He looked across the shadowy haze, death's mirage a shimmer in the space that interceded between his sickly body and my outstretched hands.
How long do I have?
His words were expected but no less difficult. I took a deep breath and cradled my thoughts before leaning over to speak.
A few days.
His lips parted and attempted to rise above his teeth. He was trying to smile.
I wondered why.
*
The lung specialist thought decades. His capacity had diminished, but the pulmonary function tests were adequate. If he used his inhalers, he may need steroids from time to time, but he would live to breath another day.
The heart doctor said it could be years. The catheterization showed the blockages were nearly complete, but wouldn't kill him. The sharp pain radiating through his chest could be ignored. He just shouldn't exert himself. Better to take it easy.
The bug doctor had stopped visiting weeks ago. His last consultation noted that all infections had resolved.
And the oncologist refused to give numbers. He optimistically ordered the next round of chemo with assurances that experimental protocols had been promising. He wrote each order with a certain flourish.
*
A week later, I imagined him smirking as I watched the nurse pull the sheet over his head and prepare for the trip to the morgue. I heard his voice bounce through my mind as if his mouth was still capable of chuckling.
Only you, my own doctor, sold me short. I told you you I'd make it more then a few days.
I couldn't help but smiling as they wheeled him away. He had set out to prove me wrong.
And indeed, he had.
Sunday, March 18, 2012
Friday, March 16, 2012
Consequences
There are days when you're not your best. Everybody has them. The editor misses a typo. The accountant forgets an extra deduction. No one expects perfection. We are human after all. Our bodies are wired to expertly sort through the morass of physical and emotional data and develop a game plan.
We do this all the time. The subtlety of human thought and judgement touch on such banalities as which shirt will go with which shoes, which turn will avoid the morning rush hour traffic.
So many thousands of crossroads heaped on the pile of our daily decision making process. And unlike computers, we are prone to lapses. The consequences are usually minor. One may suffer a fashion emergency or get scolded for sauntering into work a few minutes late. One may even lose their job.
No one looks forward to these events, but they are recoverable.
Sometimes there are periods of darkness. When the lapses seem to be less the exception and more the rule. The decision process leaves the realm of the unconscious and becomes a screaming adversary that pummels us at every turn.
As a physician, I face these times with great uncertainty. Because unlike the editor or the accountant, my decisions have life altering consequences. On the good days, I accept my own fallibility as an occupational hazard. I suspect the benefit of my efforts far out weigh the harms.
But the devil is often in the details. I sometimes choke, sputter, and gag on the noxious fumes that fill the office. Sometimes the diagnosis is wrong, the brain is addled, or the hand is clumsy.
It's at these times, I pray to follow the great dictum and "do no harm".
And I hunker down and brace myself to deal with the consequences,
come what may.
We do this all the time. The subtlety of human thought and judgement touch on such banalities as which shirt will go with which shoes, which turn will avoid the morning rush hour traffic.
So many thousands of crossroads heaped on the pile of our daily decision making process. And unlike computers, we are prone to lapses. The consequences are usually minor. One may suffer a fashion emergency or get scolded for sauntering into work a few minutes late. One may even lose their job.
No one looks forward to these events, but they are recoverable.
Sometimes there are periods of darkness. When the lapses seem to be less the exception and more the rule. The decision process leaves the realm of the unconscious and becomes a screaming adversary that pummels us at every turn.
As a physician, I face these times with great uncertainty. Because unlike the editor or the accountant, my decisions have life altering consequences. On the good days, I accept my own fallibility as an occupational hazard. I suspect the benefit of my efforts far out weigh the harms.
But the devil is often in the details. I sometimes choke, sputter, and gag on the noxious fumes that fill the office. Sometimes the diagnosis is wrong, the brain is addled, or the hand is clumsy.
It's at these times, I pray to follow the great dictum and "do no harm".
And I hunker down and brace myself to deal with the consequences,
come what may.
Thursday, March 15, 2012
Don't Worry About Them, They're Stable
I stared at the computer screen blankly as I tried to remember what I was typing. The medical floor was humming with various rings, dings, and shufflings. A maintenance person was cleaning the floors with a mini Zamboni like contraption that made more noise then a mack truck. It was six o'clock in the morning.
As I tried to center myself, I realized that what was really causing my blood pressure to rise was a series of alarms coming from the telemetry bank in the corner of the nursing station. Apparently multiple patients hearts were not behaving as they should, and the mass of wires and circuits was sputtering repeatedly for attention.
I watched as nurses and techs walked to and fro without paying an ounce of attention to the alarms. At one point, I stopped a nurse to see if she could turn the volume down.
No, we can't do that.
When I asked if anyone was attending to the patients with the concerning heart rhythms, I got an equally unsatisfying answer.
Oh, don't worry about them, they're stable.
My blood was starting to boil.
So why in God's name do we have alarms notifying us of stable conditions?
She shrugged her shoulders and moved on.
*
Health care is suffering from a complete failure of signal processing and differentiation. Overwhelmed by a morass of competing alarms, buzzers, and notifications, medical workers are unable to separate forest from trees, tress from branches, and branches from leaves.
Physicians have especially learned how to modify their work flow. We ignore the warnings that pop up every time we type in our emr. We click through the reminders that accompany each patient chart. We sign thousands of papers a day with only giving the most superficial glance at what we are putting our name on. We skim through each others note's trying to wade through the gelatinous mess and extirpate the crucial sentence or two.
And where does the fault lie for such bloated systems? We have become slaves to our government, slaves to regulation, and slaves to the technology folk who created our systems but have no idea the effect of information overload.
When alarms, notifications, and paperwork become so abundant, they lose the ability to inform us appropriately.
Let me say this again. More is not always better. We have lost our way in medicine.
We have no idea how to communicate that which is most important.
As I tried to center myself, I realized that what was really causing my blood pressure to rise was a series of alarms coming from the telemetry bank in the corner of the nursing station. Apparently multiple patients hearts were not behaving as they should, and the mass of wires and circuits was sputtering repeatedly for attention.
I watched as nurses and techs walked to and fro without paying an ounce of attention to the alarms. At one point, I stopped a nurse to see if she could turn the volume down.
No, we can't do that.
When I asked if anyone was attending to the patients with the concerning heart rhythms, I got an equally unsatisfying answer.
Oh, don't worry about them, they're stable.
My blood was starting to boil.
So why in God's name do we have alarms notifying us of stable conditions?
She shrugged her shoulders and moved on.
*
Health care is suffering from a complete failure of signal processing and differentiation. Overwhelmed by a morass of competing alarms, buzzers, and notifications, medical workers are unable to separate forest from trees, tress from branches, and branches from leaves.
Physicians have especially learned how to modify their work flow. We ignore the warnings that pop up every time we type in our emr. We click through the reminders that accompany each patient chart. We sign thousands of papers a day with only giving the most superficial glance at what we are putting our name on. We skim through each others note's trying to wade through the gelatinous mess and extirpate the crucial sentence or two.
And where does the fault lie for such bloated systems? We have become slaves to our government, slaves to regulation, and slaves to the technology folk who created our systems but have no idea the effect of information overload.
When alarms, notifications, and paperwork become so abundant, they lose the ability to inform us appropriately.
Let me say this again. More is not always better. We have lost our way in medicine.
We have no idea how to communicate that which is most important.
Wednesday, March 14, 2012
House Of Cards
Very few people knew that Jed had studied architecture before medical school. They also didn't realize that his trip to Europe after residency was less leisure and more scouting structural gems in various locales.
No, Jed was known as a brilliant general surgeon. And he was OK with that. But sometimes his curiosity and prior education got the best of him.
One morning, while rushing to get to the office after rounding on post op patients, Jed huddled in the corner on 4S to tie his shoe. He balanced his weight on one knee, while he reached out for the laces dangling from the other extremity. To his great surprise, before his grasp was successful, he clumsily fell forward and landed on outstretched hands. As he moved to the corner and braced against the wall, he completed the task absentmindedly. His brain was lost in thought.
He knew he had superb balance. He rarely fell in even the most treacherous situations. By the time he finished, he was convinced that the floor was not level. He rose and ducked into a supply closet where he looked for a round object. He quickly settled on a tiger top blood tube and made his way back to the hallway.
After looking to make sure both directions were clear, he placed the tube on the ground and pushed it due west. It meandered down the large hallway for a few moments and then slowly veered south. Jed followed it into the corner and was surprised to find that at the intersection of the very south and west walls of the building, a collection of round objects had formed.
There were tubes, marbles, and a series of coins. Someone had even apparently lost a tennis ball. Jed was now convinced that there was a material defect in the building. He stared up at the ceiling and then back at the floor. Within moments, his pager buzzed and he glanced down at his watch. The mystery would have to wait till the end of clinic.
*
Over the next few days, Jed conveniently found reasons to be on each of the hospital's eight floors. He was not surprised to find that every time, a pile of odds and ends had collected in the building's southwest corner. He envisioned an imperfection in the bracing or support. Something had to be done.
Jed decided to call the engineering department and discuss his concerns with the hospital staff. After a number of transfers and accidental hang ups, he eventually was able to reach the head of the department. As he accompanied the gentleman to the southwest corner of the building on the second floor, he explained what he had found.
The structural engineer seemed unfazed. He cleared the debris from the corner with his right leg as he looked at the wall.
It's just settling son, nothing to worry about.
Jed could see that he wasn't going to get anywhere with the man, so he thanked him and returned to the work of being a surgeon. But as the hours passed, he again felt a nagging sense of impending doom.
Jed's last option was to call the head of surgery and plead the case to his boss. Unfortunately, the conversation ended with a promise to bring it up again with the engineering department. Jed doubted very much that that would really happen.
*
Days turned into weeks, yet Jed couldn't stop the unnerving, demanding thoughts that ran through his mind. The building was insecure and needed to be corrected. The lives of countless patients and staff depended on it.
One night after waking up in a cold sweat, Jed decided he had enough. He threw on a pair of scrubs and drove to the hospital. At three in the morning, the halls were quiet, and he had no problem slipping undetected into the maintenance elevator.
He pushed the button marked SB for sub basement and waited till the doors opened. As he exited, he was cautious to avoid being seen. It only took a few moments to find the southwest edge of the building.
Upon turning the corner, he was surprised to find a door that lead to a dirt covered room with a low ceiling. As he closed the door behind him, Jed realized that for all intents and purposes he was outside the building. Looking up, he calculated that he must be standing directly under the front steps to the main entrance of the hospital. He could hear the occasional distant thumping of shoes overhead.
The room was roughly twenty feet by twenty feet, and it was barren except for hole jutting into the ground at the southern most edge. Jed stepped over to inspect and found a thin steel ladder plunging downward. He grabbed tightly and shook the metal structure before he climbed into the hole and started the descent into the earth.
Although he could barley see, he felt his way forward with his hands and feet. After what seemed like hundreds of steps, he finally came to the end of the ladder and his legs rested on flat ground. He grasped for the penlight clipped into the breast pocket of his scrubs.
By the faint illumination, he could see what lay at the bottom of the rabbit hole. The very southwest edge of the building was being propped up by something. He bent to look closer and blinked his eyes multiple times unconvinced of their accuracy. The mortar was balanced on top of two playing cards that were bridged together by a third. Jed squinted to see that the top card was facing up. The foundation came to a point and impaled the chest of a laughing joker as if amused by his own impotence.
Jed's head started to spin. A rush of memories and seemingly unrelated thoughts popped into his mind. Had not his medical school listed in a similar direction? Hadn't his clinic also felt slightly off balance?
As Jed began the long ascent back up the ladder, he felt queasy. It was not just the hospital but the whole kit and caboodle.
The whole healthcare system was built on a house of cards.
No, Jed was known as a brilliant general surgeon. And he was OK with that. But sometimes his curiosity and prior education got the best of him.
One morning, while rushing to get to the office after rounding on post op patients, Jed huddled in the corner on 4S to tie his shoe. He balanced his weight on one knee, while he reached out for the laces dangling from the other extremity. To his great surprise, before his grasp was successful, he clumsily fell forward and landed on outstretched hands. As he moved to the corner and braced against the wall, he completed the task absentmindedly. His brain was lost in thought.
He knew he had superb balance. He rarely fell in even the most treacherous situations. By the time he finished, he was convinced that the floor was not level. He rose and ducked into a supply closet where he looked for a round object. He quickly settled on a tiger top blood tube and made his way back to the hallway.
After looking to make sure both directions were clear, he placed the tube on the ground and pushed it due west. It meandered down the large hallway for a few moments and then slowly veered south. Jed followed it into the corner and was surprised to find that at the intersection of the very south and west walls of the building, a collection of round objects had formed.
There were tubes, marbles, and a series of coins. Someone had even apparently lost a tennis ball. Jed was now convinced that there was a material defect in the building. He stared up at the ceiling and then back at the floor. Within moments, his pager buzzed and he glanced down at his watch. The mystery would have to wait till the end of clinic.
*
Over the next few days, Jed conveniently found reasons to be on each of the hospital's eight floors. He was not surprised to find that every time, a pile of odds and ends had collected in the building's southwest corner. He envisioned an imperfection in the bracing or support. Something had to be done.
Jed decided to call the engineering department and discuss his concerns with the hospital staff. After a number of transfers and accidental hang ups, he eventually was able to reach the head of the department. As he accompanied the gentleman to the southwest corner of the building on the second floor, he explained what he had found.
The structural engineer seemed unfazed. He cleared the debris from the corner with his right leg as he looked at the wall.
It's just settling son, nothing to worry about.
Jed could see that he wasn't going to get anywhere with the man, so he thanked him and returned to the work of being a surgeon. But as the hours passed, he again felt a nagging sense of impending doom.
Jed's last option was to call the head of surgery and plead the case to his boss. Unfortunately, the conversation ended with a promise to bring it up again with the engineering department. Jed doubted very much that that would really happen.
*
Days turned into weeks, yet Jed couldn't stop the unnerving, demanding thoughts that ran through his mind. The building was insecure and needed to be corrected. The lives of countless patients and staff depended on it.
One night after waking up in a cold sweat, Jed decided he had enough. He threw on a pair of scrubs and drove to the hospital. At three in the morning, the halls were quiet, and he had no problem slipping undetected into the maintenance elevator.
He pushed the button marked SB for sub basement and waited till the doors opened. As he exited, he was cautious to avoid being seen. It only took a few moments to find the southwest edge of the building.
Upon turning the corner, he was surprised to find a door that lead to a dirt covered room with a low ceiling. As he closed the door behind him, Jed realized that for all intents and purposes he was outside the building. Looking up, he calculated that he must be standing directly under the front steps to the main entrance of the hospital. He could hear the occasional distant thumping of shoes overhead.
The room was roughly twenty feet by twenty feet, and it was barren except for hole jutting into the ground at the southern most edge. Jed stepped over to inspect and found a thin steel ladder plunging downward. He grabbed tightly and shook the metal structure before he climbed into the hole and started the descent into the earth.
Although he could barley see, he felt his way forward with his hands and feet. After what seemed like hundreds of steps, he finally came to the end of the ladder and his legs rested on flat ground. He grasped for the penlight clipped into the breast pocket of his scrubs.
By the faint illumination, he could see what lay at the bottom of the rabbit hole. The very southwest edge of the building was being propped up by something. He bent to look closer and blinked his eyes multiple times unconvinced of their accuracy. The mortar was balanced on top of two playing cards that were bridged together by a third. Jed squinted to see that the top card was facing up. The foundation came to a point and impaled the chest of a laughing joker as if amused by his own impotence.
Jed's head started to spin. A rush of memories and seemingly unrelated thoughts popped into his mind. Had not his medical school listed in a similar direction? Hadn't his clinic also felt slightly off balance?
As Jed began the long ascent back up the ladder, he felt queasy. It was not just the hospital but the whole kit and caboodle.
The whole healthcare system was built on a house of cards.
Monday, March 12, 2012
Wait
Wait.
No one had ever told her that such a great deal of parenthood would be waiting. Initially, there was the nine months in utero. Then, a never ending series of hoops to jump through: first full night of sleep, first steps, first day of kindergarten, etc. Although she couldn't quite put the sentiment into words at the time, she had a hunch that it wasn't the milestones themselves, but the time in between where life was lived.
She crossed her legs and shifted on the park bench where she waited for her youngest son to exit the school. Any moment his exuberant brown eyes would come rushing out the door in a sea of humanity like a mini running of the bulls.
She smiled briefly and then her mouth twisted into a frown. Last night he had talked about being a doctor again, just like his dad. She swallowed hard as she thought about his chances now that he was diagnosed with a learning disability.
It's not that he wasn't smart. The IQ testing had placed him in the appropriate quartile. But when school progressed to the point of learning how to read and write, it became clear something was wrong.
She had hired a series of tutors who were working with him closely, but progress was slow. She didn't have the heart to tell him that he likely would never become a physician. How could she crush his dreams at such a young age?
As he bravely sprinted across the school yard to her park bench, she decided that he was perfect the way he was. And only time would tell what he was meant to be. For now she would say nothing and love him the best she could.
*
Years later, that boy grew into a man and realized his dreams. Immersed in the problems of others, he married and had his own children. When his heart ached for his son, he began to understand the turmoil his mother must have felt.
He watched as life formed hurtles. Sometimes his son was lithe and agile; others slow and clumsy.
From time to time there were disappointments both great and small. He would pull those little boy hands and legs into his chest and wrap his arms around them protectively as hope fervently blasted through his soul.
And he would wait.
No one had ever told her that such a great deal of parenthood would be waiting. Initially, there was the nine months in utero. Then, a never ending series of hoops to jump through: first full night of sleep, first steps, first day of kindergarten, etc. Although she couldn't quite put the sentiment into words at the time, she had a hunch that it wasn't the milestones themselves, but the time in between where life was lived.
She crossed her legs and shifted on the park bench where she waited for her youngest son to exit the school. Any moment his exuberant brown eyes would come rushing out the door in a sea of humanity like a mini running of the bulls.
She smiled briefly and then her mouth twisted into a frown. Last night he had talked about being a doctor again, just like his dad. She swallowed hard as she thought about his chances now that he was diagnosed with a learning disability.
It's not that he wasn't smart. The IQ testing had placed him in the appropriate quartile. But when school progressed to the point of learning how to read and write, it became clear something was wrong.
She had hired a series of tutors who were working with him closely, but progress was slow. She didn't have the heart to tell him that he likely would never become a physician. How could she crush his dreams at such a young age?
As he bravely sprinted across the school yard to her park bench, she decided that he was perfect the way he was. And only time would tell what he was meant to be. For now she would say nothing and love him the best she could.
*
Years later, that boy grew into a man and realized his dreams. Immersed in the problems of others, he married and had his own children. When his heart ached for his son, he began to understand the turmoil his mother must have felt.
He watched as life formed hurtles. Sometimes his son was lithe and agile; others slow and clumsy.
From time to time there were disappointments both great and small. He would pull those little boy hands and legs into his chest and wrap his arms around them protectively as hope fervently blasted through his soul.
And he would wait.
Saturday, March 10, 2012
Social Media As An Amplifier
I'm not an early adopter. I certainly wouldn't call myself a tech geek. In fact, I'm usually the last one on the block to buy the new gadget. Email, mobile phones, and Facebook were basically forced on me. I'm chronically behind the times.
So when I read the words of many of those I admire at the forefront of the social media movement, I often struggle to keep pace. The terms and technologies far surpass my level of expertise. Yet here I am reading their blogs and tweets.
You may wonder how I got here.
The Internet is a platform. But like any stage, it is often difficult to differentiate the millions of users who inhabit the same space. Good social media, on the other hand, is like an amplifier. It takes lonely end users like me, and magnifies, nay multiplies the signal. Like any good amplifier, it reproduces the initial sound with greater strength but similar fidelity. In other words, if you put garbage in, you get garbage out. And not only will people not listen to you, they'll get annoyed.
On the other hand, if what you produce speaks to a specific audience, the volume rises. When momentum builds an idea reaches critical mass, and boom-your in the stratosphere.
I started to blog years ago when the profundity of everyday life became overwhelming. My experiences as a physician, as a person, burned deep holes in my soul and cried for expression.
In my writing, I found a place to express the truest version of myself. Unprotected by the false prophesy of appearances, I allowed my words to speak for themselves.
But years into the journey, I found my signal degraded quickly over the vast ether. My words bounced off the wall and echoed back into my own ears. The move to Facebook and Twitter has carried me farther. I've found groups of people to admire and share with. We form a symbiotic existence, the fabric of the social media universe.
So if you happen upon these words as you spin the internet dial: sit back, tune in, take a load off for awhile. I hope you find something here of value.
If not, keep looking.
And thanks for stopping by.
So when I read the words of many of those I admire at the forefront of the social media movement, I often struggle to keep pace. The terms and technologies far surpass my level of expertise. Yet here I am reading their blogs and tweets.
You may wonder how I got here.
The Internet is a platform. But like any stage, it is often difficult to differentiate the millions of users who inhabit the same space. Good social media, on the other hand, is like an amplifier. It takes lonely end users like me, and magnifies, nay multiplies the signal. Like any good amplifier, it reproduces the initial sound with greater strength but similar fidelity. In other words, if you put garbage in, you get garbage out. And not only will people not listen to you, they'll get annoyed.
On the other hand, if what you produce speaks to a specific audience, the volume rises. When momentum builds an idea reaches critical mass, and boom-your in the stratosphere.
I started to blog years ago when the profundity of everyday life became overwhelming. My experiences as a physician, as a person, burned deep holes in my soul and cried for expression.
In my writing, I found a place to express the truest version of myself. Unprotected by the false prophesy of appearances, I allowed my words to speak for themselves.
But years into the journey, I found my signal degraded quickly over the vast ether. My words bounced off the wall and echoed back into my own ears. The move to Facebook and Twitter has carried me farther. I've found groups of people to admire and share with. We form a symbiotic existence, the fabric of the social media universe.
So if you happen upon these words as you spin the internet dial: sit back, tune in, take a load off for awhile. I hope you find something here of value.
If not, keep looking.
And thanks for stopping by.
Friday, March 9, 2012
The Art Of Medicine
I don't like doctors!
It was always the same with Ronald. After years of absence, he would appear at my doorstep with some particular problem that had progressed to alarming proportions. Once, it was the abscess that seemed to swallow up his whole back. The next time, it was a hernia that had grown to the size of a grapefruit hanging out of his undergarments. But today was different. In fact, when I asked what was wrong, he told me that he was feeling fine.
Doc, I had a funny dream last night. At least I think it was a dream.
The night before, Ronald woke up to a gentle nudging on his left arm. When his eyes opened, he almost fell to the floor. His teenage daughter, who died decades earlier, was standing above him. She called out to him like she had when she was alive.
Papa...Papa, your not breathing right. Go to the doctor.
*
Ronald tried to convince himself that it was just a dream. He tried to ignore his daughter's words, but her voice paralyzed him. He walked in to my office cautiously as if embarrassed by an urge that he couldn't explain.
While I was skeptical to say the least, there was something about Ronald's story that moved me. There is a time when clinicians drop algorithms and guidelines and work from the gut.
I felt it would be reasonable to obtain basic lab tests and a chest Xray. I also informed him that given the lack of indications, medicare wouldn't pay for any of it. He took my referrals and left the office. I suspected that he would eventually think better, and decide not to go for testing.
I was wrong.
*
Three years later Ronald is disease free. The lung cancer found coincidentally on Xray was early stage, and was surgically cured. The thoracic surgeon marvels that if Ronald had waited any longer, he wouldn't be alive today.
Ronald did end up paying a few extra hundred dollars for the tests, but he now feels it was money well worth spending.
And I am left to wonder about the future of medicine. As guideline based care pervades health care reform, I fear that something will be inexplicably lost.
You may call it Divine intervention. It might be described as having a hunch. Or one could lay this gift on the doorstep of lady luck.
But if you ask me, I call it something completely different.
The art of medicine.
It was always the same with Ronald. After years of absence, he would appear at my doorstep with some particular problem that had progressed to alarming proportions. Once, it was the abscess that seemed to swallow up his whole back. The next time, it was a hernia that had grown to the size of a grapefruit hanging out of his undergarments. But today was different. In fact, when I asked what was wrong, he told me that he was feeling fine.
Doc, I had a funny dream last night. At least I think it was a dream.
The night before, Ronald woke up to a gentle nudging on his left arm. When his eyes opened, he almost fell to the floor. His teenage daughter, who died decades earlier, was standing above him. She called out to him like she had when she was alive.
Papa...Papa, your not breathing right. Go to the doctor.
*
Ronald tried to convince himself that it was just a dream. He tried to ignore his daughter's words, but her voice paralyzed him. He walked in to my office cautiously as if embarrassed by an urge that he couldn't explain.
While I was skeptical to say the least, there was something about Ronald's story that moved me. There is a time when clinicians drop algorithms and guidelines and work from the gut.
I felt it would be reasonable to obtain basic lab tests and a chest Xray. I also informed him that given the lack of indications, medicare wouldn't pay for any of it. He took my referrals and left the office. I suspected that he would eventually think better, and decide not to go for testing.
I was wrong.
*
Three years later Ronald is disease free. The lung cancer found coincidentally on Xray was early stage, and was surgically cured. The thoracic surgeon marvels that if Ronald had waited any longer, he wouldn't be alive today.
Ronald did end up paying a few extra hundred dollars for the tests, but he now feels it was money well worth spending.
And I am left to wonder about the future of medicine. As guideline based care pervades health care reform, I fear that something will be inexplicably lost.
You may call it Divine intervention. It might be described as having a hunch. Or one could lay this gift on the doorstep of lady luck.
But if you ask me, I call it something completely different.
The art of medicine.
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