Life in a medicalized society

At no point, even when it was tempting to do so, did I ever doubt the competence, goodness, and sincerity of the doctors who attended to my mother throughout the period of her recent hospitalization.  And I still do not.  And if I may, I will use this occasion to thank them for their kindness and generosity.  I think they are among the best in the world.

But, I also think that like almost all medical specialists everywhere, our doctors may have become the unwitting agents of what is sometimes called “disabling medicalization” — a view that promotes the benefits of hospitalization,  that sees human beings as nothing but the fragmented showcases of illnesses, and that equates progress toward wellness with medical intervention.

The day after I wrote a column about my mother’s near-death experience, her condition deteriorated.  The massive internal bleeding that nearly killed her the week before recurred.  The doctors ordered blood transfusion.  But the more blood was transfused, the fresher became the blood being expelled from the bowels.  The only way to find out where the bleeding was coming from was through an endoscopy, a procedure that entails  inserting a microscopic camera attached to a tube, into the mouth and down to the guts through the esophagus.   My mother protested: this would be the third time in three weeks that this invasive and painful procedure would be done to her. She looked at me and said that as it was time for her to go, she would like to be spared further pain.


I now think it is true that death is easier for the dying than for those left behind.  It was her life and her body, and none of us felt  entitled to tell our mother how long she should hang on to life and how much pain her body should endure.  We should respect her wish.  That was clear to us.  But we also wanted to make sure that it was not just the monetary cost that was preventing her from submitting to yet another procedure. I made a final attempt to plead with her to allow an endoscopy.   She relented, clearly more out of a wish to free us from guilt than to lighten the burden of her own pain.

The endoscopy showed nothing.  Her doctors surmised that an ulcer causing the bleeding might have stopped spontaneously.  Against this optimistic but unfounded assessment, my mother continued to bleed and to fade away.  She was transferred to the ICU.  In the end, the doctors told us what we had been expecting: there was nothing more they could do.  Surgery was an option, but, in her present state, the doctors said, she would not be able to withstand it.  Moreover, the blood transfusion would have to be discontinued; the anti-coagulant that comes with the blood being infused could be preventing the wound from closing.  An expensive drug being administered to counter this effect did not seem to work.

I consulted my brothers and sisters on the situation we faced.  Their unanimous view was that we should allow our mother to go peacefully, gracefully, and, if possible, painlessly.  This meant withdrawing all medication and blood transfusion. The doctors fully concurred in this decision.  But I had to sign a formal statement saying that this was our wish.

On that sad evening that we thought was going to be her last, I asked permission from the ICU to let each one of us, her children, to visit our mother.  She was still bleeding, but every form of medical intervention had been withdrawn.  For the first time in many weeks, however, she looked serene.  I asked her if she felt any pain.  No, she did not. I was not sure if she knew that she was dying, but I was bidding her goodbye.  Awkwardly, I asked if there was anything she wanted to tell me, or anything I could do for her.  Nothing, she said.  She advised me to get some sleep.

The night passed slowly but the phone in the hospital room where we waited did not ring.  By morning, when we saw her again, the first thing she said was that she was hungry.  The bleeding had stopped. The ICU doctor said she might be more comfortable if we moved her back to her room.  And of course, she said, your mother could eat anything she wants.

It took a while before the doctors who expected to find a corpse would visit her again.  One by one, they came to see their patient, unbelieving and marveling at her fighting spirit. The bleeding had sapped her strength, but she seemed convinced that the only way to get it back was by eating.  She asked for certain dishes that she used to cook as a young mother, and my sisters could only happily oblige her every whim.  It has been more than a week now since we brought her home.  Her condition remains fragile, but her will to see the new century’s dawn sustains her.

Many years ago, I came across a notion known as the “wisdom of the body”, the idea that the body was capable of detecting its own deficiencies and of healing itself.  It made an impact on me, and even bred a personal skepticism about the powers of modern medicine. There is no longer any room for these views however in a medicalized society.  They would be scoffed at instead of taken as useful reminders about the complexity of the human body.

Naturally, these thoughts came back to me as I began to wonder how much of my mother’s condition was the body’s response to wellmeaning efforts to treat her.  One does not have to be convinced about the reality of iatrogenic illnesses (disorders induced by medical treatment) to worry about the untold consequences of radical procedures and treatments performed on the human body.

These days, nothing strikes more fear in me than a doctor who no longer looks at his patients as total human beings, but from the narrow prism of his specialty, sees only disembodied hearts, lungs, livers or kidneys.


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