Well what did you expect?
Diane Forbes, DC
This past week it was hard to not have
noted the story of Ladan and Laleh Bijani, the 29-year-old conjoined
(a.k.a. Siamese) twins from Iran who requested a risky surgery to separate
them. They opted to undergo a multiple day surgical procedure that had
been untried on adults in order to attempt to live more normal lives.
Reports state that they were given a 50-50 chance that one or both of
them would die during the operation. As we now know, neither sister
survived the operation.
What interests me about this report is
that if they had been born only 20 years earlier they would never have
faced the possibility of separation through a surgical intervention.
But today many things are conceivable that
would never have been possible in earlier days. The Bijani twins would
have never dreamed of separation, and would have never considered the
possibility that they could live healthy and separate lives. They did
however dream these dreams, because they held some expectation that one
if not both of them could live out this dream.
The practical thinking about a 50-50
chance is that if Ladan had died, then Laleh would have lived and vice
versa. However this belief is unfounded. What their 50-50 chance
represents is a possibility that over many of these procedures about
half of the patients would survive. Unfortunately this means that there
could be very many failures in a row resulting in many deaths before
there are an equally large number of survivors. It could be another
decade or more before both twins could be expected to survive such a
procedure, and possibly longer to ensure that the survival leads to a
full and meaningful life. Maybe there would be such limited interest
from consenting adults that we never learn enough to ensure the
survival of both twins.
In today’s medical environment we are
constantly faced with odds of getting some disease and or chances of
cures from ailments. We are all familiar with the sense of impending
doom that a five per cent death rate from SARS (Severe Acute
Respiratory Syndrome) gives us. We also worry about increased risks of
death from eating peanuts to our children, accidental death to our
teens and from smoking to our friends and ourselves. But we rarely flip
this sense of odds awareness on our likely success of getting over some
illness or injury.
When we arrive for treatment at the
clinics of our health providers we often hold the sense that every
ailment is curable, that we should be able to resume our prior
activities without inconvenience or delay. And this is often not the
case. Two per cent of back injuries never go away, becoming chronic.
The failure rate from breast cancer treatment is around 19 per cent.
Almost seven per cent of patients have negative reactions to prescribed
medications. Often what we hope will be the outcome of medical
treatment is not what results.
When we approach the practitioner’s office
we need to have realistic expectations about what can be accomplished
through treatment. Not everything goes away, in a short time, by taking
a pill. Some conditions become issues that can only be managed over the
long term. Your health care provider is by oath making every attempt to
provide you with the best care they can. And often you are not served
better by attempting experimental therapies that are read about online
or in the paper. Odds chances provided for these therapies are just
guesses until true measures can be made by providing treatment to many
patients, some who have very unsuccessful outcomes and others who have
no success at all.
Every one needs to talk to their care
providers to make sure that their expectations are realistic. Maybe
your expected outcome and the true success rate of care are really far
apart. Even the most commonly employed treatments have failure rates
for therapy. Unfortunately some of us have to make up the proportion of
patients who end up with outcomes that less than satisfy our
expectations. Our prior good health helps us to overcome illness and
injury, but it does not guarantee our success in treatment. Sometimes
the outcome is less than hoped for, just as the Bijani sister’s case
has reminded us.