Snowblower Ranch King

Diary of a doctor, a profession of challenges

In Library from Oct. 7, "With Care" by Atul Gawande (Einaudi, 242 pages, 18 €): Cases and exciting ideas the medical profession.
Atul Gawande, a surgeon of Indian origin, working at Brigham and Women's Hospital in Boston and assistant professor at Harvard Medical School. His first was Lobro "Unless complications." In

first one of the most famous American surgeons said, in a fascinating diary of his profession through ill cases and critical situations, and are wondering about how to avoid mistakes and overcome obstacles.

Here is a story from the book:

For nearly forty years the center for cystic fibrosis of the Fairview-University Children's Hospital is led by Warren Warwick, the pediatrician who more than anyone else has devoted to studying the incredible success of the treatment of Le-Roy Matthews. The secret, he says, is simple and broke it learned from Matthews does everything you can to keep the lungs open as possible of your patients.

are prescribed to patients at Fairview the usual things: drugs to thin the secretions and sprayed to keep clear of the respiratory tract, antibiotics and a good drums chin on his chest every day. Yet there was something different in everything that Warwick did.
One afternoon I reached the clinic as he was about the usual quarterly monitoring of a student of 17 years, Janelle. Cystic fibrosis was diagnosed at the age of 6 years and since then has always been under the care of him. Blacks hair dyed shoulder-length blunt, Avril Lavigne black eyeliner, four earrings in each ear, two in one eyebrow and a small stud on her tongue. Warwick had 76 years, was tall, curved, rather shabby in the old tweed jacket, had dark patches on the skin and gray hair graying, in short, the unmistakable look of an aged scholar of the last century. He stood still a moment before her hands on her hips, then said, "So Janelle, what have you done for us? For us to be the best center in the country for cystic fibrosis? ".
'Well, it is not easy, "she said.

An exchange of blows. However, he was fine at school, so good. Warwick pulled out utime the measurement of lung function. A slight decrease, as in the case of Alyssa. Three months earlier, Janelle had a 109 per cent (better then the average of children with cystic fibrosis), was now 90 per cent. One thing good, and however we can expect some fluctuations. But Wrwick not seen her like that.
She frowned. "How come there is this reduction?" He asked.
Janelle shrugged.

cough lately? No. Colds? No. Fever? No. She was sure of having taken medicine regularly? Yes, of course. Every day? Yes if not I never forgot? Be ', of course, happens to everyone occasionally. How often is from time to time? Gradually the Warwick pulled out a whole different story: in recent months had hardly taken the medicine.
the Warwick urged: "Why do not you take the medication?".

seems neither surprised nor angry, just genuinely curious, as if it had never come across a situation so interesting.
"I do not know."
insisted: "What prevents you from taking the medication?"
"I do not know."
"And here," he pointed to his head "what's going on?".
"Non-the-know" conveyed her.
Warwick was silent for a moment, then turned to me, by adopting a different attitude. "The problem with cystic fibrosis patients is that they are good scientists," he said. "They continue experiments. And while their experience to us to help them interpret what they experience. Stop therapy and what happens? Who are not evil, so they decide that Dr. Warwick gave the numbers. "

"But let's look at the numbers," he told me, ignoring Janelle. He went to a small blackboard on the wall. It seemed very popular. "The daily risk of taking a lung infection for those suffering from cystic fibrosis is 0.05 percent. " He wrote that figure. Janelle rolled her eyes and began to beat his foot.
"The daily risk of taking a lung infection while in therapy for cystic fibrosis is 0.05 per cent," he went on, and wrote that figure. "So when one experiences, what he sees is the difference between 99.5 percent and a 99.95 percent chance of feeling good. It seems a small thing, right? Virtually every day there is almost 100 percent chance of feeling good. Instead ... "paused and took a step toward me" is a big difference. " He scribbled calculations. "Multiply for days in a year and the difference changes, it passes 83 percent chance of feeling good at 16 per cent only.

He turned to Janelle. "How do you feel good all my life? How do you become a geriatric patient, "he asked.
She finally stopped tapping your foot. "I can not promise you anything, I can only show you the difference."
That speech contained the core of the worldview of Warwick. He thought that excellence comes from being able to see every day, the difference between 99.5 and 99.95 per cent. Many things that humans do, catch a fly ball, manufacturing microchips, delivering packages throughout the night, depend on similar infinitesimal differences. What makes the medicine is that in those thin margins are lost lives.

So Warwick is so determined to search for that margin for Janelle. Eventually he discovered that she had a boyfriend, and even a new job, and who worked in the evening. The boy lived on her own and she was almost always by himself or by a friend, so often went home for treatment. At school, a new regulation required it to go to the infirmary for each dose that was taken during the day. So he gave up.
"It's a pain," she said. He found that taking certain medications and not others. It took the vitamins. "Why are vitamins?" Warwick wanted to know. "Why should I have a fairy tale." All the rest had dropped.

the Warwick proposed a deal: she would go home every day after school for manual therapy and had asked his friend to make him better. Would keep in your pocket or purse medicines more important and taking them into its own. "The nurse did not allow me," she said. "Just do not tell him," he suggested spontaneously by transforming into an act of rebellion. From there, Jane did not object. But there was something else had to remain in hospital for a few days of therapy to recover the lost ground.

"Today?".
"Yes, today."
"Why not tomorrow?".
"We were wrong, Janelle," he replied. "It is important to recognize I was wrong."
To which she began to cry.

A requirement for success is ingenuity: knowing how to think in new ways, recognizing the failure and change.