A balancing act

Abstract

The discovery that your body is no longer reliable—rather, it now threatens your existence—comes as quite a shock. For a doctor who falls ill, the psychological adjustment has an additional feature. The stricken clinician faces a two-pronged attack on their sense of self: sickness scoffs at both their vocation and their authority over their body. In his memoir, Life in the Balance, Dr Thomas Graboys tries to make sense of a devastating illness. In early 2004, Graboys, a 60-year-old cardiologist, was diagnosed with Parkinson's disease. The following year there was more bad news: he also had Lewy body dementia. Graboys first became aware in September, 2002, that something was wrong. A few months later, he scrawled a question in his diary: is this early dementia or Parkinson's? Despite this, he continued to see patients, and this period is described in the most interesting chapter, entitled “Do they know?” in which Graboys outlines his sustained efforts to hide his deteriorating condition from his colleagues, his family, and himself. Finally, in the summer of 2005, Graboys was summoned to a meeting with his fellow doctors at the Lown Foundation. It was their unanimous belief that he was no longer fit to practise medicine. He was to retire. Why was this decision necessary? Graboys was one of America's leading physicians, who strongly engaged with his patients. However, the effects of Parkinson's disease were such that in his desperation to appear healthy Graboys ceased to act in the best interests of his patients. The nurses began to double-check his work, and the exhausted doctor found it more and more difficult to hold on to a train of thought; even his patients began to wonder what was wrong. Graboys and his team avoided disaster, but he freely concedes his error of judgment. He quotes the Massachusetts Medical Society's concern that “there are no specific, empirically derived guidelines for determining if an impaired physician is fit to return to work”. Life in the Balance is co-written by Peter Zheutlin. Given Graboys' condition, it seems probable that Zheutlin is responsible for much of the book, weaving together dozens of interviews with his subject. Unfortunately, Zheutlin's prose is insipid and stolid, and the narrative is repetitive and unfocused. Graboys is schooled in the confessional soliloquising of psychoanalysis, but his insights on Parkinson's disease and Lewy body dementia are unlikely to surprise a medically trained audience.