Physician by Kurapati Rajeev

Author:Kurapati Rajeev
Language: eng
Format: epub, pdf
ISBN: 9781632991461
Publisher: River Grove Books
Published: 2018-03-15T04:00:00+00:00

CHAPTER 12

HOW DOCTORS LOST THE NARRATIVE

In examining disease, we gain wisdom about anatomy and physiology and biology. In examining the person with disease, we gain wisdom about life.

—OLIVER SACKS

Taceant colloquia. Effugiat risus. Hic locus est ubi mors gaudet succurrere vitae.

Let conversation cease, let laughter flee.

This is the place where death delights to help the living.

—GIOVANNI MORGAGNI, EIGHTEENTH-CENTURY ANATOMIST

With a heart functioning at only 30 percent, 63-year-old Maria Frances was admitted to the hospital where I worked with congestive heart failure and chronic obstructive pulmonary disease (COPD). Her health was deteriorating, and she was close to depending on an oxygen tank 24/7 in order to breathe.

Her three adult children sat by her side, concerned but frustrated. When I asked Maria about her latest symptoms, her son, a 35-year-old paramedic, sighed. “It’s her drinking.” Maria’s heart doctor had diagnosed her recently with alcoholic cardiomyopathy—heart failure due to long-term alcohol abuse.

“And we asked her to quit smoking, but it doesn’t matter—she does it anyway,” her eldest daughter added, looking away as she spoke, clearly exhausted from years of not being heard.

The reality, though, is that sometimes we choose to participate in unhealthy behaviors even when we’re aware of the consequences, or despite wanting to stop. I kept a neutral tone when I asked Maria why she continued to drink and smoke.

“I’m stressed at work,” she answered, “so I’ll come home and drink a few beers. Three, four maybe. I’ll have a few cigarettes throughout the evening, then try to get some sleep.” She seemed slightly embarrassed to reveal her vices. Behind her, Maria’s daughter rolled her eyes and signaled to me that this was just the tip of the iceberg, and the other two children nodded in agreement. Their mother’s drinking, they suggested, was far worse than she was letting on.

Maria continued, “I hardly get much sleep.” She worked as the manager of a department store, and she cited increasing demands at her job as the primary instigator of her unhealthy lifestyle choices. Even though her children resided nearby, she lived alone.

I suspected there was more to the story. No matter what treatment options we were able to offer, until we could uncover what was driving Maria’s choices, her physical health would continue to spiral.

The next day during my visit, Maria was alone, without the pressure of her children listening in. Her breathing was better, and she was hopeful that a release from the hospital was within reach and she could get back to her routines.

I asked her the same question from the previous day, but in a slightly different tone: “Tell me why the drinking and smoking?” This time, her response unfolded a bigger picture, putting her habits and health into perspective.

When Maria was 23, she had given birth to her first child. Around that same time, her husband experienced a ruptured brain aneurysm, requiring major surgery. Young, scared, and overwhelmed, Maria turned to the occasional drink to cope. Two years later, smoking entered the picture, and two children followed soon after.

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