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News1993April › Hope: the best medicine › April 1993

Hope: the best medicine

This month, the instructive case study about terrible doctoring comes from my own back yard

This month, the instructive case study about terrible doctoring comes from my own back yard.

It concerns a close relative of my husband's I'll call Marjorie. A few weeks ago during a visit to the doctor for what Marjorie thought was mastitis, her GP took one look and blurted out: you've got breast cancer.

He handed her a prescription for two drugs: tamoxifen, to slow the cancer, and metronidazole (Flagyl), to heal the open sores on her breast. He would have a word with a surgeon in a neighbouring town. "How do you feel about having your breast off?"

With that, this ordinarily animated 76 year old was left to make her way home alone, suddenly bowed under the weight of her doctor's death sentence.

On Wednesday, we heard from her husband Joe that Marjorie had nearly collapsed in town.

He'd had to start her on morphine, he told us when we rang him, since she'd asked if she could have something for the pain. "To be honest," he said, "I'd be looking into nursing home care as soon as possible."

By Friday night, Marjorie was unable to get out of her bathtub and vomiting so violently that she couldn't eat.

One of the side effects of metronidazole is sudden drop in blood pressure, particularly among old people, which could account for the loss of consciousness and falls. Tamoxifen can cause pain, and both Flagyl and morphine cause nausea. In other words, every symptom she was displaying besides the lumps themselves was entirely due to the drugs and the word "terminal" on the various forms.

How bad was her pain? I asked.

"Oh, just a little niggle," she replied. "All I'd wanted was some paracetamol. But I thought the doctor might have something better."

We told her to throw two of the three drugs in the bin. We'd managed to get the drugs out of her system, but not her GP's gloomy prognosis.

A few days later we drove Marjorie to a doctor who believes in combating cancer by enhancing the patient's immune system. His local cancer group has many other no hopers who apparently are outliving the odds.

He does not promise a cure. But a magic bullet is beside the point. The point, as cancer specialist Bernie Siegel says, is that Marjorie believes that it works, believes, indeed, that she has more than a few months more to live.

Whatever this doctor's method, it has the single vital ingredient conspicuously left out of every potion dispensed by that GP: hope. Hope is the only important medicine there is. Hope is what doctors used to provide before the currently fashionable exercise of levelling with the patient, before doctors presumed to be able to know exactly how many months anybody's got left.


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