Natural Causes Read Online Free PDF

happened
. The understatement of the week, Sarah thought. She debated going into the details of her final clash with Peter Ettinger, but quickly realizedthat this was hardly the time or place to unearth that worm.
    “Well, our techniques in the holistic center had their limitations,” she went on. “I don’t question that. But there was a certain, I don’t know, call it innocence about our goals and the way we did things—most of us, anyway. Each day we went to work and were able to concentrate almost exclusively on doing what we could for our patients.”
    “And?”
    “Well, as far as I can tell, medicine as I’m being trained to practice it now is often as much about money and liability as it is about patients. We order millions and millions of dollars in marginal or unnecessary tests so that our backsides will be covered if we end up in court. Meanwhile, government agencies, thinking they’re saving money, are telling us how long we’re allowed to keep patients with a given illness in the hospital. So what if an elderly lady here or there gets sent home too soon after a hysterectomy and falls and breaks her hip? We’re talking statistics here—actuarial tables and percentages. Not flesh and blood.”
    “Sarah, you are too young to be so jaded.”
    “Dr. Snyder, I wish there
was
something I was still too young to be—anything at all; and you know I’m not jaded. I feel I’ve made the right decision in becoming an M.D. And I love being a doctor. Sometimes I just wish it all was a little more, I don’t know, pure.”
    Randall Snyder chuckled.
    “Ivory Soap is ninety-nine and forty-four one-hundredths percent pure,” he said, turning onto Knowlton. “Nothing involving human beings even comes close to that—especially not in our racket. But, listen, I
do
understand what’s troubling you, and I promise we’ll continue this discussion sometime soon, perhaps over dinner at our place. For now, you should know that you’re on your way to being a heck of a doctor—exactlythe sort of person I would like to have as a partner in my practice.”
    “Why, thank you.” Sarah could not mask her surprise—or pleasure. It was the first time she had heard Randall Snyder even intimate he might be considering bringing in an associate, let alone her.
    “File that one away for the time being,” Snyder said. “Sometime later this year, if you want, we’ll sit down and talk business. It’s okay to take a hard look at the less appealing sides of our profession, as long as you don’t get paralyzed by what you see. And for God’s sake, don’t go putting
anyone
on a pedestal—especially me.” He pulled to the curb in front of number 313. “Now, before we go in, how about giving me a thumbnail on our patient.”
    The concise, highly stylized presentation of a medical case was emphasized more, perhaps, than any other skill during Sarah’s training. As a student, she would often lie in the bathtub, oblivious to the progressively cooling water, as she used a stopwatch and a dozen or more repetitions to perfect her next morning’s case presentation. Now the technique was second nature.
    “Lisa Summer is a twenty-three-year-old unmarried artist, gravida two, para zero, spontaneous a.b. three years ago. LMP ten-two.”
    Second pregnancy, no deliveries prior to this one, a miscarriage, last menstrual period nine months before. Randall Snyder nodded for Sarah to proceed.
    “This pregnancy has been unremarkable in every respect. There has been a thirty-pound weight gain from a base weight of one oh six. At exam one week ago, fetus was in vertex position—head was engaged, probably left occiput anterior.
    “Except for the usual childhood diseases, Lisa has a negative medical history. She is a nonsmoker and drinks occasionally. No other meds except for the natural prenatal supplement I prescribe.”
    “Ah, yes,” Snyder said. “The mysterious Baldwinmix. I was at the departmental conference last year when you spoke of