Sherlock Holmes, Dr. House, and My Appendix

Just started reading Dr. Lisa Sanders’ book “Every Patient Tells a Story.” She writes the Diagnosis column for the NY Times, and also is a resource for the TV show House. I hadn’t seen the show, so after reading a few chapters this weekend I also watched a few episodes from season 1.

Sanders references Sherlock Holmes frequently in the book, because so many of these health issues are real mysteries. It’s interesting to think of it that way. And in the TV show, House often says that the patient lies. He doesn’t really mean that they lie, but really it’s that they don’t know the right thing to tell the doctor so that the doctor can find the cure.

It reminded me of when I had to get my appendix removed, about 8 years ago. I was working in my first job and had just had my first business trip, which was exciting but also pretty stressful. I’d also just been diagnosed with Crohn’s a few months before and was sort of getting used to the diagnosis even though I was feeling really good and was basically already in remission. My stomach was hurting really bad for hours, and so finally around 3 am I took a cab to the emergency room. The first thing I told the nurse was that I had Crohn’s disease, and in hindsight it was the worst thing I could have done. It was a busy ER, and even though I had every classic sign for appendicitis, they chalked up my symptoms to a Crohn’s flare and left me sitting there as they ushered everyone else through. Delirious with pain, I ended up calling my GI and begging him to come down to the ER and help me get admitted, which he did, and it was the only reason I was admitted – by then I’d waited 6 hours, and then after multiple tests to confirm appendicitis, I was put in surgery, a full 12 hours later.

It was a mystery, I guess, just how any other diagnosis story begins. However, the ER docs were terrible detectives because they didn’t pay attention to the clues. Yes, I had Crohn’s, but I also had every symptom for appendicitis. If they’d paid attention to that, I may not have suffered as long as I did.

Dr. Sanders’ book shows story after story just like that one. Strange symptoms and doctor’s assumptions send them down the wrong path again and again, sometimes resulting in harm and/or death. It all comes down to poor communication in a lot of ways.

Which is why this is the important thing – communication. Eye contact. The doctor spending time listening, talking, working to really figure out what’s going on. I am hoping that my doctors take a look at this book.

Bye Boston

Isn’t it strange to visit a place you used to live, to find that it has changed? It’s unsettling somehow.

 
I lived for a few years in Davis Square, which my friend Lynne assured me hadn’t changed much, and yet I felt strange to see many of the stores and restaurants there had turned into something else. I took a few photos of the things that remained the same. It made me so happy to be there and to see Lynne who is gorgeous inside and out. Did you ever have a friend who just glows? That’s my Lynne. Add me to your RSS Lynne!

 
I got a lot of work done in our Boston office, and as a treat to myself visited Windsor Button, a craft shop near the office that I’d never visited before. It was AMAZING – a ton of yarn, just an excellent selection, and (true to its name) an incredible selection of buttons. I couldn’t decide on buttons for the Central Park Hoodie, but I did get a skein of merino malabrigo (on left – photo unfortunately not true to color) and my good friend & coworker Wendi bought two skeins of yarn (on right) so that I can make her a scarf. The pinkish yarn on top is knit one/crochet too and the one on bottom is malabrigo. I love that word mal-a-bri-go. Mmm. Sounds like the breeze on a distant island. The yarn is heavenly soft and I can’t wait to work with it. Wendi is one of those lovely people with skin that Chanel would love to figure out how to bottle, so the colors she chose for this scarf are just perfect.

Speaking of things that make me happy, I started reading Memoirs of Sherlock Holmes – really fantastic. I got a great old copy from our favorite used book store in Omaha.

  

I love the cover and the feel of the book (take that, e-readers.) The stories themselves are timeless and so fun to read, Sherlock Holmes was the original Monk. And I was very interested to find the line I photographed (if you can’t read it – “the curious incident of the dog in the night-time”) which is the name of another book I liked very much.

Awaaaaaaake

Oh hello Prednisone! WOOOOO-ya. Ladies and gentlemen, I have been up since 3 am.

So.

Yesterday I finished a fantastic book and I think everyone should read it. Great title, great ending.

And in the spirit of lemon cake and insomnia, wanted to share a great muffin recipe for my daughter that I made up and she loves.

1/2 box pumpkin pancake mix (Trader Joe’s)

2 cups applesauce

2 schmooshy bananas

Enough milk to make it batter, about 1 cup

Mix and bake in muffin tins for about 30 minutes on 350. Makes 12.

The Decision Tree

I’m halfway through The Decision Tree by Thomas Goetz, which is subtitled “taking control of your health in the new era of personalized medicine.” I’m finding it to offer a very interesting history of medicine in terms of diagnosis and the doctor/patient relationship.

The other day I posted about the difficult decision to have a child when dealing with a chronic condition. In response to the post, a friend told me via email that she’s also going through that, and so we discussed it a bit more; coincidentally I’d just read something in The Decision Tree that was relevant, and I wrote this to her:

“It’s a risk, it’s always a risk. I remember in my first trimester I was just scared all the time when I’d think of what couldl possibly happen. Then I had to take a deep breath and say, ‘Stress is bad for baby.’ You have to bury that away, push it aside, so you can just live, or else you’ll go completely crazy.  With most things today, a diagnosis is not a death sentence. People are beating things all the time that were previously just thought of as fatal. I read today that just 60 years ago, no one understood the dangers of hypertension – no one even knew it existed. Even though President FDR had unbelievably bad hypertension, which now can be seen plainly when looking at his medical records, his doctors didn’t know it existed because no one did. So, even though he was president and had access to the best medical care available, one day he just had a stroke and died. And the doctors were all shocked. But there’s no way that would happen today. I guess my point is that our children will have access to even better care than we do, so even though ‘anything’ can happen, that isn’t necessarily a bad thing.”

Yes, I totally just quoted myself.

Also, I like how Goetz ends chapter 5, “Throughout, our overall objective should not be to avoid or manage disease. Rather, we should aim to mazimize and improve our health.” I like that – prevention as cure. Obviously I couldn’t prevent having Crohn’s, but I can help manage the disease by taking good care of myself.

I promise to share any other items of interest as I finish up the book.

Time’s 100 Most Influential People: Atul Gawande

Time magazine has come out with its annual 100 Most Influential People feature. As always, it’s an inspiring (and mildly controversial) list. Atul Gawande made the list under the “thinkers” category, and I’m glad he did – I recently read his book The Checklist Manifesto, which I highly recommend. From a career perspective, it was insightful as a way to understand how to get the most out of your team members and especially the people who work under you (briefly: empowerment can create results); and from a patient perspective, it’s helpful to know that so many healthcare professionals, namely surgeons, are now using a relatively simple method, the checklist, to decrease mistakes in the operating room. I feel that as a patient, the more knowledge we can gain, the more we can understand what our doctors are experiencing, the more we can connect with them and produce better health result for ourselves. There’s no doubt Atul Gawande is an accomplished and brilliant man, and certainly deserves this honor, along with Lady Gaga and her flame-throwing bra.