As I read this book, I noticed different facets of my identity being called forth. Sometimes I found myself as a doctor, remembering patients I had known in my internship, and wondering whether there was more I could have done for some of them. I remembered the woman who spent several hours describing to me, a 22-year-old medical student, what it was like to be dying. She told me things she had never told anybody, and advised me to enjoy my life, because it passes very quickly. She died that night. At other times I identified as a psychiatrist, reminded of the powerful relationship between our thinking and our bodies. I thought about some of the people who consult me, for example the woman whose mother lives in constant chronic pain from neuropathy. She screams much of the day, which is very stressful for my patient.
Until reading this book, I had accepted her doctor's words "there is nothing that can be done for her pain." While reading the first few chapters of the book, I was acutely aware of my role as a concerned and terrified friend. One of my closest friends, Shelley, was writhing in pain on her bed in Southern California, her doctors reluctant to prescribe narcotics. By the time I finished reading the book a couple of weeks later, Shelley had died of disseminated cancer, in an intensive care unit.
Michel Foucault, the French philosopher and historian, said that knowledge and power are inextricable. This inseparability of knowledge and power is most apparent in the health professions where particular expertise rests exclusively in the hands of the professionals. This renders so-called nonexperts disempowered in relation to their own bodies. As Nancy Hassett Dahm tells us, there are doctors who are specifically trained in the art and science of pain management. In the case of my friend Shelley, it was her doctor who ultimately had the knowledge/power to prescribe or not prescribe. He chose not to. I do not know why he left a woman with ovarian cancer suffering throughout Memorial Day weekend. I can only imagine that his choice was guided by what he considered to be in her best interest. I believe this decision was influenced by the powerful discourse in our culture that drugs are addictive and should be avoided if possible. I think as doctors we are afraid of authorities, and do what we can to avoid prescribing strong analgesics. This idea is further strengthened by our cultural narratives about illness, which praise people for having a "high pain threshold," and see them as brave heroes for being stoic and not complaining.
Mind, Body, and Soul is an important work. It furnishes us with a vast body of knowledge regarding cancer: living with it, and dying from it. As readers we are empowered to take charge of our own process throughout the course of our illness, or the illness of a loved one. As such, we the "patients" become experts of our own bodies. For doctors this is an important book too. It reminds us to listen to our patients. Nancy Hassett Dahm reminds us that the best way to measure pain is to ask someone whether they have pain, and how severe it is. In the 21st century there is no reason for anyone to suffer in pain, or to die in pain. We have sophisticated technology, pharmaceuticals, and methodologies available to us, to ensure that we can all die with dignity, pain-free, in our homes, should we choose.
I encourage you to read this book with an open mind. While it may be uncomfortable, it is ultimately a book that creates freedom for us; freedom to face our lives and our deaths with information, wisdom, and courage. Paul Browde, M.D.
Faculty, Albert Einstein College of Medicine
Table of Contents
Chapter 1 Valley of the Forgotten
Attitudes and behaviors towards the sick and dying
Chapter 2 A Storm Is Brewing
The problems of managed care and HMOs
Chapter 3 Through the Forest of Fear
Copyright Nancy Hassett Dahm October 2000. All rights reserved.
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