Friday, September 6, 2013
Cheating Death by Dr. Sanjay Gupta
by Dr. Sanjay Gupta
Wellness Central, 2009
I do so love my adult book club. I was pretty scared of it at first, when I started running it around three years ago. I didn't know anything about book clubs. I didn't really want to read books that I thought book clubs read. Luckily, I had stumbled upon leading a book club that didn't want to read those books either. Now we read everything we can agree might be somewhat interesting.
This was certainly interesting, and those of us who are science wonks (there are thankfully a couple of us now!) really enjoyed the experience. Others were rather meh on the book, but we have come to accept that there are very few books in the world that the entire group is going to like, no matter how excellent those books may be (one recent exception: To Say Nothing of the Dog by Connie Willis.) We did have some great discussion mostly tangential to the book, regarding medical ethics.
Ah, but how did I do with it, you ask? This is indeed my blog about me, so here we go.
I quite enjoyed it for the most part, in that it was a series of interesting facts and stories well-told. Gupta knows how to tell a story, and he knows how to make statistics (which are few and far between in this book) and medical jargon accessible. His chapter about fetal surgery had me literally on the edge of my seat, my heart pounding and my mouth dry. I suspect this is more than just Gupta's ability to tell the story, though he's certainly extremely adept. But two years out from my own very medical experience with a baby that should have stayed a fetus for longer than she did, I think that I still have a lot of emotional baggage when it comes to anything involving infants and/or their parents in less-than-ideal situations. (My own is now a very speedy toddler, and doing just fine.)
I was also captivated particularly by two of the first chapters, a chapter about therapeutic hypothermia and another about CPR without the artificial respiration. I've been trying to figure out why these chapters were so much more interesting to me than the rest of the book, and I think it's because they were particularly strong at outlining the practical treatment, the case for using it, the people involved in researching it, the hurdles the treatments face to becoming accepted and then standard practice, and then people who have benefited from the treatments. Not necessarily in that order, but wound around each other in such a way as to make a good story and still deliver the facts. Many of the other chapters I found a little less captivating, though still very interesting; I think this was because of the fact that they were either about treatments or phenomena still in the very early stages of testing, or because of something that triggered the medical ethics discussion at my book club.
There are two chapters specifically -- one about a patient who was seemingly headed straight for brain death, and another about a couple of patients with cancers that should have been lethal -- that seemed... good, but not perfect. They were good, because in all fairness to Dr. Gupta, he makes sure to state that we don't quite understand what happened and that these are vanishingly rare cases (though he perhaps doesn't make either point quite strongly enough.) He makes sure they are cases that are rigorously documented, and he also seems to argue that patients and their families must fight for the best care possible. I think this is all good. The part where I got a little uncomfortable was the feeling that... well, a) most people don't have $2 million lying around or even have the hopes of raising it, to get their loved ones the best, most cutting edge treatment available; b) there is so little information on why these particular few, out of the thousands of people in similar situations or with the same conditions, were able to survive; and c) there are lots of good reasons, physically and emotionally, for not trying absolutely everything to survive when the odds are so drastically bad, and for compassionate doctors to let people know the truth rather than fidgeting around the difficult answers.
People in situations with loved ones in comas or with inoperable brain tumours are extremely vulnerable. I can't even imagine what would happen to me in one of those situations. I honestly try not to think about it too much because I am perfectly capable of making myself weep just by imagining it. I want doctors in that situation to be totally up front and honest. I don't want them to give up because their case load is so heavy, or because they don't feel up to the challenge -- one gets the impression that Dr. Gupta feels this is a problem, and if so that's worrisome -- but if they honestly and truly tell me they don't believe there is anything that can be done and also offer a good chance of a high quality of life post-treatment -- I want to know that. I want to know I can trust that information, and I want to know that I'm not prolonging pain or suffering, or going to end up with a loved one who can't swallow their own food due to brain damage that may or may not be reversible. What I'm saying is that I think there is a tendency in human nature to grasp at any straws, and I don't want to be given false hope.
This is where the ethics comes in: is it in a patient's best interest for a doctor to tell him about the one-in-a-million case who survived an extremely aggressive cancer for twelve years when given three months, with help from a treatment that he/she may not be able to get, much less benefit from? What about if that treatment is available, but might make your last three months -- maybe four or five with the treatment, maybe longer if you're really lucky -- complete hell because of side effects? Is it fair to tell the wife of the terminal coma patient that once someone did come out of it, and walks around with a normal life treating his own patients at a rehab centre today, and no one knows why or exactly what happened? (What wife in their right mind would pull the plug after that? Not me.) Could you live with the what-if?
Which is not to say that Sanjay Gupta shouldn't write about those things. These are cases we should be studying. I just wish that in his effort to popularize the information, and to gently suggest that people advocate better for their own health care, he had also made it more clear that these are such rare outliers, that there isn't some sort of treatment plan that your loved one just isn't getting because of physician stubbornness or laziness, or government red tape. I think that having the information -- knowing, for example, that the brain is an amazingly plastic organ that can totally reorganize itself, given the chance and lots of time to heal -- is crucial, because it contributes to a patient being able to have a full and complete discussion with health professionals. On the other hand, I think suggesting that the problem is that doctors give up too easily, as one of his subjects seems to, is going a bit too far.
I'm not even going to get into some of my other thoughts related to the chapter on near death experiences (aside from the thought that I wasn't quite sure what it was doing in the book, other than it had to do with death) wherein I wish to discuss, as related to Karen Armstrong's A Short History of Myth, whether or not there are places science can't always provide all the answers. Pretty conflicted on this question, too, frankly. I was a bit surprised to find myself on the "I am not sure I want to know the mechanics of this" side of the line.
So if nothing else, this book gave me an awful lot to think about. The reading experience was easy and mostly pleasant, fascinating and a bit like brain candy for a science junkie like me. It's very clear to see why Sanjay Gupta is considered one of the best popularizers of medical science in the English language. Recommended, but maybe don't swallow Gupta's enthusiasm without a grain or two of salt.