Wednesday, March 21, 2012

Doctors' dilemmas

One recurring thought that I had while reading The Emperor Of All Maladies: A Biography Of Cancer by Siddhartha Mukherjee was about how doctors dealt with all the sights and sounds of misery, pain and death all around them. One of the main characters in the book, Sidney Farber, is described by Medical World News thus - 'Sidney Farber’s entire purpose consists only of “hopeless cases”.' The author of the book (you can listen to him talk about the book) writes about the time when he faced such dilemmas:
The stories of my patients consumed me, and the decisions that I made haunted me. Was it worthwhile continuing yet another round of chemotherapy on a sixty-six-year-old pharmacist with lung cancer who had failed all other drugs? Was it better to try a tested and potent combination of drugs on a twenty-six-year-old woman with Hodgkin’s disease and risk losing her fertility, or to choose a more experimental combination that might spare it? Should a Spanish-speaking mother of three with colon cancer be enrolled in a new clinical trial when she can barely read the formal and inscrutable language of the consent forms?
I wonder how doctors deal with such dilemmas on a daily basis. I sometimes have to go to the casualty ward of a hospital for getting the tracheostomy tube changed and I shudder when hearing the screams of patients on whom some emergency procedure is being performed. Doctors will be encountering such scenes every day. There must be some psychological mechanisms that must be kicking in that enables them to deal with such traumatic scenes everyday. I read an interesting piece about the struggles that doctors face. Here is another piece about when a patient is ready to talk about death, but a medical student is not.

Apart from giving an account of the various approaches used to treat cancer, the book also tells about the problems faced by the doctors and patients during the early days of surgery. At that time there were two major difficulties. The first was that the patients had to endure immense pain during surgery because there was no anaesthesia. The second was the problem of infection after the surgery. Nobody knew what caused the infection. There is a description of a typical operation theatre of those days:
At Bellevue, the “internes” ran about in corridors with “pus-pails”, the bodily drippings of patients spilling out of them. Surgical sutures were made of catgut, sharpened with spit, and let to hang from incisions into the open air. Surgeons walked around with their scalpels dangling from their pockets. If a tool fell on the blood-soiled floor, it was dusted off and inserted back into the pocket – or into the body of the patient on the operating table.
That looks like a scene from a horror movie.

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