America the Beautiful: Rediscovering What Made This Nation Great (19 page)

We have an awesome military with tremendous leadership, and we wisely have civilian oversight of the military. If our leadership is willing to once again return to the moral high ground and use our power to achieve peace and a chance for all to prosper, I believe we will have fulfilled a most noble purpose in the history of our world.

M
EDICINE FASCINATED ME AS A CHILD.
W
HENEVER A MEDICAL STORY
was featured on the television or radio, I was drawn to it. Fueled by my love of books on nature, I was captivated by the life-and-death struggle of animals and insects, and I was also extremely curious when one of our older relatives died about what caused the death. I became convinced as a child of the evils of tobacco and would try to hide the cigarettes of friends and relatives who smoked. I had an insatiable desire to know how things worked, and I was constantly taking things apart (and sometimes reassembling them successfully!). The chemistry set that I received for Christmas when I was eight years old was an endless source of entertainment and learning. All of these things indicated early on that medicine would be an ideal profession for me.

I was particularly intrigued, however, by the stories presented each week in Sabbath School that featured missionary doctors who traveled to remote areas of the world at great personal sacrifice, not only to spread the gospel, but to bring physical healing and reform the health habits of the populace.
What courageous compassion
, I thought,
for them to lay down their lives for others
. Those missionary doctors seemed to me the most noble people on the face of the earth.

In fact, my first public speech, at the age of eight, involved the story of a missionary doctor. It was my turn to give the mission story in the primary division (children aged seven to nine) of our church, and when I told my mother about it, she said, “You should present it as if you were the missionary doctor talking to them.”

To do so, I practiced memorizing the story and presenting it dramatically, until I almost convinced myself that I had been there. My mother helped me create a costume the missionary might have worn, and I tried to emulate the speech of an authoritative but compassionate preacher by raising and lowering my voice at the appropriate times in my delivery.

On the morning of my presentation, the children chattered away among themselves, distracted as always, until I began reeling them in with my story. “I was quietly tiptoeing through the jungle in the dark of night without a weapon,” I confided to them in a whisper, “knowing that savage warriors had been told to bring me in dead or alive.” I fanned a fly away from my face as I pressed on through the imaginary jungle surrounding me.

“Suddenly,” I exclaimed, whirling around as I had practiced at home, “a large branch broke behind me.” To my joy and amazement, I realized everyone was drawn into the moment with me, and I had my entire audience hooked from there on.

When I finished, the teachers were so enthusiastic they asked me to give the same presentation to the adults the following week, which was unheard of. I refined my presentation over the days that followed, growing ever more nervous as the day approached about performing before a whole church auditorium full of adults. My mother told me I should simply pretend that everyone in the audience was naked — but that did nothing to alleviate my anxiety. Imagining everyone in my church naked was not a pleasant thought!

On Sabbath morning, the stage seemed larger than usual to me. Some of the adults did not look particularly happy to be there, and as I began speaking I initially took refuge behind the large white podium. But as I began to get caught up in the presentation I had practiced so many times, I ventured farther out onto the stage and began whispering and shouting and jumping to the delight of my audience, who applauded loudly when I finished. The adults were incredulous that an eight-year-old could present something so powerfully, and the seed of my public speaking career began to germinate.

After that experience, my desire to be a missionary doctor continued to grow until I was thirteen. By that time I had a much better understanding of what the life of a missionary doctor was like, and the appeal of its lifestyle had dissipated. Perhaps if I had grown up in an environment of economic privilege, I would have pursued my original goal more vigorously, but the thought of a lifetime of continued poverty was something I had a difficult time facing.

By then, however, human behavior and the lives of psychiatrists had captured my attention. The psychiatrists I saw depicted on television seemed
like such wise individuals who made a real difference in the lives of desperate people — and to top it off, they drove fancy cars, lived in mansions, and had plush offices. My brother, Curtis, knew of my interest in psychiatry and bought me a subscription to
Psychology Today
for my fourteenth birthday. I really looked forward to receiving my magazine each month, and I became the local amateur psychologist for many of the people around me. I majored in psychology at Yale and took advanced psychiatric courses in medical school at the University of Michigan, fully believing that I was going to become a psychiatrist. However, I was so impressed whenever the neurosurgeons made presentations to our class that I began to have second thoughts about my area of specialization.

So I asked God to give me wisdom to make a proper decision that would have a lifetime of implications. I truly believe God gives everyone special gifts and talents, and as I began to assess mine, I quickly realized that the talents necessary to be a good neurosurgeon — good eye-hand coordination, steadiness, calmness, and the ability to think in three dimensions — were all things I possessed already. After realizing that, the decision for me was quite easy, and I have never regretted it. When I made that decision to become a neurosurgeon, I did briefly think about the fact that I would have a much smaller impact on the lives of people than I would have had as a missionary doctor, but I felt that God was leading me and that he clearly knew more than I did about his plans for me. As it turns out, because of the amazing career that he orchestrated for me, I have been able to touch more lives through my books, magazine articles, interviews, and a made-for-television movie than perhaps I could have as a missionary doctor. It was that very ability to positively touch lives that attracted me to medicine in the first place — and is the reason that many of our nation’s doctors, nurses, and other health-care professionals are attracted to the field as well.

When I was a neurosurgery resident at Johns Hopkins, on numerous occasions my wife and I would be in the car driving and suddenly a motorcyclist with no helmet on would whiz past us, seemingly without a care in the world. I had to fight feelings of anger as I thought about how often I was awakened at two in the morning to respond to a severe head trauma case from a motorcyclist who was not wearing a helmet involved in a motor vehicle accident. Yet that motorcyclist had every right to neglect his own safety, and at that time, that right was protected by law.

Subsequently, helmet laws were enacted, much to the displeasure of many motorcyclists, but to the great relief of many health-care practitioners. The ramifications of such irresponsible behavior on behalf of the motorcyclists, however, extend far beyond the inconvenience suffered by people like me who had to take care of them. Sometimes the head injuries were very severe, and saving the victims became an extremely expensive process that involved not only acute medical care, but also long-term rehabilitative services, and in some very sad cases, chronic maintenance for those with little or no chance of resuming productive lives. Although doctors sometimes resent having to give up time with their families and the many other sacrifices associated with the medical profession, few people stop to philosophize about whether the victims have a right to consume enormous amounts of medical resources. In our society, we do not discuss the behavior that created the problem, and we generally do not discuss the price of treatment or the significant impact on their family and societal resources (welfare).

Not many years ago, when I was on call, a fifteen-year-old boy was brought into our pediatric emergency room with a high fever and a decreasing level of consciousness. After a rapid and thorough workup, we discovered that he had multiple intracranial bacterial abscesses. It took several operations and extended time in the intensive care unit to get his health temporarily under control. Saving him cost hundreds of thousands of dollars, and in the end he had no insurance or other means to pay his bill. We subsequently discovered that he was in the country illegally, but that did not change the fact that he was in dire need of medical care.

We do not like to ask questions in situations such as this that force us to make judgments about who should get care and how much care they should get. It is far easier to simply render whatever treatment is necessary and let someone else worry about the bill. In America, we tend to have a very negative reaction to the health-care systems of countries such as England that are based on a socialized model. And we particularly abhor the rationing of care based on such factors as age.

For example, under some socialized systems, kidney transplants are not even considered for individuals over the age of sixty, which means that most of our United States Supreme Court justices would be too old to be considered for such a life-saving treatment in many countries with socialized medicine. Who is right? Those who feel that it is our moral obligation to treat everyone regardless of cost, or those who feel that rationing and other means of cost containment make more sense to our nation’s health-care funding in the long run. As with virtually all controversial issues, the answer usually
lies somewhere in between, and compromise can be very helpful. I must admit that in my many years of medicine, I have never witnessed a patient abandoned because of lack of money. In America we suffer much more from a lack of money than we do from a lack of compassion.

One of the by-products of our society’s strong value on compassion is the development of an entitlement mentality among large portions of our populace. I have noticed at Johns Hopkins Hospital that many of the indigent patients — instead of feeling grateful for the fact that people are willing to extend to them sophisticated and expensive care with little or no remuneration — are the most belligerent and the most likely to initiate lawsuits. By no stretch of the imagination are all indigent patients like this — and I shouldn’t even have to make such a disclaimer — but there exists in our society today a vocal and highly sensitive minority who are constantly monitoring every word to try to find fault with the finer points, rather than examining the overall message and attempting to engage in constructive dialogue to help find solutions. The fact that some of these patients become abusive and threatening does nothing to improve their care and actually is destructive to the development of the kinds of relationships with nurses, doctors, and other health-care providers that ensure quality care. No one likes to be around those always looking to pick a fight, which means that a belligerent person or their child might not be checked on and chatted with as frequently as someone who is reasonable and pleasant to be around. That, of course, means something might be missed, which continues to exacerbate the doctor-patient relationship.

Contrary to popular belief, one of the reasons many physicians refuse to see indigent patients is not that they cannot pay, but because of the poor treatment they receive from such patients. This cycle can then lead to degenerating doctor-patient relationships and a higher frequency of lawsuits. Care of the indigent has always been a big part of medicine in America, as it should be, but it should be seen as charitable work as opposed to mandatory labor. As a society, we could even explore certain incentives for health-care workers to engage in even more charitable work.

Our first child, Murray, was born in Australia, and though he has dual citizenship with the United States, he was officially an Aussie first. The health-care system in Australia provides substantial benefits for its citizens, and when a baby is born, the family receives a “baby bonus,” which
provides substantial income throughout childhood. There was also a “milk allowance” and free nursing care centers for babies. Basic medical care was provided for all citizens at no cost, but everyone had the right to purchase private health insurance, which enabled subscribers to enjoy more personalized services and less waiting time. Although it was a two-tiered system, I did not witness much resentment by those receiving their basic care free of charge against those who could afford private insurance. There may be some substantial lessons that we can learn from such a system.

For instance, everyone has different needs and we do not have to have a cookie-cutter, one-size-fits-all system. Because one person drives a Chevrolet and another drives a Mercedes, it doesn’t automatically mean that the Chevrolet driver is deprived or needs some supplement. The fact is, he can get to the same places as a Mercedes driver with perhaps slightly less comfort. People have different medical needs and some can afford the Chevrolet plan while others can afford the Mercedes plan. We should leave it at that and not try to micromanage people’s lives as long as the care is adequate.

Not long ago, as I was writing in a patient’s chart at the Johns Hopkins Children’s Center, I overheard two female housekeeping staff members complaining about the fact that they had to shell out five to ten dollars as a co-pay every time they saw their doctor. It was grossly unjust, they felt, for anyone to expect them to use their meager salaries to contribute to paying their health-care costs. I started to ask them whether they thought medical care should be completely free — and who should be responsible to cover the cost of the free program. I did not want to embarrass them, and so I did not press the issue, but that conversation underscores widespread attitudes in our society today. Those ladies are not bad people, and they do their jobs very well, but they are totally misinformed about health-care financing and the implications of a nation perpetuating irresponsible medical fiscal policies. As long as everyone is concerned solely with their own good, equitable health care for everyone will be impossible.