Archives for posts with tag: Doctors

…which is a quote from Anna Quindlen, the Pulitzer Prize winning journalist, novelist and essayist.

But her question does not in any way relate to her hugely impressive CV and achievements. Rather, it stems from her encounters with healthcare professionals, which has prompted her reflections on the extent to which she was seen as an individual in that context, as a person rather than as ‘justĀ another patient’.

The writer was recently invited to deliver the Humanism in Medicine lecture at the Association of American Medical Colleges (AAMC) annual meeting (http://humanizingmedicine.org/anna-quindlen-advises-physicians/).

Quindlen’s question – “Do you know who I am?” – arose from her experience of two separate medical encounters, both involving anaesthesiologists. The first was patronising (my judgement call), and left her doubtful as to whether he knew anything about her or about her previous history.

The second encounter was a positive one:

“Only a short interchange, yet in some fashion she knew who I was.”

Quindlen continues:

“And I assume she was at least as busy as her male colleagues.”

But gender distinctions are not the point. Instead, what Quindlen wants to get across is that she felt ‘seen’ by one professional, and not by the other.

“She was professional, and she was kind. Oh, what a combination that is in what often seems like a cold and inhuman world.”

Quindlen sees the problems in health care – patients feeling ignored, isolated, patronised – as part of a larger societal problem. Power relationships wherever they occur, and which too often underlie the doctor-patient encounter, ‘foment fear and mistrust and alienation’. She speaks of the ‘MDeity’, doctors as little gods, and is surprised how pervasive this remains, despite huge technological and other advances.

Quindlen’s conclusion is that in the end, the person – the patient, the sufferer – seeks and needs ‘the human touch’, to be seen as an individual, and to be considered as such.

She ends with advice for the doctors she addresses:

  • Try to be present in the moment
  • Acknowledge uncertainty
  • Practice empathy
  • Try to be kind

CQ

This play by Margaret Edson (London: Nick Hern Books, 2000) is a must read for anyone working, or considering working, in healthcare. Particularly, most particularly, doctors.

Edson, a school teacher, worked in a cancer and AIDS unit, an experience that inspired the play. It won the Pulitzer Prize for drama in 1999.

The play does not feel like a work of fiction, and I guess it is probably more of a fact/fiction hybrid, as presumably the narrative was informed by many individual stories Edson encountered in real hospital life. I saw the TV adaptation of the play, with Emma Thompson in the main role, some years ago, which was extraordinary. Only recently have I read the play itself, twice as it deserves a re-read, there is so much to experience in just 55 pages. It is a deeply moving, and harrowing, literary work.

Vivian Bearing, a Donne specialist, is diagnosed with advanced ovarian cancer. The play is set in a Cancer Centre, where Bearing is currently having chemotherapy. Flashbacks piece together her story, from diagnosis, and before, to ‘now’, the opening scene, which takes place just a few hours before her death.

She opens with her musings on how the ill are greeted:

‘I have been asked ‘How are you today?’ while I was throwing up into a plastic washbasin. I have been asked as I was emerging from a four-hour operation with a tube in every orifice, ‘How are you today?’

This reminded me of John Berryman’s Dream Song 207:

‘ – How are you? – Fine, fine. (I have tears unshed,

There is here near the bottom of my chest

a loop of cold, on the right.

A thing hurts somewhere up left in my head.

I have a gang of old sins unconfessed.

I shovel out of sight

a many-ills else…)’

With some irony and a dark humour that to some extent define her personality and coping ability, Bearing concludes on the question ‘How are you?’ that doctors routinely, and often unthinkingly, ask:

‘I am waiting for the moment when someone asks me this question and I am dead.

I’m a little sorry I’ll miss that.’

The humour continues (and we are only on page 2):

‘It is my not my intention to give away the plot; but I think I die at the end.

They’ve given me less than two hours.’

Thus, from the very outset, we know where this story is heading… But the remaining minutes in Bearing’s life are so worth attending to, and witnessing. We are invited into a (at least partly unneccessarily) tragic story that powerfully highlights the gap between how doctors behave and deal with illness and what the experience of such illness might be for the sufferer.

We hear of words such as ‘insidious adenocarcinoma’, ‘primary adnexal mass’, which are dropped into the initial breaking bad news consultation. We share Bearing’s experience of the medical ‘Grand Round’, where ‘the patient’ is discussed in the third person (or merely as the condition from which they suffer), and is visible only in a medical sense.

Bearing is keenly aware how the doctors ‘anatomise’ her, armed with a ‘potent arsenal of terminology’, which is mostly incomprehensible.

Cancer and its treatment constitute a life mostly of awfulness:

‘I receive chemotherapy, throw up, am subjected to countless indignities, feel better, go home. Eight neat little strophes. Oh, there have been the usual variations, subplots, red herrings: hepatotoxicity (liver poison), neuropathy (nerve death).

But she survives the radical treatment, and indeed becomes a somewhat celebrity case:

‘I have survived eight treatments of Hexamethophosphacil and Vinplatin at the full dose, ladies and gentlemen. I have broken the record. I have become something of a celebrity.’

And then, with insight and poignancy she observes:

‘But I flatter myself. The article will not be about me, it will be about my ovaries.’

It is this insight and knowing (and seeing-through the medical profession) that makes Bearing’s story feel, not just real, but authentic.

When pain becomes a major problem, and Bearing needs aggressive pain management to ‘stand it’, she comments:

”It’: such a little word. In this case, I think ‘it’ signifies ‘being alive’.

Donne provides a backdrop throughout. Bearing was an expert on the poet’s Holy Sonnets and her life had always been suffused and intricately linked with his words, words that now become acutely apposite:

‘Death be not proud, though some called thee

Mighty and dreadfull, for, thou art not soe.’

To mention Bearing’s death at the end does not indeed betray the plot. It is an important, and tragic, ending, which says so much about what is wrong with the whole business of how the voice of the ill is listened and attended to.

CQ