50 Becoming a Patient
the internist and war refugee, said, ‘‘I can be more realistic and hopefully
less emotional. The amount of risk I’m willing to take is part of my
personality.’’
Jacob’s wife asked whether doctors were ‘‘morally obligated’’ to vol-
unteer for experimental treatments in order to help other sufferers of a
disease. She argued:
A Jew is supposed to want to preserve life. So if a patient has lung
cancer, and is told, ‘‘We have this treatment, a potential cure,’’
then, as an observant Jew, are you required to do it? To go for every
single thing offered?
Often, these doctors were grateful for the ability to be aggressive, as
this approach succeeded. Dan commented, ‘‘Very few surgeons have
experience taking out a sternum. If I wasn’t aggressive, my sternum would
still be there with tumor.’’
But such experimental treatment can be difficult to procure. Walter, a
politically active internist with lymphoma, tried research treatments to
which other patients did not have access. But he found even these in-
terventions difficult to arrange.
I tried this experimental use of interferon, because a cancer re-
searcher I consulted thought it may help me. My oncologist said,
‘‘I don’t agree, but if you want to, it’s ok with me. I’ll write the
prescription.’’ But weeks went by, and I could not get him to give
me the prescription. As a doctor, I was asking another doctor—but
couldn’t make it happen. When I stopped being really sick, I
dropped down a lot on his list of priorities.
These differences in degree of aggressiveness raised questions about
how physicians treated patients generally. Doctors must triage, but a
patient sees his or her own serious illness as critically important. With
their own patients, these physicians also tended to be more conservative;
only gingerly suggesting, but not ‘‘pushing,’’ less conventional and more
research-level treatments. Dan said:
I am much more aggressive for myself than I would be for my patients.
I would offer these options to my patients—sort of hint that
these were possibilities—but wouldn’t push them. For myself,
I have really pushed: I’ve had over double the usual doses of
radioiodine, to be as aggressive as possible: research-level medicine.