|Genre||Case Study (12 pp.)|
|Keywords||Art of Medicine, Body Self-Image, Cancer, Caregivers, Communication, Death and Dying, Depression, Doctor-Patient Relationship, Grief, Human Worth, Medical Ethics, Patient Experience, Physician Experience, Psychosomatic Medicine, Suffering, Survival|
Kirk, a man in his 50s with highly metastasized kidney cancer, presents himself to Dr. Groopman after having been turned away as a helpless case by several respected cancer clinics. He tells Groopman that he is a risk-taking venture capitalist and is willing to take any medical risk on the chance that it will save him. After pondering the ethics of the situation and the nature of informed consent under such conditions, Groopman agrees to treat Kirk. He proceeds to devise a highly risky (and untried) combination of chemotherapeutic agents. The course of treatment is excruciatingly difficult, but the experiment succeeds, and Kirk's cancer goes into complete remission.
Kirk calls it magic, a miracle, and the hospital interns call it a "fascinoma," a case defying normal expectations. Groopman releases Kirk to home and weekly checkups with a local internist, but in doing so he notices that Kirk's mood has mysteriously changed. He has lost the "piss and vinegar" of their earlier contact. Kirk continues to improve physically, traveling and playing golf and even tennis, but Kirk's wife soon reports that Kirk has stopped reading the newspapers he used to devour, which now collect in their driveway.
Several months later some physical symptoms return, and Kirk's cancer is back. A month later he is dead. In talks with Kirk near the end, Groopman discovers that Kirk's brush with death had brought with it a new and sharply negative view of himself as selfish and disconnected from the world and other people. Suddenly all his financial success seemed to him "pointless," and, since his life contained nothing else, it seemed to him a waste, and he felt it was too late to live it over. What Kirk ironically calls "my great epiphany" seems to have undone his doctor's "magic."
This is an unusually dramatic (and apparently nonfictional) medical story, combining high-risk, high-stakes therapy and a miraculous outcome followed by a mysterious failure. Groopman's case study gives us a highly sophisticated treatment of a doctor-patient relationship, in which Groopman "reads" Kirk and then designs an approach to him that will optimize the therapeutic result by making their communications and the therapy as meaningful to Kirk as possible. Thus doctor and patient are on a first-name basis, they use the language of high-risk financial deals, they occasionally talk "tough" in their dealings, and, perhaps most important, they explicitly cast the highly experimental cancer treatment as a win-or-lose-all financial game.
And some combination of those things and the risky chemo wins. We cannot help agreeing with Kirk that Groopman has worked a medical miracle. What later goes wrong is something completely outside Groopman's control, which is Kirk's near-death epiphany that seems to undo the ego strength that had driven Kirk through his life to that point, including his miraculous healing. The role of self-image in cancer treatment is controversial, but I think it's not so controversial to assert that self-image can have some effect on physiology, which in turn can affect health and mortality.
Whether or not Kirk's original feistiness cured him, it did lead him to embrace the remote possibility of cure, and his reversal of mood plausibly had a part in his demise. Hospitals are full of stories of dying patients who hold on until some important event occurs, then die--presumably because they let go. In Groopman's story, Kirk also seems to let go because he no longer sees any reason to hang on. His end is so painful to imagine because, unlike the dying patients who have in some way rounded off their lives, he is a living, cured patient who stumbles into a personal void in which his life is suddenly, and tragically, recast as a wasteland.
The role of Kirk's wife as caregiver in this story is briefly presented but moving, when we see Kirk brusquely refusing the basic comforts she offers as she accompanies him to Groopman's office.
|Source||The Measure of Our Days: New Beginnings at Life's End|
|Place Published||New York|
|Alternate Source||The Measure of Our Days: A Spiritual Exploration of Illness|
|Place Published||New York|
|Miscellaneous||The story was first published in the September 8, 1997 issue of The New Yorker under the title The Last Deal It was the basis for much of the first episode of the television series "Gideon's Crossing," titled "The Gift," in October 2000.|
|Annotated by||Woodcock, John A.|
|Date of Entry||01/28/05|