(no subject)
Look what my Daddy did!
Has anyone considered how the Kennedy clan feels?
By James Gordon
Special to The Times
PREV 1 of 2 NEXT
CHUCK KENNEDY / KNIGHT RIDDER NEWSPAPERS
Sen. Ted Kennedy is said to have a malignant glioma in the left parietal lobe, the part of the brain that helps govern sensation, movement and language.
If I were a pundit, I might call it a media frenzy. If I were an editor, I might call it a unique opportunity to educate the American public. If I were a politician or an entertainer, I might call it the cost of doing business as a public figure.
But I am none of these things. I am a physician, a husband, a father, a son and a brother, and a teacher. And as such, I can't help but squirm at all the news about Sen. Ted Kennedy's brain tumor.
Nothing is more cruel than brutal honesty to a person whose life is threatened by illness. When medical students are learning to break bad news, we teach them first to find out what the patient is ready to hear. The mantra goes: Find out what he knows, find out what he wants to know, and only then break the news.
Maybe fire a warning shot first, just to give him a chance to brace himself. And then be prepared for a reaction, any reaction. Pay attention, listen, be quiet, and whatever you do, don't you dare walk away, no matter how devastating it is to stay.
Eric Cassell, a wise internist at Cornell, says that information must serve three purposes: to reduce uncertainty, to provide a basis for action, and to give meaning. Don't open your mouth until you know what you're trying to say. I teach my students that, too.
I'm not sure where Kennedy fits in all this. His tumor is certainly in the news. I don't think anyone asked what he was ready to hear or read before ubiquitous headlines declared that he had less than a year to live, or that he'd never again talk or understand a word if he had surgery to remove it - the one desperate act that could conceivably save his life.
Sure, he probably isn't spending much time reading papers or watching TV these days, but what of his family? Did anybody ask them?
Some good might come of this. Somebody, maybe even the U.S. Congress, might put a pile of money into brain-tumor research. People who watch Sanjay Gupta on CNN might learn more about seizures and brain tumors, and maybe even about the brain, itself. Good news for neurologists like me.
And even if the worried start beating down their doctors' doors, demanding scans for the flimsiest reasons, there's always the upside that MRI sales and jobs might therefore go through the roof. If you look hard enough, there's always an upside.
Still, I can't help but wonder how Kennedy and his family feel. I suppose it could be that their lives have been public so long, have been suffused with tragedy so many times, that this is just another in a long series of terrible events.
Maybe they understand their unique position in American public life and accept the obligations and prerogatives of the journalism upon which we depend to define and preserve our identity and freedom as a society. Maybe they're used to it.
But I'm not. No matter how well I understand every single issue involved, I just can't help thinking there's something indecent about this. I can't help thinking we should just shut up and leave them alone.
Dr. James Gordon, a neurologist at Northwest Hospital, is vice chair of the Ethics, Law, and Humanities Committee of the American Academy of Neurology; a member of the board of trustees of the King County Medical Society; and clinical associate professor of neurology at the University of Washington.
Copyright © 2008 The Seattle Times Company
I'm sure my Dad isn't the only person watching this whole Kennedy debacle and thinking the thoughts he's articulated in that piece. But he seems a particularly apt person to give voice to them.
Is it weird to say that my dad is an expert in giving bad news? He teaches medical students how to do it. That's the thing with neurology, he's said to me a few times: in most medical professions, the two questions you ask are, "What's wrong with this person?" (diagnosis) and "What do we do about it?" (treatment). In neurology, however, you end up spending a lot more time asking a different set of questions: "What's wrong with this person?" (diagnosis) and "How long does s/he have?" (prognosis). Of course, a lot of neurological conditions are treatable, but a large proportion of them aren't, just because of the complexity of the brain as an organ, and how little of it we understand. Dad has told me that "giving bad news" -- his somewhat euphemistic way of referring to the practice of telling patients (and families of patients) that they're going to die, or, perhaps worse, that they're going to live in conditions of drastically-reduced mental and/or physical capacity -- is something he does literally every day, usually several times. This is not because he's a bad doctor. On the contrary -- bias aside, I have a lot of reason to believe he's a very good doctor. It's because so many neurological diseases are simply incurable. It's so strange, for me, to think of him having to explain to people, day in and day out, that their headaches or shooting pains or tremors foreshadow long engagements with illnesses for which there may be treatments but no cures, and which will eventually result in death. It's funereal. It's strange. It makes me wonder how many people have had brief moments of hating my father; moments that pass, surely, but many of us have been in that situation. When a doctor treating a loved one tells you that there's little they can do, don't we all -- just for a minute, usually, but still -- hate that doctor for not being able to fix things? That doctor is my Dad, a lot.
But at the same time, it makes me happy. Most of the people who read this have never met my Dad, but I'd like to think he's the kind of person from whom one would want to hear bad news. He's usually a bit rumpled in a professorial kind of way, though he's not an academic. He is incapable of eating without getting food on his shirt. He wears $5 Costco reading glasses on the tip of his nose, which drives my mother apeshit. He's soft-spoken. He's also kind of astoundingly smart, and you can hear that pretty much whenever he opens his mouth. He's good at explaining complicated ideas in clear, common-sensical terms. I think he's the kind of person who could tell you you're going to die in terms that you'd understand, with an approach that makes you listen. You'd probably still hate him, at least for a minute or two. But (and I embrace my daughterly bias wholeheartedly here) I don't think most people could hate him for much longer than that.
Has anyone considered how the Kennedy clan feels?
By James Gordon
Special to The Times
PREV 1 of 2 NEXT
CHUCK KENNEDY / KNIGHT RIDDER NEWSPAPERS
Sen. Ted Kennedy is said to have a malignant glioma in the left parietal lobe, the part of the brain that helps govern sensation, movement and language.
If I were a pundit, I might call it a media frenzy. If I were an editor, I might call it a unique opportunity to educate the American public. If I were a politician or an entertainer, I might call it the cost of doing business as a public figure.
But I am none of these things. I am a physician, a husband, a father, a son and a brother, and a teacher. And as such, I can't help but squirm at all the news about Sen. Ted Kennedy's brain tumor.
Nothing is more cruel than brutal honesty to a person whose life is threatened by illness. When medical students are learning to break bad news, we teach them first to find out what the patient is ready to hear. The mantra goes: Find out what he knows, find out what he wants to know, and only then break the news.
Maybe fire a warning shot first, just to give him a chance to brace himself. And then be prepared for a reaction, any reaction. Pay attention, listen, be quiet, and whatever you do, don't you dare walk away, no matter how devastating it is to stay.
Eric Cassell, a wise internist at Cornell, says that information must serve three purposes: to reduce uncertainty, to provide a basis for action, and to give meaning. Don't open your mouth until you know what you're trying to say. I teach my students that, too.
I'm not sure where Kennedy fits in all this. His tumor is certainly in the news. I don't think anyone asked what he was ready to hear or read before ubiquitous headlines declared that he had less than a year to live, or that he'd never again talk or understand a word if he had surgery to remove it - the one desperate act that could conceivably save his life.
Sure, he probably isn't spending much time reading papers or watching TV these days, but what of his family? Did anybody ask them?
Some good might come of this. Somebody, maybe even the U.S. Congress, might put a pile of money into brain-tumor research. People who watch Sanjay Gupta on CNN might learn more about seizures and brain tumors, and maybe even about the brain, itself. Good news for neurologists like me.
And even if the worried start beating down their doctors' doors, demanding scans for the flimsiest reasons, there's always the upside that MRI sales and jobs might therefore go through the roof. If you look hard enough, there's always an upside.
Still, I can't help but wonder how Kennedy and his family feel. I suppose it could be that their lives have been public so long, have been suffused with tragedy so many times, that this is just another in a long series of terrible events.
Maybe they understand their unique position in American public life and accept the obligations and prerogatives of the journalism upon which we depend to define and preserve our identity and freedom as a society. Maybe they're used to it.
But I'm not. No matter how well I understand every single issue involved, I just can't help thinking there's something indecent about this. I can't help thinking we should just shut up and leave them alone.
Dr. James Gordon, a neurologist at Northwest Hospital, is vice chair of the Ethics, Law, and Humanities Committee of the American Academy of Neurology; a member of the board of trustees of the King County Medical Society; and clinical associate professor of neurology at the University of Washington.
Copyright © 2008 The Seattle Times Company
I'm sure my Dad isn't the only person watching this whole Kennedy debacle and thinking the thoughts he's articulated in that piece. But he seems a particularly apt person to give voice to them.
Is it weird to say that my dad is an expert in giving bad news? He teaches medical students how to do it. That's the thing with neurology, he's said to me a few times: in most medical professions, the two questions you ask are, "What's wrong with this person?" (diagnosis) and "What do we do about it?" (treatment). In neurology, however, you end up spending a lot more time asking a different set of questions: "What's wrong with this person?" (diagnosis) and "How long does s/he have?" (prognosis). Of course, a lot of neurological conditions are treatable, but a large proportion of them aren't, just because of the complexity of the brain as an organ, and how little of it we understand. Dad has told me that "giving bad news" -- his somewhat euphemistic way of referring to the practice of telling patients (and families of patients) that they're going to die, or, perhaps worse, that they're going to live in conditions of drastically-reduced mental and/or physical capacity -- is something he does literally every day, usually several times. This is not because he's a bad doctor. On the contrary -- bias aside, I have a lot of reason to believe he's a very good doctor. It's because so many neurological diseases are simply incurable. It's so strange, for me, to think of him having to explain to people, day in and day out, that their headaches or shooting pains or tremors foreshadow long engagements with illnesses for which there may be treatments but no cures, and which will eventually result in death. It's funereal. It's strange. It makes me wonder how many people have had brief moments of hating my father; moments that pass, surely, but many of us have been in that situation. When a doctor treating a loved one tells you that there's little they can do, don't we all -- just for a minute, usually, but still -- hate that doctor for not being able to fix things? That doctor is my Dad, a lot.
But at the same time, it makes me happy. Most of the people who read this have never met my Dad, but I'd like to think he's the kind of person from whom one would want to hear bad news. He's usually a bit rumpled in a professorial kind of way, though he's not an academic. He is incapable of eating without getting food on his shirt. He wears $5 Costco reading glasses on the tip of his nose, which drives my mother apeshit. He's soft-spoken. He's also kind of astoundingly smart, and you can hear that pretty much whenever he opens his mouth. He's good at explaining complicated ideas in clear, common-sensical terms. I think he's the kind of person who could tell you you're going to die in terms that you'd understand, with an approach that makes you listen. You'd probably still hate him, at least for a minute or two. But (and I embrace my daughterly bias wholeheartedly here) I don't think most people could hate him for much longer than that.