cutting for stone

On Monday as I was driving to a meeting I was listening to the Diane Rehms show on NPR (if you aren't a member, join now - I'll wait) and she was interviewing a guy named Dr. Abraham Verghese who has written a book called Cutting For Stone.

The title is a play on the Hippocratic oath. Because, back in the day, vagrants of various types would show up in a town and cut kidney stones out, and leave before their patients died of sepsis, part of the oath is that a physician will not cut for stone (i.e. kill their patient with bad practices). Of course, now they just use a laser or whatever to remove kidney stones, or sometimes people manage to pee them out. I've heard a few stories of people who have passed a kidney stone. Makes my medical experiences seem downright civilized. If you've passed a kidney stone, and want to share, leave me a comment and I'll post it. Do not mail me any kidney stones.

Dr. Verghese teaches at the Stanford school of medicine. He was an orderly before he became a doctor. Diane asked him if he learned anything as an orderly that put him ahead of the class when he was in medical school. He made one of the most profound points I've ever heard a doctor make.

In essence what he said is that, as a doctor, he actually unlearned stuff he had learned as an orderly. When Diane questioned him about this he said that most doctors focus on curing problems. As an orderly he focused on healing his patient. Western medicine is all about curing people and misses a big aspect of illness, which is healing.

The example he gave was of someone coming in with a broken...something...oh, let's just say hand since I have first hand (ha ha) experience with that. A doctor cures the broken hand, the bones mend, you get a smack on the ass, a warning to be more careful next time, and you're out the door. However, you may still have trauma from whatever caused the broken hand. Even though you are cured, you may not be healed.

Anyone who has suffered from a traumatic injury (knee surgery, cancer, car accident) can probably relate to that. I know that I still had after effects from my knee surgery long after the brace came off my leg. Pain does weird things to the psyche and doctors usually don't discuss that with their patients.

I vividly remember my first panic attack, which occurred about a month after my second knee surgery. I was sitting at my desk at work when I suddenly felt as though I couldn't breathe. I also was sure I was going to die. The attacks continued and even though the average person would look at me and not see anything was wrong I was sure there was something wrong with me.

I started researching panic attacks and discovered that when the body undergoes a major trauma it doesn't always know when to switch off that thing that causes the body to react to pain. It's a primitive response that is meant to alert the body to shut down all but necessary functions in an attempt to save itself. Because I can't take pain medication, and was suffering from acute pain for weeks, my brain kept relapsing into that state even though I was in reality getting better.

When I went in for a check up with my doctor I asked him about the attacks and he was like "oh, yeah, that's very common". Yet he failed to tell me that they might occur, causing me to think for a few weeks that I was having a nervous breakdown or something.

I don't know what physicians in particular can do to improve the "healing" aspect of medicine. In contrast to my knee, when I went through chemo, my doctor forced me to go to various group meetings, swims (after I decided that group meetings weren't for me), and yoga classes (after I quit swimming because of a chlorine allergy). At the time I thought it was stupid, but after hearing the show on Monday I realized that those things helped address the healing part of my illness.

Anyway, I haven't read the book, and it's fiction, so I probably won't read it, but I'm going to check out some of Dr. Verghese's non fiction work.

Well, you just whiled away another 5 minutes of your life that you'll never get back reading my blog. But maybe this time you learned something useful.