Cause and Effect

As I learned in my bioethics class this semester, there are numerous approaches to the study of medicine, one of which is the narrative method. This literature-based approach is slowly becoming more popular as more and more physicians are trained to truly listen to the patent's story, not just his/her symptoms. As many patient narratives indicate, when narrative medicine comes face to face with evidence-based medicine (the prevalent school of thought), the result is often frustrating for the patient and the doctor, especially if the case does not fit into a neat paradigm of previous cases. Clearly there needs to be a happy medium that combines the casuistry model based on information gleaned from previous cases and the narrative method based on the individual patient's story. All of which actually brings me to the story of Dancing Forever, a horse that brings narrative medicine to life.

Dancing Forever is the son of Dancinginmydreams and he recently won the $200,000 Grade II Fifth Third Elkhorn Stakes at Keeneland, an event his trainer called "a miracle." Dancinginmydreams, you see, spent thirteen months at Penn's New Bolton Center, recuperating from five surgeries on the hind pastern bone that she shattered while running in the Frizette Stakes in New York eight years ago. According to an article in the Lexington Herald-Leader, trainer Shug McGaughey recalled that the surgeon at the track told him the horse's hind leg "looked as if a shotgun shell had been shot into the bone." And yet, the horse's owner asked, "Can we get her to New Bolton without being cruel?"

Off she went to New Bolton, hooked up to intravenous tubes, her leg stabilized in a brace, where Dr. Richardson put her leg back together again in five different surgeries. She healed for thirteen months, during which time, Barbaro's trainer, Michael Matz, would often go to New Bolton and check on her because he was close by. He phoned his reports to McGaughey. And when she left New Bolton for a nearby farm in Georgetown to continue her rehabilitation, Dr. Richardson and many others shed a few tears because they had grown so attached to her.

Dancing Forever was born five years ago and is Dancinginmydreams' first foal and the only one racing to date. Dancing Forever is a late bloomer and, according to McGaughey, "only turned the corner last year, at age four." He also prefers long distances such as 1 1/4 miles and 1/12 miles, but no one is complaining. To his owners, Dancing Forever is simply a miracle horse and the fact that he is racing at all is just icing on the cake.

So to those naysayers who questioned Dr. Richardson's ability to put Barbaro's leg back together again, there was indeed, medical precedence for him to try. The injury to Dancinginmydreams was not identical to Barbaro's injury but it was equally life-threatening and she survived, walked out of New Bolton and produced a graded stakes winner. Her story is as compelling as Barbaro's but many don't know about it simply because she did not win the Kentucky Derby or break down live on national television before an estimated viewing audience of four million people.

So using an evidence-based medical approach, there was every reason to try and save Barbaro. There was scientific evidence to suggest that his leg could be surgically repaired. It is the narrative approach, however, that, pardon the pun, gives the story legs and keeps it running long after the medical science has become a case on which to base future life and death decisions for other horses.

Of course, there is also the financial aspect and both Dancinginmydreams and Barbaro belonged to owners who could afford to spare no expense to save their horses. But without their willingness to try, we would never know if it could be done. And the irony, of course, is that even great men of science are moved, in the end, by the stories that give meaning to their work.