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Death of the Good Doctor: Lessons from the Heart of the AIDS Epidemic by Kate Scannellh

1999; 194 pp. $14.95. Cleis Press.

This is one of the most startling and beautifully written books I've ever read from a doctor.

When Kate Scannell was appointed director of a hospital AIDS ward, she writes, she "stalked the...ward like a weary but seasoned gunfighter, ready for medical challenges to present themselves. I would shoot them down with my skills and pills." Enter Manuel, a 22-year-old AIDS patient, admit-ted "as a huge, bloated, violaceous, knobby mass with eyelids so swollen that he could no longer see." (Throughout the book, Scannell does not shield us from the hideous tumors and early putrefaction that overwhelm the body dying of AIDS. But she writes with such skill and compassion that we can tolerate the unspeakable and see directly into the heart of the patient). She interprets Manuel's, "Doctor, please help me," as a charge to attack all his medical problems.

The next day she learns that the evening-duty physician responded very differently to Manuel's pleas?by taking off Scannell's monitors and tubes and giving him additional morphine. "The nurse said that Manuel smiled and thanked the doctor for helping him," Scannell recalls. "He died within an hour, finally freed from his suffering." Sitting at Manuel's empty bed, she starts to experience the "death" of the "'good doctor' in the conventional Western mode" that she had been taught to be and striven to be. She begins to interact with patients in ways that take us deep into the psyches of caretaker and sufferer, until we don't know which is which. Her recollections are tinged with a mindfulness exploring each detail of life's last events, of an enlarged respect for each person's unique joy and manner of passage.

"As in an archeological expedition, I have tried to reclaim parts of myself that were buried beneath the rubble of the failed structure, the flawed foundation of the medical model I had lived and experienced....

"Some of the rubble I can identify as remnants of that conventional structure: the trend toward increasing technological interventions; the overriding philosophy that physicians save lives, not "lose" them; the blatant chastisement and devaluation of physicians who use their empathy and intuitive insights when interacting with patients; the taboo against using compassion as a diagnostic and therapeutic medical skill.

"I learned how to substitute ice cream and French bakery products as principal or even sole therapy for some AIDS patients with "complex medical problems." I officially prescribed sunshine, a trip to the local department store, an afternoon with a tomcat, and massage as "primary" treatments for others. For weeks on daily rounds I visited a demented AIDS patient who believed that he was back on his Texas ranch tending his beloved pigs and chickens; for days we discussed the problems posed by a few errant hogs and the most lucrative schemes to market fresh eggs. Once we invited the neighbors/patients on the ward for a farm-style breakfast in his room. This man never saw a needle in his arms or a catheter in his veins. I believe he was peaceful and free of pain when he died."


ISBN: 1573440914

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