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Medicine Vs. Religion: My Brother’s Keeper Revisited

A few weeks back, I had introduced a patient who was willing to let her religious beliefs stand in the way of receiving the proper medical treatment she needed to stay alive. I want to revisit with you this dying patient, who hadn’t known me or any doctor for over 30 years.

As the rest of the family, who were not as committed to a religious path, stood by her expectantly, I said to her: “I had a brother who was a true believer in the power of God and that faith could heal all things or be called God’s will. Like you, he was a competent adult in charge of his decisions. He wouldn’t listen to anyone else — not his wife, father, mother, children, brother — not even me, the doctor. He died two years ago, leaving behind 10 children and a wife who depended on him. We all believe he died unnecessarily.

“I visited his widow a few months later. Honoring her husband’s beliefs, she’d not gotten any medical help in over thirty years of marriage. For several years she became sicker and sicker, with an illness that reminds me exactly of yours: she had lost a lot of strength and stamina, was short of breath, and short walks wore her out. Like you, it was obvious that she had a severe anemia, but I couldn’t explain the exact cause. I  put together a differential diagnosis of seven possibilities and told her, like I’m telling you, that some of these possibilities are irreversible like cancers whereas some are easy to fix like iron replacement or Vitamin B12 replacement.”

“From my religious standpoint, we don’t believe that anything is irreversible,” my current patient corrected me.

“Fair enough.” I conceded. “But some lab tests might help us see the difference. In my sister-in-law’s case, the labs I ordered indicated a severe anemia from B12 deficiency.  With simple transfusion and B12 replacement and she was completely back to normal; she’d suffered for too much time with something that was easy to fix.

“A few tests may help us better understand if something as simple as taking iron, or  vitamin B12, or a natural thyroid pill, might help you.”

She wavered, conceding that taking vitamins or iron wouldn’t be against her faith. Her family asked where she could have the labs done.

“I have everything here in my medical bag if you’d like?” I answered.

All involved, most importantly the patient consented. When I drew the sample, I noted that the blood was very watery.

Three hours after delivering the samples to the lab, I received a call with the result: “We just want you to know that there is something wrong with the blood sample so we didn’t complete the rest of the samples. The Hemoglobin was 1.9, so we stopped testing.”

“The sample is correct’ I drew it myself. After thirty years of practice, I haven’t seen a number that low before.”

The lab tech answered, aghast, ”You mean this person was walking and talking at your office?” That’s got to be impossible!”

“Talking yes.” I responded, “Walking, no. Keep running the rest of the tests and I’ll call her right away.”

I called her and the family. My point was straight forward: Although the cause of the anemia was still unknown, a transfusion was critical to keep her alive.

“Here is my point,”  I stressed, “A transfusion can buy you two months of time — time to find out what’s causing this, to make a decision. Plus you’d breath more easily and have little more strength. You’d also get more time with your family, who clearly care about you.”

Without a fight she relented to the idea of an ambulance, a trip to the hospital, a transfusion. And today, she lives on. She still believes in prayer and surrender that perhaps her time has come. For this I honor and respect her. May we all be in meditative surrender when our time arrives, when the walls of science are nothing but an illusion, nothing but a sand castle facing the relentless power and surge of the rising tide. From dust we came and to dust we will return.

As for my brother, I’m betting that St Peter is holding my brother up at “The” gate with this well known story:

There once was a flood and everyone had reached safety except for one man.He climbed to the top of his house with the water lapping at his feet. A helicopter flew over his head and hung down a rope for him to climb, but the man said, “It’s alright! The Lord will save me!”

The helicopter flew away. The water continued to rise and a boat came to him and offered help.  Yet, once again, the man shouted, “No! Go AWAY! The Lord will come and save me!” The boat sped off.

The water was getting dangerously deep by now so the helicopter came back to help.  The man insisted, “Go away! My Lord will come. I am a man of God!”Reluctantly, the helicopter left.

The rain continued to pour, the water continued to rise and the man drowned. When the man arrived at the gates of heaven, the man met St. Peter. Confused, he asked, “Peter, I have lived the life of a faithful man – why did my Lord not rescue me?”

St. Peter replied, “For pity’s sake! He sent you two helicopters and a boat!”

In a way, I hope that St. Peter is holding my brother at the gates and that his key is compromise. I lost that battle for compromise, and thus felt that it cost my brother his health and ultimately his life.

Until next week, I remain yours in primary care,

Alan Dappen, M.D.

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2 Responses to “Medicine Vs. Religion: My Brother’s Keeper Revisited”

  1. Rob says:

    I tell folks that when God sends rain, he doesn’t do it out of blue sky; he uses clouds. God COULD make it rain out of the blue, but why should he when he’s got clouds? It’s not his style to do things miraculously when natural means work just fine.

    The unfortunate thing for this type of person is that they feel that getting medical help is a sign of a lack of faith – a failure. This puts pressure on them to control something that, for lack of better words, is only in God’s control.

  2. Edwin Leap says:

    Perhaps she can be reassured that it is equally miraculous that she was still alive and capable of making a decision when her hemoglobin was 1.9. I suspect God was oxygenating her body apart from her lack of ‘box-cars.’

    Nice post,

    Edwin Leap

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

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Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.


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