Health and Luck of the Draw

by Danielle Ofri
New York Times

Sometimes you hear stories from your patients that leave you staggered by the caprice of life. A young West African patient told me how his extended family had trudged through the forest on foot to escape rebels. He was 10 years old at the time. At one point in the journey, he had to urinate. He excused himself and retreated several feet into the bush. Moments later shots rang out. When he finally had the courage to crawl back out onto the path, he saw that his entire family had been killed in an ambush.

After that, he wandered alone through the countryside, a child with no resources, crossing paths with some who would try to kill him and others who might offer help. An ongoing series of chance encounters eventually brought him to New York City. To this day he does not comprehend how he survived. Nor can I.

We imagine medicine as a rational science, and we imagine our attention to our lives and our bodies pays off in reasonably predictable ways. But our health and well-being is much more bound to random chance than we’d like to think.

For one patient of mine, it was a car accident that changed her life — entirely for the worse. Her injuries healed, but ongoing pain and post-traumatic stress derailed her, and she has become a permanent patient. Her life now revolves around doctors’ appointments, therapy, tests and medications. She never recovered her spirit or her outlook on life.

For another patient, an injury did the reverse. A gunshot wound from a drug deal gone bad landed him permanently in a wheelchair. The years of rehab served to wrench him from the drug-dealing environment. For him, life as a patient offered a stability that he’d never had, plus exposure to new influences. He was able to treat his drug addiction and return to school. He became a drug-treatment counselor and routinely proclaims that the gunshot wound saved his life.

Sometimes the random occurrences are as dramatic as literally winning a lottery. One patient of mine had been studying law in an East African city when he learned that he’d won a visa in the annual United States visa lottery. Nearly overnight, his life screeched to a halt in Africa and was recast in America. Unable to afford law school, he took a job as a taxi driver. He also adopted a more American diet, setting off a chain of metabolic events that resulted in diabetes and hypertension.

Then there are the small, serendipitous occurrences. A woman noticed a fellow subway rider reading a pamphlet about lupus and thought she should go to a doctor to get herself checked out. She didn’t have lupus, as it turned out, but we did uncover early diabetes that could be treated.

Human beings seem eternally wedded to the rational when it comes to health. Witness the profusion of advertisements that appeal to cause-and-effect notions for this herbal supplement or that workout regimen or this particular hospital.

As a primary care doctor I assiduously defer to the rational, exhorting to my patients about the solid clinical data that support certain medical treatments — aspirin to prevent heart attacks, vaccines to prevent measles and influenza, Pap smears to detect cervical cancer. Yet I have to admit that random, irrational, unplanned events can often have greater effects on overall health.

One of the smallest random occurrences is the union of doctor and patient, and whether this relationship gels. In the autumn of 1993 a 53-year-old man was discharged from our hospital after suffering a heart attack. He was sent to our clinic with a slip of paper that instructed him to get an appointment with “any M.D.”

As a newly minted intern, I was one of 50 “any M.D.’s” to whom patients were assigned in the same manner a deck of cards is dealt. His chart was dealt to my box, and as luck turned out we were a perfect fit for each other. Nearly two decades later, he is still my patient. We’ve outlasted hospital mergers and unmergers, the rise and fall of managed care, various health care reforms, assorted governors and presidents, not to mention the marriages of many of our friends and colleagues.

I know of many doctors and patients who seem unable to connect, despite personal referrals, impeccable credentials on the physician’s part or painstaking research on the patient’s part.

I wish I could deduce the rational explanation for this so that I could advise people who ask for recommendations about doctors. But as with my patient who won the visa lottery, or the ones who suffered accidents or trauma, some of the most powerful determinants of health end up being the luck of the draw.  (From the New York Times.)