Walking Tightropes: Response to Montgomery   1 comment

“When the results are normal, we go back to normal too. We are reimmersed in our ordinary lives and their more immediate concerns” (14). And when they are not, everything changes.

The introduction and first chapter of How Doctors Think elucidates how prevalent medicine is in our lives and how forcefully we can be thrust into its uncertainty. Montgomery’s first chapter starts with a story that I know well, as my sister had a lump in her breast removed just months before my mother was diagnosed with stage three follicular Lymphoma. We had barely gotten over my sister’s “scare” (her lump was benign) when my mom felt lumps in her neck. Montgomery’s opening resonated for me and I realized the timing of this class is both opportune and intense. It was hard to read chapter one being so fresh from my mom’s chemo. I met many women with breast cancer, along with others battling its cousins: melanoma, leukemia, throat cancer, prostate, bladder, lung, brain…the stories circulating during those twelve-hour days at the hospital made me feel lucky that my mother’s prognosis was good. I felt guilty being grateful that she was usually much better off than her roommates, but I couldn’t help it. It was hell nonetheless and Montgomery captures the experience effectively. She speaks with the voice of a mother and a professor and researcher critical of the very practices that will save her daughter’s life—a nuanced, unique, and appropriately biased perspective.

Montgomery’s discussion about chemotherapy is important because chemo is both hard science and application or practice. It is the chemistry of life and death and must be administered with skill and compassion. The treatment process can be confusing for patients. Montgomery writes, “If consensus has been reached about who needs chemotherapy, there are nevertheless bewildering choices among chemotherapeutic agents and regimens” (19). It is overwhelming to be faced with such a grave and pressing set of options, particularly for a scared patient still processing a diagnosis.  The language of chemo (Bendumustine, Rituxin, chop), the tools (mints, distraction, that one comfort food to quell nausea), the time passers (crosswords, puzzles, knitting), the accessories (lime/pink/blue bracelets, cups, ribbons)—this was not a language I expected to learn. Those who work in oncology, and as Montgomery asserts, all fields of medicine, must strike a careful balance between the factual/scientific/concrete and the emotional/compassionate/uncertainty that cancer treatment demands. One of my pharmacist friends jokes that she wanted to be a doctor but did not like working with the people as much as the drugs. Oncologists must be the pharmacist and the nurse, the counselor and the medical expert, the scientist and the practitioner.

Montgomery’s discussions consistently relate back to a persistent distinction between science/objectivity (as if science is objective) and art/practice/subjectivity, reiterating our culture’s love affair with binaries. She asks why “clinical judgment [is] not celebrated” (34). Is it because we feel more comfortable putting our lives in the hands of objectivity rather than the conjecture of one single subjective individual? Relying on the comforting assumption that science and thus medicine is objective, factual, fixed, and reliable makes us feel better. Of course that “singular” opinion is the result of countless case studies, much research, and many other opinions (objective and subjective), and while that might be a better bet than prayer, the holistic nature of medicine involves mind, body, and spirit—or at least it should. We are whole beings and should be treated as such. The same goes for medicine, which requires combination of science and humanity, case studies and kindness.

My question is for discussion is one Montgomery poses on page 79 (since she spends most of the book entertaining the question of misdescription, I wonder what you think): “Does the misdescription of medicine matter?” To elaborate, if medicine is actually practicing what Montgomery preaches by being a science and art of medical application, does it matter if it is categorized as a science? Or does it impact the practice of medicine more than we realize? After reading Groopman, I’m not so sure.

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Posted August 31, 2010 by Lela in Uncategorized

One response to “Walking Tightropes: Response to Montgomery

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  1. Great question, and I think she only begins to answer it, mostly in the context of medical education/training.

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