How is that possible?
FORGED THROUGH FIRE
The collaboration took time to blossom. When Morse-Dwelley first met Pellegrini, she was in no position to bond. Septic, unconscious, and close to death, she needed emergency surgery to extract that gangrenous colon. Pellegrini, who had just moved to Maine to start her practice, got the call on Mother’s Day.
So Morse-Dwelley’s husband, Tom Dwelley, and her children (then a 14-year-old daughter and an 18-year-old son) had to size up the young trauma surgeon themselves. They were tough customers. Already, Morse-Dwelley had suffered mightily at the hands of doctors: A misdiagnosed gallbladder rupture had hospitalized her for weeks. An earlier colon surgery, which had failed to heal properly, induced raging infections. When daughter Carrie saw one surgeon whom she thought had mistreated her mother, the teenager began crying and screamed, “He’s going to kill my mom.” A nurse had to lead her away from the emergency room.
Pellegrini, however, telegraphed competence. Tom Dwelley remembers her as concerned, honest, and confident. And he put the health of his sick wife into her hands. “The moment she spoke to me, I had a feeling she knew what she was doing and she was going to help us,” he says. The first surgery to repair Morse-Dwelley’s compromised intestines began within the hour.
It failed. Pellegrini managed to remove the dead tissue, but escalating pressure in Morse-Dwelley’s abdomen forced Pellegrini to reopen the wound. The next attempt didn’t go much better. Or the third. Pellegrini’s repeated repair efforts brought Morse-Dwelley back from sepsis and certain death, but the patient was still so sick that her body responded poorly to surgery. Pellegrini struggled to reattach the damaged intestines. Infections set in. When the first round of operations ended, Morse-Dwelley had an open 20-inch incision and a fistula—a hole in her bowel that made her prone to infection. She spent nine days in a coma and more than two weeks in intensive care. That was just the beginning of a months-long hospital stay.
It’s difficult to know what made this case so complicated, Pellegrini says. Maybe she tried too many repairs too early. Maybe Morse-Dwelley’s compromised immune system interfered with healing. Some cases simply defy expectations. Because the physician’s job is to help the patient, and that proved so tricky, Pellegrini began to feel deeply invested. She was practicing alone, and she remembers visiting Morse-Dwelley in Room 319 every day for weeks, sometimes twice a day. She asked her children to pray for her patient. “You make a vow to the patient,” Pellegrini says. “I am going to get you through this.”
Morse-Dwelley explains that the personal bond ultimately mattered more to her than anything medical, and she ignored family members who told her she should transfer to Boston. “It wasn’t a blind faith at all,” she says of her loyalty in the face of adversity. “It was a faith in her really emotionally connecting with us. We knew that she wanted me to be alive as badly as anybody else, and she wasn’t afraid to ruin her own surgical stats to help us.”
WHAT DOCTORS KNOW
At its core, medicine is a personal business. Even as health care has become more technological (surgical robots, electronic medical records) and physicians have become more squeezed for time, nearly every medical encounter involves a face-to-face interaction between a doctor and a patient. A machine may take your blood pressure, but a person still asks what ails you and then helps fix it. Pollsters and scholars of medical ethics say that this personal interaction is a key to doctor-patient trust.
When you ask patients if they trust doctors, they imagine their own doctors—specific people who have helped them when they were sick. A doctor is rarely seen as the agent of a big institution or, like a member of Congress, as a well-liked but distant individual. Your doctor is the person who sits in a room with you and helps to solve your problems. If you ask people how they feel about the medical system, they grade it much lower than they do physicians. “Trust in doctors is very much interpersonal trust,” says Mark Hall, a professor of law and public health at Wake Forest University, who has studied the dimensions of the doctor-patient relationship.
Doctors benefit from a reputation for altruism that has remained mostly unblemished. They still take the ancient Greek Hippocratic oath, and most patients still believe that a desire to help, and not to make a profit, motivates their doctor. The medical profession has closely policed its ethical boundaries to preserve its standards.
The structure of medicine may also account for some of the lingering trust. The insurance system places an intermediary between care and payment, which makes it harder for patients to see doctors as profiteers. (Doctors who have their own imaging equipment have been shown to order more MRIs, for instance, but patients don’t necessarily associate their physicians with the bills or realize that the additional procedures may be unwarranted.) “They believe the goal of the physician is for you to do better with your hypertension. It isn’t to make a million dollars in selling hypertension medicine,” says Robert Blendon, a professor at the Harvard School of Public Health who studies public attitudes.