"Doctors have to be able to think of the absurd"

Ingrid Müller is a chemist and medical journalist. She was editor-in-chief of for twelve years. Since March 2014 she has been working as a freelance journalist and author for, among others, Focus Gesundheit, the health portal ellviva.de, the publishing house living crossmedia and the health channel of rtv.de.

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Some doctors surpass themselves. And some patients too. You push your limits, enter new medical territory and focus on life with bold therapies. The physician Bernhard Albrecht has written down nine such stories in a book * - the interview

Mr Albrecht, you write about doctors who dare to do anything - what makes them so special?

These doctors then move on when others say, 'We have done our duty. We have exhausted all therapies and now there is nothing more we can do for you. But often these doctors have only gone to the limits of standard procedures and do not consider the case they are facing individually enough. One example is the chronic pain patient in my book. She was last on the strongest opiate but her pain was still there. This pain therapist just went a step further and wondered: What else is there? He came across cannabis.

This helped the patient, but the doctor was left with the cost of the drug. Over the years he stuttered around 45,000 euros into the health insurance company. Is that what you mean by dare?

This doctor was not even aware of what he was risking, because he was dealing with the concentrated German prejudice against drugs. He saw himself absolutely in the legality. The effectiveness of cannabinoids has been proven. The drugs are approved for chronic pain patients, but are not paid for because there is no indication. He is therefore allowed to prescribe them “without penalty”, but the patients have to pay for them themselves. The doctor, who made his career in the GDR, would never have expected such refinements in the accounting system. He probably gave everything rather than dared to do anything.

How much rebel, how much adventurer does a doctor have to be?

In any case, he must be able to think of something off the beaten track, of something that lies next to the path that has been mapped out. The doctors I am describing are all individuals, but they have one thing in common: They do not allow themselves to be influenced too much by convention and the mainstream. I even once thought that you might find out in early testimonials that they were extremely headstrong in their heads or particularly rebellious. But I haven't found anything there yet.

What drives doctors to foolhardy therapies?

Doctors have their own motives. For one it is love for people and the willingness to help. But not all medical professionals are pure people friends. It is also great ambition that makes some doctors jump over all hurdles. For example, a middle-aged doctor may not have achieved enough for fame and career. He is driven by one idea that he absolutely wants to realize. Even so, this doctor can be a personable person.

With the will of the patient everything is possible, without it nothing.

It is not the will alone. The foundation is boundless trust, letting yourself fall into the hands of the doctor. He will fix it - even if he openly says that the intervention could mean disability and death. Trust is the prerequisite for the doctor to think further at all. Of course, this is a double-edged sword - a patient needs to know who he is confiding in.

How do you elicit fleeting thoughts from a doctor about out-of-the-way therapies, asks a terminally ill young woman with advanced colon cancer. How did she do it

She somehow managed to reach her doctor deeply emotionally. The feeling of not being able to lose anything is often paired with a special daring. The young woman saw herself on her deathbed and planned the lives of her children and her husband after death. She said, 'Do everything you can to ensure that my children have mothers for as long as possible. I am ready to endure anything. "If she had stayed on the operating table, this woman would not have cared. In view of her clear words, the doctor even felt obliged to take maximum risk. With such announcements, doctors can try something, which they might otherwise only test on themselves but never on a patient because they would get a lot of headwind.

If daring attempts at therapy don't work, doctors quickly come under fire. Right?

A big daily newspaper would probably write: 'Irresponsible! These are experiments on people. ‘That is partly justified. But when you dive into the history of medicine, you always come across therapeutic risks that were borderline and the ethics committees might not let go today. I think the first live liver transplants are such an example. Back then, the lives of healthy people were jeopardized, knowing that things could go wrong. Today you can use it to save lives.

“I am only responsible for your feet, not for what happens in your life afterwards,” says a specialist who builds new feet. What can happen to patients when doctors are fearless?

The patient was 40 years old and had two club feet since childhood. The older he got, the worse he could walk. After the operation, he hung up his special shoes, ran barefoot for the first time in his life and discovered that he had missed all of his youth because of his feet - and he wanted to make up for that. But his wife married him as a disabled person and felt she was indispensable for him. Her husband from earlier no longer existed. That almost broke the relationship. The foot surgeon has made this experience again and again and therefore consciously pronounced this sentence. Incidentally, this applies to all patients in the book: Life after an existential illness can no longer be lived as before.

A doctor gives birth to the youngest premature baby of all time at 21 weeks and five days. Is it allowed to go to the limit like that?

In the case of extreme prematures, you really can't say whether they'll make it or not. This is a border crossing. But this doctor had worked as a neonatologist for 30 years. His experience was that the limit at which a premature baby is viable has shifted further and further forward. With the length of pregnancy getting shorter and shorter, one can hope to have a healthy child today. Nevertheless, doctors have to be able to let go, even though the technical possibilities are almost unlimited. My message is that you shouldn't always try everything. Once the lungs are working on their own and the whole body machinery is started, it cannot be reversed.

You write that the perfect combination is an experienced doctor with a young savage by your side. What's their secret?

The two doctors performed an operation that went beyond any textbook knowledge. They were the perfect team. The patient was 35 and had colon cancer with liver metastases that were inoperable. In 1995 - the year it happened - liver transplants were occasionally performed, but with disastrous results. That's why they wanted to give up the method at the time. The young savage fought to give the young woman this chance.

The real risk was not the liver transplant, but the surgery afterwards. On the operating table, the two doctors found that the woman had metastases beyond the liver. So they suspected the cancer was all over the body, and the operation actually seemed pointless. Then this woman's will came to fruition. The young doctor was instructed: 'You also have to push your limits, not just me'. The doctors performed extensive operations in the abdomen, removing part of the small intestine, stomach and pancreas. The woman is still alive today.

Your stories are isolated cases - what can they show us?

Such individual cases give us an indication that we may sometimes be completely wrong with our previous knowledge. Even today, in extreme cases, they can shake clinical pictures and entire diagnostic systems. These special patients tell us, 'Look, it could be very different.'

Thank you for talking to us, Mr. Albrecht.

* Bernhard Albrecht: Patient of my life: From doctors who dare to do anything, Droemer, August 1, 2013

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