Medicine’s prism

I generally don’t spend much time ruminating about Being a Doctor.  I mostly like being a doctor (most days), and I’m lucky enough to have found a vocation that is intellectually challenging and gives me the sense that I’m doing some small thing to make people’s lives just a little bit better.  It’s not quite how it’s cracked up to be in most television shows, but it’s a good gig.  However, I suspect if I spent a lot of time around here wheezing about my Sacred Duties or some such it would get pretty tiresome pretty quickly.  Back when I entered medical school, I made a commitment to never be one of those physicians who can only talk about medicine.  I like to think I’ve been relatively successful thus far.

But something put me in a ruminative mood the other day.  Maybe I didn’t get enough sleep the night before.  Maybe I didn’t drink enough coffee.  Maybe there were too many melancholy songs on the radio.  I don’t know.  But ruminative I was.

Things began with the usual conference I have every week with my colleagues in the office.  We discuss a variety of things at these meetings.  Often we’ll go over some new recommendation or revisit our practice’s approach to a particular illness or issue.  We frequently review journal articles in an effort to stay abreast of the newest standards of care.  And sometimes we’ll discuss difficult cases.

This week was one of those difficult cases weeks.  Ethical probity (to say nothing of HIPAA) prevents me from going into any particular detail.  Suffice it to say a couple of my colleagues have had to deal with some very challenging families lately.  The medical term of art for their kind of problems is “social issues,” a broad term that encompasses just about anything going on in the home, school, community, etc that is not strictly medical but that has a negative impact on the patient’s health or well-being anyway.  (Its medical connotations and political connotations have some overlap, but not much.)  And this week’s social issues were some real doozies, from the extremes of neglect to the various ways parents’ own psychological scars can insinuate themselves into their failing their children.  Not the worst of human behavior from a global perspective, but a depressing collection of pathologies nonetheless.

Of course, our ability as medical providers to “fix” these things is quite circumscribed.  We can provide the best medical care we know how, we can try to operate within “the system” to whatever extent it has gotten involved in the children’s cases, and we can find as many resources as possible for these kids.  But we can work no miracles, and sometimes a miracle is the only intervention that will make a meaningful difference.  Situations like this can create a feeling of, if not actual despair, then of extreme impotence and futility.  There is little so disheartening as being involved in the care of a child who needs much more than you can provide.

So that was the morning.  And with that I headed into Boston to attend the noon teaching conference.

The conference was about immune hydrops fetalis, a medical condition that used to be a relatively common cause of neonatal mortality, but which has become increasingly rare in the past few decades due to the advent of effective immunotherapy.  The actual topic of the conference isn’t particularly important, however.  What stuck me was learning just how far the technology has come in treating this one small disease in such a short time.  The condition can be detected by measuring the blood flow in an artery in the brain via ultrasound.  Severe cases can be treated in utero by giving blood transfusions to the fetus.  It really is quite amazing.

And so I sat in wonderment and saw detailed models of the antibodies that circulate in the mother’s bloodstream and the infant’s.  I learned about the genetic sequences that encode the different proteins that fold together to make them, and how they vary between species.  I saw time-lapse images of electron microscopy showing these tiny structures being moved across a cell and into the bloodstream.  In a single hour, I saw the work of countless brilliant men and women, striving to better understand and treat this one problem.

The only word to describe the feeling I get in these conferences is joy.  It is joyful to see humanity’s ingenuity and industry bent toward curing disease, and toward better understanding the finest machinery of the human body.  Even though the overlap between what I learned and the work I actually do is very small, it is joyful to apprehend some newly-discovered subtlety of our physiology and its remarkably intricate functioning.  Whatever your beliefs about the origins of our species, we are wonderfully made indeed, and there is little more wonderful to behold than our ever-increasing understanding of ourselves.  Aside from time with people I love, there is no more reliable gateway to joy for me than through the doorway into a teaching conference.

It was on my drive back from the hospital that I started musing.  Within the span of two hours, I had gone from feelings of intense frustration and unhappiness to awe and joy, all within the context of my professional obligations.  I had come into contact with people at their best and their worst.  Life was wretched, life was sublime.  All within two hours of one fairly routine day.

I know every profession and vocation is given its own vantage point to survey the world.  We all have prisms and spyglasses that refract and distort our perspectives.  Medicine is not unique.  But I found myself grateful for the privilege of seeing people the way I do, in the problems they bring and in the ways my profession has come up with to meet them.  We are not wizards, and we too often lose the humility that is a necessary piece of truly helping people.  (The god complex isn’t associated with doctors for nothing.)  Some problems defy our best intentions to solve them, and we fool ourselves to pretend otherwise.  We can’t work miracles.

But sometimes we can work wonders.  And it can be wonderful to be a part of it.

It was one of those days when I was happy I do what I do.