The other day I drove to Chicago for an appointment with my radiation oncologist. With time to kill, I hung out a bit in the DCAM Center for Care and Discovery, a name that sounds more like a theme park than a hospital and compared it to the other hospitals I’ve spent time in in recent months. DCAM is certainly the luxury class, surpassed in my experience only by the elegant oasis of the Mayo Clinic. Two more down-to-earth hospitals I spent much time in at my son’s bedside were the Hilo General Hospital in Hawaii and Bromen in my town of Normal. Probably Hilo would rank low for the very reasons I rank it at the top: it’s personnel and medical care are the least specialized, but they work together and, without exaggerated concern for confidentiality, with the parent or family of the patient. Bromen is a little more specialized, ranking no doubt a bit higher, but the cooperation I valued in Hawaii is much less. At the lower end, no doubt, would stand Lariboisière in the poor Paris neighborhood of the Gare du Nord. It is very old and physically in poor repair. I had to go there after cutting my finger deeply with a new serrated knife I bought. It’s impossible to bandage a cut like that with one hand. After the emergency room, they had me return to the Polyclinique all of six times to have the bandage changed. Despite the depressing material conditions, I was well and attentively cared for. As a hospital habitué, I know how to joke around and strike up a relationship of sorts with doctors and nurses. Since I am patient in such situations, I probably come across as the model patient. A typical American would recoil in horror at the prison-like atmosphere of the Emergency Room and the shabbiness of the fixtures, but in the best sense I was well cared for. On my last visit, I asked for a bill so that I could pay. They promised to send one but never did. In Hilo or at Lariboisière where specialization was less developed, the patient is treated more as an integral human being rooted in society. At the opposite end, DCAM approaches the patient organ by organ, specialist by specialist.
As expected, I received the usual clean bill of health but was disappointed to learn that this is not my last routine visit. It’s finished five years after the treatment, not after the diagnosis. It seems like yesterday that I spent the better part of a winter coming and going here, five days of round-the-clock chemo and daily radiation therapy followed by a week off back home. I remember the state-of-the-art floor accommodations and the long way down into the hidden bowels of the hospital complex where you would encounter the disfigured and the dying, your comrades in suffering. I remember the middle-class patients who behaved like defensive white-collar criminals (“I’ve led a clean life; I shouldn’t be here!”) and the patience of the poor. I saw the same patience in Lariboisière and in the street poor of Hawaii. I remember the agonized face of a homeless man writhing outside the windows of the Hilo harbor café where I went for my drink and one full meal a day. The division between inside and outside, high and low, suffering and satisfaction seems to dissolve in certain moments of distraction. Now I’m here and full of vitality for my advanced years. I will be those unfortunates soon enough. We all will.
For my University of Chicago radiation oncologist, I brought along an editorial from the previous Sunday New York Times on Rudolf Virchow, the great 19th -century German physician whose report on the health and suffering of the hard-presssed Silesian weavers became the founding document of social medicine. To cure the patient, you have to cure the society. Shortly after submitting his report, Virchow went to the Berlin barricades in the 1848 revolution.
Signed,
Andrew (Weeks)
Normal Thoughts 