The recent headlines about the death of Joan Rivers - in particular the alleged role of her otolaryngologist unauthorized to operate at the GI Endoscopy clinic where Ms. Rivers went into cardiorespiratory arrest - feed the theory that pursuing a career as an MD has transformed dramatically in our lifetimes.
I can remember meeting with many a doctor of my own generation, back in the late 1980s and 1990s, who said, "I'm getting out." Either early retirement because of their unwillingness to participate in the New Paradigm with its curbs on autonomy and excellence, or, perhaps for the less scrupulous, seeking employment/consultant positions with biotech/pharmaceutical companies.
For all the jokes, it may be fair to say that we were better off when, in and of itself, a clinical practice could be as lucrative as an ambitious physician desired. Thus it could attract those who enjoyed clinical work, interacting with people, sleuthing diagnoses, keeping abreast of the latest medical breakthroughs and research, paying careful attention to medications, and supervising assistants and office staff. Medical doctors could look forward to excellent remuneration for the tremendous responsibility.
Today (with third-party-hands on more of that remuneration), if Lucre is still an MD's objective, the name of the Game is: Gimmick.
"Procedurists" (seeing patients on Mondays - routing them into Procedures Tues.-thru-Fri.)
A Little Business On the Side (co-owning ambulatory "procedures" clinics with colleagues)
Competitiveness: "Be The Only One In Town Who..."
Celebrity photos on the wall
Performing procedures "backstage"
Administering anaesthesia at the patients' homes (remember that one?)
Taking unauthorized photos of an unconscious patient, with impunity (Doctor as Paparazza)
Waltzing into a surgery center with NO OPERATING PRIVILEGES and being treated like a star oneself
...Normal medical cautions be damned.
The phenomenon figures into the growing conviction of many that naturopaths and osteopaths, as well as other "alternative" practitioners, are safer to life and limb, which is 180º from the old saw that they were the Snake-Oil salesmen! Among this population, there could be not only increased safety, but greater health and educated participation.
In the PME (Pre-modern Medical Era), I had some very lovely Old School doctors with many famous clients. They were wealthy, but they were humble, careful, and friendly in the examining/consultation room. They were well-informed and gave very considered and conservative counsel to this non-celebrity. If a "procedure" were required, they had attending privileges at reputable hospitals they did not own. Never a soupçon of Conflict of Interest.
As the song said, "Those Were The Days, My Friend".
PS. Interesting: Two days after this blog posts, the following appears in The New York Times:
"The Famous Can Present a Minefield for Doctors: Joan Rivers' Treatment Seen as Possible Example of V.I.P. Syndrome".
Fall-out from some of the Gimmicks I describe.
The recent hospitalization has definitely affected my overall outlook profoundly, even with respect to diet / lifestyle. I've faced a "worst case scenario" head-on, and it only confirms me in an easygoing approach.
No sooner did I recover from February's life-threatening ARDS than I found myself being recalled a couple of weeks ago about a suspicious radiologic finding. Then I was quickly worked up via diagnostic radiology and ultrasound, whose results compounded clinician suspicion. The lesion in question had four classic features of malignancy.
Yesterday's biopsy was under ideal conditions, including its being performed at a top-rated US hospital. Slides were prepared a few feet from my head, where the pathologist sat at her microscope and read them. She then delivered the good news.
Throughout the biopsy and the preceding two weeks' workup, I was serene.
1. I have enough of a medical background to know how advanced the technology is and how much of its use is justified by the need to train the personnel who use it! On the less cynical side, there's a necessarily high ratio of healthy patients who must be rendered anxious or apprehensive to those the technology really saves by finding their cancers early. So: Intellectually, I'm hip.
2. February's acute brush with death and day-to-day personal submission to Emergency and Critical medical care accustomed me to being pricked, probed, medicated, turned, transported, ventilated, and discussed by roving schools of clinicians and their acolytes, as well as nurses, aides, therapists and techs. My attitude is a paradoxic combination of exhausted "Yeah, yeah: Do what you have to do," and firm "Give it to me in straight clinical jargon; no 'lay language' for me, thanks," not to mention a very strong faith in God.
One thing I've always appreciated about Peter D'Adamo is his respect for holistic, as opposed to merely biochemical, individuality. He understands that not only diet but one's attitude toward health is unique to one's personhood. Some of us can tolerate more uncertainty, more sickness, more ignorance, than others. Some are more frightened by or intolerant of dysfunction or disability. Some are more scared of death than others are. And all of these factors must be considered when choosing a "compliance-level", because: Compliance with What? is the operative question.
Compliance with the D'Adamo books' recommendations?
Compliance with one's social situation? With one's workstyle or schedule?
Compliance with one's personal distribution of comfort zones?
I daresay the dadamo web forum community is far more concerned with dietary than these other sorts of compliance, necessarily to promulgate that aspect of the teaching. But dietary compliance as a major life preoccupation isn't for everyone or even for most, even in the wake of catastrophic illness – maybe especially under those circumstances! It's the old story of regretting not having told someone you loved him, say, as opposed to having used too much cinnamon. "Living Right" 4 one's bloodtype is not identical to living right for one's soul or spirit.
Emergency and intensive patient-hood often elicits a clearer expression of essence. There's a distillation, a purification, a consequent clarity. Nothing wrong with that. Having emerged from that crucible, the more recent "cancer scare" tested the substrate, and I'm pleased with the result.
In February, I spent two weeks in the hospital – ushered in through the Emergency Room – and eleven days of that in critical care. The month's final week found me at home again, weak and tired. Throughout March, I have slowly crept out of that sudden, unexpected abyss, to re-orient, re-group. After about thirty years as an adult in excellent health under my own "alternative" recognizance, it was quite a shock to take up the identity of Hospital Patient and, then, Outpatient thereafter. I do have a background in Medicine, working for years with doctors, in and out of hospitals. I think this helped immensely; my hospital course was never scary for me.
Convalescence has been more challenging than hospitalization was. I have been visited by six different home healthcare professionals, two different unknown maids, three or four outside contractors and my apartment building's maintenance man a few times. I have taken regular pharmacy deliveries. I've had four appointments with three MDs and been to a laboratory to drop off a specimen. I've also shopped at the supermarket a couple of times, had a couple of friends over for dinner, and returned to work here and there.
In my lifetime, my Standard Operating Procedure has involved amassing tons of scholarship on any and every subject I encounter, and during the past 5 and a half weeks that's been my continued and constant practice. I have studied each drug I'm taking, each drug I took in the hospital (after remembering them!) (and there were many), each procedure I underwent in ER, ICU, TICU and on the ward; various hospital practices and protocols; the Hospitalist specialty; the Intensivist specialty; the history of Intensive Care; ICU nursing, and more. I've of course studied my own disease and conditions - their stages, causes, treatments and prognoses.
During my hospitalization I encountered the whole gamut of career-suitability of various practitioners, from shining examples of professionalism, to those with clearly inappropriate motives for being in health care; from the energetic and thorough to the lazy and disinterested, to the exhausted. As an outpatient and in-home consumer of Home Healthcare services, I've observed the same range.
And now? I enter another phase: No Longer Med-Free. While investigating their possible side-effects and interactions, and correcting the various nutrient-depletions they cause, I'm also physically processing new drugs, monitoring their effects in addition to monitoring vital signs and treating symptoms in non-Rx ways. Plus: I'm also having to make dietary and lifestyle adjustments. In the hospital, it was easier: All I had to do was let other people keep me alive.
We natural-types have to be on guard against disdain of the allopathic system's "Magic Pill" answers when a quick improvement is imperative. In the ICU, this was literally and immediately a matter of Life and Death. At home, while the stakes are less immediate, they are just as serious: The "right" medication can immediately restore function to an exhausted patient who is challenged or failing. Yes - under better circumstances, one has months to compare modalities, to experiment with supplements that are less toxic, and their dosages. For my part, I'm discovering that Rx meds are right for me NOW - because I haven't had the luxury of months or years to plan for new conditions and their treatments. I'm cutting myself that slack, knowing I can wean myself from them later, when I'm stronger and have emerged more completely from the convalescent stage. Perhaps I will blog about the process of jettisoning those crutches? We'll see.
Meanwhile, I count myself blessed to be under the oversight and care of a fine MD who is forthcoming, friendly, flexible, considerate and accessible. In his practice, he routinely uses diet, exercise/fitness and nutritional supplementation in addition to Rx meds and allopathic methods. I feel safe letting him share responsibility for my health at this point, because this flurry of self-education (while mentally fascinating) is unable to keep pace with the urgency of my situation and the variety and depth of medical/pharmacological knowledge required.
I'm blogging on a natural health site. I'm pursuing a Complementary Medicine program. Bear with me. Thanks.
Today I ordered a home kit for self-blood-typing from North American Pharmacal (1-877-ABO-TYPE or right4yourtype.com), taking advantage of the Free Shipping special. At $9.95 it's a great buy!
This is far from the first time I'm mid-wifing someone's initiation into blood type medicine; this one is for a friend, long familiar with my approach, but other times it's been on behalf of friends, yes, and clients. I've even stabbed their fingers for them if they were afraid to do it themselves. Apparently many people can not bear to see blood on their fingers; they might even feel faint if they do.
For my part, I stabbed my own finger in seventh grade Science, back in the 1960s. It was our first "lab". I discovered my B-ness then. When I was in college, as a preMed student my first job was at a hospital blood bank. It was my responsibility to screen potential donors - take their histories and vital signs, blood samples, and perform the hematocrits. My supervisor, a medical student, wanted to train me to draw the pint, but I was at that point reluctant. Instead I monitored post-donation status, restored fluids and nutrition, and sent the donor on his/her way.
As for modern self-typing kits, the new lancets, in their little casements, are very user-friendly. Somehow not seeing the actual weapon renders its use more benign. And within - oh - ten minutes of opening the package, you know your blood type. At a doctor's office, the ABO test can add seventy or more dollars to your lab bill, and you won't know the results right away.
Knowing your blood type grants you entry to the marvelous world of Blood Type Medicine pioneered by Dr. D'Adamo. I am personally more a Blood Type- than Genotype-follower (there's a quiz on his website that might help you decide which model would be most appropriate for you), but even the Genotype teaching is informed with blood type principles. Know your blood type - yes, even you, fellow American! Find a friend willing to perform the test on your finger if necessary, but order it and do it! Free shipping, $9.95 the pop. What's your excuse?
Following up on my previous blog ("Taking it Easy: Life in the Normal Lane", 12 Feb. 2011), I notice that one of the terms in vogue on the dadamo Forum lately, in describing adherence to Dr. D'Adamo's principles, is "this lifestyle". I confess I don't know what this means.
The Bloodtype and Genotype diets are adaptable to almost any lifestyle, as I see it. To call their use - and/or Dr. D'Adamo's view of medicine - "this lifestyle" is alien to what his work means and has always meant to me. Are "Individualists" thus becoming conformists? Choosing a "lifestyle" wholesale is often related, rather, to cult-involvement!
My own lifestyle doesn't involve inordinate attention to the purchase of foodstuffs at the market, their preparation and their analysis. So I don't share what Forum participants proudly call "this lifestyle", even though I've been an avid D'Adamo proponent for 14 years.
When you call it a "lifestyle", that implies you have more of life in common with the Forum's other people (sitting in front of computer screens across the globe) than you do with human beings (in your actual vicinity) who shop and eat differently from you. If two neighbors are carpenters and each has a wife, 2.3 children, a dog, and drives a Jeep and belongs to, say, a bowling league, do their lifestyles differ that much if one avoids dairy products? Me, I don't think so. Does the vegan I know have a different lifestyle from his meat-eating friend? Not necessarily. Does Dr. D'Adamo expect his readers to adopt a lifestyle? I don't think so.