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GP 26 July 2006: Good Morning, Heartache

Heartache.  Lady Day, the pained and powerful singer other crooners could only hope to imitate, had a song that told of lost lovers, the existential pain of life, and, not least, the agony of unrelenting illness called “Good Morning, Heartache”

Good morning heartache
You old gloomy sight
Good morning heartache
Thought we said goodbye last night
I turned and tossed until it seemed you were gone
But here you are with the dawn

Wish I’d forget you, but you're here to stay
It seems I met you
When my love went away
Now everyday I start by saying to you
Good morning heartache, what’s new? 

Whatever the origin, it’s something to live with pain every day.  We must admire those who can endure and then talk their way through it. 

Anatomy of an Illness.   Almost from the beginning, the gods made clear that Norman Cousins was an extraordinary fellow, all the more so since he, too, would suffer greatly. Journalist, author, professor, and advocate for World Government, he carried his message to every podium in the country.  You could not utter the words World Federalist and think of anybody but him.  As deftly, forcefully, but peacefully as anyone, he worked for peace and nuclear commonsense. 

But, ironically, he is much better remembered and achieved wider prominence for his battles with disease.  “At age 11, he was misdiagnosed with tuberculosis and placed in a sanatorium.”  During the course of his life, he battled serious illness, to include heart disease and arthritis, on 3 occasions: he was a 3-time loser, but a 3-time winner.  No doctor ever suspected he would live to the ripe old age of 85.  Through it all, he put out the Saturday Review of Literature, a balanced effort, free of the axe-to-grind mentality that dominates today’s book and literary reviews, carrying it from a circulation of 20,000 to 650,000.  It’s hard to believe it’s gone now. 

Anatomy of an Illness is an account of his encounter and victory over his collagen disease, an encounter which later was made into a TV movie of the same name starring Ed Asner.  Later on, he recounted his affair (illness) of the heart in The Healing Heart: Antidotes to Panic and Helplessness.  His true grit comes up time and again: “Death is not the greatest loss in life.  The greatest loss is what dies inside us while we live.”  “The more serious the illness, the more important it is for you to fight back, mobilizing all your resources-spiritual, emotional, intellectual, physical.” 

The Sickness of Medicine.  As we have said elsewhere, healthcare is chewing up 15% of our national product, and it’s not particularly making us healthy or healthier.  Reasonable scientists estimate that perhaps 30% of the care rendered in America is unnecessary and sometimes downright harmful.  Preventive medicine, the answer to all of it, is in a shambles.  Those with chronic conditions who must be constantly attended to—outside the hospital—are receiving spotty help at best.  As consultants to a bunch of healthcare companies, we puzzle how to put Humpty Dumpty together again. 

Such a system tends to turn doctors into mechanics.  A vivid account of how a doctor can turn into a production line automaton is found in Robert S. Rosson’s “Confessions of a Recovering Endoscopist”

You might say I did it for the money, but that is blatantly untrue.  With the squeeze on reimbursements by Medicare and the HMO’s, it was clear that one could make more by grinding patients out in the office.  It was more of a silent, sneaky addiction that crept up on me forcing me to do more and more procedures at the expense of my health, sanity and personal life. 

I decided to try to taper, to withdraw slowly.  For the next 2 years, I cut back my hours, went off emergency call and gave up ERCP.  The attempt failed.  With the advent of screening colonoscopy for everyone, I found myself doing more than ever and liking them less.  Finally I decided to go “cold turkey.”  I retired from active practice and limited my professional activities to seeing GI consultations one morning a week and teaching medical students a second morning. 

I am now a new person, freed at last from the curse of endoscopy.  I have time for my family and for new non-medical pursuits.  I spend an hour with my new patients, taking a thorough history and doing a complete physical examination.  I realize now that this is what I enjoyed most about medical practice through the years.  I welcome the chance to find out about a patient’s family, work and interests.  I have rediscovered the fact that a good history makes most endoscopy, laboratory tests and imaging studies unnecessary, or at best confirmatory. 

With our medical system so awry, we need physicians who consciously swim upstream, fight the tendency to churn our procedures and pills, and understand thoroughly the humanistic dimensions of their art.  Patients with critical illnesses who endure heartache day after day require artists first, plumbers second. 

We should note that the Yale School of Medicine, over the years, has paid more attention than most to the empathetic aspects of medicine.  Some of its physicians have authored books that make common cause with the layman and the patient.  In this regard, we recommend the Yale Journal for Humanities in Medicine, which you can find online.  It hints at one direction the medical system must take to heal itself.  It must do better at the heartache. 

Installment Three.  Another Day, Stephanie Day, is chronicling for us her duel with breast cancer.  Our readers have been writing, asking how she is doing, wondering when they are going to hear from her next.  She’s alive and kickin’ and kickin.’  In this 100-degree weather, we particularly like one of her tips and are thinking of checking into a hospital for a fluid change: 

Tip #14: Blood transfusions can make you feel like a million bucks.  I felt rejuvenated when I left the hospital.  If your doctor recommends one, do it and do not be afraid. 

At any rate, finish year one with Stephanie in her account “Surviving a Mastectomy.” 

P.S.  Make sure you click the “Good Morning, Heartache” title above, since you will get a chance to hear Lady Day sing.  You’ll feel better.

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