I've been reading Oliver Sack's book "The Man Who Mistook His Wife for a Hat" and it's a pretty deep book. Dr. Sack attempts to show his audience that patients aren't merely a collection of debilitating symptoms, rather they have an identity with perceptions, emotions, consciousness that needs to be considered both inside and outside the context of their disease. I think it's fascinating, as he has the ability to look through people's problems to try to find out who they are deep within. I really admire Dr. Sacks because his approach seems to represent how doctors should look at their patients, and how this approach can be easily lost resulting in negative consequences for their patient specifically in their quality of life.
The first two clinical cases he discusses are about two men who have neurological disorders that have caused "deficits" in recognition and short-term memory. He hates the work "deficit" as he says doctors tend to use this label to de-humanify their patient. It's easier to think a patient lacks a function that can or cannot be corrected. The label in essence, allows the doctor to view his patients solely as a symptom or condition. From what I understood, he thinks deficit should not be used because a patient's quality of life doesn't revolve around the lack of one or two functions, and rather if things aren't looked at as "deficits" but instead as quirks or challenges, doctors can then proceed to help the patient cope with their disease and help patients develop an alternative lifestyle. Of course this only relates to patients whose particular disorders are incurable.
The first man is a music teacher who suffers from lack of facial recognition. He can never recognize people by their faces, only by familiar sounds or characteristic features. In fact, he mistook his wife's head for a hat! This man's condition at least in 1985 did not have a cure, as it was prosopagnosia. Interestingly enough, the man was unaware that he couldn't recognize faces in the first place, which seemed to be a problem rooted in his consciousness or awareness, which is what makes this condition so fascinating. The quality of life issue comes into question because if he himself doesn't realize it, does he really feel any sense of suffering. Rather from a doctor's perspective the issue becomes about what he's missing out on in life. The ability to connect with people by associating expressions, beauty etc. any all of these types of visual communications that occur through the face. I suppose then a doctor's role isn't just fixing what's broken but opening up a world of potential satisfaction for their patient. Isn't it worth restoring sight to a blind person, even if they have never seen before?
Also, in the case of Dr. Sack's patient, he did have some trouble navigating streets and interacting with people as he mistook them for various objects. It didn't seem like something intensely debilitating, but it may be annoying to live with year after year. So how was this patient treated for this condition? Dr. Sacks told this patient to immerse himself in music because it was something he could recognize and coherently apply his mind to. In a sense, the patient albiet confused in a faceless world was able to find himself through music and auditory identification. He used his musical rhythm to work his way through the day. To find his way to his work, to put on his clothes etc. even if he couldn't rely on his vision. In essence, his doctor successfully treated this patient by making him functional in the context of his disease. It was quite profound.
Similarly, Dr. Sack's second patient suffered permanent retrograde amnesia. If you have seen "Momento" it's the exact same thing. The patient was stuck with memories from 1945, but could not remember anything after, even construct any new memories. It was interesting as this patient also was not aware of his disease, as he would forget about it even if you told him. But, what was most profound was that after observing him, Dr. Sacks saw that he had some sort of awareness deep down within his soul of the lack of progression in his life. He did suffer from not being able to progress in time, being constantly stuck in more of the same, these fixed memories which imprisoned him in a constant, unchanging past. Signs of this were that the patient was restless, could not feel happiness, had this underlying sadness even though consciously he didn't know why nor could ever confront it as he would constantly forget. Thus, it was an issue of quality of life. However, amazingly the patient was able to achieve progression and continuity through one thing...prayer. As a Muslim and a person of faith in the unseen world of souls, this was quite profound.
Even though the patient was at a loss in every intellectual and mental endeavor, he was able to find continuity, a sense of progression and existence in prayer. It seems that he was able to exist through a spiritual reality. Dr. Sack's recognized this spiritual dimension and facilitated this patient to garden and do things which would get him more in touch with his soul. Over time, this patient was coherent in tasks of gardening, praying, became familiar with areas of the building and where to eat etc. Even though he could never recognize or remember people or perform complex intellectual tasks that last over a few seconds, he still had an odd familiarity with spiritual tasks. What this meant to me was that a doctor must help his/her patient in all dimensions, and that medicine isn't about quantitative pathology alone. It's a holistic approach, which attempts to restore balance and function to a patient's life. Again, the patient may regain their identity and in tern quality of life.
I'm really benefiting from this book. It deals precisely with an issue I've always wondered about. How doctor's should view their patients? Not as specimens, but as people, as individuals, as souls. I think you can only help someone else if you understand who they are, and the context of what they are experiencing. If you can't understand your patient, then how are you going to help them? Why would they listen to you? Why would they trust you? More importantly why would I as a patient put my life in your hands if I'm not convinced you know what I'm going through both physically and spiritually? I wouldn't because my health is a collection of the physical, mental, and spiritual.
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