Sweet’s book pivots from this point into a memoir of her education as a doctor. In often lyrical stories, she recognizes ailments that elude her colleagues. After poring through charts to diagnose a patient with multiple myeloma, a blood cancer masquerading as schizophrenia, she writes that it is proof that being rushed in medicine is not only wasteful but dangerous.
Sweet maintains a healthy respect for modern medicine, however. Dialysis, antibiotics and intensive care units save lives. She knows their power but their limitations, too, and this girds her subtle and insightful commentary.
Sweet is an unlikely advocate for a kind of soft paternalism. For example, if not for Kathy, a determined nurse who browbeats a man with a tear in his aorta to return to the emergency room that has twice misdiagnosed him, the patient surely would have died. “Kathy showed me,” she writes, “that the best doctor diagnoses, prescribes, drives the patient to the ER, and then makes sure he gets the right treatment. By force, if necessary.”
Such hardheadedness, in Sweet’s view, is also needed when patients insist on aggressive, possibly futile, end-of-life treatment. “ ‘Patient autonomy’ goes only so far,” she explains. “No patient, no family, can know what they are saying when they say, Do everything. Being a doctor means seeing things clearly, explaining things clearly, but in the end, if necessary, it means saying no.”
One of the most compelling stories in the book is about Joey, a 3-year-old who is diagnosed with terminal lung disease after a near-drowning but against the odds makes it off the ventilator and out of the hospital. Sweet interprets Joey’s recovery in part as a victory for prayer. “Prayer worked,” she writes, “at least that once and maybe sometimes and maybe always.” I would see it differently: Joey was saved because a lung specialist slowly decreased airway pressure and tidal volume over several weeks in a patient with acute respiratory distress syndrome. And, as Sweet points out, it was slow medicine that allowed that doctor to make the proper adjustments.
Perhaps Sweet’s most depressing conclusion is that Joey would have died today. His doctors “would have been too busy entering health care data” that was required “according to all the mandated protocols.” Physicians would do well to learn this most important lesson about caring for patients from Sweet’s book: “Establishing the correct diagnoses and then getting them off all those unnecessary medications, with their side effects and adverse reactions, took a lot of time, but in the long run it saved way more money than it cost. It was slower but it was better.”