[24 July 2002]
“The quality of mercy is not strain’d
It droppeth as the gentle rain from heaven
—ace beneath: it is twice bless’d;
It blesseth him that gives and him that takes.”
William Shakespeare, The Merchant of Venice
A typical twist in medical stories is where the “doctor becomes the patient,” most lately exemplified in the television drama “ER,” as Dr. Mark Greene struggled with a brain tumor. In these scenarios, the doctor wrestles with sudden helplessness. He is used to having all the answers, but now somebody else holds the information. He was the one dictating orders in a white lab coat, but now he lies prone in bed in a paper gown.
As I Live and Breathe, a memoir by Jamie Weisman, M.D., explores the opposite situation. Stricken with an unusual and mysterious immune deficiency syndrome that causes her daily discomfort, makes her susceptible to everything from painful infections to cancer, and requires monthly intravenous infusions of immunoglobulin, Weisman decided to become a doctor as a means of better understanding the body that betrayed her, gaining control, instead of relinquishing it.
Not unlike Atul Gawande’s book Complications, Weisman mixes personal tales and opinions with a revealing glimpse into the medical world, showing us the errors, egos, and human side of medicine. Both use a simple, engaging narration to tell their tales that make the reading easy and enjoyable. Weisman utilizes a dry humor at times, discussing tongue-in-cheek the impoliteness of infant and child patients, or when she says “We know that ICU stands for both Intensive Care and In Case U might die.”
While Gawande brings a human element to a discussion on medicine, Weisman freely mixes her medical observations with her personal stories. We are told of the trials and tribulations of medical school as well as her childhood and the birth of her own daughter. After a year spent with a facial deformity, Weisman shows us the importance of looking healthy, as well as feeling healthy. And, sadly, we see the doctor who does become the patient, as Weisman watches a surgeon and family friend succumb to a brain tumor. Weisman waxes on the importance of him in her life versus the relative unimportance of her to him, as she says, “The doctor has many patients, but the patient only one doctor, or a few.”
While Weisman is certainly passionate about her subject matter, at times she pontificates, especially on the subject of patients who contribute to their own illnesses, when she herself must struggle with a disease so unfairly inflicted upon her. “There isn’t any food or other substance I love enough that I wouldn’t sacrifice it to have my health back. And so for me to see otherwise healthy men and women cripple themselves is sad, baffling and infuriating.”
She also clearly has an axe to grind regarding the cost of health care, as she has been denied life insurance and has figured out that she has gone well through the estimated worthwhile expenditure of $30,000 per year of life saved. However, Weisman can also touchingly glorify the beauty of human life as she marvels at the magic of the senses, her language almost flowery at times. In fact, this may be the one technical weakness to which she succumbs, especially as at one point she compares medicine to murder mysteries and The Wizard of Oz, nearly on the same page. Her frank discussions redeem this, however, as she says, “Some writers say that every death is unique, but I have found that every death is more or less the same.”
Weisman’s observations on both sides of the patient/doctor fence are illuminating. For instance, she knows firsthand, but also by being around similarly ill people, that “often the patient ends up consoling the listener,” after describing their illnesses. Her sensitivity ultimately shows her compassion as a doctor, as she says, “The patients I met shaped the doctor I would become,” as she describes how the ‘regulars’ in her infusion room took care to describe their diseases in words that went beyond medical textbooks. She has experienced the necessary professionalism of being a doctor, yet understands physical pain, as she says, “Pain changes you. Your mind and your body temporarily become enemies, and your body has a strong advantage.”
While Weisman’s experience as a doctor and a patient provide her certain advantages, she also realizes the conflict of interest: “After all, if you are sick, the last thing you want to hear about is your doctor’s problems.” But at the same time, Weisman has made it clear that it is important for the patient to know that she knows, first-hand, what they are going through. Or, the same medical knowledge that she uses to understand her own illness can turn against her, making her paranoid during her own pregnancy.
Weisman has created a poignant, compelling memoir, not only with the delicate balance between the patient and doctor, but that between sickness and health. It is clear that her enthusiasm for life has influenced her enthusiasm for writing and medicine. The reader of As I Live and Breathe will likely finish the book with a newfound appreciation for illness, medicine, and life in general.