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Discourage All Treatment

When I look at my past with the present in mind, I find that I am someone who did not stay in the standard tradition of occidental medicine. For me, medical school and residency was a beginning, a crash course in the evaluation and treatment of the infirm. There is one man who stands out amongst all of my mentors. His name is Irving Hanenson, MD. He valued my contempt for the healthcare industry's establishment of the standard treatment for the ill.   Dr. Richard Levy, Chairman of Emergency Medicine at the University of Cincinnati, gave me the opportunity to be either the first forth year resident in Emergency Medicine or the first Toxicology Fellow at the University of Cincinnati. I chose the two year Fellowship in Medical Toxicology. Being a Chief Resident lacked appeal. The only other option after my training was complete was to go out in the real world and work. I felt there was something lacking in my knowledge, so I decided to commit to an adventure focusing on medical toxicology and clinical pharmacology. Dr. Levy had recruited a faculty member named James Roberts, MD who was responsible for my training. James was a self-centered individual in his mid-forties and treated me like I was his academic mule. He wanted me to apply for as many grants as possible, perform a multitude of clinical studies, write scientific papers and list him as a co-author on every paper in an effort to build his curriculum vitae. He was not interested in mentoring me whatsoever. He gladly gave that responsibility to Dr. Irving Hanenson, Professor of Internal Medicine. Jim told me to report to Dr. Hanenson's office on my first day of Fellowship training.   Back in the early eighties, Internal Medicine at the University of Cincinnati was a large teaching department. It was housed in the Coleman building, quite remote from the offices of Emergency Medicine which were located in the University Hospital. I had very little exposure to the layout of the administrative wing of Internal Medicine, but I knew roughly where Dr. Hanenson's office was located. It was a bright sunny day in July when I took my first trip to Dr. Hanenson's office. I did not know him, but most of the internal medicine physicians were grumpy old curmudgeons, who did not want to evaluate or treat patients. They wanted to be left alone to carry out their specialized research which meant they wanted to go home early and not interact with anyone other than those involved in their hobbies or personal self interests. A few of them wanted to teach, but they were a rare find in my opinion.   As I walked through the catacombs of the vast intertwined hallways, I got lost. I could not find Dr. Hanenson's office, it was tucked away in a remote area of the building. He had a phone, so I called him. When he answered and said that if I couldn't find his office, I might as well go home because finding his office was much easier than learning toxicology. "If you can't find my office, you sure won't be successful in your Fellowship. Get moving." He was not nice. I was accustomed to academic faculty being rude, so I was not shaken, I was probably annoyed. I wandered around a bit more and finally found his office. The door was shut. When I knocked, he shouted, "It's about damn time young man." How did he know it was me? I had this vision of a fat, grumpy man, gray haired, in his sixties who was hanging on for retirement. I suspected he spit saliva when he talked and had very poor hygiene. "Come in for God's sakes," he shouted. "I don't have all day." At that moment, I became a little disillusioned. I worried about meeting this professor every day for the next two years. Perhaps choosing the Fellowship was a bad choice.   When I opened the door and walked in the office, I was shocked. Dr. Hanenson was sitting in a motorized wheel chair. He was a quadriplegic. He was well dressed, tidy and his office was immaculate. He was thin, had short gray hair and thick black rimmed glasses. He wheeled himself from under his desk, looked at me and smiled. "So you want to be a toxicologist. Well good. I think we've got a lot of work to do. Let's get going." In his hands he held a log of all of the patients who had been admitted to the hospital who were intoxicated, overdosed or suffering from drug reactions. There were about twenty patients on his list located in either the adult and/or children's hospitals. He started up his wheel chair, used his right hand to direct the lever on the control box and zoomed out of his office. I could hardly keep up with him. He was like a caged animal finally released from his prison into the wild. He could not wait to get into the hospital to see patients. From his brief descriptions of his recent career, I gathered he was a full tenured professor and had been assigned to his current office until retirement. He had not taught anything to anyone over the past fifteen years.   When we arrived in the Medical Intensive Care Unit, there was a patient on a ventilator. A young man who had tried to kill himself by carbon monoxide. His family was distraught. He was brain dead. There were several doctors in the room discussing the possibility of organ donation. The family was hesitant to agree. Dr. Hanenson surprised everyone since he just drove his wheel chair into the room, uninvited. He drove to the head of the bed, and as he painfully extended his arm, he softly touched the boy's face. He looked at the family, smiled and with a kind, compassionate voice said, and “He is a handsome lad. Bet he was smart too. It's a shame he's in this state. Horrible being dead on a ventilator. I was there once for six weeks with Polio. I thought I was going to die. But I lived. The difference between me and him. I had good brain function. He's in coma because the carbon monoxide killed his brain. He's never coming back." As he spoke, there was a silence that crept into the room, a calm and peaceful silence. The sadness lifted. "Why don't you let him live through others. I suspect they'll want to make sure his organs are uninjured. But if they are not damaged, your handsome child could leave a legacy that outlives all of us here. Just consider all the young men and women who are dying too, but not because they wanted to, just because they're sick. He could save a lot of lives." After he said what he had to say, he dismissed himself from the room. I followed him as he sped away through the ICU doors, on his way to another patient. I asked him, "Did you really get Polio?" He stopped his wheel chair, "Yep. Almost died. Left me paralyzed. Haven't had anyone around me since. It's so good to have you as a Fellow. I have a purpose now. Thanks. Now we got work to do. You better get your ass in gear." He sped down the hallway. We stopped. He looked at me, "I didn't take the Polio vaccine. I was a fool. I went to Mexico City to present my most recent work in hypertension. Little did I know the gastroenteritis I caught there was polio. It near killed me. After six weeks on the ventilator, the staff took me off. Told me to breathe if I wanted to. So I did. And the rest of me failed miserably. I couldn't do my research anymore. So because I was a tenured professor, they stuck me in a closet. Years. Now you. You've got lots ahead. I hope you're up to it."   As we went through the morning hours, visiting patients and chatting about our lives, I realized he was not an angry old man. He had compassion for everyone we visited and spoke to the attending physicians about treatment. He kept saying, "The role of a toxicologist is to make the proper diagnosis and discourage all treatment. The body can handle it." I spent hundreds of hours with Dr. Hanenson, and I never regretted a single moment. It's been almost thirty years and I still remember him saying, "Discourage all treatment." To hear it from a man who suffered from Polio to the extent that he was a quadriplegic was even more profound.   The idea that our human bodies can handle an acute insult from a toxin and recover with little or no complication seemed odd to me at that time, but I have grown into it. I diagnose all kinds of disturbances in patients the greater majority of them are not poisoned. Most of the time however, some form of treatment is needed to bring their body back into harmony. We are in the industrial age of medicine and every disturbance is being medicalized. Retail shop to much, you are a shopaholic. Ride your ten speed bike too much, you suffer from bicyclacosis. As a result, more drugs are being used than ever and people's irresponsible behaviors are being explained away by some new found mutation in their DNA.   Eating in accord with our human nature will not fix every ailment. Keeping ourselves in an authentic frame of mind will not stop us from catching cold once in a while. Finding our passion for living will not stop tragedy from happening to us and others we love. But getting off that fast train taking us to the standard industrialized practice of medicine will reduce iatrogenic disease and complications from unnecessary surgeries, drug treatments and screening procedures.   Because sometimes, the treatment is far worse than the disease.   Doc
Posted by Amanda Sanders at 9:09 AM
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