Chapter 2. A Fascinating Case

Glioblastology, the Book

Before we dive into this week’s chapter, I have a special shout-out for a member of our reading community, Col (ret) JW, who is our first to earn a referral bonus for sharing Glioblastology, resulting in three referrals! JW is a good friend I’ve come to know and respect through his service to our local community and for his leadership of a strengths-based workshop to equip other leaders. JW is also a man of career service to our country. Thank you, my friend, for extending an invitation to others to join us here. And thanks to all new subscribers!¹

If you would like to catch up on reading, here is the Introduction and Chapter 1.

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Chapter 2. A Fascinating Case

I shift uncomfortably in a paradigmatic schoolroom chair and desk, synthetic wood, a wire cage beneath the chair to place books, a metal frame soldered to hold the piece together. We sit in these desks in a row of five—four patients, one clinician far right; we smile under the gaze of one hundred and thirty first-year medical students. My cane rests visibly between my legs, and I wonder if Freud would have it that I am overcompensating for the emasculation of disability. My left leg tangled in the wired cage and soldered steel, I cannot stand without the aid of visual input—my sensory processing and spatial awareness, a faculty of sense called proprioception, permanently impaired by the brain tumor and surgery. Unsure of the needed movements to unhook my leg, I employ my coping mechanism: myself, experiencing; myself observing. I describe brain surgery to students clad in white coats; the infamous “short coats,” remember? I reply to questions about breaking bad news. I compete with other patients for microphone time. Already the lot is sorted and stratified: the physicians-in-training with laptops and smart looks, peering from auditorium seats. Patients sit twisted and awkward in schoolroom desks. I glance down to free my left foot.

A student catches me after class. She was shadowing the day of my surgery.

What a fascinating case! she exclaims.

I knew it! I thought, that’s what I told Whitney!

Your composure was incredible. We were all talking about that after.

Nodding, The brain is relaxed for the procedure, I thought.

Students queued behind her, and I allowed my eyes to drift and refocus. She politely excused herself, and I greeted the thoughtful attendees who extended their thanks for my speaking. I tracked the first student as she slipped out the door. Her comments circling my mind with enough weight to press my eyelids and squint my eyes, the sort of thinking that presents with expressions on the face. Later I would ask the professor if she would not mind passing a note of thanks along to the student. “Her comments really struck me,” I explained, “I was caught off guard to meet someone who was in the operating room. I would like to send her a note. Please ask if that is OK.” It was acceptable to the would-be doctor, but she would send little in return. Her gesture after class was significant to me, and the experience that prompted it, seemingly significant to her.

I walked briskly away from campus that day, toward the hospital where my wife works, where I receive many of my medical services, and where, at least several days each week, I set up my laptop, books, and journal in a commons space and write.

I walk away from the School of Medicine building. The urban campus exists perennially in a state of renovation and new construction. I attended university here, and I continue to enjoy winding through narrow lanes behind buildings, remembering with nostalgia my time as a student. Yellow construction tape lines the sidewalks, opening to a recent brick-laid intersection behind the children’s hospital in front of the medical library. I smell cigarette smoke from students tucked around the corner, adjacent to the main walkway. I turn to face my destination: a newly built hospital, reflecting the city skyline in its modern glass façade. My cane slips precipitously from a brick onto the cement beneath, and the uneven stones shift my weight slightly off-balance, pressing through my thin-soled shoes. Doctors rush past, with wind-blown white coats and hospital badges flapping in syncopated rhythm with their hurried steps. A group of eight or more nursing students spills out between double doors from one of the older buildings. They are dressed in school-branded scrubs, young, energetic, and laughing. My “fascinating case” is on my mind, and I replay the brief conversation from no more than fifteen minutes earlier.

For some time in the proceeding months, I rolled this conversation around in my head. What do you mean about my composure? What made it fascinating? Who was talking about it? These questions bubbled like a stovetop espresso maker, thick with the ingredients of my analytic mind, hot with self-doubt. Was the OR arranged in the way I remember? Where were you in the room?

The life of the clinician and the life of the patient are not as dissimilar as we imagine. I think it is important we—all of us—realize our common experiences. I do not suggest we are similar because we are all human, though we are. I do not suggest we are all patients at one time or another, though we are that, too. What I have in mind just now is that the clinician toils under a reimbursement-driven system, accountable increasingly to coding, record-keeping, billing, administrative policy, and an undue burden on the practitioner, programmed into the culture of medicine, to at least treat, if not cure, each patient seen; each malady faced.

The patient, too, is accountable to standards of billing and reimbursement, requisite procedural pre-authorization, hospital policies, surviving illness, sometimes chronic or advanced, with the cultural notion that each disease is treatable, if not curable. Patient-centered care is a misnomer. We should strive for physician-centered care, too, because clinicians are drawn to medicine to heal, which should not come at the expense of sacrificing personal health.

The patient and clinician share a desire for human-centered care, to facilitate healing for the care team, including the patient, the physician, and loved ones. I cling to the idea that healing is a collective event when therapeutic partnerships blossom in the intimacy of relationship instead of the cold clinical gaze.

Though, the life of the clinician and the life of the patient are dissimilar, on at least one important point, and this point steals my thoughts on this brisk Autumn day: the notion of the “fascinating case.”