We Can’t Go On Dying This Way

Abstract

Only yesterday, in a seminar with a dozen interns, my colleagues and I were discussing ways in which to bring an medicine ideal into a more vital, cohesive, effective practice, so that the term integrative wasn't reduced to a marketing strategy. We cited the story of a 50-year-old woman, a resident of New York, a mother of six, who during the course of her very sudden and difficult cancer, had required the consultation of several additional specialists. The six physicians involved had never had a conference call or collaborated together. Four of them had never spoken with, examined, or met the patient; they reviewed and interpreted film and sent faxes to the primary or the oncologist. During the year after her burial, the surviving spouse not only grieved the loss of his wife, but with a painful retrospective gaze, expressed confusion and personal dismay, largely with himself rather than at any system. How did this happen? he would say, remembering small things that could have made a huge difference for his wife had any team ever assembled. Why didn't we have the presence of mind to ask for some kind of cohesion? was his question. The learning curve the family had endured, just fighting the cancer, had been comprehensive, some sort of blitzkrieg, and most days had been devoted to mere survival. In marked contrast to an institutionally entrenched fragmentation, today's guest author, board certified in both Internal and Holistic Medicine, reflects on a vision that surpasses basic concern. He addresses the theme of cohesion from the perspective of the provider, who has the power to assemble the team and directs the medicine program—a conductor! He also works from within a dynamic, committed teaching situation. As such, the director is uniquely positioned to encourage cohesion and implement improvements routinely, in the same way that one tunes and retunes a fine musical instrument or an orchestra. It happens daily, and does so simply, as a matter of course. Poignantly describing ways in which quiet disconnections or missed opportunities can happen within the ordinary or routine events of life, (medical and familial, at home, and in the hospital), the author uncovers a perfect antidote, team communication, if only we do not succumb to the tyranny of the urgent. —Therese Schroeder-Sheker The Chalice of Repose Project www.chaliceofrepose.org