October 2008
by Vicki Rackner MD
As I watch the financial news unfold, I think of my patient I'll call Sally. One normal Thursday morning Sally felt a small lump in her breast while showering. Though she regularly finds new lumps in her lumpy- bumpy breasts, she said there was something different about this lump. She just knew it. A biopsy showed a small cancer. Her primary care doctor sent her to a surgeon who offered his opinion. She came to me for a second opinion, and chose me to operate on her. We had further conversation about her surgical options. She made the choice that best fit her situation, and her operation went well.
We expected that with such a small tumor, chances were good that the cancer cells would be contained in this breast. That meant that a local treatment--the surgical removal of the lump--would be her primary cancer treatment. Chemotherapy, which treats cancer cells anywhere in the body, would most likely be offered as an insurance policy, just in case a few cancer cells had already escaped the confines of the breast
All of us were surprised when the pathology report came back. She had cancer in all of her lymph nodes. That meant that the cancer was widespread in her body. Her very life depended on the ability of a systemic treatment--chemotherapy-- to kill the cancer cells that might be trying to set up housekeeping in her bones or liver or brain.
When we first heard news about the problems with sub-prime mortgages, it was like Sally noticing a lump. There were, of course, experts who told us how this lump was different and why it should be removed. For the most part, we just went on about our crazy- busy lives, believing this was just another one of the economy's many lumps and bumps.
Then the bail-out of Fannie Mae and Freddie Mac, like Sally's biopsy, showed this was no ordinary lump. We had a serious problem. The response to the faltering banking giants was like Sally's operation. It looked like a local treatment would cure the problem. The failure of AIG was like learning the surprising news that Sally had cancer in her lymph nodes. We are dealing with advanced systemic disease, and we will need potent systemic treatment.
And all of this is happening just as we choose the president who will lead the country for the next four years. Voting for a president is like choosing a primary care doctor. This is the person you rely upon to guide you to a life of optimal health in good times and in bad. It's the person who offers leadership in the theoretical times of crisis we hope will never come.
Yet, the crisis is right here right now. We are, in fact, choosing the head of the treatment team whom we will trust to manage this life-altering systemic financial disease.
We're all paying close attention to the presidential candidates. We know how high the stakes are. We need to make an informed choice as we cast our presidential votes. If only there were a right choice! Your job is to choose the candidate who offers the best fit between your needs and your take on his ability to respond a way that makes most sense. You may choose a different doctor--and president-- than even your best friend
When my patient Sally made her many treatment choices, she had a general idea about the general plan. No one could tell her the exact course, because it would depend on how her body responded at each step. However, every choice, big and small is made the same way. You gather the best information possible, and weigh the risks against the benefits. Then you compare it to alternative plans.
As we approach the time to cast our vote for president, we come to a fork in the road. The response to our financial crisis is another fork. These two major forks are converging at the same place and time
Yogi Berra who spoke at another at another notable national event this week--the final game at Yankee Stadium-- offers some fitting words for all American to heed. "When you get to a fork in the road, take it." Choose well.
Copyright © Vicki Rackner MD, 2008
Who will treat the ills of our nation?