Sunday, December 23

The Anatomy of Hope - Jerome Groopman

Haematologist Dr Groopman has seen a lot of patients over the thirty years of his practice. In this book he uses clinical cases to illustrate how hope can help, and how lack of hope can interfere in the recovery of a patient. He traces a path from some of the first patients he was involved with as a student, through to more recent cases in his own practice, to his own experiences with chronic pain, to map the place of hope in health care. At the same time Groopman creates a picture of how health care in general, and medicine's image of its role, has changed over the last three decades.
This is not a New Age, 'have faith and beat cancer through the power of positive thinking' approach. Instead Groopman explores how belief, particularly in the form of hope or lack of hope, has a significant effect of the clinical picture. In the first case he recounts, Groopman talks about a patient who delayed seeking treatment for breast cancer, then was reluctant to have intervention, and opened up to him through their common heritage (she was Orthodox, he Observant) that the cancer was punishment from God because she strayed. She had no hope because you cannot (and should not) avert His will.
In the second case Groopman discusses his discomfort as a very junior doctor working as a locum in a country oncologist's practice - the experienced physician believed in deliberately withholding distressing truths because they would just cause depression for the patient and her family, even if this policy resulted in false hope, falsely high expectations and, in the end, lack of faith in the doctors.
He illustrates how the lack of hope can interfere with a patient's decision-making through the case of a former soldier who was adamant he was going to die, to the point where he wouldn't even consider intervention, had no hope of recovery because he'd seen a comrade die in ICU many years earlier and thought the same lay ahead of him. That man, too, had been told he could fight it, but succumbed, so that the words intended to sway him toward choosing life-saving intervention were heard as just so much hot air.
Groopman is able, as great writers can, to use one story to convey a multitude of messages. Tied in with the central topic of hope in medicine are reflection on the changing face of medical practice; his own journey as a clinician; what he's learned from patients, their families, and from skilled nurses; and the difference of opinions skilled doctors can have. He discusses his experiences as a patient and how both that and his counter-intuitive cure have coloured his view, and he talks about the case of a colleague diagnosed with the very cancer he spent his career fighting - and how intimately knowing the heavily-stacked odds doesn't necessarily equate to doing what everyone else thinks is reasonable.
I went to the library looking for Groopman's more recent work (which I found at uni), but am very glad I met this book. It is unsentimental but warm, detached but involved, articulate and informative and very interesting, and a text book example of how a writer can include the I in their narrative without losing academic rigour - something I'm aiming to achieve myself. - Alex

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