Be well. Practice big medicine.

Blair Schwartz | On listening to your grandmother

Blair Schwartz providing emergency med services for The Ride to Conquer Cancer in 2008

As a fairly new attending physician, I’ve taken to the habit of asking some of my more senior colleagues for tidbits they wished they had known when starting out. One wise practitioner told me, to never forget to practice some “grandmother medicine”.

Having grown up in a traditional Jewish family, my mind instantly darted to the miraculous curative powers of homemade Chicken Soup and the admonition to put on my scarf lest I catch a cold. While the medicinal properties of Chicken Soup are undeniable even in the absence of a randomized control trial, this wasn’t quite what my colleague was referring to.

He was talking about Bubbemycin.

While Bubbemycin sounds like something you take an injection of to treat the clap, its role in treating patients is irrefutable. The colloquial translation of this Yiddish expression refers to tall tales, but literally means grandmother stories, and it is from this definition that I’ll operate.

My colleague was referring to the kind of information your grandmother garnered when you brought a friend to meet her: How did you meet him? What does she do for a living? Who are his parents? What does he enjoying doing in his free time?… also referred to as “getting to know someone inquisition style”.

In healthcare we all too often focus on disease. We focus on its pathophysiology, what our protocol tells us to do in response, or resuscitating to specific goals.  Attaining clinical stability, or a semblance thereof is a primordial goal. However, when time allows,  it is only by getting to truly know the person with the disease that you can ever hope to truly treat them.

I remember as a young paramedic working in Montreal’s infamous Ice Storm being flummoxed by the undue resistance and at times abject fear I faced as I made the rounds to evacuate seniors from their now heat-free apartments. I failed to appreciate that asking someone for their ID number (Medicare) and hurrying them to a waiting bus, might have a different interpretation for a Holocaust Survivor…. lesson learned.

As a junior ICU Fellow I had received a patient in transfer for shock of unknown etiology from a peripheral hospital. The young patient was known to our center’s transplant clinic and came by ambulance surrounded by her husband and children. Like a good intensivist I promptly began appropriate resuscitation and began my workup, ultimately culminating in a diagnosis of extensive Necrotizing Fasciitis (aka Flesh Eating Disease). I rallied the troops, called the surgeon and prepared to go to war with this newly discovered enemy. The extent of her disease meant she was likely to lose her entire leg up to the pelvis. I went to explain my diagnosis and plan to the family.

After presenting my case, her family started telling me about the woman who lay intubated in my ICU. She had spent several years on dialysis waiting for her kidney transplant, a process she told her children she found absolutely unbearable. As they began to tell me how she was before she was sick and how miserable she was during times she was dependent on others, I was able to get a perspective for this woman, her nature and her spirit. I was proposing a procedure that had a small chance of saving her life. It would be a life in a wheelchair with a protracted rehab course just to allow her to sit in that chair.

Together, we chose not to treat the disease, because we had taken the time to get to know the patient WITH the disease…

Suffice it to say, grandma is often right.

Now go put on your scarf.

Be well, Practice Big Medicine.


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