Saturday, May 23, 2009

Richard's Underlining

     Shelia had a book on the dresser, Atul Gawande's "better, A Surgeon's Notes on Performance." I like his writing a lot, so I asked if I could borrow it. When I opened it, I found pink magic marker highlighting the pages. I knew that Richard, Shelia's husband, had made these marks and that now that Shelia's selling his books on Amazon, she always notes how much of the book is over-lined. Sometimes someone buys a book that's completely marked because it was printed ten or twenty years ago and it's hard to find, but the purchaser always knows what it's going to look like since Shelia is scrupulously honest in her descriptions.
     Before I met Shelia this week, I'd heard many stories from Susan, her friend, about Richard's long, difficult illness, about all the people who gathered around them and helped in various ways. About his fortitude and about the struggles. About his death. About that big loss.
     The first chapter of the book is "On Washing Hands," about the difficulties of controlling infectious diseases in hospital settings even in this day and age and about Gawande's tour with Deborah Yokoe, an infectious disease specialist, and Susan Marino, a microbiologist, to see the improvements, difficult as they were to make, at Brigham and Women's Hospital in Boston. 
     One of the nuggets in this chapter concerns Ignac Semmelweis, a Viennese obstretician, who realized that women who gave birth at home had a far smaller chance of dying of childbirth fever than those who had their babies in the hospital. This was in 1847.
     To quote Gawande --"Semmelweis concluded that doctors themselves were carrying the disease between patients, and he mandated that every doctor and nurse on his ward scrub with a nail brush and chlorine between patients." 
     Richard has run pink marker across the words "scrub with a nail brush and chlorine"  and then "some colleagues were even offended by his claims" and [Semmelweis] "ultimately dismissed from his job." The point that Gawande was making is that it often takes an obsessive, totally focused person to make any significant changes, but that it's better if that person is moe tactful than Semmelweis was. "It was another twenty years before Joseph Lister offered his clearer, more persuasive, and respectful pleas for antisepsis in surgery." (Richard had only marked two words, Joseph Lister, in that whole paragraph about Semmelweis' diatribes against his fellow doctors who would not follow his painfully clear instructions.)
     I like following Gawande's line of thought and I liked following Richard's markings. I felt lonely when they stopped after the first chapter. Shelia said he marked whatever he read, but that sometimes he started a book and then stopped reading it. I imagine that he was particularly interested in the specifics of this first chapter because he was undergoing so many hospital procedures and that he might not have had the intellectual energy to read the rest of it. The book was published in 2007 and he died a year and a half ago. 
     He'd noticed a lump in his neck, Shelia said, and went to the doctor who said he thought it was nothing, but to come back if it got larger. It did, but Richard didn't go back for a number of months. I can imagine how easy it was to ignore that problem. I'm more surprised when anyone rushes back to the doctor than I am when he doesn't.
     The most surprising and instructive story I've heard was from a friend who had fallen on the street and then found a lump in her breast the next day. She's just had a mammogram, so there was no reason to worry, but she went to the doctor immediately. By then the lump had disappeared so he didn't feel anything, but he said something like, well, you might as well check this out with a surgeon. The surgeon felt a thickening in her breast and sent her for an MRI. Thus, the cancer was detected and the long treatment, including two operations began.  
     I'm sure that I would never have gone to the doctor if I'd found a lump right after I'd had a good mammogram. Then, if the lump disappeared, I would have decided it was from the fall. I can't imagine that a doctor finding no lump would send me on to a surgeon.  That all seems highly unlikely, yet it happened.

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