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June 16, 2011

An Interview with Carol Cassella, Author of HEALER - Part II

Posted by Stephen

Here is the second part of an interview with Carol Cassella, author of Healer and Oygen, where she further discusses medical issues that inspire and inform her novels.

healer.JPGQ: You have a remarkable talent for capturing the rhythm of a hospital and the routines of calls and breaks and procedures. Was it hard to bring them to life so vividly?

A: The hospital scenes (working in the operating room, taking call, bantering with the nurses and technicians and other doctors) were some of the easier sections of the novel to write. I just lifted examples right out of my actual working life and tweaked the characters and stories to better match the purposes of the scenes.

I don’t currently work as many hours as Marie does, but I used to. I know many doctors who work extraordinary hours, late into their careers. It can get fatiguing, and that fatigue can go home with you and affect your relationships and creativity, and certainly your health. The hospital can become your whole life --- your social community and point of connection with the rest of the world. In Marie’s case this leaves her feeling abandoned and friendless when her career implodes.

I also tried to write these scenes realistically to show the mundane aspects of hospital life as well as the dramatic. Unlike the medical stories in movies or TV, doctors really don’t spend every moment in the middle of a tragedy or medical miracle!

Q: In a few places in the book you mention the shortage of anesthesiologists, and it turns out that Joe was hired for lack of a better option. Does the shortage really exist? If so, why?

A: There is currently a shortage of anesthesiologists in the United States, and that's projected to persist for a number of years into the future. There are a lot of reasons for this, but some of it can be traced back to the 1990s when concerns about an oversupply led to a downsizing of anesthesia residency training slots, and fewer doctors choosing to specialize in anesthesia.

So much for forecasts! In truth, the volume of surgery has increased, and we have an aging population that needs more operations. Also, a greater than expected number of anesthesiologists have retired or chosen to work part-time. I suppose I have to blame myself for some of the shortage in that case.

Q:  In the final pages of the book, you write that Marie and her peers were “engulfed in a healthcare machine that has outstripped our individual competence with its monstrous ambition and complexity.” Do you feel that the “healthcare machine” that manufactured the circumstances of Jolene’s death is more at fault than Joe? How has it evolved into something that compromises rather than enables patient care?

A: Medicine in America today is indeed complex and sophisticated, and its evolution has been exponential in the last fifty years. In the most extreme cases of medical intervention, I sometimes wonder if our technical capacity to diagnose illness and extend lives may have outpaced our medical moral wisdom. Technology allows us to do so much for patients. But technology has exploded both the costs and the capacity to do harm. As in any complex system, if you trace a bad outcome back to its roots you’ll usually find that there were many small mistakes that added up to one catastrophe. That’s certainly what happened to Jolene; Joe’s actions were only one factor. Was Joe also a victim? I think so. The decision to hire him arose from economic pressures in the healthcare industry that are very real. In fact, all the elements of this story have happened, I just brought them together in this fictional situation.

We do many things very, very well in hospitals today, and we are focusing on medical errors and trying to eliminate them. Anesthesia is actually one of the specialties that has significantly lowered rates of complications and errors in the last decade. But the insurance and healthcare delivery systems we depend on work better for some population groups than others. Despite having the most expensive healthcare system in the world, some regions of this country are actually seeing life expectancy go down. I don’t have the answers for how to fix that, but I want to raise the questions. We need to be asking why, from both a scientific and a moral perspective.

Q: The book sensitively portrays the other side of the malpractice lawsuits that have become common. Was it important to you to portray the complexity that is frequently lost in media coverage?

A: A medical malpractice suit is painful for everyone involved, the physician as well as the patient and their family. I’ve never been involved in a malpractice case, but I know doctors who have been emotionally devastated by the experience, even when they were found completely innocent.

In Oxygen, both Bobbie and Marie find themselves isolated and wounded by the lawsuit. Marie feels driven to attempt some personal contact with Bobbie; to try to resolve their mutual despair on an emotional level that the legal system can’t possibly address. Of course, that’s completely taboo while they’re sitting on opposite sides of a malpractice suit.

Medical litigation has its place, and wronged patients need an avenue for monetary compensation. But I think we sometimes expect legal action and money to achieve an unattainable peace, and both sides of a malpractice suit may end up losing.

Q: We have an ongoing fondness for stories like Oxygen or television shows such as "Grey’s Anatomy" and "ER." Why do you think medical dramas play such a large part in pop culture?

A: Almost everyone winds up in the role of a patient at some point, and sometimes the medical experts surrounding you can seem like the wizards behind the curtain. But of course, we aren’t wizards. We’re just people, and eventually we have to be patients ourselves.

To be a patient, particularly a surgical patient, is to lose control. You hand over your clothes and slip into a teeny tiny little hospital gown with no underwear, and give permission to near strangers to knock you unconscious and cut you open. That’s a pretty vulnerable position! I think we’re drawn to fictionalized versions of these stories because we want to see what happens on the other side of the magic curtain --- look inside the lives of the people to whom we give up control.

When I was in medical school we would take a break from the library to watch "Saint Elsewhere." It gave us a sense that what we were studying so hard to become was worthwhile; it dangled a romanticized version of the lives we wanted live. One thing I've discovered is that the day-to-day life of a physician is not nearly as exciting as what you see on television. We aren’t all beautiful, and we definitely don't have all those love affairs!