Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [16]
A high school teacher in his thirties, the son of Mexican American immigrants with a devoted wife and two young daughters, came to UCLA for an experimental therapy for his testicular cancer. With standard treatments the malignancy had spread widely, his lungs filled with metastases the size of golf balls. At the time, researchers were testing a new anticancer treatment, cisplatinum, a drug based on that metal. The teacher knew what he was facing, so despite the risk of toxicity of the new drug, including kidney damage, neuropathy, and hearing loss, he readily signed the informed consent document.
Three months later, the man’s cancer was completely gone. I had witnessed what is often termed “a medical miracle,” a moment when desperate hope is fulfilled against all odds. The story of that success is now widely known, largely because of Lance Armstrong, whose testicular cancer had spread not only to his lungs but also to his brain and who subsequently went into remission and won seven Tours de France. There are such moments when the dream of a new therapy that restores life becomes reality. In the early 1980s, when I first became a staff physician at UCLA, I saw people with AIDS die terrible deaths in months; a decade later, with the discovery of new drugs, the protease inhibitors, the death rate plummeted and lives were restored. Many children with neuroblastoma and adults with lymphoma now can go into remission with breakthrough therapies like monoclonal antibodies that did not exist when I started my training. To be sure, scientific advances are unpredictable. Many fail, but a few succeed. For me, that uncertainty was a basis for treating patients with severe illness in an intensive and sustained way, struggling to keep them alive until better therapies might arrive.
Every day after work, a group of hematologists and oncologists gathered near the UCLA Medical Center dressed not in white coats but in nylon shorts and T-shirts. We were distance runners: seven miles on weekdays, twelve miles on weekends. We pushed the pace until our legs cramped and our breath came in short gasps. We trained for marathons. Even outside of work, everything we did, we did to the maximum.
And it was that maximalist mind-set that resulted in the signature medical mistake of my life. One Sunday morning in Los Angeles, feeling fine, I stood up from a chair and nearly collapsed from excruciating back pain. The pain persisted for weeks, and the doctors I consulted had no ready explanation for it. But I was sure that medical science could pinpoint the cause of my pain. There had to be a fix somewhere in the universe of physicians and procedures.
I have written before about my back surgery, how I underwent the most aggressive operation, a spinal fusion, and its disastrous consequences: worsening pain and increased debility. But only when my wife and coauthor Pam and I began to think about this book, speaking in depth with patients about what guided their choices, reading studies in psychology and cognition, did I see how my mind as a patient had worked. In the early 1980s, there was already a school of clinical thought that most cases of back pain lacked a clear anatomical cause and that we can return to health by essentially doing nothing more than gradually moving about and waiting for the pain to pass.
But I lacked the patience to wait. I was headstrong, intolerant of the lack of an explanation for my misery. And I didn’t believe that my body would heal itself. A naturalism bias was contrary to the beliefs