The Alternative Patient.

                                                        The Alternative Patient.
                      

           He was a freelance science writer, and had interviewed me about a year earlier regarding an article he was writing on the management of hypothermia.  For this article his name was Harley.

          "I think I'd like you to be my doctor," he said, "so I set up an appointment to discuss this with you, as I do have some conditions, before I make up my mind.  There are treatments I don't accept."

          "Tell me what they are, and I'll tell you if they are acceptable to me,“ I said, reflecting on some of the bizarre requests that had been made of me in the past.

          "Well, I refuse to be burnt, cut or poisoned," he said.

          "Exactly what do you mean by that?" I asked.

          " I had cancer of the bowel about five years ago, and had it removed surgically.  When I was attending for a follow-up examination about a year later, my liver was enlarged. An ultra-sound showed spread to my liver. so when they offered me chemotherapy, I decided that I would reject the triad of further surgery, radiotherapy or chemotherapy - cutting, burning or poisoning."  He smiled, "that is why I parted company with my previous doctor, and I am coming to you with these conditions. I thought you might be more flexible."

          "I have no problem in accepting that you have the right to decide what treatment you will consent to, as does every patient.  The converse of this agreement is that you accept that I am going to give you the best medical advice I am capable of, and try to make sure that you understand the benefits and the complications of such therapy, and the consequences of not taking the treatment.  If after that you decide you don't want the treatment, then I will have no difficulty in respecting your decision.  I will contact the Cancer Clinic and obtain a copy of their findings and impressions."

          "That's fine with me, Dr. Smith," he said, extending his hand.

          "Now let me tell you exactly why I am here today," he said.  "I have had diarrhea now for about two weeks and that's how my original cancer manifested itself.  So I really want to know what's going on."

          " And yet you're not going to accept any therapy whatever the results of the testing shows?"

          "Well, I didn't exactly say that. It depends on what you have to recommend, and I also have some views and treatments of my own, that helped me get through the previous bout with cancer."

          My curiosity, was peaked.  I wondered what sort of a challenge I was taking on.

          I said, "what sort of treatments are you talking about?"

        He smiled patiently at me as if to say I know you think I'm crazy, but I've got you interested anyway!

          "I did a number of things when the doctors told me they thought the tumour had spread to the liver and that even with the malignant therapies that they had to offer my survival was strictly limited with no indication that the quality of life would be worthwhile.  I decided that the prognosis I was being offered was so gloomy that I was going to take my care into my own hands." Harley smiled again. "In other words, I decided that my health was too important to be left in the hands of doctors. So I decided to do two things immediately.  I decided to try some alternate therapy.   I am not a naive man, and I do have a considerable background in science, nevertheless, I decided to give Laetrile a try. Not because I thought it was a miracle drug, but because if you have nothing to lose except a little money, even the remote possibility that it will do some good is better than nothing.  You doctors don't seem to understand that.  You are so busy protecting yourselves, and so preoccupied with particular types of studies, that you forget that most of the great scientific and medical discoveries were serendipitous events.  Alexander Fleming didn't need any studies to show that penicillin works.  Anyway, I went down to Mexico and had a course of Laetrile.  How much a part that played in my survival, if any, I really don't know.  But I am still here, so I don't discard the possibility that it helped - and if I had another episode, I would try it again.  The other thing I decided was to remove all the sources of stress from my life that I possibly could, and this was the really difficult part of my regimen. You see to do that, I had to give up my job, and my home, and eventually the woman I lived with.  I had a regular, dull writing job, that didn't interest me very much and I gave that up in favour of freelance writing which was something I wanted to do, despite the uncertainty of making a steady living at it. My mortgage was demanding and I got rid of that too.  Just sold the house, paid off the mortgage and had about enough money left over to go down to Mexico for my laetrile treatment."

         

          In addition to the above history, Harley had diabetes for years and was on regular doses of insulin.  Recently he had an infected foot, and had been on antibiotics for this for two weeks about a month earlier.  It was following this that the diarrhea had started and persisted.  I told Harley that his diarrhea might well be due to the antibiotics and to eat some yogurt to help replace his gastro-intestinal flora.  In view of his past history we did investigate his gastro-intestinal tract, all of which was normal, apart from evidence of his previous surgery. 

          In due course I obtained Harley's test results from the cancer clinic.  There was no doubt that he had a pathologically proven carcinoma of his large bowel, which was resected, and that subsequently he was found to have an enlarged liver, which when investigated by ultrasound was reported to be suspicious for metastases, but for which he refused a biopsy.  At that point the cancer clinic lost track of him, as he did not go back for further follow up after refusing any of their other treatment options.

          Harley, as I call him, continued to visit me sporadically. He did not take his diabetes very seriously, and although he took some insulin daily, frequently changed the dose 'because he knows how he feels'.  He knew all about the complications of diabetes, but really didn't worry too much about tightness of control, because from his interpretation of the literature he didn't think that it made much difference.  When I told him there is much evidence to the contrary, he stated that he was going to review the literature when he had time and would get back to me, he was now very busy organizing a major youth group who had hired him as a public relations man.

          The last time I saw him was some months before my absence from the department for a year's sabbatical.  He wanted to talk to me about an interview he had with a noted veterinary researcher, who was researching a new substance that helps diabetes. It hadn't been used on humans yet, and he thought he would like to be the first, so he wondered, perhaps if he could get the substance that I might supervise his progress.  Even when I told him I couldn't prescribe such a thing or be a party to using it, he was not deterred. He said he'd take it himself, without my prescribing it.  He'd just come in for his follow-up checkups more regularly.  I had no doubt that when I got back to my practice after my sabbatical, Harley would be waiting for me with some new therapeutic regimen he had researched and would like to implement.  He was, and continued to manage his problems his way, sometimes accepting a little guidance from me, as he was still doing a year later when I departed the province to take another post.