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304 pages, Paperback
First published January 1, 2011
“Many brain problems don’t announce themselves. Aneurysms, notoriously, give no warning; they hide in the brain until one day, when the blood pressure proves too great for the strength of the artery wall, they rupture and bleed, causing a tremendous headache, loss of consciousness—and eventual death. Sometimes, in the fortunate cases, the aneurysm will push against a nerve or brain structure and prompt some odd symptoms that might alert someone before a catastrophic rupture.”
“So much of a doctor’s job is in not just diagnosis but in demeanor and presentation as well—the way you come across as you speak, the way you comport yourself, the way you relate to patients. Are your eyes steady, or are they shifty? Do you look into their eyes or over their shoulders or around the room? What does this subtly tell them about their prognosis? What can they read into your body language, your hand motions, your almost imperceptible movements of facial muscles, your ease or lack of ease, and your willingness to engage with them as persons, not just medical problems? Pre-surgical consultation is a dance. You have to practice it, becoming light on your feet and making the right moves in sequence, for it to seem graceful to you and to your patients. Fortunately, I have a calm manner that seems to set people at ease. Still, it takes a great deal of experience to make bedside manner seem effortless, and ultimately that is what you want to achieve: a sense of peace and confidence”
“I know that I have given you a lot to think about. Would it be okay if I said a prayer with you?” I asked in a tone that made it safe for her to say no if she wished. I had asked earlier about her spiritual history and learned that her parents were Catholic but that she did not attend services.
She tilted her head to one side and looked at me curiously, as if reading a financial report she didn’t understand. She relaxed slightly and nodded.
“Uh, okay,” she said, a little confused. “Fine.”
“In medical school we had talked a little about what was called the “art of medicine.” This included the creativity to elicit the correct history, the insight to ask the right questions, and the meticulous attention to detail that would lead us to order the right test and thus lead us to the correct diagnosis. This method of diagnosis, which occasionally touched on areas of spirituality or emotion, was used much more in the days before CT and MRI scans.”
“I was trained to believe that success in surgery is always the result of applied knowledge and expert technical skills. I believed that the intellectual acumen needed to correctly diagnose a problem and the ability to technically execute a plan comprised the real healing power; I had worked diligently to obtain and apply this expertise. To suggest that knowledge and skills were inadequate would be to challenge not only my own sense of self-worth but the very way in which Medicine is practiced.”
“In truth, the doctor-patient relationship is based on something more than hierarchy—it’s at least partially based on fear. Doctors fear being sued; patients fear a bad outcome. This is the overriding dynamic of the relationship, especially when it involves a high-risk surgery, which includes every brain surgery. Because of the fear of being sued, doctors are very careful not to let their humanity turn into any sort of vulnerability. The questions in the back, or front, of their minds are always, How could this relationship go bad? What might turn this happy scene into a lawsuit? The questions in patients’ minds are, The Doctor seems nice, but is he or she competent? What if something goes wrong? What will happen to me?
Being sued is one of the few possibilities that make doctors feel vulnerable. It is the worst possible scenario for a medical professional, because it means someone has broken through the protective barrier of your life and threatens your personal and professional well-being.”
“When I first see patients in the office, I generally ask two questions related to “spiritual history”: “In what faith or religion were you raised?” and “Are you practicing now?” This gives me some spiritual background on each patient and helps me not to offend anyone. As a surgeon, I want all my patients to know and feel that I personally care about their complete welfare, not just the part of their health for which they are seeing me. I want them to enjoy the best physical, emotional, and spiritual health possible, according to their own definitions. And I want to encourage them wherever they are on their spiritual journeys with their own faith, not to push my faith on them. It is not my job to insist that they address spiritual issues any more than I insist that they exercise, which is also good for health.”
“My experiences have convinced me that spirituality is a crucial element to the well-being of a person as a whole; moreover, if we let him, God can do powerful, supernatural things in our everyday lives. That’s why I began inviting God into my consultations, exams, and surgeries.”
“I had always approached this area of “study” with the idea that spirituality and Medicine were weakly connected and could be explained by the placebo effect: if some people thought their faith would help them, then they would improve merely because they believed it.”
“Claudia, being angry or offended when God doesn’t do what we expect is natural, especially when we are in pain. The problem is that when you need him most, you have no access to him because you have pushed him away.”