Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [1]
So this is what it means to have a stroke. My doctor warned me this could happen.
The door to the examining room clicked open and his cardiologist entered. Dave snapped out of his terrifying daydream. He was not on the tennis court, but in his cardiologist’s office. He stretched his right arm and leg, reassuring himself that nothing had really happened.
“Good morning, Mr. Simon,” the doctor said. “Have you had a chance to think more about the medicine? Are we going to start treatment today?”
On a routine checkup several weeks earlier, Dave’s internist had found that his pulse was irregular. An electrocardiogram revealed that he had atrial fibrillation, a common abnormal heart rhythm. Dave was referred to a cardiologist, but his repeat EKG was normal. The cardiologist recommended that he wear a heart monitor throughout the day, which showed that he was still having episodes of the abnormal rhythm, even though he didn’t realize they were happening. She explained that this condition could cause clots to form in Dave’s heart; those clots might break off and go to his brain, causing a stroke. But the risk of stroke was low. There were medications that could help stop the clots from forming. But these drugs had serious potential side effects, primarily bleeding.
Dave was friendly with a neighbor who had been on such a drug. Several years ago, on a flight to Europe, his friend began to vomit massive amounts of blood. He almost died in the plane. The flight was diverted to Greenland, and the man, in shock, was rushed to the hospital. Emergency surgery saved his life.
Dave’s mind veered back and forth between his chilling fantasy of a stroke and the image of his friend nearly bleeding to death. He looked at his cardiologist and replied, “I haven’t decided yet.”
Dave was caught in what psychologists call “decisional conflict,” uncertain which option to choose. He knew the stakes were high and anticipated regretting either choice.
Susan Powell had already made her decision when we spoke with her. She wasn’t going to take a statin drug for her high cholesterol.
Susan wasn’t ignorant about high cholesterol and its consequences. Nor was she “in denial,” as some physicians liked to put it. Fifty-one years old, she spent her days as a nurse’s assistant caring for people of all ages and backgrounds with a variety of diseases from congestive heart failure to cancer. Her doctor had explained that high cholesterol levels could lead to heart disease and stroke and advised her to begin taking a statin pill. Susan was familiar with this type of drug, which is sold under brand names like Lipitor, Crestor, and Zocor. Some of the people she took care of were on it, and she had seen ads promoting these drugs on TV and in magazines.
“My father also had high cholesterol, and he died after a long and healthy life, without taking any medication.” She told us that when her own health is at issue, she is the kind of patient who approaches medical treatment with skepticism. “I’m careful about what I put into my body, and I don’t like medication,” she said. “If I have a headache, I just deal with it; I don’t immediately reach for Tylenol.” Susan is a “doubter.” You may see your own thinking in her, or she may remind you of a friend or family member.
Or you may take a very different approach to treatment, like Michelle Byrd. Michelle is an administrator at a university near Boston. She’s in her fifties, too, she exercises every day, and she’s proud that she can “power walk” two miles in less than twenty-nine minutes. Her college degree