The Art of Medicine

This past Friday I shadowed an orthopedic surgeon at Temple; given the occurrence that all of my doctor’s cases were mysteriously cancelled for that day, what I actually ended up doing was OR hopping, tagging along with a number of 4^th year med students and residents, which gave me a well-rounded look into a variety of surgeries.

Prior to that day, I had done a little bit of research on the procedures scheduled. The website “Knee Guru” gives includes the following in its description of a Fulkerson osteotomy:

“…surgeons may attempt to improve the stability by realigning the patella by changing the forces through the whole patellar system – what is known as extensor mechanism”

That sounds almost like art, I think incredulously. I pose that idea to the resident that I get to sit next to during the first operation of the day.

“It’s not really art as much as engineering,” he replies, and I can see his point. The orthopedic surgeon’s tools, some of which look almost like wrenches, only seem to confirm this idea.

Yet later in the day, I’m watching another surgeon meticulously whittle down the bones of a knee joint in preparation for a partial replacement, sticking the parts into the groove only to remove them again after some testing and whittle down some more, and it comes to me that there is only a fine line between the art of the craftsman and the art of a sculptor.

“Beautiful.” It comes out in almost a reverent whisper, from the resident whose shoulder I’m peering over as he looks at the before and after X-rays of an ankle reconstruction. “The fibula became a little misaligned, which is a real shame…but that ankle reconstruction is just beautiful after what it went through; Dr. So-and-so is really talented.”

And I get a sense that after the years and years of experience, there must develop an inseparable art behind it all.

Where are you from? What do you do?

“There are two things I like to ask of my patients before anything else,” Dr. G tells me. “Where are you from? What do you do?”

It may seem strange that those are the first things out of the anesthetist’s mouth, minutes before he wheels you into the operating room and literally takes your life into his hands. But it seems perfectly natural for this slightly weathered man with years of experience, who faces even a high-stakes error-in-intubation with a soothing voice and warming smile.

“It really humanizes the patient,” he explains to me on our way out. “It reminds you that this isn’t just another case, but a human being with a family, with dreams, and a life beyond this dreary hospital.”

Dr. G’s attitude and astounding bedside manners strikes home a point that’s easy to miss when you’re a fledging undergraduate yearning to create ground-shaking change in the world; as a doctor the change you create often occurs with the individual. I’m a strong believer in numbers (partly why Hopkin’s public health school motto, “Saving lives…millions at a time” appeals to me), but I think working solely at the realm of numbers leaves something to be desired. In my mind, one way to define “patient” is a “person at their most vulnerable”. It’s a lot of responsibility but there’s a lot of potential for change as well, even at that micro level. When you can walk up to someone who has been forced to drop all their defenses and somehow assure them that they don’t need those defenses at all…you seem no longer able to relegate that individual to a mere number.

Healthy Eating in Chester

This past Thursday, four Swatties met with two members of the Chester community in a small coffee shop in the ‘Ville to tackle the problem of unhealthy eating in Chester. The students were part of a course on making democracy work in America. The Chesterites were members of the DelCo Alliance, an organization devoted to environmental justice. Yet they were brought together by the topic of food, propelled by the belief that food choices are intricately tied up with environmental issues, and that only healthy citizens can have the energy and spirit to participate in local democracy.

After a dynamic session of brainstorming, we decided upon a plan to engage in a comprehensive community assessment—interviews, focus groups, observation—to elucidate some very key points about what is currently being done, what are people’s attitudes toward healthy eating, and what opportunities exist for us to craft effective programs. In doing this, we mitigated an instinctive and oft-disastrous tendency to rush into programs and interventions that waste resources and do not mould to the community’s needs and perceptions.

Apart from the lofty vision that good health equals good participation, the theories and practices concerning civic engagement explored in the classroom will doubtlessly seep into our work as this project progresses. Will we become analogous to the social institutions that Verba et al. describe, which cultivate psychological participation and serve as loci for both recruitment and development of organizing skills? Can we tap into the existing social structure, especially the countless churches in Chester that cultivate participation among the poor? Will the three resources of time, money, and skills also become necessary prerequisites for citizens of Chester before they can achieve healthy eating practices? (Time to cook meals, money to buy healthy foods, and skills to recognize healthy choices.)

Yet crucial questions remain. How can this energy be translated into productive, organized, and ultimately meaningful change? Can the tendency for the disadvantaged to care more about basic human needs and personal issues (Verba et al.) be leveraged to motivate concern for long-term health? How can we measure the impact of our actions, the ultimate assessment of what our efforts amount to: effective, replicable model or hopeless student project?

Corruption—Why Yes, It’s Everywhere

While I was in China, it seemed like almost every problem from education to healthcare could be traced back to a lack of money. And it seemed like every time there was a lack of money, the shadow of corruption was not far behind. Take, for example, the problem of expensive healthcare. The common people I talk to accuse the doctors of trying to steal their money. The doctors I talk to complain that they work long hours and don’t even make that much. So where does the money go? I ask in bewilderment. Apparently, into the hands of friends and relatives of hospital administration.

And then, people would turn around and ask me, how about corruption in the U.S.? Surely it happens just as often?

And I just didn’t know.

In a class I’m taking this year that’s looking like it will be amazing, I recently read an article about the history of Chester, PA—the “second most economically depressed city in the nation”. And you start to see an awful lot of similarities. After the loss of industry jobs, the local Republican machine started siphoning money from public funds awarded to Chester. $1,000,000 in housing rehab grants was used to pay the salaries of 20 policemen and 20 firemen. Funding for the school system is diverted into administration and not into educational programs. Chester has fallen from a thriving American city to a shithole.

And here, 10 miles away in the town with the highest educational level in the state, Swarthmore students are partying downstairs with loud music and alcohol. Makes you realize how sheltered you’ve really been. I’m grateful for the social awareness that Swarthmore supposedly nurtures in its students, but in the face of such widespread and heavily entrenched problems, I don’t think it’s enough.

Awareness is a good first step but we’re going to need some tools in our belts to help us face these problems.