In a perfect world, when there's something wrong, an expert is there to diagnose it and fix it: and so in medicine, A (illness) leads to B (diagnosis) leads to C (cure). I suspect we all have that in our heads somewhere; it's just a question of finding the right doctor, like finding the right person to marry.
My dear old-world mother, who revered doctors as much as any self-respecting Jewish immigrant, would relate in reverent tones, "And she's seeing a big shot on Park Avenue". We never saw Big Shots, Park Ave or otherwise, because there was no money. We saw sweet Dr. Leban, who had wire-rimmed glasses, never asked questions, and came to our house to deliver a "shot" in the butt to anyone lying on the living room couch with the flu, for which he was paid in cash. Before she could afford that, she took subways and buses to Coney Island Hospital on a regular basis to treat my older brother's asthma in the Emergency Room, as so many poor people still do today.
But I was socially and economically mobile, as she intended me to be, and when I was a married lady with a child in my late twenties, I acquired an actual doctor on Park Avenue. It's not that we had a lot of money; my husband was a lowly Assistant Professor at a public university, and I was a graduate student. But I'd suffered from a misdiagnosis (in an Emergency Room) of an ectopic pregnancy and had to have emergency surgery to save my life. Afterward, the idea was to get nothing-but-the-best, and so I found myself a patient of Dr. Z, a portly (to put it nicely), chain-smoking OB-GYN with a lavish office and a long wait to get in to see him. Dr. Z. had an excellent rep -- yes, a Big Shot -- and you could tell he was beloved by his patients because pretty photos of the babies he delivered adorned the walls of his waiting room, along with gushing letters along the lines of "Dr. Z, we love you JUST BECAUSE YOU'RE YOU!" My friend DK will testify that I'm not making this up.
Anyway, when I entered my forties, an odd thing happened: unexpectedly, my periods stopped coming regularly, and then, at age 44 or so, not at all. It seemed too early for menopause, but that's what it was, apparently. Dr. Z. said not to worry; he had just the thing. All I had to do was take this prescription for HRT -- hormone replacement therapy, a combination of estrogen and progesterone -- and I would not only avoid the symptoms of menopause (none of which I actually had), but it would be good for me in every way. I remember something about prevention of heart disease and dementia, not to mention looking and feeling young till I was 120 or thereabouts.
Cut to age 53, when I'd been taking this little pill daily for nine years. That's when I was diagnosed with breast cancer, and before I knew it, it was all over the paper: major studies had shown that taking HRT for more than five years was definitely correlated with a higher risk of breast cancer (it's now known to be even worse than that). I had an estrogen-positive tumor, too, meaning this cancer was fed by estrogen. This was appalling, but how could I be mad at Dr. Z? It wasn't his fault, right? That was the wisdom of the day. However, I remember that while I was taking HRT, an aunt once told me her female doctor, who tended to be skeptical about pharmacology, advised her not to take HRT and she had done without it. I remember thinking this was wacky; Dr. Z. was, after all...a Big Shot. On Park Avenue.
The reason I'm thinking about this is that The New York Times ran an article the other day about a new study showing that lymph node resection does not prolong survival for breast cancer patients. Oh. No kidding. Really? Because eleven years ago, when I had my first surgery for invasive cancer, the sentinel node (the one nearest the tumor and thus most likely to be malignant if any are) was removed and found cancerous. So I had another surgery, excising more tissue, and also had twenty or so more lymph nodes taken from under my arm, hunting for the supposedly all-important number of malignant nodes that would tell us about my prognosis. There were no more, so the flesh cut from my underarm and the numbness in the area that makes it a torment to scratch an itch there were for nothing (actually I was very lucky not to get lymphedema, possibly thanks to the skill of the famous Dr. C, my once and future surgeon).
So now you tell me that this wasn't necessary. It didn't prolong my life. It didn't do much at all, except cause more pain after surgery and a deformity in my underarm.
Plus Dr. Leban's shot of antibiotic (though for all I know, it could have been saline) almost certainly didn't help us get over the flu.
This does not raise my level of faith, hope and trust in the medical field, dear reader. I suppose that is the way medicine works, yes. Except that there is a class action suit against the pharmaceutical company that produced the drug I took, because, according to a lawyer who works exclusively on the suit, the drug company suppressed evidence of a suspected estrogen-cancer link long before the study that exposed it. I won't see any of the money, though, if the suit is successful, because I didn't learn about it until it was too late to sue. Put that in your pipe and smoke it. Or rather, don't smoke at all, unless you trust what the tobacco companies were telling you.
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