Our society thrives on tension and competition.
- GOP vs Democrats
- Civil Libertarians vs Eavesdroppers
- Ohio State vs Michigan
- Creationists vs Darwinists
Ideas, like sports teams, compete to win. We are the referees of these contests. Many of these competitions in the public square are ongoing. Some of these duels are locked in a dead heat. Others are in overtime. Some are ‘challenge matches’ when a vanquished idea wants another shot to change the original outcome. Many of these controversies may never be resolved.
In addition, the outcomes may change because we – the referees – have changed. What was considered to be a foul years ago may now be regarded as fair play.
The medical profession is riddled with many internal conflicts that will not be easily resolved. Here are a few, and I’m sure readers could add generously to the list.
- Primary Care vs Medical Specialists
- Physicians vs Insurance Companies
- Obstetricians vs Medical Malpractice Attorneys
- Fee-for-Service vs Salaried Medicine
- Evidence-Based Medicine vs Alternative Medicine
A patient I saw some months ago in the hospital illustrated another conflict that we physicians face, from time to time. Although the case was a typical case of internal bleeding, it could be classified as a Case of Faith vs Reason. Here’s a brief synopsis of the case.
An 81-year-old male was hospitalized with rectal bleeding. I had treated this man years ago, and was requested to assist in his care once again. Gastroenterologists are typically consulted on patients with internal bleeding. A day later, I performed a colonoscopy and determined that the bleeding was originating from pouches in the large intestine called diverticula. This is a common scenario and the bleeding usually ceases spontaneously. Each day, he continued to bleed, but never to an alarming degree. He received only 2 units (pints) of blood over the first few days, indicating that he was not in urgent danger. Then, he had an abrupt event when he bled suddenly and dropped his blood pressure. At that point, he was transferred to the intensive care unit for closer observation. He was given additional blood transfusions and a 2nd bleeding event occurred. We performed an urgent angiogram, which is useful in acute, ongoing bleeding to identify the leaking artery and to seal it. The result was completely negative.
Most physicians at this point would advise the patient to consider surgery, to remove the section of the large intestine that is continuing to bleed. I requested that surgeon evaluate the patient and anticipated that he would perform surgery on that very day. My assumption was incorrect. The surgeon, a careful and compassionate physician, agreed that surgery was indicated, but no operation would take place. The patient preferred a different therapeutic plan, which I will paraphrase here.
“I think I’m just going to pray. If I’m still bleeding after the weekend, then we can talk again.”
This is a man who knows something about faith. He has been a priest for longer than I have been alive. He also knows about reason. He has more post-graduate formal education than nearly anyone I know. After earning his baccalaureate undergraduate degree, he earned a masters and doctoral degree. But for a dissertation, he would have earned a second Ph.D.
I would have opted for the surgery for myself, and would have enthusiastically supported his decision to undergo it. But, I wasn’t the referee in this contest, he was. He listened carefully to the medical professionals, and then viewed this information through the prism of his own life experiences and beliefs. I’m sure there was a contest occurring in his own mind, but he was able resolve it calmly and confidently. He didn’t say that he wouldn’t have surgery, only that he wanted to try something else first.
The bleeding stopped and the patient was discharged. The surgeon remained idle. Did the patient know something that the rest of us trained physicians didn’t? Clearly, he knows that choosing the best answer on the gastro board exam may not be the right answer for him. It’s refreshing to watch someone who can choose a different direction defying convention and momentum. Again, this man is not an ideologue. He was willing to call the surgeon back.
I was so honored when he presented me with an inscribed copy of his autobiography entitled, I Looked Up and Heard God Calling Me. At the end of the book, Father Pittman writes:
Even now as I look back, I believe that I reached a stage of prayer that I have not yet equaled in fifty years of training and practice as a religious. I can still see the goodness of the Lord in all that happened.
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I am honored to care for many priests and nuns in my practice. They are wonderful human beings who exude peace and contentment. They tell me that they pray for me, and I’m glad that they do.
Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.
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