Wednesday, February 26, 2014

In Sickness As In Health

I've just read an excellent book called In Sickness As In Health: Helping couples cope with the complexities of illness, by Barbara Kivowitz and Roanne Weisman.  I recommend it highly. It serves an an excellent reference to people who find they have to deal with the acute or chronic illness of one of the partners in a marriage or other close relationship.  Beyond exploring the three phases of such situations--crisis, balancing act, and regaining equilibrium--it offers thoughtful commentary about a lot of related issues. 

There was one that I found particularly perceptive.  You've been informed by your doctor that something bad has occurred, and s/he offers a prognosis for the illness and thereby implies what it is likely to mean for the physical or mental functionality of the patient.  As the partner, you take this to be true:

All their normal coping skills remain on planet Earth even as they have to immediately learn to breathe in this new atmosphere.  In this unhinged state, they naturally seek a powerful guide, and typically grant omniscient status to the doctor.

The doctor becomes the orientation point in this new and frightening universe.  Her words signify more than educated opinion; they become oracular.

It is not unusual, in the aftershock of diagnosis, for patients and their partners to either submit silently to the sentence or pummel the doctor with questions as they desparately seek loopholes through which they can squeeze their fading hopes.  The doctor remains the focal point. Her words at this delicate moment . . . can have fateful impact.

This a superb observation, and the authors quickly explain the fallacy.  The doctor, after all, is making judgments based on personal experience, observation, and general statistics about the illness--but cannot actually predict the course of your particular illness.  What the authors call a "healing doctor," though, will:

call on his own humility and acknowledge that while death or disability are possible, he can't write your next chapters or know the exact trajectory of your illiness.  Healing is being present and promoting hope while presenting the medical perspective, and, at the same time, acknowledging the patient's fears with compassion.

So, how ironic and telling that a book designed to help couples is also an advisory to doctors who serve for and care for those couples!  My advice is that this book should be read by physicians as well as those of us who might need it for our families.


Stephen Borstelmann MD said...


Thanks for sharing. I became educated to the difference between caring and healing a few years back. Allopaths can be so focused on “the cure” that when a chronic or uncurable condition presents with limited or poor treatment options, the physician may look at the patient as a “treatment failure” and feel hostility towards the patient or internalize frustration and blame him or herself.

Offering physicians the option to be “healers” allows them to practice a more global level of care (and in my opinion, better) where they acknowledge their limitations. It doesn’t give them a pass to perform inadequate care and cover up with social skills (the incompetent Dr. Feelgood cliché), but it does allow them to reach out past pathophysiology and exercise compassion and thereby heal – even if they cannot cure.

Spouses who are dealing with a serious chronic illness may be blindsided by the diagnosis and have a different reaction and pathway to coping than their ill partner. Healing of that spouse may be necessary too.

Years ago as an extern in Boston, I had gone to the mecca to work under a famed neurosurgeon, wanting to model myself after the best of the best. It was a long day in the OR and we were rounding with the patriarch of the department. It was late. We were all bone-tired.

He entered the room of the patient in which he had tried to completely extirpate a malignancy, but backed off from – to do so would compromise the patient unacceptably. The patient, a woman, asked him if this was it – if she was going to die. He looked at her, and in a soft voice said yes. She started to cry.

Then this man of 60+ years experience, countless publications, a golden reputation. He then walked over to his patient, sat down on the edge of the bed, and put his arm around her to comfort her as she wept. He held her until she stopped.

My conclusion? If the best have time for compassion, the rest of us do too. I believe he was healing her, even when he was unable to cure her. The lesson was powerful, and has stayed with me.

Paul Levy said...

Lovely, Stephen. Thank you.

e-Patient Dave said...

Late to the party here -

> the physician may look at the patient as a “treatment failure”

Remember the best thing Patch Adams ever said:

“You treat a disease, you win, you lose. You treat a person, I’ll guarantee you’ll win.”