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When people pass around that old
chestnut that doctors can't be emotional if they want to
do their jobs properly, I always cheerfully disagree. The
thing I remember most about my obstetrician (besides his
expertise) was that he cried out in wonder, ''Oh, he's beautiful!''
when he delivered my son. During one terrible year when
I was critically ill, one of my surgeons wrote me a heartfelt
letter that strengthened me with each reading. I knew that
my doctors were as sensitive to me as they were to what
was going on with my body, that rather than stoic practitioners,
they were also deeply, emotionally, human. Maybe that's
why Danielle Ofri's ''Singular Intimacies: Becoming a
Doctor at Bellevue'' (Beacon, $24), about the emotional
life of doctors and their patients, captivated me so much.
Ofri is fascinating not just because she's an attending
physician at Bellevue, ''the oldest and craziest hospital
in the nation,'' but because she's also the cofounder and
editor in chief of the revolutionary Bellevue Literary Review.
Ofri began the journal as a way to get doctors to think
more about the role emotions play in healing. Every patient's
history, she says, is a narrative that unfolds full of surprises,
and doctors need to understand how and why each story is
part of good medical care. Discovering that someone lives
on the street means they can't change their dressings easily,
so outpatient care has to do it. Knowing that a patient's
afraid of being labeled a drug addict at work may mean he
won't take his meds during working hours, so a doctor had
better adjust the dosage.
Ofri bares her soul, from anxious-to-succeed
intern thrust into the ''slippery chaos'' of an urban hospital
to seasoned doctor determined never to treat a patient like
a statistic. Wonderfully human, she lets us see her clay
feet. She hates some patients. She screws up. In the gripping
chapter ''M & M'' (morbidity and mortality), she chronicles
the medical decisions that ended a patient's life. ''I cried
for my belief that intellect conquers all,'' she says.
It's this marriage of intellect
and emotion that makes ''Singular Intimacies'' read like
a deftly crafted and luminously written novel. Haunted by
the death of a friend, Ofri uses her grief to ensure she
always sees the person inside the patient. In one of the
book's most gripping scenes, she's stuck by a needle in
the OR and, horrified, visits the patient in a clumsy attempt
to find out if she might have contracted AIDS from her.
Ofri's fear is so palpable that she ends up being comforted
by the patient -- an encounter that's healing for both.
While Ofri interacts with all varieties
of patients on all sorts of levels, the denizens in Michael
Ruhlman's astonishing ''Walk on Water: Inside an Elite
Pediatric Surgical Unit'' (Viking, $24.95) are all babies,
who ''don't know anything else but living.'' And what's
most terrifying is that unless a doctor can repair their
walnut-size hearts -- they die.
Because Ruhlman relates the stories
here, instead of the surgeons themselves, it's a little
less intimate a read -- but no less thrilling. Ruhlman's
gotten deep inside the hearts and minds of these surgeons
to re-create the ''brutal and beautiful'' world of pediatric
surgery, focusing on Roger Mee, the surgeon who can ''walk
on water'' at the world-famous Cleveland Clinic Center for
Pediatric and Congenital Heart Disease. There's a lot at
stake here, and the language used to deal with the procedures
-- the narrative, as Ofri would call it -- is horrifying.
Pediatric surgery is so dangerous that it's described as
having a license to kill. Mee, himself, worrying over a
tiny patient, says, ''I just don't know if I'm going to
assassinate this kid.'' But in a world like this, harsh
language is necessary. ''You can't hide when you're a peds
heart surgeon,'' says one doctor. ''You know who you are
and where you stand. Because there's so much at risk, there's
no room for dishonesty.'' This is a world where the unthinkable
always happens: A mother must shake her baby -- something
associated with abuse -- to keep it alive. A newborn, taken
off life support to die, instead breathes on his own for
the first time since he was born.
The doctors here called Ruhlman
their conscience, and he doesn't shy from exploring the
ethics. ''The biggest risk factor is being admitted to the
wrong institution,'' one doctor insists. Patients don't
realize they should ask about mortality rates at different
hospitals, and hospitals, responsive to insurance companies,
often refer patients not to the best centers, but to the
nearest, with potentially devastating consequences. This,
plus the life-or-death pressure of pediatric surgery, can
make or break caring doctors. ''I never want to operate
again,'' says one weary doctor after a failed procedure.
As much as Ofri stresses the need
for doctors to feel, Ruhlman makes you understand why a
pediatric surgeon might resist. But feel these doctors do.
When babies die, says one surgeon, ''we cry and cry. The
day that I don't, I'll go back to India.''
These two incredible books make
an intense story out of medicine. Exploring this emotional
terrain doesn't just humanize doctors. I think it humanizes
patients, too, making us both more responsible for -- and
responsive to -- the healing that goes on for doctor and
patient both.
Caroline
Leavitt
Caroline Leavitt's
novel ''Girls in Trouble'' will be published in December
by St. Martin's.
This story ran on page E9
of the Boston Globe on 4/27/2003.
© Copyright
2003 Globe Newspaper Company.
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