Revisiting Complications of a Cure
The patient’s letter was short and angry. I had not helped her; she did not plan to return to see me. And, she didn’t; she might as well have moved to Australia, such was her silence.
Six months earlier, she had undergone a temporal lobectomy for epilepsy, present since her teens, usually manifested by episodes of being disconnected from her surroundings, and only partially controlled by medication. I had been her epileptologist for a dozen years, guided her through two successful pregnancies and assuaged her nervousness about her condition several times a year. Her brain scans showed a stable cystic lesion. We had often discussed surgery, but she was not ready until she had a major motor seizure at age 35, almost 20 years since one other similar event had heralded the onset of her condition.
During the complicated pre-surgical evaluation, we met frequently and at length, all to ease her mind. Though I suspected she might be too afraid to go ahead, the operation was completed and she emerged unharmed, and seizure free for the first time since childhood.
I was thrilled for her, and proud of myself; of my perseverance, my patience with her endless questions and need for reassurance.
Within a month, the phone calls started. She had back pain and difficulty with urinary control. I feared a spinal cord lesion, but her examination was normal, her tests were negative and my neurosurgical colleague found nothing of concern either. I was enthusiastic about her new freedom from seizures, reminded her that she would soon be able to drive, but felt she was unconvinced. When the symptoms got worse, we admitted her to hospital for 48 hours. Tests, observations, and examinations were again unremarkable.
There was an episode of abdominal pain evaluated at a community hospital, again without an underlying cause being found; an assessment by a gastroenterologist at the university was benign.
The pace of phone calls and return visits to my clinic picked up. I reassured her. Then, silence, and out of the blue, the letter.
I had failed her. In my desire to cure her epilepsy, I had not considered or examined the wholeness of the patient.
Had I some God-like right to take away a relatively benign illness, which might have represented an essential part of her being for 20 years? In enthusiastically telling her that she would soon be able to drive again, was I ignoring the evidence that her husband had brought her to every visit to see me? In seeking a permanent cure for her epilepsy, and thus her reason to visit me, was I telling her that she was less important to me, as I was to her?
I had placed myself above her. I had shown my power. With her letter, she showed me my powerlessness.