Slow Medicine

Slow Medicine: The Way to Healing

Victoria Sweet (2017, Riverhead Books)

We last heard from Victoria Sweet, M.D., in her 2012 book God's Hotel, about the charity hospital in San Francisco where she had practiced Slow Medicine for some twenty years. She has continued to meditate on what makes 'the practice of medicine' distinct from 'the delivery of health care'; not surprisingly, the latter suffers in the comparison. She's doing her part to help the pendulum to swing the other way, so that sick people can be healed as well as cured.

That's not to say that she does not give due respect to the modern methods of medicine. She tells one remarkable story of saving a man's life because she had simple surgical instruments with her on a hike through Nepal. Blood tests and imaging systems will always have their place as extensions of the physician's senses. Intensive care units can keep a body ticking over, sometimes longer than makes any sense.

Parts of Slow Medicine put me in mind of Perri Klass, whose memoir of a medical education was memorably titled A Not Entirely Benign Procedure. Sweet's progress through med school, internship, and residency had what seems to me an unusual number of detours, all of them fruitful. Her original intention was to become a Jungian analyst, hoping to meet the most interesting philosophical questions. "Medicine asked the wrong questions –What is causing that ear pain?–practical questions, not deep and interesting questions. But it did have answers, and I preferred answers to questions."

But she's quite open-minded about where she gets answers. Chinese medicine's model of the body bears little relation to what she learned at medical school, but in some circumstances it seemed to work better. She also became interested enough in the teachings of Hildegard of Bingen to acquire a second doctorate, in medical history. But also, always, Harrison's Principles of Internal Medicine, its 2,600 pages well-thumbed.

And always, first, the physical examination, meeting the patient with sight and sound and touch. Given time to examine a patient and read carefully through his record, the doctor can build a story about what's wrong, run tests to be sure, and make a plan to treat it. Essential to the plan is a judgement about what is urgent to treat, and what can be left to watchful waiting. Sweet's study of Hildegard suggests that the patient has the same drive for life and growth that a plant in a garden has, which the doctor/gardener needs to seek out and make way for. "I found myself practicing a kind of Fast Medicine and Slow Medicine together–at many different levels. At the level of actual time, of course, but even more, at the level of style. Mechanic and gardener. Focused and diffuse. The parts and the whole."

In addition to Klass, this book resonates within the tradition of Oliver Sacks, Jerome Groopman, and Atul Gawande. On some level, Sweet loves her patients. "I liked watching them improve, reconstitute, heal. Day by day, their minds clearing, their limbs strengthening, their wounds reconstituting. Not everyone got well, but almost everyone got better, and it was the same pleasure as watching a film go backward. The pieces of the broken vase coming together, jumping back up on the table, the spilled water collecting and running back inside, the tossed flowers righting themselves and reassembling until the vase of flowers is whole again."

The tools of modern medicine are impressive, and sometimes life-saving, but that doesn't mean that our bodies are machines. It's not too much to hope that our doctors will be craftsmen, or gardeners, and not just mechanics.

May 2018