WHAT THE OTHER HAND IS DOING (Or: How I Learned To Stop Worrying and Love the Knife)

There is bipartisanship at the core of healthcare, and it has nothing to do with the riven politics dominating today's headlines.

Far from the legislative chambers of our government, doctors function in a two-party system of medicine and surgery. I am a member of the former who has personally benefited from the expertise of the latter.

It is always tempting to dichotomize groups. The TV comedy Scrubs lampooned the divide between medical staff to hilarious effect, exporting the nerds vs. jocks trope from high school to the hospital. While good for a laugh, these stereotypes end up being reductive, constricting expectations of what a doctor can do. A much more dignified comparison can be found between Drs. Abraham Verghese and Atul Gawande. Both esteemed physician-authors at the top of their game, they bring different but equally valuable perspectives on patient care as an internist and a surgeon, respectively. Dr. Verghese has written, brilliantly, about the lost art of physical examination and the practitioner's attention shift from the sick person to their digital avatar. Dr. Gawande has shone a Klieg-bright light on what happens in the operating room, using a series of deserved best-sellers to deliver illuminating revelations about risk and mortality; his candor has been evident since he titled his first book Complications (if I ever wrote a volume about chemo, I'm not sure I'd be brave enough to call it Side Effects).

What Drs. Gawande and Verghese share, of course, beyond the ability to spin gold from their pens, is a profound humanity that transcends their disciplines and scopes of practice. Here again it is too compartmentalizing to label surgeons 'doers' and internists 'thinkers' (or, worse still, 'overthinkers'). It might be tempting to characterize the latter as excessively intellectual, loving the mental exercise of differential diagnosis over the tangible satisfaction of fixing a problem by physically removing it from the body (on the first day of my general surgery rotation in med school, I was told "the only way to heal is with cold steel"). In fact, many medical sub-specialists are hands-on proceduralists, e.g. interventional cardiologists & gastroenterologists. Obversely, surgeons -- far from unthinking technicians -- need to enter the OR nimble of both fingers and mind, ready to adapt to the shifting landscape of the operative field with the improvisational deftness of a jazz musician.

Are physicians prone to being factional and cliquish? Of course (I will leave it to the anthropologists to comment if any social group can ever be truly exempt from tribalism). But we are also capable of working together towards the best possible outcome for those under our multidisciplinary care.

As a patient, I can offer personal testimony to the bicameral mind that conjures solutions to medical problems. While it was my residency in internal medicine that gave me the acumen to diagnose my own hyperparathyroidism, I couldn't actually correct the issue on my own. I needed the talents of an endocrine surgeon, who made an incision at the base of my neck and extracted the bulk of the overactive glands. Remarkably, this gracious man also acceded to my peculiar request that the entire procedure be videotaped. Watching the footage will make many squeamish but I find it profoundly compelling to see the gross anatomy I learned from cadavers vivified in my own flesh. Also on display is the incredible dexterity you'd hope to see in the person holding a blade to your throat. Parathyroidectomy can go wrong in a number of ways, including damage to the surrounding blood vessels (I prefer my carotid arteries intact, thank you very much) and the recurrent laryngeal nerve that supplies the voicebox (one dreaded aftermath of the surgery is permanent hoarseness). In my case, there were no such complications; instead, the surgery, by normalizing my calcium levels, restored me to a vitality and strength I hadn't felt since adolescence.

All of this is to say that, as I prepare to return to the operating room table to undergo a Whipple procedure, I am extremely grateful for my colleagues who thoughtfully and skillfully wield their scalpels. Every patient should also give thanks that the bipartisanship in the practice of healthcare results not in gridlock but in symbiosis and mutual betterment.



Mark Lewis1 Comment