One hundred days: My unexpected journey from doctor to patient
2001; Elsevier BV; Volume: 44; Issue: 5 Linguagem: Inglês
10.1016/s0190-9622(01)70198-3
ISSN1097-6787
Autores Tópico(s)Medicine, History, and Philosophy
ResumoOne hundred days: My unexpected journey from doctor to patient David Biro, MD, New York, 2000, Pantheon. 289 pp. $23.00. Doctors, and I am no exception, love a good zebra.David Biro, MD By all accounts, David Biro was a fortunate man in the summer of 1995. Fresh from residency, the 36-year-old dermatologist had earned a PhD in English literature from Oxford University while at medical school. He had a half-time practice with his father in Brooklyn, was a junior attending at State University of New York Downstate School of Medicine, and spent his mornings writing fiction. To top it off, he was married to an exotic woman who worked in the heady high fashion world, and he had a close, loving, and supportive family. “Too good to be true, I knew it. I was beaming with success, in the office, at the writing table, home with Daniella.” So, he was not surprised to find himself “metamorphosed into a zebra.” In September 1995 peculiar ophthalmic symptoms were diagnosed as retinal vein thrombosis. Work-up revealed pancytopenia, and he was finally diagnosed as having paroxysmal nocturnal hemoglobinuria (PNH), a rare disorder which few of us will ever encounter and about which he, a physician, knew nothing. His blood indices gradually fell and he came to believe that bone marrow transplantation (BMT) was his only hope for a relatively normal life. I admit to a certain fascination with pathographies: illness narratives. Although we, as physicians, spend our days with those who seek our help, it is not often that we get to listen for protracted periods to the musings and insights of those who visit or reside in the Country of Illness. Less commonly is the illness chronicler a fellow physician. Even rarer is Virgil a member of our particular fraternity: doctors who ply the skin trade. One Hundred Days: My Unexpected Journey from Doctor to Patient is the harrowing and fascinating history of a young dermatologist's journey from most fortunate man to abject cowering BMT patient and his long road back. Illness is our profession; however, Biro shows us how poorly prepared we are to cross the barrier between doctor and patient. In doing so, he helps us to understand the fears and panic our patients often experience. “I become blank in the presence of doctors, unable to remember what I wanted to ask or to respond coherently to what they have to say”—this from an eloquent, confident physician with a PhD in literature. Biro describes how he panicked during an MRI scan and fainted during his second radiation therapy session. He is not the stoic patient. His medical degree confers no equanimity with which to face fear and uncertainty and seems to have little impact on the anxieties and doubts that the travail imparts. We learn the importance of relationship with our doctors. How even we, cynical, wise practitioners, in our hour of need reach out for a diagnosis and the promise of cure. Biro was lucky to have competent doctors at Sloan Kettering, but they didn't always agree with each other and this schism was demoralizing. He is kind to his physicians, perhaps more generous than a layman might have been since he understands the system and has worked in it. Knowledgeable and caring as his physicians were, Biro's most effusive praise is reserved for the nursing staff and for his mother. Who can quantitate the importance of being cared for when one is ill? Little kindnesses may play great roles in recovery. “My mother spends more time in the hospital than anyone else. She rearranges my pillows and covers me with blankets. She brings water and ice chips, nose bandages and medication. She makes sure the room is cleaned, the sheets are changed…She is tireless in her efforts. I am not surprised. My mother would do the same for all of her children.” The family angle is central to Biro's story. He comes from a warm, close-knit family. A dermatologist father, a mother, 3 sisters, the youngest a perfect HLA match, his hope for cure. This army of supporters will cushion the blows and tribulations of the BMT, but it is also problematic. Biro's wife is a more complex character. She juggles a demanding job with being a hospital spouse and he suspects she may resent his cloying family ties. This tension is alluded to, sometimes mentioned, but never delved into. Biro is a gifted writer, and his descriptions of PNH, the immune system, the BMT, and its effects on his body and spirit are penned with clarity and grace. This book can be recommended to anyone contemplating BMT or to family members or friends of prospective patients. Biro wrote his boards shortly before his transplant. He learns many truths not imparted or even hinted at during medical school and residency. “Only I'm surprised—and will continue to be throughout my ordeal—at how indefinite things are in medicine. I thought having a diagnosis meant an end to uncertainty. I was mistaken.” The test of a successful novel or memoir is our desire to know more about the characters. In the finale of Middlemarch, George Eliot wrote, “Who can quit young lives after being long in company of them, and not desire to know what befell them in their after-years? For the fragment of a life…is not the sample of an even web:….” Having finished One Hundred Days, I found myself wanting to know how David is doing now and how his family and wife are managing. I have a hundred little questions about these people I have grown to like and feel compassion for. This is a fascinating volume, one difficult to put down. It is all the more special because it is the true chronicle of one of our colleagues.
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