Your Medical Mind_ How to Decide What Is Right for You - Jerome Groopman [30]
Lisa Norton’s story gives insight into the experience of patients confronting serious conditions. When you feel good, it’s difficult to imagine the choices and to forecast the decisions you will make when you are ill. When her lupus did not go away, as Lisa termed it, “through a natural path,” with nutrition, meditation, relaxation techniques, and other approaches, her apparently fixed preferences became more flexible. New circumstances moved her to alter her mind-set. Yet she still retained her fundamental belief in a natural approach.
When the pain returned, Lisa rested at home with her foot elevated. Over the next few weeks, she tried icing the area and was fitted with new orthotics. But the pain didn’t get any better. She returned to the surgeon.
“I’m not surprised,” he said when Lisa told him about her condition. “You need surgery, I told you that before.”
Lisa and her daughter had scheduled a trip to Europe in a few weeks’ time. The trip had been planned for a long while, and she told the doctor that she didn’t want an operation to interfere with it.
“You have pain from the bone spur, the ganglion cyst, and lots of arthritis in that joint,” the doctor reiterated. “That’s going to interfere with your trip. I can fix all of that, and in two weeks you’ll be fine to travel.”
“I’d rather have another cortisone shot,” Lisa replied.
The doctor paused and then spoke deliberately, emphasizing each word. It sounded to Lisa as though he were speaking to a badly behaved child. “I will give you the shot. But this is not a cure. Let’s get you on the schedule for surgery.” Lisa agreed.
The trip to Europe was everything that Lisa and her daughter had hoped for. They both loved art, and they spent days lingering in the museums in Paris. Despite the many hours Lisa spent on her feet, she didn’t feel any discomfort—the shot again had worked. But her surgery was already scheduled. So when she returned, she went to the hospital for her preoperative evaluation.
In the examination room, Lisa almost dozed off waiting to meet with the nurse who would clear her for surgery. Her jet lag still hadn’t worn off. The nurse greeted Lisa with a warm smile and went over a checklist, reviewing Lisa’s past medical history, asking about any allergies or reactions to medication. She noted the normal recent electrocardiogram and chest X-ray, which showed that Lisa was healthy enough to undergo surgery.
“You know,” Lisa said, “my foot feels fine now. I wonder if I really have to have such an extensive surgery?”
The nurse glanced up from the paperwork and gave Lisa a quizzical look. “You really should discuss that with your doctor,” she said. “But in any event, since you’re here, let’s get your pre-op blood tests done.” The nurse handed Lisa a sheet with a series of tests marked off and told her how to find the phlebotomist who would draw her blood.
The next day at school, Lisa confirmed with the principal that her class would be covered by a substitute teacher for at least two weeks after the operation.
“You know, my foot feels good, even though I walked all over Paris,” Lisa told her. “I wonder if I really need this kind of operation?”
The principal raised an eyebrow. “You should talk to your doctor,” she suggested.
When we spoke with Lisa, she reflected back on these conversations. “I guess I was afraid to confront the surgeon one-on-one,” she said. She still wasn’t sure exactly why she hadn’t told him her foot felt better. “I guess I just didn’t want to deal directly with him. He had such a frosty and assertive way about him. And I also really wanted to believe that he knew best.”
Lisa underwent the operation. The surgeon removed the bone spur and the ganglion cyst and then fused the arthritic joint, inserting two small titanium screws so that there would be no motion that could cause pain. The day after the procedure, the surgeon called Lisa and said that the postoperative X-ray was “not satisfactory.” It looked as if the screws weren’t correctly aligned,