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Excerpt From 'The Kitchen Shrink'

A psychiatrist reflects on patient care in a changing world

No one from Selena's insurance company, no one who ultimately judged whether she should live or die, ever laid eyes on her, spoke with her, or knew her personally.

See also: The new health care law and denial of claims.

For them, Selena was just notes on hundreds of pages, just a series of numbers — diagnostic codes, and numbers that follow a dollar sign.

I picture Selena holding the elbow of a white-haired man, guiding him down the hall. She completed herself by caring for others, much like those of us in the health caring professions, much like the best of us anywhere. And yet today, we all should be demanding and litigious to be cared for, to be chosen to live.

For the insurance company to have denied Selena life was legal. Do inmates on death row have more rights of appeal than any of us when we are sick?

And if Selena thought the all-powerful insurance company considered her life worthy, would she have fought harder for her own life?

I finally realize why I fought so hard for Selena, why I couldn't stop writing her story.

At stake was her life, but also my own way of life, a way of practicing medicine that's now slipping away, replaced by cold, calculated decision-making at a desk across town, or at the stock exchange, rather than here in the hospital, where the patient's warm heart pumps or stops.

As for Selena's father, during the last weeks of her life something changed for him. In the evenings, he sat outside her hospital room, crying. One night he pulled me aside. He realized that he needed to keep watch over his daughter's medical condition, to put his whole life into it, he said. He was even engaged to be remarried. A new mother for Selena. He and his fiancée would tend to Selena day and night after the transplant, if that's what it took.

I made more calls. I tried again. But it was too late. The decision was already made, and not by me. But who was I? Just the psychiatrist, the only doctor left of our liver transplant team, not one of those now charged with final medical decisions.

It took Selena's father a while, and he realized too late. Our medical system isn't like Marcus Welby anymore, not wise, benevolent, or constantly caring anymore. It's no longer a system that compensates for weaknesses when patients and their families falter with the newness of life-changing, or life-taking, illness.

What took Selena's father so long to see?

I could ask the same of all of us. Aren't we all too trusting of our medical system?

The Kitchen Shrink: A Psychiatrist's Reflections on Healing in a Changing World by Dr. Dora Calott Wang. Reprinted with permission of Riverhead Books. Copyright 2010 by Dora Calott Wang. Read an interview with Dora Calott Wang.