Department of Medicine
Con necting Tec h n olog y, Educ a tion a n d D iscov e r y w i t h H u m a n i s m i n M e d i ci ne
Vol. 2 Issue 4 October 2013
A Perspective On Healing
Soon after I came home to practice, a close friend of my parents asked me to assume his care. I knew him well enough that I had concerns about whether I could be objective, but reluctantly agreed when he said, “Objective is what I got from that other doctor.” He lived for six months after that discussion. His cancer grew through chemotherapy. He had a horrendous paraneoplastic clotting syndrome. He often called me at night or in the early morning, complaining of pain that was “all over” or “deep inside” or “indescribable.” I never felt as if I understood it, much less controlled it despite the liberal use of powerful opioids. Once, when he was vomiting his pills and delirious with pain, I admitted him to the hospital to manage his symptoms. When I rounded the following morning, I found him sitting up in bed, lucid, talking to his brother about his business and how to dispose of it after his death. We had our first conversation in months without his symptoms being the centerpiece of the discussion. His brother later told me that the chaplain had visited earlier. My patient shared with him an experience during WWII that had burdened him for half a century, something he couldn’t share with me. He’d found some measure of peace after they talked, and I started to understand that there is a difference in curing and healing. Even though medicine is a healing profession, the word “heal” is rarely used in the context of medical care. Maybe it’s because healing carries with it a spiritual connotation. “To make whole” doesn’t fit into a treatment algorithm. It doesn’t work as a core measure. The mystery of it can’t be explained in scientific terms. We are much more comfortable with the word “cure.” The discomfort with anything not evidence-based has come to characterize internal medicine. In the pursuit of biologic plausibility, scientists have amassed a formidable library of new and evolving information about the biology of neoplasia, atherosclerosis, Alzheimer’s
The Healing Garden at UT Medical Center
and more. Some diseases are now identified by genotype rather than phenotype. There are meaningful treatments for previously untreatable ailments, some aimed at molecular targets. It is reasonable to expect that someday cancer will be managed like hypertension, without regard for its etiology, controlled with a pill or two taken daily with breakfast. Even with all these breathtaking advances, people continue to die. Surgeons replace arthritic joints, but they don’t reverse the ravages of osteoarthritis. Better drugs and minimally invasive procedures dramatically enhance our ability to help patients live longer and better lives, but they ignore the spiritual, emotional and psychological aspects of suffering. The essence of medicine is palliative care at its best. It is a blend of evidence-based treatment balanced with concern for the person and the context in which they suffer. It’s the recognition that the mysteries in medicine, if left untended, can thwart the most elegant treatment plan.
Points of View
Rajiv Dhand, M.D., Chair
Back in the sanctuary of my office after a long and hectic day of caring for patients, I have a feeling of disquiet, like a lone grey cloud hanging in an otherwise clear blue summer sky. On further reflection, I marvel at the complexity and diversity of illnesses that physicians encounter on a daily basis. Finding the right answers and treatments for a wide variety of problems--for each patient is unique and presents a different set of challenges-makes the practice of medicine such a meaningful profession. Imparting these experiences, and the knowledge they
bring, to students and residents is even more gratifying. Then, why the unease, I wonder? Every teaching physician’s life is stressed because of a host of rules and regulations controlling the number of hours a resident may spend in the hospital and the number of days that they are off each week. With each passing year, the clinician’s focus has shifted from an emphasis on teaching to ensuring that trainees are relieved of their clinical responsibilities and leave the hospital in a timely manner. Traditional team-based bedside teaching is rapidly becoming a relic of the past. Each patient encounter in the clinic has become a battle with a metronome that regulates the time “allocated” to each patient and whose cadence increasingly governs each day. Couple that with a larger number of patients, greater complexity of problems, and heightened expectations, and there’s a recipe for dissatisfaction at all levels. Truly, there are no winners in this constant race against the clock! 1