iatrogenic

Learned today that before insulin was discovered, the treatment for diabetes was starvation. If you ate normally, you'd die from ketoacidosis (without insulin, your body makes too much acid, a process which pretty much messes up everything that's regulated by acid-base balance in your body and kills you). So people could choose, our teacher told us, a slow death of starvation over the quick one of diabetes. Then they found a way to isolate insulin and use it as treatment. Now, though there are still awful consequences of diabetes, it's possible to have it relatively under control. This all reminded me of how I recently learned the meaning of the word iatrogenic. This describes harmful, unintentional consequences of medical treatment. This doesn't quite exactly apply to the starving diabetics thing, but the extreme of a "treatment" directly causing death made the idea resurface.

It's something I've been thinking about for awhile. I've probably heard it before but the first time I remember it, and remember understanding it, was when I met a patient whose esophagus was perforated while receiving anesthesia for surgery for bladder cancer. This caused life-threatening inflammation of everything in his middle chest area. That was a mistake, which is what iatrogenic refers to. But somehow I take it to encompass all the fundamental harm medicine knowingly and necessarily inflicts, in order to treat illness. Last semester I met a patient with malignant bone cancer, a frank man in his thirties who managed to be friendly without smiling. He'd done a lot of research on his chemotherapy treatment, and told me that after he'd agreed to it, he read that there was a slight chance of developing leukemia from the chemo. He said he'd wished he'd been told that before. When I asked him whether it would've changed his decision, he said quite possibly, because why fight one bad thing to just acquire another.

I'd taken it for granted that one would choose to go through the treatment, especially for one so young. This is how I'm personally built, and in some ways how medicine is built. To try your damned hardest to do everything you can to fix people and situations and lives. But sometimes there's no insulin to be discovered, and trying too hard can mean starvation.

I wrote a long time ago about Jonathan Franzen's "The Corrections" and recently about "Breathing Lessons," both of which deal with the futility of our efforts to change things, and the irony of our solutions creating or worsening the problems they seek to resolve. I don't know myself how to get out of that cycle, sometimes. Despite complete understanding and direct acknowledgment of the reality of things, of the net gain or loss of happiness from my choices, of the same recurring hurt that results--I refuse to stop trying. I have found so many ways to see the value in things that are unpleasant, painful, non-ideal, but I have never reconciled myself to loss. And I mean, really. I think about it almost every day, and it is not just a matter of time or out of sight for me. People say that loss isn't your fault; it's natural, so you shouldn't try to resist so much. But I think it would be easier if it were our faults, because as reasonable and obvious as it is, the reality of loss as natural and incorrigible is incomprehensible to me sometimes. In the few connections I've had, I've fought so hard to preserve certain aspects, even when the process chipped away at me, that I ultimately have to let it all go if I want to keep myself together. I end up with a loss greater than the one I was trying to prevent.

I read Norwegian Wood during a time of all consuming ache, and one of the passages that meant most to me then comes to me again often and particularly now when I ache again: "Things will go where they're supposed to go if you just let them take their natural course. Despite your best efforts, people are going to be hurt when it's time for them to be hurt. Life is like that....You try too hard to make your life fit your way of doing things....But who can say what's best? That's why you need to grab whatever chance you have for happiness where you find it, and not worry too much about other people. My experience tells me that we get no more than two or three such chances in a lifetime, and if we let them go, we regret it for the rest of our lives."

I felt this to be so true and something that fit right into me at the time, but of course I didn't listen, not then or now. So here I am, a girl who for some inexplicable reason hates losing people more than anyone I know, turning away from a friendship that means so much to me. Giving up a connection in its entirety because not wanting to give up anything before, wanting to fix to make you and thereby myself happy, put me in a place to hurt you and be hurt. In the end it's true that this is right because we all deserve the same happiness, and it's true that we have a choice in our own happiness and I have to be the one to think of my own. Still, I'm sad.