When doctors disagree
The Roman philosopher Cicero said “In nothing do men more nearly approach the gods than in giving health to men.” At times you will meet a doctor who buys this. More times, however, you will meet patients who do. As was the case with an older gentleman I spoke with briefly in a waiting room some time ago.
“Dr Royce(name has been changed) is the best out there, just to get a consult means months and months of waiting. He has seen it all.” “Luckily,” the gentleman gushed, “we knew somebody.” Upon meeting him I couldn’t help but think this guy was in for the disappointment of his life when his introduction to Royce revealed the distinct lack of a halo hovering above the doctor’s head.
And although the guy’s reaction was excessive, none of us are far from it. When your ill all goals have been replaced by a single goal, to get better. And even when you find the sort of activity to distract yourself, a movie, or night out with friends, your illness is always lurking somewhere in your mind. And then there is a person—a doctor—who believes they can help you reach that goal of better, of healthy. Their words become gospel, their recommendations law. “Whatever you say doc, we just want to beat this..”
Two weeks ago I met with the physician who has been treating me since July. He has recognized that the treatment I underwent four months ago does not appear to be working, and a bone marrow transplant is looking more and more probable. He also recognizes my HLA-type, the system of individual proteins that allows my body to recognize self vs. not self, is fairly unique. My unique combo—and more importantly, where it is unique— puts me at greater risk of rejecting transplant. It also, according to the doctor, decreased my chance of Graft vs. Host Disease(GVHD), a common side effect of bone marrow transplant where donor’s cells identify my cells as foreign and attack. GVHD can be life threatening, so any mention of”decreased chance” was more than welcome.
Then last week I spoke with a different doctor. The information she offered was mostly consistent with what I’ve heard. Except for one difference. My unique HLA type would actually increase my chance of GVHD, according to the information she’s seen. What? But the other doctor said…
She was fully aware of what he said, after all they are colleagues at the same facility had discussed my case in length only days before. Agree to disagree. That’s it? I left the consult considerably annoyed. How could two doctors at the same facility, with the same information reach such different conclusions?
And then a day later something dawned on me. When we go to the doctor we expect clean, clear answers. We ask them questions and they come back with numbers, statistics, studies, tendencies and the opinion they have derived from them. But we tend to leave out the opinion part in reflection, tend to forget the the imperfection of their craft. Because the sick want a soothsayer to tell them exactly what will happen, it’s a physician that admits to the unknown quantity that terrifies us.
In a freshman year biology lecture I remember a professor once telling a class something very simple. “The only thing more amazing then all science understands, is all it doesn’t,” he said. And it’s far-fetched to think of a day where we have it figured out—where we proudly look down at science from above like some puzzle we’ve finally pieced together. The human body is infinitely complex. Just when it seems you have something entirely understood, some unexpected outcome leaves you scratching your head and looking towards the heavens.





November 22nd, 2009 at 12:43 pm
Matt, How wonderful that you can experience such a frustrating situation and come through with a depth of understanding and wisdom that moves us all forward.
November 24th, 2009 at 10:47 pm
This sounds like the same office I go to. As disturbing as this may sound, I think that is how I’ve been dealing with all of this…the hope that another doctor will have the opinion I want to hear
It is SO frustrating, and trying to explain it to friends and loved ones is even more frustrating because they are use to cut and dry answers.
November 25th, 2009 at 9:44 pm
Matt, Don’t stop exploring. Try a different hospital if you aren’t happy with varying opinions. Granted we all read and hear the same things differently but this is not the time to be wondering who heard what. My best to you and your family. Ellen
November 27th, 2009 at 3:24 pm
Matt
You are a brave young man. I’ll keep you in my prayers and trust that you will have the strength and opportunity to resolve this. (FYI, I’m Sarah’s Aunt) Good luck and good health
December 1st, 2009 at 12:50 pm
Dear Matthew:
Michael had similar reaction to ATG..first treatment supposedly failed..He had his first in February 2009.. He received his 2nd (rabbit serum, instead of Horse serum on the 2nd of July, 2009.) Neuprogen shots continued, …cyrosporine continue…until…recently…cryrocsporine was stopped last week..docs said not working…however…no transfusions have been given in over 2 months.// Mike is to undergo testing, and preparation for a non-related bone marrow transplant after Christmas… Puzzled by his levels seemingly improved…even though docs stopped cycosporine.. This is a very frustrating disease…One day at a time…..that’s all anyone can do. There is no rhyme nor reason to insane diagnosis.. I understand your delimma well. I keep you in my prayers every day. Whatever help I can be to you, please let me know.
Sincerely,
Mary Barner
June 8th, 2010 at 1:36 pm
06/08/2010
Dear Matthew:
We have been thinking about you.. and keeping you in prayer…haven’t heard from you in quite a while.
Hope all is going well.. Michael is doing very well…He did not have to have his transplant and now he is off all meds for the last 5 months.. Miracles do happen,…
Hoping to hear the same from you.
Sincerely
Mary Barner
mcbarner@comcast.net