WWWWF:You Gotta Fight ...
...To make sure doctors aren't dismissing factors and to make it through the chapter
Chapter 5, "A New Mother's Challenge," had some good stuff in it, providing one woman's story as insight into how "diagnosis momentum" can run amok. Basically it happens "Once a particular diagnosis becomes fixed in a physician's mind, despite incomplete evidence ... the first doctor passes on his diagnosis to his peers or subordiantes. ... Diagnosis momentum, like a boulder rolling down a mountain, gains enough force to crush anything in its way."
A child starts having severe pneumonia and when all the doctors determined it was SCID, animmunodeficiency disorder, the mom refuses to discount the counter-evidence. She ends up helping doctors discover the true cause, a nutrional deficit.
The best thing about the chapter is depth about medical techniques and technology, giving a real sense of the action.
"There is one last resort," the ICU doctor told Rachel. "ECMO."Rachel's thoughts moved slowly. "What is ECMO?" she asked in a whisper.
ECMO, he explained, stands for extracorporeal membrane oxygenation. It is a process whereby Shira's blood would be freshened with oxygen outside her body -- thus "extracorporeal" -- via a specialized machine. First an incision would be made in her neck and a large catheter inserted to drain the blood out of her veins into the machine. Inside the apparatus, the blood is percolated over a broad porous membrane. Then oxygen is pumped up through the membrane into the blood. At the exit, a pump returns the oxygen-enriched blood to the body. In essence, ECMO acts like an artificial lung and heart.
But Groopman also gets into some problems with his narrative, particularly as he tries to build sympathy for the mother. Groopman puts in so much work -- a lot of it to get across the woman's religious convictions that just seems forced -- that sometimes the message gets lost. Take this, after the child is helped but the mother learns of 9/11.
Rachel stood frozen in the room and felt as if her heart, so full of joy, were being torn. At the moment she celebrated Shira's restored life, thousands were likely dead in the attack on the World Trade Center. How can I rejoice when God's creatures are dying?
Laying it on a bit too thick for me.
Well, by the end of the story, Groopman's gotten to his point: "Rachel Stein was not an expert in cognitive psychology and did not study errors in medical decision-making. She was a desperate and frightened mother. But she found the strength to educate herself about her child's plight. And when she found inconsistencies in the many doctors' reasoning, she politely but persistently refused to e deterred. She diverted the boulder."
It was just a little difficult to see the forest from the trees thanks to all the paper filled with the winding tale.