treat the body and the person with the necessary tenderness and attention. 

But the Yellow Rose is sitting up on my table (because lying down is too painful) gasping in pain, squinting in pain, telling me my hand on her shoulder feels good.  I can't breathe because I feel useless, punched in gut by her suffering.  I want to punch back, violently. 

It won't do for both of us to be overwhelmed.  Like my instructor knew, any small measure of peace can't happen that way.  I tighten my core and take the punches, absorb the violence and try to give back to her only tenderness and care.  Later, in my car on the way home, I will sort out the damage.