Tuesday, August 3, 2010

good read for all

1: The Voice of the Universe

While visiting the US in July 2010, I ventured into many bookstores to find what other cancer books I would be able to buy to bring home. Unimpressed, except for a mere handful, as I have most of the books on their display shelves. I must say I was fortunate to have picked up a copy of The Scalpel and the Soul written by Dr. Allan J. Hamilton, an acclaimed Harvard-educated neurosurgeon who was once the chief of neurosurgery and chairman of the Department of Surgery, University of Arizona Health Sciences Centre.

Commenting on the book, Dr. Bernie wrote: A tragic error in medical education is that doctors are taught to think and not feel. In this book, Dr. Hamilton wrote how he felt. He opened his heart and eyes to life’s spiritual lessons and the mystery that thrives amidst his professional practice. Indeed, this is a book of its time. Anyone in the healing profession should read it. Those who miss it missed much of life’s mysterious lessons.

I have learned much from this book. And I am going to share what I learned with you.

Dr. Andrew Weil, founder and Program Director of the Arizona Center for Integrative Medicine, wrote the foreword for the book. He said: Like me, (Dr. Hamilton) regards patients as not just physical bodies but also mental/emotional beings and spiritual entities. In order to understand health and illness, doctors must examine and attend to those dimensions of human life as well as the physical.

Indeed, in this book, Dr. Hamilton shared his spiritual experiences. He wrote: I started my journey as a doctor trying to understand the differences between the brain and the mind. In the end, I also had to grapple with the conundrum of the soul … (leading) me to affirmation of life beyond life, beyond death, and beyond fear … I could hear the voice of the Universe. And the voice of the Universe is that of a mother calling after her beloved children.

At the age of eight, Hamilton and his mother met a Gypsy fortune teller. The Gypsy woman held his hand and said: This one, he will become a doctor. May be even famous. It was a dim prospect indeed. Hamilton studied oil painting in College – having good fun sketching naked women but he admitted I couldn’t make a go of it. With reluctance he switched to studying English and American literature. When he graduated he got a job as an assistant janitor! He mopped, polished and swept the place that he worked for. Then he worked part-time as a kennel boy helping a veterinary surgeon. This was when he fell in love with surgery – I learned I loved working with my hands. Fate has it that Hamilton ended up in Harvard Medical School. Hamilton wrote: But as I look back, it was the personal episodes and insights that shook me up and changed me … I would kiss that Gypsy woman now if I could find her. She gave me a secret dose of hope – a shot of mythical confidence.

In 1981, Hamilton went to Africa as a surgical fellow at a small hospital in Lambarene, Gabon. This is the hospital made famous by Dr. Albert Schweitzer. Like many recipients of the Albert Schweitzer Fellowship, Hamilton found his encounter with the people in the African jungle a valuable experience indeed. In Africa, I lost a great deal of my faith in science. I began to have a deeper appreciation for the power of magic, taboos and curses. Native folklore could make more sense sometimes than all my Western science. It’s easy to scoff at beliefs in the supernatural … Africa taught me that the supernatural lies just beneath the surface. It only took a small, definite shift in one’s vantage point to see it.

In his parting remark in the foreword of the book, Dr. Weil wrote: I don’t not have patience with medical experts who dismiss accounts of spontaneous healing and unexpected responses to unconventional treatments as “anecdotes” that are unworthy of scientific attention. Good science begins with uncontrolled observations. If observations do not fit the standard model of reality… scientists should give them attention. They are the raw material from which we form hypotheses to be tested.

I cannot agree more with Dr. Weil. For twenty six years in the university, I never fail to emphasize to my students that the first step in any scientific discovery is the careful observation of the natural phenomenon that happens around us. If you miss this all important first step, there will be no new discovery to uncover, no new idea to advance, and we will remain forever blind.

2: Luck

· I have learned that luck, good or bad, can spell the difference between surviving and perishing. It can be the power behind a successful surgery or a frightening complication … (it is) beyond our control. We have to just accept it.

· Over the years, I have had to unlearn a great deal of what I was taught ... I was trained to believe that compulsive focus and a constant anxiety about the details is what would keep you out of trouble. As I grew older, I began to appreciate just how much luck has a role to play.

· When a surgical procedure goes well, it’s not just our hands that pull it off. It’s the patient, the anesthesiologist, the surgical team and then a healthy component of divine intervention.

3: Hope

· Hope is simply the desire to prevail, to survive and to win against overwhelming odds.

· A patient asked Dr. Hamilton: How long do I have? He replied: I can never give a clear answer to that question because there isn’t one … a surgeon has to be careful not to extinguish the patient’s hope.

· Wait! Just wait! Wait patiently. Wait earnestly. Wait as long as it takes. The universe has a soft spot for those who demonstrate they can endure. The heavens draw closer to those who show they can wait. Wait without pride. Without malice.

· There’s the heart of a champion in most of us. At the right time, under the right circumstances, we’re all capable of delivering an “Olympic performance” – at least once in our lives.

· I am convinced Donald (a patient) died that night because the hope that had sustained him was taken away. When I had said it was “time to go fishing,” I mistakenly cut the thin thread of hope that had kept him alive. He didn’t die directly from his tumour … he died from despair. He died from my inadvertent disregard for what was really keeping him alive.

· I’m convinced that our personal feelings have enormous impact on our health. I believe that negative feelings – anger, guilt, hatred, resentment, regret, envy – are quite dangerous emotional energies, because they are destructive to the individual that harbors them.

4: Spirituality

· Many physicians equate religious beliefs with superstition and mystical symbolism. The truth is that I pity the physician who cannot envision medical science as an integral part of God’s creation.

· Religious faith does not threaten scientific integrity. Each new secret of medical science is nothing more than one more revelation of God’s loving and majestic power.

· You can get in touch with the divine powers. They can only be heard when a person silences his or her own mind.

· All through residency, I thought it (being a surgeon or doctor) was about efficiency, speed and accuracy, when it was really about compassion. How had I finished residency training for eight years and missed such a fundamental premise of patient care?

Mrs. Hilts had terminal ovarian cancer. At the same time, she was taking care of her grandson Beau, who had a trauma of the brain. Beau’s mother was not considered fit to take care of her son because she was on drugs and alcohol. This situation was indeed precarious. So Hamilton and Dr. Michelsen, the oncologist thought it appropriate to have a frank chat with Mrs. Hilts about their bleak future. The oncologist told her: … it’s usually less than … four months. Is not such comment familiar enough to cancer patients? Responding to the prognosis, Mrs. Hilts said: I do not pretend to know what the future holds, sir, and neither should you. None of us has that power.

Dr. Hamilton wrote: Less than three years after Dr. Michelsen declared her unlikely to live more than four months, Mrs. Hilts attended the doctor’s funeral. Last year, at the ripe age of eighty-eight, Mrs. Hilts spoke the following words to a cancer survivor group: “You need to be a realist to believe in miracles, because one can only see the real truth with the heart and not with the eyes.”

Mrs. Hilts was a lady with strong faith. Cradling her grandson in her arms, she said this prayer together with Dr. Hamilton:

Lord, hear my prayer. I hold here in my arms your dearest son Beauregard. Lord, I do not fill your ears with complaints and protests. No, Lord, I ask only that you look down upon me and my tiny grandson and bestow upon us your wisdom and patience so that here, and in the future, Thy will may be done as it pertains to Beau and me. Lord, I realize that we are only passing time here on this Earth till we are able to rejoin You, our Heavenly Father, in Paradise. I ask for nothing but Your guidance and love. Amen.

At CA Care, I have often advised patients to go home and pray to your God (or gods). As a Christian, I too pray. I believe God knows our sufferings and therefore I do not go to God, day in and day out, with a long do-this-do-that list. I have often said this to our Christian patients. Pray that God will open your heart so that you can make the right decisions, and that He gives you the strength to endure this suffering. Above all, for whatever outcomes, let His will be done. This prayer of Mrs. Hilts is exactly what I always had in mind.

For those who believe in God, the words of St. Teresa of Spain would bring further assurance:

Let nothing disturb you, nothing frighten you. All things are passing. God never changes.

Patience obtains all things. Whoever has God lacks nothing. God is enough.

5: Miracle

· Miracles are the backdrop of everyday existence … (they) are the glue holding the cosmos together.

· Physicians and surgeons have been taught how NOT to see the miraculous and magical. (They) are trained to see the obvious, the concrete. Manifestation of the divine and the sacred are considered intrinsically suspect.

· We need only a pinch of hope and then the miracles appear.

6: Death

· Death is only an illusion, a figment of time.

· Suffering and death narrowed our vision. We are locked in a battle of wits and guts, fighting desperately to keep people alive. There wasn’t anything else to feel.

· After a near-death experience during a heart attack, a patient told Dr. Hamilton: I got to tell you that there really was nothing scary about it. I just felt at peace, loved. I just seemed to rise up in the air, like a puffy cloud. I could see myself lying in the grass. But it wasn’t like I was scared or anything. I just felt like going home. You know, something that you’re just dying to do … it was like I was looking forward to it. Like I’d been looking forward to it … and now I am going to finally get there, get to do it … I knew there wasn’t anything to fear about what lay beyond this life.

· There are plenty of things worse than death. But as a culture we have raised death to such mythical proportions that it has become more frightening and less approachable.

7: On Being an M.D. versus Being a Healing

Sometimes, I read that the initial M.D. means Medical Deity instead of medical doctor. This implies the extent of respect and trust society has of this noble profession. Unfortunately, with the transformation of medicine into business this noble profession is slowly losing its luster and soul. Over the years, I have patients who came and related their experiences with their oncologists. I cannot imagine nor fathom the reason why oncologists would tell their patients: Ask your husband to go and rob the bank – this was said in response to the plea of a lady who said she lacked funds after she had undergone thirty-five sessions of chemotherapy and still had to do more. Another patient was told: I would dilute the drug (of the chemo treatment) if you want me to charge you cheaper for your treatment.

We understand that it requires hard training to become a medical doctor. Today, it costs a great deal of money (or investment) to go to medical school. Often young doctors, upon graduation, will need to service their bank loans that supported their medical education. So forgive them for what they said!

Here are some other candid comments Dr. Hamilton made about being a doctor:

· To be a surgeon, any surgeon, requires an ego. There’s an old joke among surgeons: A surgeon is asked who he thinks might be the three greatest surgeons in the world. He always has trouble coming up with two other names besides his own.

· As surgeons, we all know in our guts that every surgery is only a hair’s breadth away from murder. There were no guarantees in neurosurgery.

· In many ways, it is irrational for a surgeon to dedicate his life trying to save people knowing, at the same time, that he’s an instrument of dying too.

· We train hard as surgeons because we believe each life is sacred. To take one by accident is a sin each surgeon must learn to live with.

· These days patients were plagued by far too many physicians and too few doctors. By doctor he meant a physician in whom you can put your trust and your life.

· As docs, we generally don’t tell outright lies. We just don’t speak the truth fully, plainly.

· One of the great secrets of surgery is knowing when to stop a surgical procedure – to call an end to it. Getting out at the right moment is half of a successful surgical outcome.

· Much of today’s traditional (modern) medicine started as the alternative therapy of yesteryear. It is a sad tale of how traditional medicine can turn its back on alternative therapies, even when they clearly are shown to be superior to established practices.

· This is one critical difference between healing and just practicing medicine. Healing requires that physician and patient enter into partnership, facing dangers together. Medicine is not meant to be a mechanical transaction. It’s a spiritual quest, putting your own soul on the line, along with the patient’s.

· Healing isn’t from the brain but the soul.

· Every tumour is nature’s experiment of one. We have to watch the experiment unfold. We can’t make assumptions just because the last five tumours of this type behaved a certain way. This new one might not live by the same rules.

· Doctors can be unimaginative – especially when it comes to predicting outcomes of particular illnesses or surgical procedures. There is no such thing as an average person – and there is no such thing as an average outcome.

· Statistics mean nothing when it comes to a single person. When mathematicians try to consider one individual – the so-called n=1, all the statistical odds and predictions become meaningless – they never can tell how one single person with a disease or surgical problem will fare.

8: Burnt Out

I was terribly impressed by Dr. Hamilton. In my mind, I knew that he was a good and dedicated surgeon – the doctor I would like to refer my brain cancer patients to. But it is not to be. My hope sank after reading his epilogue.

In 2004, Dr. Hamilton underwent a major reconstructive surgery of his lower spine. He wrote: And I surrendered, knowing surgery can fail, no matter how hard we wish it to succeed. If surgery could end well – without risk – then it wouldn’t be surgery as we know it. Without chance, luck, fate, it can’t be surgery.

Unfortunately, there was no complete recovery. Dr. Hamilton took calcium, vitamin D, supplements and herbs like what his patients once took. He tried every available alternative therapy to help him heal his bones. He still had to walk with a cane.

Fate has it that being a surgeon seemed to be in the past now, behind me, in another life. Is a surgeon still a surgeon when there’s no more surgery? The surgical profession is not passive in this matter – no more surgery and it rejects you. You get the boot. Banned. Busted.

Indeed Dr. Hamilton had given his heart, mind and soul to his noble profession. He had made great sacrifices trying to save his fellow beings but at a personal price to himself. On reflection he wrote: I realized my whole world had collapsed around my single-minded ambition to become a neurosurgeon. I have passed up a lot of my children’s lives. I desperately wanted to change my priorities, as a father and as a physician.

I experienced similar experience when managing CA Care. Dealing with thousands of patients over these fourteen-years, I had to cope with all kinds of demands from patients. However, from the very beginning I became aware of this phenomenon called burnt out if I do not exercise my judgment wisely. And over these years too, on a few occasions, I did have patients who came in and cautioned me to slow down: Doctor, take care of yourself first! I am indeed grateful to these precious few for their reminder.

Dr. Hamilton ended his book with a list of twenty rules to live by. Here are some of them:

· Never underestimate luck – good or bad.

· Find a doctor who cares about you.

· Never trade quality for quantity of life.

· Live your life with death in it.

· You cannot dodge the bullet with your name on it.

· Ask your doctor to pray with you.

· Never believe anyone who says “Nothing will go wrong”.

· The will to live is yours.

· To heal quickly, avoid negative influences.

· Never be dissuaded from alternative medicine.

· There’s NO surgery like NO SURGERY.

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