Doctors, sausage-making, and killing hope

No secret around here that my friend’s breast cancer diagnosis has had a profound effect on Karen and me. For Karen, this has dredged up some painful memories regarding her own health problems and her father’s death.

Here’s Karen.

Yummy bratwurst: you know you love it. But do you really want to know what goes into that bratwurst? The sausage-casing alone should give you pause. If you allow the sausage-making process to remain a mystery, your enjoyment need not be impaired.

Medical decisions are sausages. Some folks want their doctors to give them their plan as a fait accompli, while others would rather know every last fact and study result the doctor considered in making his decision. These patients want to know what’s in their sausage.

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Lucky Canadians

This diary at Daily Kos by nyceve deserves a shout:

My doctor is really starting to scare me

She’s writing about her doctor, a surgical oncologist. Snip:

He said this woman needed a digital mammogram. A digital mammogram is a state-of-the-art screening procedure.  It is also somewhat more expensive than the more routine old-fashioned mammogram. This woman was unable to secure the digital mammogram. Then the doctor said, she has a terrible history, she needs a breast MRI–but the insurance company will not pay. They won’t pay for a digital mammogram and they certainly won’t pay for an MRI.

So what will happen to her I asked? “We’ll fight, we’ll appeal” he said.  “Then she should file a criminal complaint, insurance companies are practicing medicine without a license.”

Read the whole thing, please, especially if you’re living here in the US.

I’ve said it many times (although perhaps not here): most medical insurance corporations are EVIL. From their point of view, the best patient is one who pays his premium, then steps in front of a truck and is killed instantly.

I can think of many examples in which insurance companies don’t put up roadblocks, pay promptly, and don’t deny care as their SOP, but the big operators don’t do business this way.
D.

Don’t worry, be happy

Last night, Karen and I spent a good bit of time reading Corn Dog’s blog. She writes intelligently and poignantly about illness and healthcare, and her non-medical posts are entertaining, too. Consider this a big shout. Corn Dog deserves a bigger audience.

Patients with serious illnesses have to deal with a lot of emotional garbage. ‘Garbage’ excludes the important work: coming to terms with what your illness means to yourself, to your friends, to your family. ‘Garbage’ is garbage, a huge and largely unnecessary manure pile of guilt.

Anyone who has been ill — life-threatening ill, I’m not talking about broken bones here — knows what I’m about to say, or will recognize it soon enough. You see, the patient’s family and friends expect her to cheer them up. They want the patient to say to them, I’m okay. Really! I’m going to be okay, too. Nothing wrong here, oh no.

They want to hear these things because they’re scared and threatened by the patient’s illness. This fear breeds many odd behaviors, none of which help the patient. I’ll mention briefly the blame the patient shtick: “You have cancer? Oh, my. I’m so sorry. Did you smoke?” The healthy person searches desperately for reasons why it cannot happen to him. Doctors, friends, family members — everyone wants to blame the patient for her illness, for her “failure to respond” to treatment, for her “bad attitude.” The unstated assertion: If it’s your fault, I feel much better.

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Saving lives

Me here, maundering again.

A conversation with Karen last night sparked this post.  She’s convinced I’m trying to save my friend’s life.

I don’t know why, exactly, but the idea of saving anyone’s life disturbs me.  Aside from a few dramatic cases — crash tracheostomies or cricothyrotomies on suffocating patients — I can’t think of many instances where I directly and unequivocally saved a life. Ear, nose, and throat docs are not ER docs, nor are we critical care docs. The big S just doesn’t come up that often.

Some patients, however, perceive that I’ve saved their lives. Most common situation: prompt diagnosis by me followed by correct referral, when the patient had been bounced around from one doc to the next. Does that count, I wonder? But I usually deflect the credit in those cases. Don’t forget, I tell them, I’m not the one who operated.

It’s not humility. I feel an almost physical discomfort when these folks try to thank me. Here’s a thought: maybe I don’t want the responsibility. If I take credit for the saves, I have to take credit for the losses, too.

I’ve touched on this before and I’m not sure I can say it any more eloquently. Disease terrifies me.  Death terrifies me. Becoming doctors, we gain no mystical control over the health of our loved ones. I can’t keep myself or my family from harm. I suppose I’ve learned how to control the terror, learned how to do what’s necessary and not be paralyzed*.

So, yeah, I can get the job done. Dealing with my feelings, dealing with my patients’ feelings, that’s the tough part.

It has taken me all day to write this much.

What am I trying to do with my friend? What do I try to do for my patients? Am I really trying to save lives? I guess so. Mostly, I’m trying to make a difference. You know, we’re taught in medical school that just caring helps all by itself. “The laying on of hands” — touching people helps, too.

Selfishly, I’m trying to do something to combat this awful feeling of helplessness I get not only with my friend, but with every patient in whom I diagnose (or others diagnose) a life-threatening disease.

In a perfect world, I wouldn’t get sick or die. My loved ones wouldn’t get sick or die. The only people who get sick and die would be the evil people. Often, though, it seems like the only ones who get sick or die are the good people. It really does seem that way.

D.

*Maybe that’s what those crash situations are good for — the emergent tracheostomies, or, better example, removing half a pigeon skull from a toddler’s windpipe (true story). You feel that paralysis gripping you but you get past it because you have to.  Inaction is not an option. And when you learn it in those situations, it’s easier to carry the feeling over to other patients . . . the ones who won’t die in the next five minutes, but will die in the next five days, weeks, or months if you dick around and don’t do the right thing.