Open Heart: A Patient’s Story of Life-Saving Medicine and Life-Giving Friendship
Jay Neugeboren; Boston, Massachusetts; Houghton Mifflin; 2003; ISBN 0-618-11211-1; 371 pages; $24.00
Neugrboren’s newest book is a substantive read because it addresses multiple topics of importance to members of the medical community. On the surface, Open Heart is an illness narrative – the story of Jay Neugeboren, a vibrant, healthy 60-year-old man who swam and played tennis and basketball regularly, often against competitors less than half his age, only to receive a diagnosis of heart disease. Like other illness narratives, this book attempts to make sense of illness by describing the patient’s experiences of diagnosis, treatment and recovery while also inquiring into the meanings of health and illness from the perspective of the patient.
On another level, the book illustrates the potential contributions of friendship to the process of healing. Neugeboren’s diagnosis begins with a telephone conversation with a friend, a cardiologist who lived 3,000 miles away. That friend joined with three of the author’s friends in the medical profession – a neurologist, an AIDS researcher, and a psychologist – to serve as invaluable sources of tangible and emotional support. They contacted other physicians on Neugeboren’s behalf, helped him select a first-rate hospital and surgeon for treatment, assisted him in sharing the news with his family, listened attentively to his concerns, and offered insights into the experience of treatment from the health care provider’s viewpoint. It should not be overlooked that the doctors’ comments reveal much about the reach and limits of contemporary medicine.
It is in the combination of the first two interpretations of the book that its third, and most noteworthy, contribution emerges. Neugeboren reflects on the friendship exhibited by the four doctors and notices similarities between the qualities patients seek in physicians and the characteristics people look for in friends. For instance, both lists are likely to privilege dialogic interactions in which each person speaks openly, honestly, and from a genuine concern for the well being of the other. In the remainder of the book, Neugeboren advocates an approach to medicine that merges prior views of medicine as art and medicine as science into a unifying style of practicing medicine that requires knowledge of medical information and appreciation of the physician-patient relationship formed in the medical encounter. This relationship, Neugeboren contends, requires knowledge of the patient that might exceed the minimal medical histories often taken by health care providers. More knowledge about their patients will make physicians more effective by increasing the likelihood of accurate diagnoses and by minimizing patients’ distrust of physicians (which will also lead to increased levels of patient compliance).
Although medical technology has empowered doctors with enhanced knowledge of the human heart (and of the body in general), many questions remain unanswered, as evidenced by the absence of a causal link to Neugeboren’s heart disease. No lifestyle behaviors or information from his family history suggests him as a likely target of heart disease. Medical attempts to explain heart disease are varied and sometimes contradictory. In addition, Neugeboren cites research claiming that many medical schools do not adequately train students about heart auscultation – a failure that prevents early detection of disease. However, in Open Heart, Neugeboren does not assail the medical community for the questions is has not yet answered. Rather, the author merely wishes to remind us, as his friend Rich once told him, that “medicine, even in cardiology, is still essentially an art, and one where the key element remains the relationship between the doctor and the patient” (p. 17).
