A Taste Of Her Own Medicine

I just read an excerpt from a new book that I am putting on my Must Read list.

Let me give you some context really quick. An ICU doc by the name of Dr. Rana Awdish was 7 months pregnant when she lost her baby and almost died due to HELLP Syndrome. It was an eye-opening experience for her in a number of ways, obviously, but it was especially eye-opening to be on the patient side of a doctor/patient interaction. Enough so that she wrote a book about the lessons she learned.

Did y’all ever see the movie The Doctor with William Hurt? It’s from 1991, and Hurt plays a surgeon, a not-so-nice but amazingly competent one, who discovers he has cancer and experiences what it’s like to be treated like a number and not a person. It was based on a true story, and book which was titled A Taste of My Own Medicine, a title which should have carried over to the movie, if you ask me. It was a fantastic film, and if you haven’t seen it, I highly recommend it.

Anyway, back to Dr. Awdish’s book. I was particularly struck by her story as I suffered HELLP syndrome with my first pregnancy, a pregnancy which resulted in my now 21-year old son, who has severe cerebral palsy. I remember going in for my 29 week check-up, thinking everything was normal, and then being whisked away by ambulance to the hospital and being admitted into ICU, and thinking it was absurd that I was being treated as though I could die at any moment.

I had no idea that I actually could have, nor was I aware of just how much danger I was in. Now I know.

I also remember, since I was in a teaching hospital, being gawked at by gaggles of students/residents who were learning about my “case.” I was talked about as if I weren’t in the room.

And that was Dr. Awdish’s experience too, as a patient in a hospital ward in which she also practiced medicine. The excerpt from her book is amazing:

When I arrived at the labour and delivery unit, my vision tunnelled. My mind felt bubbly, as if it had gone without me on an effervescent New Year’s Eve binge. I realised that I was experiencing shock.

Could I give them a urine sample? I imagined the co-ordination involved and shook my head. I was turned over to the obstetric nurses with the single-minded intention of evaluating the baby.

‘The baby . . . is fine,’ I grunted, breathless from pain, ‘but something . . . is wrong . . . with me. Please . . . call surgery.’

The doctor ordered morphine, which caught my attention. Oh my God, they are giving me morphine. We almost never give pregnant women heavy intravenous narcotics, understanding that it puts the baby at risk.

How had I gone from not wanting to take an over-the-counter antacid to getting intravenous morphine in just one day?

The trauma surgeon on-call was someone I had worked with. Dr G checked my lab results, winced, and began listing the possibilities. ‘Liver failure, perforated ulcer, ruptured appendix . . .’
I heard and thought: No, I’m dying faster than any of those can kill you. This is worse.

By now I’d received 50 milligrams of morphine in total — enough narcotic to kill me had I been well, but due to the ferocity of my pain, my body barely acknowledged it.
My intuition that I was dying was validated by a second set of lab results: I’d lost nearly my entire blood volume somewhere in my abdomen. This served only to amplify concern for the baby, and they wheeled an ultrasound machine to my bedside.

‘Bear with me,’ the obstetric resident [a junior doctor] warned, his foot tangling in the cord. ‘I’m not great at these yet.’ He didn’t need to be. From the first grainy images I could see, the heart was still and pulseless. ‘There’s no heartbeat.’ The words cascaded out of me on a torrent of agonised breath. ‘Can you show me where you see that?’ he asked. I shuddered in a shock of pain. As my breath caught, I stared at him, incredulous. Could I show him how to interpret the ultrasound images of my dead baby?

I realised his perspective in that moment was aligned squarely on himself. His detachment reveals an unsettling, largely unspoken reality.

As doctors, we aren’t trained to see our patients. We’re trained to see pathology. We’re taught to forage with scalpels and forceps for a diagnosis. We excavate in delicate, deliberate layers, test by test, attempting to unearth disease.

The true relationship is forged between the doctor and the disease. This bond is disclosed when we re-encounter these diseases: we greet them respectfully as the worthy adversaries they are. The patients are at risk of becoming an accessory to the whole affair.

As his question echoed, I discerned genuine curiosity and I realised, with an uncomfortable tug of recognition, that indeed I was not a person to him, but a case. And an interesting case at that. I affixed my eyes on to his, willing him to see me. I instinctively felt that if he didn’t see me, if he didn’t connect with me, he might not care enough to do what it would take to help me to survive.

The baby, having declared her own distress, meant the surgery came easily now, briskly even. As they began sedating me, I heard the anaesthetist’s voice: ‘We’re losing her.’ I was drawn back into myself, from failing consciousness, by those words. Are they losing me? I attempted to survey the situation. ‘We’re losing her.’ ‘Guys! She’s circling the drain here!’

You know, I can hear you.

I struggled to maintain consciousness, trying to surface against a submersive force, a weighted pull into an obliterative darkness.

I regained consciousness to discover I was wholly dependent on machines. My eyes darted around the room, imploring those present to explain what had happened.
There were no mirrors in the ICU. Instead, I gauged my appearance by the reactions of the people entering my room. Physician colleagues who were masters of the reassuring, permanent half-smile, gasped and cried instead. At one point I awoke to the voice of my childhood priest. As an ICU physician, I had only ever seen priests enter patient rooms when last rites were being administered.

I overheard myself being presented by the surgical resident in the hallway for the morning rounds. ‘Thirty-three-year-old female with HELLP syndrome, post-op day four, status post-crash C-section for foetal demise. Intraoperative observation of a large subcapsular haematoma [a solid mass of clotted blood near the liver].’ The acronym he used, HELLP, stood for hemolysis, elevated liver enzymes, and low platelets, a poorly understood, often fatal condition that affects less than 1 per cent of pregnant women. A condition in which the blood is shredded into useless shards, the liver fails and women bleed to death.

‘She’s been trying to die on us,’ the resident continued.

Um, no, I thought, becoming angry. I was trying desperately not to die. By blaming me, I felt he was positing me as an adversary. If my care team didn’t believe in me, what hope did I have?
Then I cringed with the discomfort of an uncomfortable memory. I had used that phrase often and thoughtlessly in my training. Oh my God, we all said it all the time.

Dr Awdish goes on to write about how a nurse from neonatal ICU visited her room shortly after the doctor’s baby died and asked if she wanted to see the baby. Dr. Awdish did not want to. The nurse laid a guilt trip on her about that – it’s brutal to read. The nurse was trying to do the right thing, Dr. Awdish knew, but wasn’t taking into account that sometimes patients know what is right for them, more so than doctors.

Some months later, Dr. Awdish returned to work, but she was a different doctor. She found herself treating her patients as people, rather than bed numbers. She found herself admonishing her fellow doctors/nurses to do the same. She spoke with patients directly instead of assuming they couldn’t hear her.

And one day, she saw a resident placing an IV line into a very sick and also unconscious pregnant woman. The resident asked Dr. Awdish, “Do we know who’s going to get the baby when she dies?”

‘Out!’ I said. ‘Now.’

I didn’t know then why what I heard made me so angry. I only knew that when I was dying, the very last thing I heard was: ‘She’s circling the drain here. We’re losing her.’
And that could have been the last thing I ever heard.

She got a taste of her own medicine. And I love that she’s telling her story. I hope that it becomes required reading in every medical school, and then again after doctors have been in practice for say, a decade. This needs to be a constant reminder.