Wednesday, June 29, 2011

WHAT'S TO BE DONE (OR NOT DONE)?

A friend has been visiting his mother in a hospital ICU. She's old and frail and may well be dying.

He wrote this to me:

I was thinking of your blog yesterday as I sat in her room waiting. A load of technology--wires, tubes, machines--being applied to her body by a pack of mortals. Not one magician or demigod in the crowd. Staff tripping over tubes as they add yet another medication and IV pump. Apply another mask and sticky crap to her beautiful face. Piles of discarded supplies. Top down control, nurses know what to do but can't until they obtain an "order" which requires tracking down the overloaded doctor.

It all feels so bumbling. Not that I see the people as incompetent. On the contrary, I experience them as skilled and caring. The bumbling and fumbling comes from trying to fix something that may not be "fixable." Maybe I just don't get it. It's painful to watch Mom suffer. It's hard not knowing where it ends or where it goes to next. 

So he's suffering, too. If he asked for advice, what would you say?

Tuesday, June 28, 2011

DR. JEKYLL AND HIS MR. HYDE OFFICE STAFF

My friend Theresa told me she'd just had a visit with her doctor and left confused.

"About medical stuff?"

"No," she said. "Dissonance."

She said she'd been reluctant to go to Dr. D's office but never quite knew why, and now maybe she was learning why. 

"Dr. D's a terrific physician," she said. "He's warm, knowledgeable, tolerant--a great human being. That's why I wondered why I didn't like visiting. Now I realize it's his staff."

She went on. "It came to me today that his office is a factory! Or maybe an insurance bureau, I don't know, but I'd never think of it as a remotely healing place. I check in and soon a woman calls me in from the waiting room. Walking ahead of me to an examining room, she asks how I am. I mean, she isn't even looking at me. And who is she, anyway? A nurse? Drug rep? Another patient? Am I supposed to ask? Is it up to me to teach plain old manners to grownups? She weighs me, takes my temperature, and leaves the room. In a few minutes, Dr. D comes in and right away he lifts my dark mood. Afterward he walks me out to the front desk, hugs me, and goes to see his next patient, I guess. The woman at the desk says, 'We don't take Medicare. Today's visit is seventy-seven dollars.' She's like a clerk selling me a train ticket. She hands me a bill with my name on it, misspelled.

"So here's what's confusing. Dr. D cares about me. I'm lucky he's my doctor. But his office staff acts like they're his competition. If it weren't for his charisma, the place would get closed down as an anti-healing black hole. Now, how can a guy like that not notice that disparity?"

I've had similar experiences. Why do medical offices so often feature an ambience ranging from vapidity to frigidity? When I was a kid, back in the germ days, the style was cleanliness. You knew it was a medical office because you could smell the isopropyl alcohol and eat off the white tile floor. For today's diseases, which stem mainly from lifestyle and aging, the old cold cube doesn't work. Why not opt for qualities that comfort and encourage trust? Look, office staff: "providing" healthcare to "consumers" isn't just another business. Besides, wouldn't you enjoy your work more if you felt friendly and compassionate?  

My suspicion is that Dr. D is aware of the flavor of his office. He likes his employees and finds them efficient. He has no idea, though, that every element of a medical office can be a placebo. The furniture and the lighting are potential placebos, as well as the first word from the receptionist, who as tone-setter is arguably the most important person on the staff. Look, Dr. D: give your staff permission to be the caring people they are, and by the time you see your patients in the examining room, they'll already be half-treated.

Wednesday, June 22, 2011

MATERIALISM AS MENTAL ILLNESS

Neurosis is characterized by an idée fixe, as Freud put it--a view of the world that one refuses to reconsider even when confronted with valid opposing evidence. Jung said, "…people become neurotic when they content themselves with inadequate or wrong answers to the questions of life." One example is obsessive-compulsive disorder, a common manifestation of which is repetitive handwashing. I've washed my hands thirty times now, but I figure they're still not clean, so here goes again.

Suppose I feel my life is empty, that I lack something vital. I sense a void inside me, yearning to be filled. So I try a little retail therapy. I buy a Giants baseball cap, hoping that will do the trick. It doesn't work, though, so I buy a George Foreman grill. Nope. I know! A Chrysler PT Cruiser convertible! That satisfies me for a day or two, but then the empty sensation returns. Its pervasive discomfort slowly turns my life into a search for the literal fulfillment I seek, though I gradually forget why I'm doing it. I look for my Grail in food, sex, drugs, and a hundred other things, to no avail. My idée fixe is that my deliverance must come from something in the material world. But my deficit isn't material. No thing will suffice.

This is America's painful conundrum. Attracted by clever marketing, we're mesmerized by things. Way down deep, we know new underwear or another wristwatch won't make us whole, yet we buy anyway, persuaded by ingenious advertisements that don't promote their ostensible product as much as they promise love, security, ecstasy.




As we adhere to this glamorous but useless route, our internal skills atrophy. We come to believe that love, security, and ecstasy are actually qualities of products and not of us. We forget who we really are.

If this isn't a socially significant mental illness, hardly anything else is worthy of the name.

But it's treatable. One effective approach is knowledge of mortality, a revelation I see regularly in cancer support groups. Most cancers aren't immediately life-threatening. Having cancer doesn't mean you're going to die tomorrow, but it does underline the certainty that none of us are here forever. Thankfully, that realization is very often a lever for renovating one's life: what are my deepest values after all, and how passionately am I living them? One of my joys in this work is hearing people say, "I'm just beginning to understand what's really important."

Tuesday, June 14, 2011

IT SEEMS CRAZY

AARP's June 1 news bulletin features an article, "Before and After Weight-Loss Surgery," which unabashedly recommends gastric bypasses as a corrective for obesity.

This operation is effective for its stated end, weight loss, which can help type 2 diabetes to disappear as well. The picture's not all rosy, though. At first, post-op patients can eat only small amounts of pureed foods. When they graduate to solids, they need to be carefully chewed or they don't go down. Some pills are too large to digest; alcohol, carbonated drinks and caffeine are verboten; protein, vitamin and mineral supplements are necessary. Some patients need to wait two hours after a meal to drink water or other liquid. But hey, they lose weight.

 

Obesity is epidemic in America. In 2004, the National Institutes of Health reported that nearly two-thirds of U.S. adults were overweight or obese. Over a million Americans have had a gastric bypass, which costs about $35,000 and, like other interventions, isn't getting any cheaper. Do the math.

 

Not everyone's wild about this tendency. Comments one surgeon, "When I put on my public health hat, I have to admit that it seems crazy. But I'm a clinician. I treat patients who have tried everything else, who have type 2 diabetes and other complications of obesity, and they're desperate. This is the only thing we can offer that allows for a cure."

 

The operative phrase here must be "…the only thing we can offer…" Why can't we offer anything else? Our ability to put people on the moon is, in my mind, totally useless except for the fact that it demonstrates the efficacy of American will. Why can't we offer anything else to the obese? How is it we can deftly rearrange people's insides but don't have a clue to helping them modify their behavior?


In addition, the expenditure feels unseemly, to put it mildly. The millions of people in the world who go to bed hungry could be nicely fed with this money we spend hopefully to correct our overeating .

Overuse of expensive interventions is a kind of selfishness, but there's something even more destructive at work: abdication of personal power, actually a reversal of the American "can-do" ethic. We're more and more assuming the role of "consumer" rather than doer. In my next blog entry, I'll make a case that consumerism may well be a form of mental illness.