April 13, 2011

the healer's art

     It's the final session of my Healer's Art class.  Three hours on a Tuesday night when I should probably be at home studying.  Overcoming the urge to head home, I stroll on over to the other medical school.  It turns out to be well worth it.  The theme of the evening is Service and Calling.  Blank sheets of paper are handed out and we are instructed to close our eyes and clear our mind.  "Now imagine that all practical considerations of practice are removed - financial, logistic, time constraints, etc.  What kind of patient would you like treat?  What kind of doctor-patient relationship do you envision?"
     A bit of resistance goes up inside of me.  A ruthless pragmatist, I don't like wishing upon a star, so to speak.  But I suspend my disbelief and give the instructor the benefit of the doubt that this exercise has utility.  I ponder.  I envision.  I ruminate.  Now we are told to distill the thoughts down to 2 or 3 sentences.  And to be fair, I am more than a bit surprised and enlightened at what comes out on the paper.
Allow me the ability to help bring out the patient's own desire to get better.
Allow me the ability to help guide the patient down their walk through life and experiences, regardless of what end may come.
These two statements have a lot of personal baggage for me.  Within the past year, my 39-year old brother has been diagnosed with Stage IV thymic cancer and my dad with a high risk Chronic Lymphocytic Leukemia.  As a physician in training, I began to experience and truly understand one of the biggest hurdles to modern medicine - compliance.  Obviously, most patients want to get better, right?  Who wouldn't want to be rid of cancer?  But it's never that cut and dry.  I tell you that line becomes damned blurry when it comes to staring down that needle which holds the next round of chemo and all the horrific side effects which will follow.  Or, spending the umpteenth day at the hospital in a row.  Or, the simple challenge of trying to eat intellectually knowing full well that the calories are necessary but the person simply just can't get the food down.
     I don't have the answers to this problem.  But I do know that simply writing a prescription or suggesting a course of treatment is only half the battle.  Trying to bring out the best in the patient, trying to engage their inner will to live, and probably the most difficult of all, realizing that not all sufferings can be assuaged, these are the subtle yet infinitely difficult challenges that came out for me during this exercise.  The pharmacological repertoire is limited here, as is the standard medical training.  Philosophy, humanity, and empathy are much better tools.

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