Saturday, August 17, 2013

The Highs & Lows in MEDICINE

The art of medicine consists in amusing the patient while nature cures the disease ~ Voltaire
Often on quiet evenings, memories roll in the past and the forward motion of time is suspended for a while. These are mixed memories yet they are mine and define me to a certain extent, of who I have become. Nature disassembles and then assembles the nuances of what is called life through the web of her own making and we humans live through the lens of that web.

On a moonlit night, I remember walking in to see a 18 year old with low back pain. After the evaluation was complete, the diagnosis was that she was pregnant. She cried, I couldn’t tell whether it was joy or grief. Outside, her boyfriend confronted me and said, “You wrong doc, my GF ain’t pregnant. Now you go fix the record.” Taken aback, I answered that I was a resident on the case and walked across the courtyard to the resident quarters. I saw him from the corner of my eye pull out a gun. Nothing happened that night. But in the morning, after a 36 hour shift, my car stood on bricks with its tires gone and I without a ride.

Another morning I remember running besides a woman who was in semi-stupor with my gloved hand in her belly compressing the aorta that had been breached by a posterior penetrating ulcer. The anguish and pain, the joy and relief, the sweat of it all, still come pouring out at the thought.

One late afternoon, there was this beautiful young lady aged 16 in earth years, with wisdom beyond her age in her eyes, who battled leukemia and lost. The loss aged me overnight. The pain has never receded. Nature’s prize had been lost. A potential gone, vanished, disappeared and it still haunts me this many years later. Why? This simple question cannot and will not find an answer anytime soon.

As nightfall covered the twilight views, I remember the 78-year old undergoing CPR in his hospital room as the muted, anxious and heartbreaking cries of his family drowned all other sound. He was their rock. He was the repository of an aged wisdom. The team worked for over 45 minutes and then finally the aged atrio-ventricular node started its rhythmic electrical impulse again and the monitor went from a flat-line to a depicting a beating heart. Or was it? Relief was momentary, and clutched from the smiles of that relief, the ever looming grim design of nature held her sway. There was no pulse, no blood pressure and no other signs of life. There was a failure to communicate between the electrical supply and the mechanical stubbornness. An electromechanical dissociation had conspired to give us the momentary joy.

And then there are the wonderful joys of young patients who became fathers and mothers. Of impossible survivals that rearranged impossibilities into possibilities and others that should have couldn’t.

Practicing medicine is a tough art. The science is mushy, the art is not, because it is human. My twitter friend @jordangrumet writes eloquently about his coming into this sacred state of empathy after the haze and rituals between the agonies of defeats and the joys of victory in the practice of medicine. And so, I fear, it is for all who aspire to practice this craft of medicine. Another favorite @GregSmithMD sees through the turmoil of the human mind and dispatches equal wisdom. There is @Doctor_V whose concision in exploring the differing arts of medical education and current events is a true reader’s reward. Two others who I can ill afford not to mention are @DrJohnm who wraps his expertise and knowledge around the discontinuous and sometime disharmonious medical literature and makes it understandable and the voice of reason @medskep who delivers a wealth of information that dismantles the heart of most idiocy that derides medicine today.

Of those who have practiced medicine there are few who would give it up, because we love the art of medicine. But lately the quicksand of the scientism of medicine has evoked new outbursts from the many that have never touched a human heart, felt a human pulse or seen the untimely frost lay its cold claws on a beautiful flower of nature. No, they have instead marshaled the spirits from the catacombs of statistics and gathered their armies of propellants to vouch for, in their minds and those of likeminded others, a better version of  medicine, one that is guided by guidelines and mandates, software codes and hardware interfaces, sprawling digits of useless and meaningless words repeated over and over to fill in the gaps on paper while the human touch lies withered and atrophied.

In the name of better care, there is an electromechanical dissociation between what is and what should be.

Maybe it is time. Maybe these new holograms of medicine who perceive disease through the vigor of digitally inspired words, the rigor of scans and the knowledge of various chemicals in the blood will create a better life for all of us, or maybe, just maybe, they might not.

But however this age of information turns out, somewhere in this newness, humanity must preserve its humanity!

It has become appallingly obvious that our technology has exceeded our humanity ~ Albert Einstein

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