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"The author's Cherokee grandmother conducted healing ceremonies and her beliefs inspired this book, which teaches other options patients have when answers in traditional Western medicine are not clear."
Mehl-Madrona, who now teaches family-practice medicine at the University of Hawaii, offers two books in one. The first is an account of the education of a doctor, one that often veers into self-importance ("I have always believed I have a mission on earth") but that may prove instructive for anyone tempted to enter medical training. The second is a look at Native American healing practices, and it is even less satisfying. The literature of Native American medicine is already peppered with naive and uncritical texts that suggest that healing techniques can be divorced from their cultural contexts and readily adapted elsewhere. Mehl-Madrona contributes to this notion of mix-and-match doctoring: "The medicine passed in a dipper around the circle," he writes in a description of a healing ceremony. "Everyone took a sip. Then we passed the dipper again, pouring water on our heads to open the crown chakras." (Hanta yoga, anyone?) The author, who claims Cherokee ancestry, is clearly a longtime student of Native American traditions, and he discusses some of them with welcome clarity. He inclines, however, to a mysticism that will discomfort some readers, as in his description of an encounter with a curious rattlesnake during healing ceremonies in the Arizona desert ("its head rested on my shoulder, and its rattle massaged my foot"). Elsewhere Mehl-Madrona writes, "Native American spirituality is a gift to us from North America itself. . . . Native American people have been preservers of this spiritual path for centuries, but they do not own it."
This position is likely to appall cultural purists, but it will comfort browsers in the great department store of spiritual salves that is the New Age.
Why Are You Here?
I started medical school expecting to become a research scientist. While still in college, I had joined a professor in his efforts to study biological membranes using a then-new technique called magnetic resonance imaging (now referred to by its acronym, MRI). As a member of his research team, I was named as a co-author of a paper he published on the work, and I imagine my acceptance into Stanford in the early 1970s was based partly on my participation in this new line of research. Indeed, I soon found a professor in my new California home with whom I intended to continue these studies. What I never expected was to become a clinician, focused less on research than on seeing patients.
At Stanford I actually started clinical work immediately. I had pushed myself to finish high school before turning sixteen, and as an undergraduate at Indiana University I had persuaded professors to let me take medical and graduate school biochemistry courses. These gave me advanced standing when I entered Stanford at age eighteen. As long as I took a necessary pharmacology course concurrently, I was ready to start seeing patients on clinical rotations. I was on track to finish medical school in June of 1975, with the required nine-quarter minimum. A decade later I learned I was Stanford's youngest ever peacetime graduate, at twenty-one years of age.
The challenging part for me was not in learning about pharmacology and anatomy but in understanding other doctors. There were numbing lists to memorize, of course, of nerves, muscles, bones, blood vessels, symptoms, diseases, drugs, and side effects; but compared with the knottier puzzles of philosophy orhigher mathematics, nothing taught was all that difficult. There was plenty to memorize, but all memorization takes is time. The problem for me was that my interpersonal skills had languished in my race through high school and college. Thankfully, I had a new wife to coach me in the car on the way to dinner parties and social events. Professionally, though, I was on my own.
Medical students on clinical rotations were expected to examine patients and entertain a diagnosis. We would discuss our potential diagnoses, and the treatments and medications they implied, with the faculty physician. The challenge was to show that we had considered every possible diagnosis and had either ruled it out or planned the necessary tests to confirm or disconfirm its existence. Although most patients suffer from common diseases, we relished considering all the outlandish possibilities. First prize went to those who, in the end, turned in exactly the diagnosis our faculty physician had already reached -- we had to learn his or her style and mimic it. At nineteen, much to my own detriment, I was still young enough to be idealistic. I thought it was more important to think for myself than to try to think like someone else.
I also thought other doctors shared my own ideal of medicine: that its purpose was to restore unwell persons to health. Imagine my surprise on hearing a renowned professor of internal medicine begin a lecture by noting that the physician's job lay in "slowing and making less painful the patient's inexorable and inevitable progression toward death and decay."
Despite this my first rotation -- three months in neurosurgery -- was challenging and rewarding. I had already done work in college on the neural functions of rats. I was studying a particular brain rhythm, hoping to show that a molecule called serotonin triggered it. To do this, I implanted electrodes into rats' brains, then measured what happened when I introduced serotonin to different sites of their limbic systems. If the rhythm was produced by the serotonin, I would have strong evidence that serotonin was a neurotransmitter -- a message sent by a nerve to the cells in the vicinity. Neurotransmitter molecules are the only verbs a nerve has at its command; which molecules are produced, and how many, determine a message's content. At the time, scientists were certain of only two neurotransmitters; we have since identified twenty-six. These few molecules and the simple messages they carry from one to another of our three billion brain cells are the vital chemistry behind human thought.
Although this wasn't the concern at the outset, neurotransmitter research eventually had the practical yield of all sorts of drugs. Now we know, for instance, that serotonin depletion often accompanies depression. Drugs that increase the availability of serotonin, like Prozac, are common treatments for depression. Prozac, which belongs to a class of drugs known as serotonin reuptake inhibitors, works by blocking the enzymes that cause serotonin to be reabsorbed.
I found that rat brains produced the theta rhythm I was interested in when serotonin was introduced to certain sites "upstream" of the hippocampus -- which, in plain language, meant that serotonin was indeed a neurotransmitter, at least for rats. This was a publishable result. With my professor's advice and assistance, I finished my first solo paper and published it in a neurosurgery journal. I was very proud to become a part of a centuries-old tradition of expanding the known limits of scientific knowledge.
Since I already loved research, it was no surprise to find the data-gathering aspect of the neurosurgery rotation appealing. But I was unprepared to find how much I enjoyed simply working with people, practicing clinical medicine. Even if I was still more comfortable in a lab than on a ward, two months into the rotation I was starting to consider a career that wasn't pure research but combined research with clinical work. Perhaps I would become a pediatric neurosurgeon. Three months later I was on my second rotation, in urology, about to meet the four very sick men who would challenge my career plans even more profoundly.
It was a foggy April morning outside the renal room of the Intensive Care Unit at San Mateo County Medical Center (SMCMC), a major teaching hospital of Stanford University. A nurse introduced me in a perfunctory manner to the first three of the four men inside. There was little hope for them. The fourth man -- whom I will call Juan Martinez -- had a chance to survive. He was a forty-two-year-old carpenter from Los Gatos, in the foothills of the Santa Cruz Mountains. He had lost one of his kidneys in a San Jose hospital. After the operation, his remaining kidney had stopped working. When Señor Martinez's twenty-three-year-old daughter offered him one of her healthy kidneys, he had been transferred to SMCMC's renal room to be evaluated for a transplant.
My job was to begin a pre-transplant evaluation of Sr. Martinez to decide if there was any reason not to proceed with the surgery. I wondered what had happened to the man before he lost his kidney -- what had brought him here. I started by asking when he had last been well. We had to speak up to be heard over the bustling doctors, the efficient nurses, the constant drone of the voice of the paging operator (these were the days before beepers). Only his three drugged roommates were quiet.
The carpenter was lying on his back, holding himself perfectly still, looking more like a quadriplegic than a dialysis patient. His face had the texture of an onion skin. His muscled arms lay uselessly on the sheets. He took longer to answer than I expected; he seemed to be searching for an answer to a question much bigger than mine. Finally he said, "I was never sick."
"What do you mean?" I asked. He was avoiding looking at me, focusing instead on the grains in the ceiling panels overhead.
"There was nothing wrong with me," Sr. Martinez said flatly. His usually dark Hispanic complexion was blushing ocher, and he began to cry quietly. His jaw continued working after he spoke, as if there were more to say but no words with which to say it. I glanc
Posted August 25, 2011
Posted July 8, 2003
I enjoyed reading this book. I found it while doing a title search for books about coyotes. The title intrigued me though, so I bought it. Although I don't hold the same belief system that the author did I do agree with what I perceived as his main objective which is western medicine isn't a panacea of health and healing. Health and well being is the balance of mind, body & soul. Disease is when an element is out of balance. We can't treat one without addressing the others which, in my humble opinion, western medicine lacks. It is refreshing to find a doctor that also understands this balance but doesn't go completely over to the other side and ignore sound science. The stories the author tells in this book are both horrifying and enlightening. His personal testimonies, I found, gave it a very deep personal touch.Was this review helpful? Yes NoThank you for your feedback. Report this reviewThank you, this review has been flagged.
Posted July 9, 2011
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Posted October 26, 2008
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