Entering a New Country

Nora's in New York this morning, helping Estelle go through the next procedure in her treatment plan.  I'm not going to get into the details of it, at least partly because I don't UNDERSTAND the details of it.

Entering the world of contemporary medicine really is like visiting another country.  The habits are different—on even the simplest visit, you'll be handed off from the receptionist to a physician's assistant to the physician, in a sort of diplomatic procession from junior aide to senior staff to consul.  The language is certainly different—every trip is a vocabulary lesson, with long Latinate words like pleurodesis and whole new concepts like hazard rate (which isn't as simple as it sounds).  And the beliefs are certainly different—the idea of gluing internal body parts together sounds, on its face, as primitive as the application of leeches.  And the idea that closing off a space will prevent fluid from building up in that space certainly makes sense, but as every plumber knows, you have to shut off the supply at some point or the fluid will find another place to go.  Apparently, medicine and plumbing are NOT perfectly analogous, who knew?

When you enter the serious medical world, you find the land of specialists.  And those specialists, knowing their one body part or system far better than the other members of the team, have to negotiate an outcome which may not be optimal from their own vantage point but which serves the whole patient best.  But the specialists rarely meet now—it's all rapid exchanges of e-mails from the BlackBerry while going from one procedure to the next.  And any of you who have a smart phone know that it's not hardware that supports one being garrulous; you state your facts and move on.  So we're relying strongly on Estelle's long-time family physician to hold the center, to see her as not just pleura and effusion rates but as a whole person, and to be the ambassador between one nation and another.

We can talk about this in terms of one person with a particular illness, but really, all of us are dealing with these questions of balance between competing specialties.  I have for years focused on work to the neglect of other areas of my life.  And I never meant to do that.  But the specialties of work are more immediately demanding than the rest, at least in part because the goals are more overt and more short-term.  I knew what that accreditation report required, and I knew when it was due, and I knew that being late was not acceptable.  Neglecting your own health, or your family, or your emotional life, doesn't have the same kind of clarity of outcomes until much later.

This year has largely been about rebalancing, about defining the relative importance of the multiple aspects of our lives.  We are entering a new country.