The Best Medicine
Excerpt from “The Best Medicine:”
James K. Bennett, M.D.
Linda Richardson was just thirty-six years old when she began to suffer from recurrent bladder infections. Initial exams showed nothing unusual. A year later, her symptoms worsening, she learned she had bladder cancer. Partial removal of her bladder followed by chemotherapy were not enough. When the cancer recurred, she began looking for a pioneer in urological surgery. That was when she found Dr. Bennett.
“I had been pretty healthy all my life. I had taken care of myself, gone to the doctor for checkups, and I had never had a major illness. I thought I was on top of things. But I now know I was a little naive. I really didn’t know how much to work with a doctor. I didn’t know what my expectations should be and how to assert myself.
When I was diagnosed with cancer I was only thirty-six. It was very upsetting. A friend recommended I read some books. One of them was Love, Medicine and Miracles by Bernie Siegel. Those books gave me the confidence to put my judgment first. They taught me that doctors are very well trained and know their stuff, but we know our own bodies better. We can accept what doctors tell us, but we don’t have to let them make decisions for us.
After the first surgery, the oncologist I went to told me immediately that my whole bladder should have been removed. He predicted that cancer would come back and it did, in less then a year. I knew that this time they would take the entire thing out, but also I also knew that there were some new surgical techniques that might let me avoid having one of those bags on the outside of my body for the rest of my life. At my age, I wanted to avoid that if it were possible.
This kind of operation wasn’t something my original oncologist had ever done, so my primary care physician sent me to Dr. Bennett. He had been a pioneer in it and was very experienced with it. When I met with him it was pretty clear to me that he was confident that he could help me, but he wasn’t promising miracles. He said, “I’ve done many of these operations and I have a good success rate. But I’m not God. I’m not going to be able to give you back what God gave you. But it should be pretty good.”
He was very confident, which I liked, and very scientific. And he seemed to respect the fact that I had some specific questions about his record, the possible negative outcomes, and my prognosis for the future. We came to an understanding. I was making the decision, and he was going to use his skills to help me the best he possibly could.
There was another thing that I noticed about Dr. Bennett that was also very important. He seemed to be very aware of who I was, that I was still fairly young, and that this was going to affect my life in a lot of ways. One of the things he did was arrange to have another surgeon there for the operation so they could make the kind of repairs that would allow me to have a normal sex life. When they take out your bladder there’s a lot of other tissue that comes out too. He was sensitive to my needs, and I really appreciated that .
“Dr. Bennett is serious about helping people, about using his excellent surgical skills to improve the quality of life for his patients. I guess that’s what came through to me. He was really excited about using techniques, advancing the science, but it was always in order to help people.
“I go back every six months for checkups and everything has been fine for a long time. Recently I went to see him and he told me about this new operation he had done, in another country, where he reconstructed a bladder and then was able to reconnect the urethra in way that allowed his patients to go to the bathroom normally, without a catheter. He was really excited about the surgical success, his technique. But he was more interested in the fact that he had restored someone to normal. It was about the person, not the medicine, and I liked that a lot.”
The defining moment in James Bennett’s life is marked by the wail of a siren and the sight of an ambulance rushing to the scene of an accident. Then just twelve years old, Bennett knew in an instant that someone in his father’s logging crew had been injured in the Georgia woods. Soon he would discover that it was his father, and that he had been killed when a tractor overturned.
From the moment of his father’s death, Bennett vowed to make life that was more stable and less dangerous than his father’s. The town’s only black physician became his mentor , and soon he was determined to become a doctor. “ He was very gentle, very understanding, and very much respected by the community,” recalls Bennett. “ No wonder I wanted to be like him.”
“ I believe there are scientific answers to every question. We may not have all the answers yet , but they are waiting to be discovered .But I think that for my patients, it’s just as important that I recognize that medicine is an art. It’s the art of being with people and understanding them, no matter who they are and where they come from. I grew up in rural Georgia. No one in my family had finished school past about the eighth grade. We didn’t have indoor plumbing for a long time. So you see, I can relate to just about anyone.
“This is very important in a specialty like urology, which involves a lot of things that people don’t want to talk about. You have to make them comfortable. That’s why I look at a patient’s chart before I go into the room, but I never carry it in with me. I don’t take notes while they talk, either. I’ll do that later. I don’t want anything to come between us. I want them to know I am listening very carefully.
“ Obviously urology involves a lot of male patients, and they can be very difficult to get information out of. I mean, most urologists will ask, “ How are you urinating?” The guy will say, “Fine” and that’s it.
“ I don’t settle for that. I’ll give him an example , like, “Could you write your name in the snow when you pee?” if he says he couldn’t do that anymore, I’ve got some valuable information.
“ I also make an effort to get their wives in the room. That will get it out. Once I asked a man to tell me how many time he gets up every night to urinate. He said, “ Never”. Then his wife said, “ What about that jug under the bed?” It turned out that he had been rolling over and peeing into this jug. I would have never thought to ask about something like that specifically, but having a wife present meant I got the information.
“None of this really takes me by surprise. I mean, I learned very early in life that people live in all kinds of ways and have all kinds of habits. I’m here to help all of them, if I can.
“One way you help is by giving them hope. I never take away hope. I also give them as much concrete information-facts- as I can. Some physicians might think this overwhelms patients, but I think it does the opposite. It makes them feel like they understand what’s happening to them. A good example of this is the patient with prostate cancer. The absolute truth is that there is not one proven best treatment for it. Once patients understand this, we can discuss all the options and make choices together about what will be done.
‘ Just being open about the facts helps people a lot. This is really true with impotence. There’s some controversy over whether this is a medical problem. I don’t have any doubt that it is. How can you place a value on a man’s ability to function? Even if you say that the benefit from helping him is solely psychological, what’s wrong with that?
“ Sexuality is very important to people. I’m not here to judge anyone, or impose my ideas on them. But I do think that if someone wants to be sexual, to express themselves that way, it’s part of normal human functioning and I want to help them if I can. This means that I have to be open , too. I’ve learned a lot about this working with spinal cord injury patients. A lot of what happens sexually takes place in the brain. Even people who are paralyzed can have sex, very enjoyably, if they learn new ways to do it.
“ The ability to be open with people, to understand the importance of sexuality, and my interest in the science is a pretty good combination. I think other doctors know my reputation. It’s probably why I got the call from the trauma surgeon when one of my patients was in terrible motor vehicle accident. He had actually had his penis almost burned off. He was not even twenty years old.
“ Well, I talked to him for a long time. I acknowledged the trauma he had experienced, but I also gave him hope. We developed a strategy to reconstruct it for him, using what was left as a start. He now has full function, and has a chance at leading a normal life. I think our relationship, and the confidence we developed in each other , was a big part of it. It wasn’t the surgical success that was the most important thing. It was that we helped that young man stay whole as a person with a future.”