Barbara Natterson-Horowitz: What veterinarians know that doctors don't

Prevoditelj: Djurdjica Ercegovac Recezent: Ivan Stamenković

Ten years ago,

Prije deset godina

I got a phone call that changed my life.

jedan telefonski poziv mi je promijenio život.

At the time, I was cardiologist at UCLA,

U to vrijeme radila sam kao kardiolog na Kalfornijskom sveučilištu u Los Angelesu

specializing in cardiac imaging techniques.

na specijalizaciji slikovne dijagnostike u kardiologiji.

The call came from a veterinarian at the Los Angeles Zoo.

Nazvao me veterinar iz zoološkog vrta u Los Angelesu.

An elderly female chimpanzee

Jedna starija ženka čimpanze

had woken up with a facial droop

probudila se s facijalnom klonulošću

and the veterinarians were worried that she'd had a stroke.

i veterinari su se bojali da je doživjela moždani udar.

They asked if I'd come to the zoo

Pitali su me da li bih došla u zoološki vrt

and image the animal's heart

i snimila srce životinje

to look for a possible cardiac cause.

radi utvrđivanja mogućeg kardiološkog uzroka

Now, to be clear, North American zoos are staffed

Da ne bi bilo zabune, u sjevernoameričkim zoološkim vrtovima

by highly qualified, board-certified veterinarians

rade visoko kvalificirani, licencirani veterinari

who take outstanding care of their animal patients.

koji vode izvanrednu brigu o svojim životinjskim pacijentima

But occasionally, they do reach into the human medical community,

No povremeno se ipak obraćaju ljudskoj medicinskoj zajednici

particularly for some speciality consultation,

pogotovo radi nekih specijalističkih konzultacija,

and I was one of the lucky physicians who was invited in to help.

i ja sam imala sreću da budem pozvana da pomognem.

I had a chance to rule out a stroke in this chimpanzee

Imala sam priliku isključiti moždani udar kod ove čimpanze

and make sure that this gorilla didn't have a torn aorta,

i provjeriti da ova gorila nema puknuće aorte,

evaluate this macaw for a heart murmur,

pregledati ovu aru radi šuma na srcu,

make sure that this California sea lion's paricardium wasn't inflamed,

provjeriti da ovaj kalifornijski tuljan nema upalu perikardija,

and in this picture, I'm listening to the heart of a lion

a na ovoj slici slušam srce lava

after a lifesaving, collaborative procedure

nakon što mu je spašen život, zajedničkim postupkom

with veterinarians and physicians

veterinara i liječnika.

where we drained 700 cc's of fluid from the sac

gdje smo drenirali 700 kubnih cm tekućine iz srčane maramice

in which this lion's heart was contained.

u kojoj je bilo srce ovog lava.

And this procedure, which I have done on many human patients,

A ta procedura, koju sam radila na mnogim ljudskim pacijentima,

was identical, with the exception of that paw and that tail.

bila je identična, s izuzetkom ove šape i ovog repa.

Now most of the time, I was working at UCLA Medical Center with physicians,

Većinu vremena radila sam s liječnicima u Medicinskom centru sveučilišta

discussing symptoms and diagnoses and treatments

diskutirajući simptome i dijagnoze i terapije

for my human patients,

za moje ljudske pacijente,

but some of the time, I was working at the Los Angeles Zoo

no dio vremena sam radila u Zoološkom vrtu

with veterinarians, discussing symptoms and diagnoses and treatments

s veterinarima, diskutirajući simptome i dijagnoze i terapije

for their animal patients.

za njihove životinjske pacijente.

And occasionally, on the very same day,

A ponekad, u jednom istom danu

I went on rounds at UCLA Medical Center

išla sam u vizite u Medicinski centar sveučilišta

and at the Los Angeles Zoo.

i u Zoološki vrt.

And here's what started coming into very clear focus for me.

I evo što mi je počelo bivati sve jasnije.

Physicians and veterinarians were essentially taking care

Liječnici i veterinari u suštini brinu

of the same disorders in their animal and human patients:

o istim poremećajima kod svojih životinjskih i ljudskih pacijenata:

congestive heart failure, brain tumors,

kongestivno zatajenje srca, moždani tumori,

leukemia, diabetes, arthritis, ALS, breast cancer,

leukemija, dijabetes, artritis, ALS, rak dojke,

even psychiatric syndromes like depression, anxiety,

pa čak i psihijatrijski sindromi poput depresije, anksioznosti,

compulsions, eating disorders and self-injury.

kompulzija, poremećaja u prehrani i samoozljeđivanja.

Now, I've got a confession to make.

Sada moram nešto priznati.

Even though I studied comparative physiology and evolutionary biology

Čak iako sam studirala komparativnu fiziologiju i evolucijsku biologiju

as an undergrad --

na dodiplomskom studiju --

I had even written my senior thesis on Darwinian theory --

čak sam i svoju disertaciju pisala o Darwinovoj teoriji --

spoznaja o značajnom preklapanju

learning about the significant overlap

between the disorders of animals and humans,

poremećaja kod ljudi i životinja

it came as a much needed wake-up call for me.

došla mi je kao prijeko potreban poziv na buđenje.

So I started wondering, with all of these overlaps,

Tako sam se počela pitati, uz sva ta preklapanja,

how was it that I had never thought to ask a veterinarian,

kako to da nikada nisam pomislila da upitam veterinara

or consult the veterinary literature,

ili konzultiram veterinarsku literaturu

for insights into one of my human patients?

radi uvida u vezi nekog od svojih ljudskih pacijenata?

Why had I never, nor had any of my physician friends and colleagues

Zašto nikada nisam, niti je itko od mojih prijatelja i kolega liječnika

whom I asked, ever attended a veterinary conference?

koje sam upitala prisustvovao konferenciji veterinara?

For that matter, why was any of this a surprise?

Što se toga tiče, zašto to uopće iznenađuje?

I mean, look, every single physician accepts some biological connection

Mislim, svaki pojedini liječnik prihvaća neku biološku povezanost

between animals and humans.

između životinja i ljudi.

Every medication that we prescribe or that we've taken ourselves

Svaki lijek kojeg prepisujemo ili kojeg sami uzimamo

or we've given to our families

ili dajemo našim obiteljima,

has first been tested on an animal.

bio je prvo testiran na životinji.

But there's something very different

No ima nešto veoma različito

about giving an animal a medication or a human disease

kada se životinji daje lijek ili ljudska bolest

and the animal developing congestive heart failure

i kada ona dobije kongestivno zatajenje srca

or diabetes or breast cancer on their own.

ili dijabetes ili rak dojke, sama od sebe .

Now, maybe some of the surprise

Dakle, možda dio iznenađenja

comes from the increasing separation in our world

dolazi od sve veće odvojenosti u našem svijetu

between the urban and the nonurban.

između urbanog i neurbanog.

You know, we hear about these city kids

Znate, čujemo o tim gradskim klincima

who think that wool grows on trees

koji misle da vuna raste na drveću

or that cheese comes from a plant.

ili da se sir radi od biljke.

Well, today's human hospitals,

Pa, današnje bolnice za ljude

increasingly, are turning into these gleaming cathedrals of technology.

sve se više pretvaraju u blistave katedrale tehnologije.

And this creates a psychological distance between the human patients

A to stvara psihološku distancu između ljudskih pacijenata

who are being treated there

koji se tamo liječe

and animal patients who are living in oceans

i životinjskih pacijenata koji žive u oceanima

and farms and jungles.

i na farmama i u džunglama.

But I think there's an even deeper reason.

No, ja mislim da postoji i dublji razlog.

Physicians and scientists, we accept intellectually that our species,

Mi liječnici i znanstvenici intelektualno prihvaćamo da je naša vrsta,

Homo sapiens, is merely one species,

Homo sapiens, samo jedna vrsta,

no more unique or special than any other.

ništa više jedinstvena ili posebna od bilo koje druge.

But in our hearts, we don't completely believe that.

Ali u svojim srcima, ne vjerujemo sasvim u to.

I feel it myself when I'm listening to Mozart

Osjećam to i sama kada slušam Mozarta

or looking at pictures of the Mars Rover on my MacBook.

ili gledam slike Mars Rovera na svom MacBooku.

I feel that tug of human exceptionalism,

Imam taj lagani osjećaj ljudske posebnosti,

even as I recognize the scientifically isolating cost

čak iako priznajem znanstveno izolirajuću cijenu

of seeing ourselves as a superior species, apart.

toga što sebe smatramo superiornom vrstom, izdvojenom.

Well, I'm trying these days.

No, ja se sada trudim.

When I see a human patient now, I always ask,

Kada vidim ljudskog pacijenta sada se uvijek pitam,

what do the animal doctors know about this problem that I don't know?

što životinjski doktori znaju o ovom problemu, a što ja ne znam?

And, might I be taking better care of my human patient

I, da li bi možda moja skrb za mog ljudskog pacijenta bila bolja

if I saw them as a human animal patient?

ako ga gledam kao ljudskog životinjskog pacijenta?

Here are a few examples of the kind of exciting connections

Evo par primjera uzbudljivih povezanosti

that this kind of thinking has led me to.

do kojih me doveo ovakav način razmišljanja.

Fear-induced heart failure.

Zatajenje srca izazvano strahom.

Around the year 2000,

Oko 2000. godine

human cardiologists "discovered" emotionally induced heart failure.

ljudski kardiolozi "otkrili" su emocionalno izazvano zatajenje srca.

It was described in a gambling father who had lost his life's savings

Opisano je to u slučaju oca kockara koji je svoju životnu ušteđevinu izgubio

with a roll of the dice,

jednim bacanjem kocke,

in a bride who'd been left at the alter.

nevjeste ostavljene pred oltarom.

But it turns out, this "new" human diagnosis

No pokazalo se da ta "nova" ljudska dijagnoza

was neither new, nor was it uniquely human.

nije bila ni nova niti jedinstveno ljudska.

Veterinarians had been diagnosing, treating and even preventing

Veterinari su dijagnosticirali, liječili i čak sprečavali

emotionally induced symptoms in animals

emocionalno izazvane simptome kod životinja

ranging from monkeys to flamingos, from to deer to rabbits,

u rasponu od majmuna do flaminga, od jelena do zečeva,

since the 1970s.

još od 1970-tih.

How many human lives might have been saved

Koliko je ljudskih života možda moglo biti spašeno

if this veterinary knowledge had been put into the hands

da je to veterinarsko znanje bilo na raspolaganju

of E.R. docs and cardiologists?

liječnicima hitne službe i kardiolozima?

Self-injury.

Samoozljeđivanje.

Some human patients harm themselves.

Neki ljudski pacijenti nanose sebi ozljede.

Some pluck out patches of hair,

Neki si čupaju pramenove kose,

others actually cut themselves.

drugi se zaista režu.

Some animal patients also harm themselves.

Neki životinjski pacijenti također ozljeđuju sami sebe.

There are birds that pluck out feathers.

Ima ptica koje čupaju svoja pera.

There are stallions that repetitively bite their flanks until they bleed.

Ima pastuha koji učestalo grizu svoje slabine sve dok ne prokrvare.

But veterinarians have very specific and very effective ways

No veterinari imaju vrlo specifične i vrlo učinkovite načine

of treating and even preventing self-injury

za liječenje i čak sprečavanje samoozljeđivanja

in their self-injuring animals.

kod svojih pacijenata.

Shouldn't this veterinary knowledge be put into the hands

Ne bi li to veterinarsko znanje trebalo staviti na raspolaganje

of psychotherapists and parents and patients

psihoterapeutima i roditeljima i pacijentima

struggling with self-injury?

koji se bore sa samoozljeđivanjem?

Postpartum depression and postpartum psychosis.

Post-porođajna depresija i post-porođajna psihoza.

Sometimes, soon after giving birth,

Ponekad, ubrzo nakon poroda,

some women become depressed,

neke žene postaju depresivne,

and sometimes they become seriously depressed and even psychotic.

a ponekad postaju ozbiljno depresivne i čak psihotične.

They may neglect their newborn,

Mogu zanemariti svoje novorođenče,

and in some extreme cases,

a u nekim ekstremnim slučajevima,

even harm the child.

čak i ozlijediti dijete.

Equine veterinarians also know that occasionally,

Veterinari za konje također znaju da će ponekad

a mare, soon after giving birth,

kobila, ubrzo nakon poroda,

will neglect the foal, refusing to nurse,

zanemariti ždrijebe, odbijajući da ga doji,

and in some instances, kick the foal, even to death.

a u nekim će slučajevima udarati ždrijebe kopitom, čak do smrti.

But veterinarians have devised

No veterinari su osmislili

an intervention to deal with this foal rejection syndrome

intervenciju za ovaj sindrom odbijanja ždrebeta

that involves increasing oxytocin in the mare.

koja uključuje povećanje oksitocina kod kobile.

Oxytocin is the bonding hormone,

Oksitocin je hormon povezivanja

and this leads to renewed interest,

pa to dovodi do obnovljenog interesa

on the part of the mare, in her foal.

za ždrijebe od strane kobile.

Shouldn't this information

Ne bi li trebala ta informacija

be put into the hands of ob/gyn's

biti na raspolaganju porodničarima i ginekolozima

and family doctors and patients

i obiteljskim liječnicima i pacijentima

who are struggling with postpartum depression and psychosis?

koji se bore s post-porođajnom depresijom i psihozom?

Well, despite all of this promise,

No unatoč svemu što ovo obećava,

unfortunately the gulf between our fields remains large.

nažalost, ponor između naših područja ostaje velik.

To explain it, I'm afraid I'm going to have to air some dirty laundry.

Da bih to objasnila, bojim se da ću morati razotkriti nešto prljavog rublja.

Some physicians can be real snobs

Neki liječnici mogu biti pravi snobovi

prema zdravstvenim djelatnicima koji nisu doktori.

about doctors who are not M.D.'s.

I'm talking about dentists and optometrists and psychologists,

Govorim o zubarima i optometričarima i psiholozima,

but maybe especially animal doctors.

ali možda najviše o životinjskim doktorima.

Of course, most physicians don't realize that it is harder

Naravno, većina liječnika ne zna da je danas teže

to get into vet school these days than medical school,

upisati se u veterinarske škole nego u medicinske,

and that when we go to medical school,

i da kada idemo u medicinsku školu,

we learn everything there is to know

učimo sve što je moguće znati

about one species, Homo sapiens,

o jednoj vrsti, Homo sapiensu,

but veterinarians need to learn about health and disease

dok veterinari moraju učiti o zdravlju i bolestima

in mammals, amphibians, reptiles, fish and birds.

sisavaca, vodozemaca, gmazova, riba i ptica.

So I don't blame the vets for feeling annoyed

Zato ne krivim veterinare što osjećaju ljutnju

by my profession's condescension and ignorance.

zbog prezira i neznanja moje profesije.

But here's one from the vets:

Ali evo jednog veterinarskog:

What do you call a veterinarian

Kako zovete veterinara

who can only take care of one species?

koji skrbi samo o jednoj vrsti? (Smijeh)

A physician. (Laughter)

Liječnik. (Smijeh)

Closing the gap has become a passion for me,

Smanjivanje jaza postala je moja strast,

and I'm doing this through programs

i to radim kroz programe poput

like Darwin on Rounds at UCLA,

Darwin u vizitama na Kalifornijskom sveučilištu

where we're bringing animal experts and evolutionary biologists

gdje dovodimo eksperte za životinje i evolucijske biologe

i uključujemo ih u naše medicinske timove

and embedding them on our medical teams

s našim stažistima i specijalistima.

with our interns and our residents.

I putem Zoobiquity konferencija,

And through Zoobiquity conferences,

na koje dovodimo medicinske škole zajedno s veterinarskim školama

where we bring medical schools together with veterinary schools

radi skupnih diskusija

for collabortive discussions

of the shared diseases and disorders

o bolestima i poremećajima koje su zajedničke

of animal and human patients.

životinjskim i ljudskim pacijentima.

Na Zoobiquity konferencijama

At Zoobiquity conferences,

sudionici uče kako nam liječenje raka dojke kod tigra

participants learn how treating breast cancer in a tiger

can help us better treat breast cancer

može pomoći da bolje liječimo rak dojke

in a kindergarten teacher;

kod odgajateljice u vrtiću;

how understanding polycystic overies in a Holstein cow

kako razumijevanje policističkih jajnika kod Holstein krave

can help us better take care

može pomoći boljoj skrbi

of a dance instructor with painful periods;

za instruktoricu plesa s bolnim menstruacijama;

and how better understanding the treatment of separation anxiety

i kako bolje razumijevanje tretmana separacijske anksioznosti

kod preosjetljivog šetlandskog ovčara

in a high-strung Sheltie

can help an anxious young child struggling with his first days of school.

može pomoći anksioznom djetetu tijekom prvih dana u školi.

In the United States and now internationally, at Zoobiquity conferences

U Sjedinjenim državama a sada međunarodno, na Zoobiquity konferencijama

physicians and veterinarians check their attitudes and their preconceptions

liječnici i veterinari odlažu svoje stavove i predrasude

na ulazu i okupljaju se kao kolege,

at the door and come together as colleagues,

kao ravnopravni sudionici i kao doktori.

as peers, as doctors.

After all, we humans are animals, too,

Konačno, mi ljudi smo također životinje

i vrijeme je da mi liječnici prigrlimo

and it's time for us physicians to embrace

our patients' and our own animal natures

životinjsku prirodu naših pacijenata i našu vlastitu

and join veterinarians

i pridružimo se veterinarima

in a species-spanning approach to health.

u pristupu zdravlju koji obuhvaća sve vrste.

Because it turns out,

Zbog toga jer se pokazuje da

some of the best and most humanistic medicine

neke od najboljih i najljudskijih medicina

is being practiced by doctors whose patients aren't human.

prakticiraju doktori čiji pacijenti nisu ljudi.

A jedan od najboljih načina na koji možemo skrbiti

And one of the best ways we can take care

of the human patient is by paying close attention

o ljudskim pacijentima je da budno pazimo na to

to how all the other patients on the planet

kako svi ostali pacijenti na planetu

live, grow, get sick and heal.

žive, rastu, obolijevaju i zacjeljuju.

Hvala vam.

Thank you.

(Pljesak).

(Applause).