I hate doctors. Hate. Them.
The whole thing about Serene Branson, the CBS reporter who suffered what looked like an on-air stroke but turned out to be a severe form of a migraine just takes me right back to how much I hate doctors. Serene Branson did not die. My brother did. I am enraged that the arrogance and god-complexes, incompetences and assumptions by a string of doctors killed my brother. They all consistently misdiagnosed a blood clot as a migraine.
No one can talk me out of this. Doesn't feel like grief. Feels like rage.
But a blog I just accidentally found – written by a doctor who seems bent on bridging gaps between doctors and patients – may start to write me out of my rage. Or at least it's challenging some assumptions I'm white-knucklingly holding onto.
We all love Dr. Jerome Groopman – author of bestselling "How Doctors Think," and one of the few docs who publicly and bravely admits mistakes, and says medical science is also an art. The rest of what we hear from medical professionals is certainty, dismissiveness or silence. There have been lots of scholarly journal articles and medical conferences about how admitting mistakes and apologizing to patients dramatically reduces the chances of a lawsuit.
And I know there has been a lot of publicity about the enormity and egregiousness of medical mistakes and how the secrecy and lack of accountability around them has caused a culture that stymies progress and change and prevents important conversations and learning. Once there's been a screw up the 'risk management' team takes over and doctors are no longer allowed to speak to patients, even those they have treated for decades.
A study released last year by the Office of the Inspector General (OIG) found that one in seven Medicare patients were harmed by the care they received in the hospital and that hospital patients are harmed much more frequently than previously estimated. The study calls for mandatory validated public reporting of medical errors, according to Consumers Union, the nonprofit publisher of Consumer Reports. Another study found the cost of medical errors is about $195 billion.
A lot of good doctors and nurses say there are systemic reasons for these errors and that they are under tremendous pressures that increase while staffing and resources decrease. There are insane six-minute limits on how long doctors can see patients and that while it's recommended to get a detailed history you cannot do an exam and ask questions adequately.
I know all of this is going on. I still hate them. Because regardless of all the good impulses, way too often you go to a doctor who sees only your isolated symptoms and misses the person – and too often the real disease – too often. And please do not get me started on surgeons.
So it was with great closed-mindedness and a deep attachment to my rage that I unwittingly stumbled upon a blog in The New York Times by a doctor named Danielle Ofri that stopped me cold. The particular post was called "A Doctor at the Funeral," and it just slayed me. I don't know why, really. It wasn't about how she screwed anything up and is now really sorry – which is the kind of thing you'd think I'd go for. Remorse, self-loathing, humiliation. No, this is just a doctor's meditation on losing a patient and what she was thinking and feeling and her deep wish for a different outcome. Doctors always talk in outcomes. Maybe it's that she describes getting news of the patient's death as like a 'sucker-punch in the gut…' The humanity of that response feels so different from my experience during our brief and brutal excursion into the deepest pit of medical hell.
Turns out Dr. Ofri is not only a thoughtful doctor but a caring writer and chronicler of her experiences. According to the note the end end of her blog, Danielle Ofri is an internist at Bellevue Hospital in New York City and editor-in-chief of the Bellevue Literary Review. Her most recent book, "Medicine in Translation: Journeys With My Patients," is about the care of immigrants and Americans in the United States health care system.
Here's the beginning of the blog post that knocked my rage between the eyes and may just start to help me see more clearly.
A Doctor at the Funeral
Death is a given in medicine. That truism, though, doesn't offer much comfort when it's your patient who has died. I was in clinic the other day, showing the ropes to a fresh-faced medical student, when a nurse leaned toward me and whispered that L.W. had died over the holiday weekend.
It was like a sucker-punch in the gut, the raw rope of grief lashing out unexpectedly. L.W. had been an employee of our hospital for 30 years. Two years ago, when we were working together on the cardiac ward, she asked me shyly if I could be her doctor. "I haven't had a checkup in years," she confessed, "but I'm planning to retire next year when I turn 55, so I should probably do one now."
L.W. was a healthy, energetic woman, coming to me for a routine visit. The path to colon cancer was jarringly swift and wholly unexpected. And now her death — in the midst of treatment for the cancer — was even more unexpected. An autopsy was not done, so I couldn't know if her death was directly from the cancer, from one of the complications of cancer, from one of the complications of treatments for cancer, or from some other random horrible event.
But knowing the immediate cause of death wouldn't change much. Reason would do little to loosen the coarse knot in my gut as I slouched in the hard plastic seat on the way to the funeral, the train snaking into a distant neighborhood far from my hospital. Etiologies and pathophysiology satisfy only one part of medicine. They don't edge into the other side."
Kind words written by doctors are good medicine, too
I found it healing to read this, and a lot of her other posts. It's like hearing an entirely different, human, humane side of the medical profession. I hope you do, too. If you've been brutalized by the medical industrial complex or dismissed or misdiagnosed or mistreated or unheard or in any way ill-served by the folks who've sworn an oath to first, do no harm, read Dr. Ofri's essay and see that her words, and maybe two aspirin, help a tiny bit of the pain go away.
Here are more thoughts on Grief and Healing: