Friday, October 05, 2007
Mrs. Roman needs her lung removed. It has become severely damaged, is chronically infected, does not aerate her blood, and is spilling bacteria into her good lung, causing life threatening pneumonia. However, she will not undergo the lung resection surgery because she believes God told her he will heal her. So she lays in her ICU bed, trusting that God (plus antibiotics) will cure abscess and empyema.
This is (to put it mildly) ill-advised. So much so that it makes me angry to think about it. Without realizing it, I have become the person I feared.
Back in medical school, we had a class on the "human context of medicine." It was our first year, we were still figuring out how to do the whole medical school thing, and for three hours every Thursday morning we sat in small groups and discussed the papers we had been required to write about a variety of topics. Death, end of life care, sexuality, culture, religion. Pretty much we talked about everything your mother told you was bad manners to discuss with strangers. The teacher for this class, who gave us weekly lectures on top of our discussion, was a militantly atheist Reform Jew, and one of his pet projects was to ensure we all kept our religious convictions out of our practice of medicine. At the time, I thought this impossible. I resented his depiction of a strictly empirical physician, admitting the presence of more than flesh and blood only when necessary to gain the trust of a patient. It was an odd, soulless compassion he taught.
But I realized today, standing next to Mrs. Roman's bed, that I have become more like that person than I knew. Through the next three years of medical school, and the first few months of internship, I have come to believe in the power of medicine. I've seen medicine heal the sick and make the lame walk. If we haven't made the blind see yet, we're working on it. More effective than any lecture or any crazy triple-board certified medical school teacher was merely living this life. And standing by that bedside, my first reaction was anger, or at least irritation, that this woman held to a ridiculous conviction that is going to kill her. I was angry that this pleasantly deluded woman didn't share my near-religious conviction in the power of medicine.
At the same time, I share her convictions, at least in part. I am a Christian, but I've never been the "let go and let God" type. I'm more a "praise the Lord and pass the ammunition" type. I figure that no matter what you think about the controversial questions in life, God has given us all a brain and hands, which we ought to put to good use. Because of faith, I allow that God could heal her. But I believe in medicine the way I believe in gravity: it just works. Of course, it works based on principles which are either impossibly serendipitous or intentionally designed, but then that truly is the religious question. Whatever the answer, it is not germane to Mrs. Roman's condition. She is waiting for a miracle, and if she does get better, that's what she'll call it, but I'm intensely skeptical of miracle claims. Remissions happen in many diseases, and we don't always have an explanation for them. It is only when they happen to religious people that they are called miracles.
So the focus on pathology and on biology has made me a skeptic and maybe a bit of an empiricist. Where that breaks down, and where I retain my faith and humanity, is in the big picture. Certainly, the only way Mrs. Roman is going to be cured is with cold steel. But if there is any point in curing her, it is more than molecular; she is more than a broken machine, and the only way to understand that is not found in Robbin's Pathology.