BANGOR, Maine—Mary Morse-Dwelley’s abdomen tells the story of her medical travails. A long, straight scar crosses the top. Swirls of shiny pink skin dance across the middle, revealing the many unsuccessful attempts to close an incision—with synthetic mesh and Velcro, a vacuum-pack dressing, and ultimately a skin graft. A bulging hernia on the right side shows where her abdominal muscles atrophied after repeated infections and repair attempts. The bulge has grown in recent years without those muscles to protect her swelling organs from the vicissitudes of gravity.
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Inside, it’s not much better. Morse-Dwelley’s belly, full of scars and adhesions, is missing her gall bladder, uterus, and more than two feet of intestines. There’s a medical term for such an environment: a “hostile abdomen.” It’s the sort of place that most surgeons prefer to avoid.
“The question is, where am I going to start?” asks Dr. Joan Pellegrini as she surveys Morse-Dwelley’s battle-scarred body in her office at Eastern Maine Medical Center here. She moves her hand up high, far above the hernia she hopes to repair. “I think I’m going to start here, in an area where there is no scar tissue.” Morse-Dwelley, 60, points to a diagram of the digestive system that hangs above the exam table. “I don’t have most of that,” she jokes.
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Her medical chart reads like an epic poem. Surgery to remove inflamed parts of her colon scraped away too much of her abdominal wall, which caused a strangulating hernia, which killed a section of her colon, which became infected, which induced septic shock, which required a series of unsuccessful repairs. She has undergone 22 abdominal operations, endured infections by antibiotic-resistant superbugs, spent more than 100 consecutive days in the hospital, and lived for nearly two years in bed. Through much of the ordeal, full of setbacks and complications, Pellegrini was her surgeon.
But Morse-Dwelley has been healthy for five years now. During that time, she watched her two children graduate from college, welcomed a grandchild into the world, nursed her husband through a heart attack, and helped his solo optometry practice recover from the missed days and medical bills that dragged them close to financial ruin. The crisis is over. For Morse-Dwelley, despite all the disasters, Pellegrini is the hero of her medical story. Today’s checkup lays the groundwork for yet another operation next month.
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This patient is no fool, and she doesn’t award trust liberally. A vigorous labor arbitrator, Morse-Dwelley has worked in tough political campaigns. Her brother is a priest, but she distrusts the Catholic Church. She says you’d have to be crazy to count on bankers, after the financial crisis. She saw how her long illness strained close relationships and taught her who her “real friends” are. Her husband’s career has given her an up-close—and unflattering—view of how health insurers work. Her skepticism reflects broad social attitudes: Americans have grown more mistrustful of many professions—clergy, lawyers, politicians, journalists. (See “In Nothing We Trust.”)
Yet, somehow, Morse-Dwelley never lost faith in Pellegrini. She’d hear the click of her doctor’s shoes in the hallway, see her blond hair and funky glasses, and feel confident that she was in good hands. This, too, represents a broad trend: As we have become better-informed patients, we have grown more cynical about a health care system that is ever more corporate and reliant on technology. Nevertheless, our faith in physicians has proved incredibly durable. Gallup, which has polled on public trust in professionals every year since 1976, reports high and rising marks for doctors. In the latest survey, from 2011, 70 percent of respondents rated medical doctors as high or very high when asked about their “honesty and ethical standards,” a record. When the Kaiser Family Foundation asked Americans whom they trusted in 2009—the height of the debate over the health care law—78 percent said they believed that their doctors put patients’ interests ahead of their own.
Amazingly, this trust persists even among people who have been harmed by their physicians, according to a growing body of research. As Morse-Dwelley suffered through repeated procedures, infections, and crises, she knew that Pellegrini didn’t always make the perfect decision or get the best result. Many of Pellegrini’s colon-repair surgeries failed. And Morse-Dwelley’s belly rejected several artificial patches that the doctor inserted to compensate for lost tissue. At various points, Morse-Dwelley overheard other physicians advise Pellegrini to give up, saying that Morse-Dwelley was too sick to bear further rescue efforts.
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Pellegrini pressed on, Morse-Dwelley believes, because the surgeon cared about saving her life. “A lot of the outcomes of the surgery were bad,” Morse-Dwelley says. “But I had complete confidence that she was the only person there who was willing to keep trying.” Intent, in the end, matters more than results. Now the two have been together for 10 years; they laugh like old friends.