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Black Lamb

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Now in its 14th year of publication, this magazine was created to offer the discerning reader a stimulating selection of excellent original writing. Black Lamb Review is a literate rather than a literary publication. Regular columns by writers in a variety of geographic locations and vocations are supplemented by features, reviews, articles on books and authors, and a selection of “departments,” including an acerbic advice column and a lamb recipe.

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Life & death in an age of medical miracles

April 1st, 2012

The All-Medicine Issue

BY TERRY ROSS

The reach of medicine has changed, in my lifetime, beyond all recognizing. The advent of penicillin and other antibiotics, the eradication of polio, even the demise of smallpox have occurred over the last sixty years. With these advances have come open heart surgery and other cardiac procedures, organ transplants, and entirely new ways of viewing and treating mental illnesses. We also now have ways to keep people alive almost indefinitely.

Because of these life-saving tools, we have altered our attitude to various life-ending procedures. Assisted suicide is now accepted, although controversial. And abortion is widely available, without stigma. We’ve also changed our attitude to who should decide about such forms of death. Where once doctors pronounced people terminal in their own homes, individual citizens are now routinely asked, not told, in hospitals, when to pull the plug, when to shut down the respirator.

What was once thought ghoulish — the desecration of a corpse — is now considered almost mandatory: what right have you to deny others the use of your organs once you have stopped using them? This new wrinkle on political correctness flies in the face of most religions’ views, which demand dignity for the physical receptacle of the soul of the deceased. Can it really be niggardly to deny others the use of your recently functioning entrails? Apparently so; apply for a driver’s license and watch the eyebrows of the clerk when you tell her you will not agree to be an organ donor.


This spirit of entitlement has easily extended itself — as has the welfare state — to accepting the notion that those who suffer from obesity, alcoholism, drug addiction, and other avoidable conditions ought to be treated the same as those whose diseases come upon them through no fault of their own. Despite the evidence that “curing” such “diseases” is generally futile, we still insist on the quick fix, rather than the more difficult task of repairing an economy — in fact, an entire culture — that makes such afflictions inevitable. This is equivalent to curing individual cases of cholera without removing the conditions that cause the disease, a strategy that has clearly failed in Haiti and other backward countries. The uncomfortable fact is that the quick fix mentality is a great deal more profitable for the medical industry, as Ed Goldberg points out in his article on page 3.

Nowhere is this greedy motive more evident than in the realm of medical testing. As this article is being written, the American Cancer Society, the American Board of Internal Medicine, and the American Society for Clinical Pathology — all professional organizations made up of physicians and scientists — have recently admitted, and apparently disapproved of, the health industry’s blatant overtesting.

Those recurrent pap smears, breast X-rays, prostate exams, nuclear stress tests for cardiac cases, and X-rays for lower back pain — it turns out that as many as half these procedures are routinely given to people who don’t need them and who may well be harmed by them. These patients, however dissimilar their particular conditions, simply conform to accepted “guidelines,” put in place partly to avoid malpractice suits. Don’t look for any improvement soon, say the idealistic docs who have revealed this truth; the entire hospital system of the United States is kept fiscally alive by the artificial support apparatus of these absurdly expensive tests.

Just as the oldest among us are kept alive through the “miracle” of modern medicine. I’m not talking about people on so-called “life support,” but rather the countless elderly whose inevitable retreat toward death is unnecessarily lengthened by expensive interventions. My mother, in her eighties and compromised by dementia, incontinence, and out-of-control diabetes, had a very large part of her cancerous colon removed and a colostomy installed. She lived another year, bedridden, mostly in pain, and clinically depressed by her helplessness until, mercifully, she died in her sleep. The question of whether she ought to have had the cancer operation apparently never occurred to my father. Cancer of the colon? Operate.

He was, after all, a doctor, and inclined, after his fashion, to do what could be done. Still, at the time, I regarded this is a departure for him. While I was growing up, my pediatrician dad practiced the sort of medicine that physician parents generally use with their families: the less the better, for doctors know that most ailments, if left to their depredations, eventually go away. None of us four siblings had our tonsils out. Colds and flu were allowed to run their course. Although Dad had a brief flirtation with penicillin, in time he came to think of antibiotics as a sort of court of last resort. This was wise on his part, but it doesn’t explain his concurrence in my mom’s treatment.

As for his own health, which had always been robust, my father was meticulously observant. I can attest to this as his primary care-giver for two of the last three years of his life. Not accustomed to the everyday aches and pains most of us regard as normal, Dad reacted to every form of physical discomfort as if it were life-threatening, or at least serious. This was a lifelong preoccupation, not an attitude new to his old age. For each compaint, however tiny, he insisted on seeing a specialist, not a mere “general practioner,” although he was one himself, albeit of the pediatric variety. I inevitably managed to steer him to his doctor, a generalist, who never failed to minimize my father’s concerns. Dad finally died, in a hospital, at age ninety-three, of what used to be called “the old man’s friend”: pneumonia.

Since then, as a man “of a certain age” myself, I cling to the idea of preserving my own medical prerogatives and wonder what medical science will have in store for me. If I have a heart attack (see Rod Ferrandino’s article, page 2), will I rebound? Will I be able to think, write, publish Black Lamb? If life’s not worth living (or living for), will I have 1) the wits realize it, or 2) the guts to do something about it?

I don’t know.

Ernest Hemingway’s father, a doctor, killed himself when it was clear that his diabetes and cancer were incurable. He might have done so in a fashion less awful for his family; as a physician, he could have procured the necessary poison rather than blowing his brains out in his kitchen.

But ending his life was his choice, and no one else’s. •

Posted by: The Editors
Category: All Medicine Issue, Ross | Link to this Entry

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