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Medicine as Transaction: Why I Insist on Being Human

Medicine as transaction.


I suppose I am not suited for it.


The parents who gave birth to me were unfit for the job of parenting. A cancer diagnosis at the age of 14, while terrifying, offered me an opportunity to find the nurturing I lacked. In healthcare, I found better people to parent me. 


There was Dr. Mackler, my oncologist in rural Pennsylvania, who encouraged my love of books and dance, who told me stories from Shakespeare and whose office was illustrated with black and white etchings of Hamlet, Lear, Portia, and Titania. As my own father rarely had words for me, talking poetry and theater with a sensitive, understanding man while I received infusions of cyclophosphamide, mechlorethamine hydrochloride, vincristine sulfate, procarbazine hydrochloride, and prednisone, seemed like an unexpected dream. 


When things went from bad to worse, when my lymphoma metastasized during chemo instead of withering, I knew I was probably going to die, but before that I would meet some of the staff of the Fred Hutchinson Cancer Research Center. In addition to being the finest medical professionals I will ever know, they were the most interesting people I had ever met, given that I came to Seattle from my podunk town in upstate New York. 


Terri, the teacher assigned to help me continue my education, told me stories of Carnival in Brazil and took me to art galleries and coffee shops, where she talked to me as if I weren’t a muddled fifteen year old. 


Betsy, another educator, invited me to her cottage overlooking Puget Sound, where we collected shells from the ocean and vegetables from her garden, and she demonstrated her weaving and harpsichord playing. 


Once I was an inpatient, every worker I encountered at the Hutch also managed to be a human being. I learned about Italian cooking from the chef on the bone marrow transplant unit and about jazz from the janitor who mopped the floor of my hospital room. My primary nurse showed me photos of the Vietnamese pot-bellied pig she kept as a pet. 


Perhaps I was dying, but in the meantime, with the help of these fabulous characters, I was living.


So it comes as a shock to my system to have cancer and cancer treatment again in my fifties and find, what I should hope to be relationships, are actually transactions. As no one has the time or energy to be a person and see a patient as a whole person, medicine is about tests and procedures performed, drugs administered, symptoms checked and addressed in the quickest manner possible. 


While my head grasps the economic pressures of the healthcare system, my heart shudders from them. Does any sick person want to feel like a product on an assembly line with a limited shelf life that must be sealed and stamped before being trucked out of sight? 


Like many other traumatized people, I am super sensitive to slights, to coldness, to indifference, to errors in judgment that while they may not damage the body, damage the spirit. My spirit, in order to heal and be healthy, needs as much care and nurturing now as it did when it was fifteen, but I see now how this need is incompatible with systems prioritizing efficiency and economy. People who were not abused by their parents may not mind the indignities as much, but I’m also sure they don’t enjoy these indignities; they just are more equipped to shrug them off.


So after much false hope and delusional fantasies, I suppose I’m back where I always was: alone, fending for myself, finding ways to love and nurture my spirit while my body is pummeled and health care workers check the time and pull up the file of the next body on the table.


Although I miss my false hopes and delusional fantasies, I ask myself, what are these startling realities calling me to do? Who can I reach out to? Who and how can I help? Because if I am hurting, there are other people hurting worse, and it is thinking and doing for them that gives my suffering meaning. That causes me to look out, not in, in the hope of giving to others what hasn’t, and isn’t, being given to me.


Two people holding hands
The importance of being people first

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