Medicine | The Odd and Unmentionable

The Raising of Lazarus by Rembrandt

This post has been sitting in my drafts folder (i.e. the tomb) for months because I worked on it too long the first day, evening caught me unawares, and the basic idea suddenly turned stupid. (My posts are like vampire victims. Sunset frees my inner critic to suck the blood out of ’em.)

But then a few days ago I came across the following article, Faulty Rhetoric: ‘Save a Life’, written by a real doctor and voila! My idea sat up in its coffin. The blood is back, my friends.

Let’s see if I can finish before nightfall this time. EDITOR

The myth that modern medicine can “save” lives is a primal myth, an archetypal one.

If there was ever a contest to pick the One Medical Myth To Rule Them All, I’d put my money on this puppy because its seductive, prolific, tenacious little tentacles reach into almost every corner of medicine. The belief that we can save lives is arguably the basis of our entire modern health care system and therefore the majority share of our economy, too.

And yet it’s not true. (Hence, the myth part.) It’s based on…well, denial of course. But also a verbal trick so simple that you’ll laugh when you hear it…or cry, or dismiss it as stupid and irrelevant…but here’s the gig:

To create this myth all you have to do is substitute the phrase “we can save lives” for the phrase “we can extend lives” and poof! Instant, just-add-water myth. One tiny word change and we humans now wield power over death itself instead of just (some, a little, not very much) power over time. We don our godhood.

Pretty nifty, no?

The truth is, of course, that nobody can save any life from death. No one survives permanently. All we can ever do is…maybe, hopefully…buy ourselves some extra time.

(And I am NOT knocking time here. If you have something meaningful to do with it every second is sweet, not to mention that occasionally the amount of time purchased is substantial, like years or decades or even, in the case of children, an entire life’s worth. No. All I’m saying is that, in the end, a “saved” life dies just like an unsaved one does. Death is never defeated, just delayed.)

Well…so fucking what? you may be asking and thank you if you are. That’s a very important question.

The problem doesn’t lie on the individual level. It’s not inherently bad for a person to hope for delivery from death. In fact, in the short-term it can help. Denial is a powerful and effective coping mechanism applied wisely. It really, truly is.

The harm comes in when our collective, societal focus (and the lion’s share of our national resources) shift en masse from managing time wisely to trying to “save lives” and defeat death completely. Chaos and tragedy are bound to ensue. It’s like a bunch of people flying in a plane who yell screw the landing strip, Henry! and cheer the pilot on as he tries to stay aloft indefinitely.

Get where I’m going? Anyone else having visions of an airliner full of screaming people plunging out of the sky to explode in a gigantic ball of fire when it hits? Anyone else worried about what it might fall on? (Anyone see parallels with our current healthcare system?)

In life, as in flight, it’s absolutely critical to always keep one’s final destination in mind because ultimately, most people don’t want to live just for the sake of being alive anymore than they want to fly just for the sake of being up in the air. They want to use both to experience something more…companionship, family, travel, learning, laughing, growing, adventuring, building, loving one another…something.

So what is most likely to provide the highest quality time (rather than escape from death)?

Would it be to walk into a doctor’s office and beg, Save me Doc! Save me! I don’t want to die!

Or would it be to sit down and calmly, realistically say, Okay Doc. Before we talk treatments, you need to know a couple things. 1) How I’d like to live whatever time I have left and, 2) how I’d ultimately like to die…peaceful, complete, surrounded, and loved. Not strapped to a gurney, blue, and bankrupt with my loved ones traumatized for life. Now. Is there a treatment ticket I can purchase that will buy me some meaningful time but still eventually wind up on THAT landing strip?

Of course for conversation that to happen, we each have to first figure out how we’d most like to live and die, because that’s something no doctor…however good, however wise…can tell us. But figuring that out is also how we finally start to grow up in this new medical paradigm we’ve all created together. And it’s the only way any of us will ever learn to navigate its labyrinth successfully, harnessing the miraculous benefits it offers while avoiding the substantial harms it can inflict.

And (looks at the watch quick) I’m…done! With five hours of light still left. Well done, me.

copyright Dia Osborn 2013

Fecal bacteria at 10,000x magnification.

(Pretty cool, eh?)

One of the most popular posts on this blog over time has turned out to be, of all things, Fecal Implants? Seriously?! (Yup.) When I first read about the treatment almost two years ago now, frankly, I thought it was a joke. But it quickly became apparent that, for a growing number of people suffering or dying from Clostridium difficile colitis…a spreading epidemic in hospitals and nursing homes…fecal implant treatments can often be more of a miracle than a punchline.

Well, buckle your seat belts again folks because it looks like not only do fecal implants provide an effective treatment for C. diff, they may also provide some measure of relief for a host of other gut-related illnesses. In an Australian article from The Sydney Morning Herald this morning, More Than A Gut Feeling, Sydney gastroenterologist Professor Tom Borody is quoted.

”But there’s also some evidence that other conditions, including ulcerative colitis, chronic severe diarrhoea and IBS (irritable bowel syndrome) can be improved with FMT,” says Borody, who uses the technique in his practice and believes we need more research to explore its potential.

The article talks about the growing awareness in medical circles that the legions of bacteria living in our guts, when knocked out of balance by things like sanitized environments, bad diets, and antibiotic use “may contribute to hard-to-treat problems such as allergies, autoimmune disease, irritable bowel syndrome, inflammatory bowel disease and even obesity and diabetes.”

(Evidently, a recent study by Dutch scientists shows some promise that transplanting gut flora from a healthy gut to a compromised one may improve insulin resistance.)

The wheels of research are finally starting to roll on this whole idea, which is absolutely fabulous. I can’t help but wonder though when the far bigger wheels of industry will wake up and start moving in. How-oh-how will the pharmaceutical companies and hospitals wind up packaging this one? Poo packets?

Ideas anyone?

Actually, the formal name used for fecal transplant is Fecal (faecal) microbiota transplantation (FMT) or stool transplant. Which, when I climb out of my eight-year old self, actually seems more respectful to those who need help but don’t want to wind up as a punchline in someone else’s joke. So from now on, FMT it is.