Karyn N.

Lewis
0502-460-70 Science Writing
Assignment #2
Winter 20082

Rewrite of New York Times’ Scientific Article

“The Instincts to Trust Are Usually the Patient’s,” by Sandeep Jauhar, M.D.

Every year, millions of Americans fall prey to real-life medical mysteries—ailments that

go undiagnosed or misdiagnosed for years—because their instincts are questioned. Their lives

are thrown into turmoil and sanity called into question as medical professionals struggle to

understand their baffling conditions. Remarkably, some patients know they are about to die even

when no one else does. This is the situation Long Island cardiologist Sandeep Jauhar, M.D.

recently faced when taking care of an elderly man with congestive heart failure—a life-

threatening condition in which the heart can barely pump enough blood to the rest of the body.

The case of Jauhar’s patient seemed relatively mild up until his health took a sudden and

rapid turn for the worse. His massively swollen legs dripped enough fluid to soak the bed sheets

and puddle on the tiled floor, his blood pressure dropped dangerously low, and he became

delirious. After just a few days’ stay, the man was certain he wouldn’t make it out of the hospital

alive. “I am going to die here,” he whispered, as if all of a sudden attaining the alleged predictive

powers of Nostradamus and realizing a crystal-clear picture of the future.

Roughly 550,000 people are diagnosed with heart failure each year according to the

Centers for Disease Control and Prevention (CDC), making it the leading cause of

hospitalization in people older than 65. Congestive heart failure usually develops gradually,

however, with an exceptionally slow onset and progression of symptoms over time. In some

cases, the heart becomes too weak or stiff to fill and pump efficiently, impairing the ventricles’

capacity to relax and fill. The kidneys respond by triggering the body to retain water and sodium,

causing a build-up up in the arms, legs, ankles, feet, lungs, or other organs.
 The treatments used to help improve the function and ease the workload off the heart of

Jauhar’s patient—lifestyle changes, medicines, transcatheter interventions—just didn’t work.

Strangely, nothing seemed to work. Symptoms emerged, tests were analyzed, and specialists

were consulted, but several days passed and the struggle continued.

Jauhar was perplexed by his patient’s precipitous downturn and the lack of treatment

success. “It was as if I was living in a nerve-wrenching episode of Mystery Diagnosis and

experiencing first-hand a step-by-step medical odyssey—excluding the highly stylized

recreations and CGI anatomy sequences,” he observed. Instead of the typical Mystery Diagnosis

plot of solving the puzzle due to the patient's relentless pursuit of an accurate and final diagnosis,

however, the man died. This “real-life” version of the popular TV drama did not have a happy

ending.

In his work as a critical care cardiologist, Jauhar is often asked to predict how long

someone is going to live. Such projections can be useful to patients and their families, but the

doctor rarely, if ever, ventures a guess. “My guesses are so often inaccurate. It simply amazes me

when patients have a sort of sixth sense about their own deaths,” he remarked. “It’s almost like

they feel the impending doom of a catastrophic event about to occur, akin to the Apocalypse and

Armageddon obsession, Doomsday hysteria, or Millennium madness. Somehow they are just

certain the end is near, whether the Big One hits, UV rays fry the Earth, a nuclear winter freezes

over, the Earth opens up to swallow us all, or heart failure seizes their final breath.”

When discussing instinct in medicine, people typically refer to doctors grasping

diagnoses in ways that seem to defy analytical explanation in knowing, almost intuitively, which

data to focus on and which to ignore. We assume their decision-making is based on experience

and deductive reasoning or evidence, yet it seems almost mystical. Jauhar explains, “I will never

forget the time in medical school when we presented a baffling case to the chief of medicine,

who made a diagnosis of primary pulmonary hypertension within seconds on the basis of the
sound of the patient’s heartbeat—an incredible feat of observation and logical synthesis.” Just as

mystifying is the rarity in which this sort of diagnostic intuition actually occurs.

Patients today often receive a battery of tests even before a physician examines them. The

results—usually expressed in numbers that give misleading impressions of absolute precision—

tend to lull doctors into a sort of laziness that has atrophied instinct. Jauhar comments, “We

would serve well to base our theories of a patient’s illness on subtle or controversial insights like

Hugh Laurie does in House—hold the acerbic, brutally honest and pretentious demeanor.”

Medicine is often more of an art than a science, and the journey to diagnosis can be a

twisted path full of many surprises. Not all doctors can become brilliant diagnosticians whose

unconventional thinking and flawless instincts afford them a great deal of respect. “I have

learned that the best instincts in medicine derive from the patients themselves. Their intuitions

about their own health may be denigrated by doctors, but we must learn to pay attention to

them,” Jauhar notes. “Patients’ instincts often hold the vital clue.”