Well, Doc, I Must Confess...

Anytime I go to a doctor's office, a hospital or a pharmacy, I like to think of this as "fieldwork" for my area of expertise. Because I write about health care in the real world, it's important that I know what happens "on the ground" in the physicians' waiting rooms, the hospital floors and the pharmacy counter. 

Often, my contacts at the health system or the pharmaceutical company assume that processes go the way they are supposed to. However, this is one of the things I find so fascinating about medicine -- the human element always emerges. Sometimes systems can handle that, and sometimes they can't. 

I recently had surgery, and of course, I'm a better-informed-than-average patient. I scrutinized the recommendations, the doctor reviews and cross-checked whether I really needed the surgery. Having satisfied my questions, I scheduled it. Then I had to cross the incredible bridge of surgery prep. I read the "Patients' Guide to Surgery" produced by (someone like me) in the hospital marketing department. I read the handouts from my physician (even the parts crossed out by the nurse that didn't apply to me!)

And still, in this fieldwork, I found some mysteries. Why couldn't I wear nail polish? Did that include toe nail polish? I knew I couldn't eat anything after midnight, but not even tea? no water? This was arduous for a person who constantly hydrates like me. What I wanted more than instructions was the rationale. (See Gretchen Rubin's Four Tendencies -- I'm a Questioner.) I'm happy to comply when I know why! 

So I did my own searches on the internet. I asked my nurse friends and relatives. I looked at recovery yoga breathing videos. And I went in prepared. In fact, the last thing I remember before going under was talking to my nurses about all the services that my health communications company provides. #alwayshustling

But, not everyone asks the questions, even if they want to. And more importantly, how many people don't follow the instructions because they didn't read them, they didn't understand them or they fibbed about when they did them?

The answer to the nail polish question is: it can interfere with the pulse oximeter, so you need ONE nail free of polish, and it doesn't apply to the toes. 

The answer to the water question is more complicated. It's to avoid aspiration of food particles or liquid into the lungs while under anesthesia. But there's some controversy over whether two hours prior is enough time. More on that as the research evolves. 

This week, I interviewed a surgeon about the very same type of surgery that I had last week. I thought maybe I could just not mention it, but turns out -- I had to, because I have what's known in the industry as "lived experience." This is one of the most interesting challenges for medicine today, I think -- the integration of clinical knowledge and procedures with how things actually work in the real world. It's a constant striving to make things optimal (the cleanest incision, the tightest margins, the fastest recovery) while acknowledging that everyone has their own particular situation (their health history, their phobias, their home environment.) 

I'm happy to continue my fieldwork, but let's hope it's all outside the operating room for awhile!

The Emperor of All Maladies

The book, The Emperor of All Maladies by Siddhartha Mukherjee, was a rarity in it's history, breadth and insight into cancer. In fact, it's cleverly subheaded "A Biography" as if cancer is a single unit with an identity. I enthusiastically recommended it to people, who gave me odd looks I guess because why would they want to read a big book about cancer?

I'm surprised by how the film by Ken Burns and Barak Goodman changes the experience of consuming the information in a different way. Seeing the cancer patients is so much different than reading about them. The interviews with patients and doctors bring home so much more sharply how it feels to be fighting this beast. Like in episode two, a surgical oncologist undergoing surgery for breast cancer with her fellowship mentor. 

Another very effective use of film as a medium is the news clips. How we fight cancer has been controversial, and I think that is often overlooked. We might all want to cure it, but the road to get there has been full of misguided attempts and battles of ego. At one point, everyone thought things like high dose chemotherapy, radical mastectomies and deeper margins were the way to go -- basically overwhelming the systems to the highest degree possible without killing the patient. 

What I think is important about this history is that we need to look back and see that while our  knowledge was good, it was incomplete. Or it was based on bad assumptions. So, I see it as a call to look up, think differently and collaborate -- that's what's needed for us to move in one direction.