Friday, February 6, 2009

Zé posted this in his blog, I copied and I am posting it is a bit long but he was inspired ;)

Elsa has been reading, and sharing with me, a book by Susan Sontag's son, where he describes his mother's ordeal in her last stages of dealing with cancer. This, combined with the recent passing away, also from cancer, of a dear cousin, and the different ways each dealt with, what turns out is a a similar take on a terminal condition, prompted a short but I think very insightful conversation today.

This morning Elsa told me that she understands why when people face a terminal condition they sometimes seek the intervention of faith healers and the like. Her thought is that for many people, rather than suffer the agony of certain death with an uncertain timeline, they choose to keep hope alive, to believe that, until it is literally impossible to do so, there is the possibility of changing their situation. Although some do it by continuing to press for medical treatment and others by seeking a faith based healing alternative, what is common is the unwillingness to give up. Contrary to those who resign themselves to waiting for death.
One particular insight that she shared, concerns the role of doctors in making a patient feel better. The thinking is that many doctors are trained to administer medical treatments to patients, but falter when those are no longer working, or they think they will no longer work. When this situation arises, when they put their patients on palliative care, for a patient who does not want to spend the last days consumed by depressive thoughts of impending doom, such course of action is of no use. At that stage, people who do not believe in giving up, who do not want to wallow away the last days consumed by desperation, may turn to the only people which offer a solution (hope)- priests or faith healers, or even a combination.

The way Elsa sees it, this should not be this way. Dealing with a patient until the end, offering hope until the end, should be the purview of every doctor. And it makes sense, I think. The fact is that every medical treatment, every surgery or procedure is without guarantee. People can unpredictably survive the most harrowing of situations and they can unpredictably die from the most innocuous of procedures. In between, there is a vast field of situations where survival or death occur with a fair degree of predictability. The common thread is, however, uncertainty. There is never a one hundred percent level of certainty. For this reason, patients should never be abandoned.

Elsa describes vividly, situations where a doctor's touch, or words, completely changed how she felt at a particular point in time. She points out an instance in one of her initial surgeries, when she woke up in a state of agitation, which was exacerbated by the inability of the doctors and nurses in the intensive care area, at Memorial Sloan-Kettering, to realize that no medication could resolve her situation. Then her surgeon, Dr. Brennan, came in and with a simple touch and a few words, resolved what a room full of doctors, nurses and very expensive technology could not do. Did not know how to do. Another time, this time in Boston, she had an unusual and particularly hard time after surgery. Her surgeon had to go away immediately after operating on Elsa, and she was left under the care of a team of doctors, who unfortunately could not deal very well with Elsa's post-surgical situation. She could not eat, she was connected to tubes, some doctors speculated that she may never be able to eat again. The situation deteriorated, to the brink of despair, until an intern, from Iceland, seemed to detach herself from the obvious dead end experienced by the other interns and as a human being, as if with magic, talked to Elsa and offered her a way out of the rut she was in. On yet another occasion, surgery coincided with Maya's birthday. Maya had been asking for over a year for Elsa not to miss her birthday. Still it could not be avoided so the disappointment sent Elsa into a depression. Elsa's surgeon, Dr. Bertagnoli, heard about it, and made a point to, very late in the day, just before she left to her family, came in to give Elsa a hug, a kiss, to talk about the surgery- to provide some true caring. Enough of a gesture to immediately turn the situation around.

My thought here is that doctors are not being trained fully. There is a missing component that some learn, or apply on their own, but that the vast majority misses, maybe because it is not taught, or maybe even, worse, because it is untaught in medical school.

The point is that there is a dimension of interaction, a missing component of care, which doctors are missing; and that faith healers are offering.

My theory is that back in the old days, faith healers, priests and the like, were the ones offering people relief from what ailed them. Medicine eventually proved much better adept at providing this relief and displaced the original providers. But not completely. Why not? Because medicine short circuits itself by dis-considering that mainly non-physical component of need, of relief, which people have, but which doctors are not trained, or are perhaps even dis-trained, to provide. And because medicine does not provide it, priests, faith healers, and the like, fill the void. In other words, doctors and medicine fail for not considering all of the human being and all of it's human needs.

It should not be so.


tapioca said...

assino por baixo.
Os médicos não são treinados para isso, só o físico é importante como se as pessoas fossem peças de um puzzle. É preciso ter-se uma grande sensibilidade para saber dizer ou fazer (o tal beijo e abraço) o necessário no momento exacto.
Um beijinho

Pipas said...

O post do zé, que me emocionou muito, só veio reforçar a vontade de ver um livro teu publicado, escreve-o com a ajuda do Zé. Vais ajudar muita gente ...encara isso como uma missão. Além de que escrever é uma terapia e tu (e o zé) fazem-no como ninguém. Fico à espera. Adoro-te Pipas