Tenet 2 (Continued): The personal and non-personal in practice in Health 3.0.
I have written briefly in a different post about one of the attending physicians of the neurocritical ICU who looked after my mother when she was a patient there. I’d like to elaborate more on that story here.
My mother had successful emergency surgery at our local suburban hospital to control the intracranial bleeding from her ruptured brain aneurysm. This was the main hospital where I myself practice, so I knew all the people who cared for her. And her care there was wonderful. But we eventually decided to transfer her to a large, dedicated neurocritical ICU in the Texas Medical Center, one that we felt could handle any potential complications better than our local hospital.
I did all my medical training in the Texas Medical Center. It is the largest medical complex in the world. A huge place of non-personal medicine. And we were in the biggest hospital system there.
Mom’s care in her new hospital was also excellent in many ways. From the intraventricular clot-buster that she received, to the tight control of her sodium level, to the nutrition that was started through her nasoduodenal feeding tube…it all seemed very evidence-based. We were in Health 2.0 heaven.
But even as a veteran of the Texas Medical Center experience, I began to strain under the dark side of non-personal medicine.
There’s a pressured dynamic that seems to develop for patients in the neurocritical ICU. Residents and fellows (doctors in training) would pop in every so often on Mom to see how she was recovering from her stuporous state. It didn’t seem to matter what we as a family were seeing her do during the course of the day. They wanted her to perform in front of them. And they gave her a minute to do it. If she didn’t open her eyes, move her fingers, or wiggle her toes on the spot to their commands, their conclusions were made. And I sensed their skepticism when we told them she was doing more than they could see in that minute.
The clock was ticking on her disposition. For efficiency’s sake, the system demanded it. If she wasn’t going to wake up, Mom needed to be packaged up. Trach her (long-term breathing tube). PEG her (long-term feeding tube). VP shunt her (long-term brain ventricle tube). LTAC her (long-term acute care tube).
Within a few days of arrival to the ICU…without a clearer understanding of her neurological injury…and without a better idea of what this injury meant for her future…the Case Management Police was talking LTAC transfer.
I get it. You can’t expect residents and fellows to spend as long as we had as a family to observe what she could do — as inconsistent as her movements were. They have too many patients to see. I’ve been there.
And yes, most everything that was recommended for Mom was inevitable. As a physician myself, I knew as much. The non-personal medical system wasn’t wrong.
But when you don’t feel your unique story is being heard by the practitioners in the system…when empathy and intuition are offline…when, in the words of Dr. Howard Spiro, clinicians fail to act as mediators between Mom and the machines…what you do feel is a void. The strong void that is the uncertainty inherent in much of medicine. The void that’s the gap between personal and non-personal medicine. Between Health 1.0 and Health 2.0.
Health 3.0 fills the void. It’s both personal and non-personal.
That attending physician I had talked about? At the risk of embarrassing him, I’d like to mention him by name. Because Health 3.0 came to us in the form of him. His name is Dr. Kiwon Lee.
As the director of Mom’s neurocritical ICU, Dr. Lee was the king. He was evidence-based to the hilt. Some of the evidence was based on his own studies. He had a retinue of residents, fellows, nurses, pharmacists, social workers, medical students, and COWs (computers on wheels) around him. And when he went around with them seeing all the patients in the ICU, he wasn’t just making rounds. He was holding court.
He introduced himself to us just outside Mom’s room when he inherited her case. He reminisced with my father about their days in New York City. And knowing we were a family of physicians, he kindly invited us to participate in his rounds with the team on Mom.
The residents presented the case (I asked my old-school dad to bite his tongue when they made minor mistakes in the history). Dr. Lee listened…he taught…he quizzed…he challenged…he reigned. These rounds were what I missed in solo private practice. The joy of formal learning, at the bedside.
I had a front-row seat — without the pressure of getting grilled by the big, bad attending! And I learned a lot about Mom’s illness in those few rounds.
Dr. Lee told us what the data had to say (at least, this is what I remember him saying). About sodium levels (better to stay high than go low). About intraventricular hemorrhage (easier to recover from for a 30-year-old, compared to a 60-year-old). About nutrition (all-important for recovery). About seizure prophylaxis (not necessary for a pure intraventricular hemorrhage). About thrombolytics for intraventricular hemorrhage (they do clear the clot faster than without them). And he told us where the data was silent (do those thrombolytics help outcomes? Don’t know for sure).
He accommodated the request of this GI doc to hold off on Mom getting a PEG tube…joking with me that I would inevitably lose (I did). He was conservative like we were on committing Mom to a VP shunt (we lost that one too). He laid his own hands on her to examine her — teaching his team all the while about the subtleties of the neurological exam. And when he cut the exam short and politely demanded a suction device be given to him, so he himself could relieve Mom of her gurgling…he not only relieved Mom. He relieved me.
Dr. Lee used all the resources of the non-personal health care system in his arsenal. And he dropped the non-personal badge that shields us against feeling.
He listened, with intent to connect. He showed empathy. He gave Mom the dignity that all human beings deserve. And he wasn’t afraid to use his personal intuition, informed by non-personal data, to give a transparent opinion about Mom’s future.
Embodying Dr. Spiro’s words, he pulled the attention of all the caring professions around him back to people, back to our patients, back to ourselves.
And he gave me meaning, in an illness as devastating as Mom’s has been. Meaning that’s gifted me with the thoughts I’m sharing with you right now.
Dr. Kiwon Lee was a healer of Health 3.0. The personal and the non-personal, in one. And I will never forget him.
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