werner@aecom.UUCP (Craig Werner) (10/02/85)
[Another example from the "A Piece of My Mind" column, which provides one physician's answer to the question, "Why do we do it?"] [And yes, with a month off the net, I did have a backlog of things I wanted to post, but this is the last of the directory.] A Piece of My Mind Sudden Intimacies JAMA, 254:1361 (Sept. 13, 1985) For over a year this infant had spent more of his time in the hospital than out. He had a form of Histiocytosis X with immunodeficiency, but no one truly knew the prognosis. We had all hoped for the best: that he would slowly outgrow the disease while we treated the interminable complications as they arose. He was a darling boy, with a round face, a willing smile, his father's tendency to crinkle up his nose, and blond hair that stood up vertically on his head. He was readmitted to the hospital because his fever had returned and the eczematous rash had flared up. None of us thought that he would die. But, he developed a right-sided facial palsy, began to choke on his secretions, and had to be intubated. Seizures followed, with coma and eventual brain death due to uncertain cause. One week before his death, the boy's father brought in a new toy, a stuffed dinosaur emblazoned with swirls of color. As was customary with him, the father began to brandish the animal in order to evoke some flicker of interest from his comatose son. "Hey, bud, look! A dinosaur! Hey, look at it!" Nothing happened. Then, the boy's one good eye opened slightly and fixed on the brightly colored animal prancing so closely to his face. A small smile tugged at the left corner of his mouth, and slowly his right arm reached out to embrace the toy. Within a minute, the smile faded, and the boy lapsed back into coma. We all cried. He died the following week without regaining consciousness. What fulfills the physician? Certainly, the diagnostic challenge, the financial security, the altruistic glow, and the grateful thanks all provide a measure of satisfaction. But all too often, success becomes bracketed by failure, a deluge of new information erodes the sense of professional mastery, money ceases to compensate fully for the time and toil, the good one attempts to do goes awry, and the thankfulness of patients becomes admixed with fear and suspicion. No, for me fulfillment comes from the sudden intimacies with total strangers -- those moments when the human barrier breaks cracks open to reveal what is most secret and inarticulate. A word can betray the deepest emotion. A look can reflect a world of feeling. Illness strips away superficiality to reveal reality in etched detail. This revelation can fuse together disparate lives in unexpected kinship. Is it the reat of death, the dreaded pain, the sorrow, or the loss? The physician who can see is there to share in it. Is it the joy of birth, of unforeseen recovery, of reunion with one considered lost? The physician who cares can rejoice even as a family member. Who else so often listens to the vagaries of fate, and feels another's moment so personally and powerfully? And who else has such a chance to realize that it matters less whether a moment is one of supreme sadness or supreme joy that it does that the moment itself is supreme? This is the physician's priviledge: to be lifted out of the dross of common days in order to experience such clarity of feeling. The intensity of birth and death, pleasure and sorrow as expressed in the lives of others has the power to nullify personal boundaries in sudden communion. Then, the world is seen in its proper proportions, and the tenuous miracle of existence is underscored. Surely it must profit us to feel this deeply, with the hope that somehow, in the sweep of that feeling, we might yet learn to appreciate the wondrous happening of our own lives. Michael Radestsky, MD, CM Denver. -- Craig Werner !philabs!aecom!werner "The world is just a straight man for you sometimes"