18
Dec 17

“I vould like sekond opinion please, doktorrr.”

The man looked up at me defiantly, his face haggard and creased with worry; his wife huddled next to him, sobbing quietly, their son cradled carefully in her arms.

The repeated and agitated “nyet, nyet” that peppered mom’s teary discussions with her husband should have been a clue that things were going sideways.

A public health nurse, disturbed by the 6-day-old baby’s deeply yellow complexion, had sent the young family to the emergency department.

I examined little Anton thoroughly, after obtaining important additional details from his parents, including the alarming news that the little guy had lost all interest in breast-feeding.

He was sleepy, difficult to rouse despite a firm rub of his sternum, a simple maneuver that reliably produces, in a healthy baby, lusty cries of protest.  Anton offered only a weak and high-pitched whimper, rousing just enough to display the yellowed whites of his eyes, and drifted back to sleep.

It’s not always obvious, in my line of work, what immediate next steps should be prescribed after a sick child is assessed.  Medical practice remains an obstinate mix of art and science - patients don’t present with a pathway to accurate diagnosis helpfully stitched onto their foreheads.

But in Anton’s case the way forward seemed crystal-clear.  He was badly jaundiced, lethargic and feeding poorly.  He needed a “full sepsis work-up” - an intensive hunt for potentially deadly infection.

I laid out the necessary course of action to little Anton’s parents, my words delivered with confidence and practiced ease, a spiel I had delivered countless times to worried parents in similar circumstances.

Their son would need his tiny veins punctured to obtain blood specimens, bladder catheterization to acquire a sample of urine, insertion of an intravenous cannula to deliver life-sustaining fluids and antibiotics, and a lumbar puncture – the critically important but fearsome-sounding “spinal tap” in which a small stainless steel needle is inserted into the vertebral canal to extract spinal fluid for analysis.

I explained the rationale for each intervention in “lay terms” and in detail, pausing intermittently to allow the father to translate my words to his wife.  The couple had immigrated together to Canada from Kazakhstan a year earlier, but his command of English was better than hers.

As they conferred animatedly in Russian, I briefly poked my head out of the room to alert the nurses to prepare what was needed.  It was then, with my mind already on a couple of other patients who would need reassessment before I could circle back to perform the spinal tap on Anton, that I heard the father state, gruffly, “I vould like sekond opinion please, doctorrr”.

I was momentarily perplexed.

Then I understood:  it was the language barrier, surely.  They needed a bit more explanation, additional reassurance, a few more details.

I began to deliver again the specifics of my opinion, speaking more loudly and using simpler words and new illustrations, intent on ensuring that they grasped my expert advice in its entirety.

The father interrupted, almost angrily: “Ve kame herrre bekause baby is yellow. Ve do not vant all zis stuff. He needs only some light! You make my vife verrry upset! Ve need another doctorrr. Please!  Otherrrvise ve go home.”

It dawned on me, belatedly, that he didn’t want my opinion, delivered a second time - he wanted a second opinion, from a different doctor.

In retrospect, it was understandable.  They had been led by the public health nurse to believe that their jaundiced son would simply need phototherapy, the usual treatment for this sort of thing.  Furthermore, while they waited anxiously to see me, the Russian version of Dr. Google on their iPhones had reassured them that the only treatment Anton required was some light therapy, and all would be well.

Then I had intruded like a volcano of doom, spouting off about serious infection and possibly even meningitis, practically waving a spinal needle around, scaring the man witless and sending his wife into hysterics.

Secure in my “doctor extraordinaire” pomposity and cocooned in a bubble of professional efficiency, I had failed to properly apprehend the degree of angst coming to full boil directly in front of me.

These parents looked at me and did not see a competent, capable physician, an articulate, winsome healer infused with boundless empathy.

Nope.

They saw a dangerous lunatic, a careless doctor to be kept away from their precious baby at all costs.

Out-sized ego properly deflated, I beat an ignominious retreat and skulked off in search of a colleague who could reassess the situation anew and offer this poor family the proficient, empathetic care they needed.

The uncomfortable memory of this case surfaced unexpectedly over morning coffee last Tuesday, thanks to Andrew Coyne’s ruminations in the National Post as to whether President Trump is certifiably nuts (it remains an open question, apparently, for some).

“We’re all entitled to our opinions,” wrote Mr. Coyne, “But even experts – especially experts –should not pretend that they are more than that.”

Precisely.

Opinions are like assholes, after all - everybody’s got one.

But, as Australian sage Tim Minchin rightly observed in an address to university graduates in Perth,  “Opinions differ significantly from assholes, in that yours should be constantly and thoroughly examined.”

Prejudice and bias distort our viewpoints, no matter how sturdy our scholarship, how pure and uncluttered our thinking or how solid the foundation of our intellect.  Pontificate if you wish or if you must, is Mr. Minchin’s message, but afford your opinion serious analysis and then deliver it with humility, grace, and tolerance of criticism - and always prepare to be wrong.

Many of us - I’m holding a giant mirror up to members of my own profession – have a bothersome tendency to present our perspectives like a male turkey displaying his snood – arrogant, swaggering, self-important.

In the case of physicians, given our over-stuffed educations, some propensity for hubris is perhaps understandable (albeit no less forgivable).  Few people labour so hard, so intensively, and for so long to acquire vast stores of specialized knowledge and experience.

Like most physicians, I employ that expertise daily to generate a stream of considered opinions, in the process soliciting additional perspectives as needed from colleagues to plot the best care for my patients.

In January of 2007, this medical spotlight of inquiry and analysis unexpectedly turned on me: discovery of a malignant tumour growing in the middle of my head left me scrambling for medical opinions to address my own illness.

The unwelcome news rudely upended my life and sucked all my energies into an immediate and fierce fight for survival (after the requisite period of staring, slack-jawed, at my MRI scan).  “When a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully," 18th British scribe Samuel Johnson noted astutely.

As I struggled to regain my equilibrium this nugget coined by eminent scholar W. Edwards Denning caught my attention: “In God we trust, all others must bring data.”

I freely confess to a robust trust in God, but I’m reasonably sure that doesn’t preclude me from arming myself maximally with information – God helps those who help themselves, so to speak - and so my wife and I set about to gather all the “data” we could.

We scoured the medical literature, consulted widely and internationally, obtained numerous medical and surgical opinions.  It was a gargantuan effort, disproportionately driven by my tenacious and resourceful spouse.

And, almost eleven years deep into battle with a cancer that on average extinguishes its victims in seven years, I’m beyond grateful to remain on the oxygen-rich side of this soil, and reasonably functional at that.

I’ve been the fortunate recipient of care by a world-class team of doctors, but in the context of this piece, one physician stands out.

On a Friday morning last fall, with great trepidation, I sent the most difficult email I have ever crafted.

I was scheduled in three days to undergo a ten-hour craniotomy, an attempt to remove recurrent tumour, at the hands of renowned Calgary neurosurgeon Dr. Garnette Sutherland.  My email informed him that after much deliberation we had decided “at the eleventh hour” to go instead to Toronto for surgery.

This is the Dr. Sutherland, after all, the impeccably skilled surgeon famed for development of the neuroArm, the world’s first MRI-compatible surgical robot capable of microsurgery, an innovation inspired by the Canadarm of the International Space Station. This is also the Dr. Sutherland who pioneered a groundbreaking intra-operative MRI system based on a moveable magnet.

And this is the Dr. Sutherland to whom I said, “Thanks, but we’re going to go with someone else.”

The larger context surrounding this excruciating decision lies beyond the scope of this essay, but it goes almost without saying that when my tumour grew back yet again, I felt less than comfortable reaching out once more to Dr. Sutherland for advice.  Bridges burned, and all that.

But my options had become limited, and desperate times call for desperate measures.  I decided to send him another email, recounting my clinical course over the past year, and indicating my predicament.

Within hours I received a remarkable reply, empathetic and gracious, replete with possible strategies to consider, and concluded by an open invitation to meet to discuss options for treatment.

This from a surgeon invested with the Order of Canada for his contributions to neurosurgery, inducted into the Space Technology Hall of Fame, and awarded the NASA Highest Technology Achievement Medal.

It is precisely this type of doctor in whom a towering ego in the face of colossal achievement would be expected, and accepted even as well-deserved.

But Dr. Garnette Sutherland, doctor of doctors, sets his ego aside to focus squarely on his patients, before attending to them with dedication, respect, intelligence and skill.

This is not a post designed to elicit sympathy for me, and certainly not pity, its odious cousin. After all, I’ve become a bit of a graybeard, clocking in this year at 50 years old, too old to die young; it’s worth remembering that only a century ago average life expectancy was all of 48 years.

My scribbling serves instead as an admonition to all of us, doctors and non-doctors alike, to be circumspect in our opinions and to employ care in their delivery, to be perpetually open to correction and dissent, and to be humble above all.

In sum:  what the world needs now is a little more Garnette.

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