Diligence is also what takes us through breast cancer treatment, isn’t it? The everyday drudgery of radiation; the ability to get that shot of chemo in the arm, even though you KNOW it’s going to make you dreadfully sick; the physical therapy exercises after surgery, day after day after day… diligence is a hallmark of successful cancer treatment, even though we realize it’s no guarantee of success.
Gawande’s next key factor, something that distinguishes the great from the merely good, is “doing right.” He chooses to speak of it in rather uncomfortable terms: should doctors participate in prison executions? After all, aren’t doctors supposed to preserve life, not take it? Laws require medical personnel to be present, and if necessary, to assist with executions. As Gawande writes, “How, then, to reconcile the conflict between government efforts to provide a medical presence, and our [doctors’] ethical principles forbidding it?” The answer, as so often happens in real life, isn’t black and white. While Gawande comes down on the side of medical professionals NOT assisting at executions, he recognizes that those who do “took their moral duties seriously.” Gawande concludes that “…we have to be prepared to recognize when using our abilities skillfully comes into conflict with using them rightly.” Doing right: it may mean not following the law, and each doctor –- indeed, each of us, in our everyday lives –- must look into our hearts to find our own path.
As breast cancer patients or survivors, we have the ability to do the right thing, rather than the easy thing. While it’s not against any law to focus our often lagging energy on ourselves, how much better is it, in the long run, to reach outside your own misery and comfort the teary woman sitting next to you in the waiting room? Or to grab your IV pole and push it around the chemo area to see if anyone looks like they could use a friend? That’s right; that’s good.
Finally, Gawande examines ingenuity. He uses an account of a baby’s birth via Cesarean section to detail the ways doctors over the centuries have learned to deal with childbirth, a process that despite its worldwide ubiquity can go wrong “at almost any step.” From the seemingly barbaric ways “stuck” babies were taken from their mothers in ancient times, to the skillful use of forceps prior to the advent of surgery, Gawande shows ingenious responses to life-and-death situations.
He also examines strides in cystic fibrosis treatment by detailing the inventive ways doctors LeRoy Matthews and Warren Warwick have treated their patients over the years. And he uses their performance to riff on the meaning of average. “If the bell curve is a fact, then so is the reality that most doctors are going to be average. There is no shame in being one of them, right? Except, of course, there is. What is troubling is not just being average but settling for it... When the stakes are our lives and the lives of our children, we want no one to settle for average.” Ingenuity is one of the attributes that can take the average doctor to the next level.
And truly, ingenuity is second nature when you’re dealing with breast cancer treatment. How many of us have figured out a way to carry around those darned mastectomy drains without having them flop all over the place? Or how to fit a breast form into a favorite bra? Or how about pointing out to the overworked schedulers at the hospital that if you’re having radiation at 8 a.m. anyway, why not schedule that DEXA scan for 8:30, rather than 11? There are ways, both large and small, that you can use your imagination–your ingenuity–to make cancer treatment more “do-able.”
Gawande concludes Better with “Suggestions for Becoming a Positive Deviant,” a summary of a graduation speech he’s given to students at Harvard Medical School. (A positive deviant is someone who acts in such a way that their achievements are at the top of the bell curve). And, while the examples he gives are based in medicine, the message they illustrate can apply to all of us. He urges doctors to step outside routine in their quest to become better than they are, advising the following: “Ask an unscripted question. Don’t complain. Count something. Write something. Change.”
He concludes, “The choices a doctor makes are necessarily imperfect but they alter people’s lives. Because of that reality, it often seems safest to do what everyone else is doing–to be just another white-coated cog in the machine. But a doctor must not let that happen–nor should anyone who takes on risk and responsibility in society.”
Hear that? Any of us who take on risk and responsibility in society–not just doctors, but parents, public servants, any of us with responsibilities to fulfill–should try to go beyond being “just one of the crowd.” I read “Ask an unscripted question” as thinking outside the box. “Don’t complain” needs no translation; as Gawande says, negativity drags all of us down needlessly. “Count something,” I translate to “pay attention to the details; you’ll learn something interesting.”
In writing these SharePosts, it’s often in out-of-the-way corners online that I find the most interesting writing about breast cancer: perhaps a blogger in
“Write something.” Over and over again, as I write about breast cancer, I experience the power of the written word. As I write, not only do I connect with my readers, I get in touch with a deeper part of myself, a part that’s usually buried under the day-to-day struggle to simply exist in this complex world. Gawande writes, “An audience is a community. The published word is a declaration of membership in that community and also of a willingness to contribute something meaningful to it.” Every one of us can contribute something to our community of sister survivors, if only in a sympathetic e-mail to someone beginning chemo. Write… it’s advice I’ve been following all my life.
And finally, Gawande asks his students to “change.” “Become the change you want to see” is a mantra for change at my workplace. If you’re not happy with something, don’t complain: model a solution. Change is a challenge… and change is good.
As a breast cancer patient or survivor, what can you take away from this book? Everything, if you’re willing to step out of your comfort zone. After all, becoming better than you are–better than average–isn’t a goal specific to surgeons; it’s for all of us. And now, when cancer has given you the chance to make some wholesale life changes, is the perfect time to seek your better self.
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