Tuesday, December 1, 2009

ILLNESS ISN’T WHAT IT USED TO BE


If you’re of a certain age, you’ll remember Yul Brynner in “The King and I,” singing,

"When I was a boy
World was better spot.
What was so was so,
What was not was not.
Now I am a man;
World has changed a lot.
Some things nearly so,
Others nearly not."

Me, too. When I was a young teen, Dr. Ben Casey took me under his strong, kind wing. Every week on television, this chief neurosurgery resident drained the brain abscess just before it popped, grabbed the obscure diagnosis that eluded his smug house staff (“Phil, do you mean you didn’t even think of a metastatic pheochromocytoma?”), and secured housing, jobs, and dates for his indigent patients.

Dr. Casey was actually heir to an honorable lineage that included Dr. Christian, Dr. Kildare, and Dr. Konrad Steiner, and would serve as a model for Dr. Marcus Welby and today’s scalpel-sharp tele-docs. Whatever the catastrophe, these physicians yank heaven from the jaws of hell, then take a break at the coffee machine.

One of our central healthcare myths is that we get sick and then a doctor makes us well. That was generally valid through the 1950s, when two-thirds of medical visits were for short-term, cleancut problems like infections and trauma. But since then, as Brynner noted, “world has changed a lot.” Today two out of three visits are for chronic conditions. Chronic, meaning long-term, is actually a euphemism for incurable.

All Dr. Casey can do today for your chronic condition is to moderate your symptoms, perhaps prolong your life. But he can’t often make the disease go away. Believe me, this isn’t easy on him. He’s as frustrated as you are—not only at his inability to cure you, but that healthcare isn’t living up to its legendary heritage.

And now comes an even greater nuisance, “MUPS.” Within mainstream healthcare, recently coined entities that may or may not be actual diseases are called "Medically Unexplainable Physical Symptoms." Chronic fatigue syndrome, fibromyalgia, candida allergy, multiple environmental sensitivity syndrome, and a host of other labels describe conditions for which diagnostic physical signs are between controversial and frankly absent.

You break your leg, you can jolly well see it in an x-ray. Pneumonia is visible pus in the lungs. You can remove and weigh a tumor, but how do you prove CFS or ADD? What can’t be measured is considered outside traditional medical jurisdiction. (Although the pharmaceutical industry has a definite interest in challenging that limit, and ultimately defining human life itself as a condition treatable with drugs.)

When I think about whether MUPS, these “shadow diagnoses,” are “real,” I soon fall into linguistic angst, wondering what "is" is. I have enough trouble deciding what’s real in my daily experience, for God’s sake, without taking on this one. But I’ll tell you: taking a firm stand for either the validity of these entities or their falsity bothers me.

I know a doc who “diagnoses” tumors by microscopically examining peripheral blood. Then he obliterates the tumors with what he calls nucleic acid extracts. His patients swear by him. “He’s the one who finally found my cancer,” a friend told me, “and he cured it.”

I know another doc who, upon hearing his patient complain of chronic fatigue syndrome, simply walked out of the room.

Both these docs are attending to the disease to the exclusion of the person. Whether an illness is curable, incurable, or even of questionable existence, at least we know this person is suffering. Are we docs to restrict our mission to biochemical (or, if surgeons, structural) engineering, or can we treat suffering, too?

A friend told me he’s had four sessions with his acupuncturist, and every time leaves feeling better. “I have no idea how acupuncture works, or if it works at all,” he said. “But this guy talks with me, listens to me, and touches me. Afterwards I don’t feel like a sack of enzymes. Whether what he ‘does’ works or not, I’ve feel like I’ve been deeply noticed.”

Sometimes, then, it really doesn’t matter what the diagnosis—or prognosis—is. We simply ask, “What ails you, my friend?”

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