Monday, June 11, 2007

Magic and Medicine

Sometimes a patient comes in and wants to test the competence of the doctor before trusting the doctor with her care. That happened to me today.

Mrs. Marcos, as I’ll call her, is in her 60’s. Like many people on Saipan who are part of non-Western cultures, her world view has not been significantly influenced by the laws of physics. Ordinary objects and people appear, disappear, morph, transmute, and each with some intent, either to effect good or evil. The world is magical, like the world in Gabriel Garcia Marquez’ “One Hundred Years of Solitude.” If you’re going to successfully practice medicine here, you have to embrace this world view. You have to recognize that your Western scientific world view, is just that: one particular world view. If you want to gain people’s trust and help them change, you have to do it from within their world view, not by getting them to accept your world view. That would be an affront to their view – disrespectful.

Mrs. Marcos told me that there was nothing wrong with her. She was just here for an eye exam. “Okay, let me see if there are any problems.” After a few seconds of looking at her eye under magnification, I say, “Mrs. Marcos, you have a cyst full of fluid on your eye. Have you noticed this?” She looks stunned. I’ve uncovered a secret. I’ve seen it. I must be trustworthy.

She becomes animated. “Doc, let me tell you the story of how this happened.” Now, I’ll admit, when a patient in my examining room offers to tell me stories, I get a little nervous. Stories take time, and there are lots of people outside my door waiting to see me. But I long ago learned to be attentive to the person in front of me at that moment. “I was asleep in my room one night,” she says. “It was two months ago. A man came in and I awoke. He seemed like an ordinary man, but he was this big.” She holds her hand at shin height, indicating that it was a miniature man. “He came into my room. I heard the sound. And I saw him. And then he came back with a woman who also seemed ordinary, but was like him. They keep coming back to bother me night after night, making noise. One night they climb into the ceiling and every night they throw pepper into my eyes and wake me up. And they are the ones that caused this bump on my eye.” She’s agitated. She’s crying, tortured by the burning in her eyes, and the evil little people that are causing it. I take her hand and listen. “It sounds very frightening,” I say. “Would you like me to take that bump off?” “Please, yes.”

She’s not crazy. In her world, there are explanations for illnesses that are not based upon the germ theory of disease or Starling’s law or biochemistry. Try to talk her out of her world view, and you’ll lose all credibility. You’ll cut your own legs out from under yourself. You’ll eliminate yourself as anyone that can help her. But you can’t just tolerate her world view. You have to approach her with humility, recognizing that your world view makes sense to you, but it’s not the only one, maybe not even the right one. Just one that works for you.

We set up the tiny little scissors and forceps and in about 30 seconds the mass is removed from her eye. She is completely relieved and she is comforted by my words that if it comes back, I’m here with my own little bit of magic.

(Published in World Peace, a Blind Wife, and Gecko Tails.)


marianas life said...

hey i'm coordinating a health career camp and was wondering if you'd be willing to come in and talk to the students. or can we do a field trip to your office on sat.? i know you aren't open then. presentations are from 1-2:40 every day this week. you wouldn't need to speak the whole time . we have other presenters as well.

i'm going to share this post with my students though. its wonderful.

Marianas Eye said...

Will next week work? Mark is gone so I'm chained to the clinic all week, and we're closed this Saturday. But next week should work out. If not, I can send one of my staff down to talk to your students, and they can come by for a tour any day after 3PM.


Devorrah said...

Wonderful story--thanks for sharing! (-: