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Medicine and the Arts

Commentary on “A Ballad of Aging—The Paradox of Theseus”

Salib, Sherine MD, MRCP

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doi: 10.1097/01.ACM.0000581452.18292.d5
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In seeking absolute truth, we aim at the unattainable, and must be content with finding broken portions—Sir William Osler1

“A Ballad of Aging—The Paradox of Theseus” was inspired on a sleepless December night while I was halfway across the world, battling jet lag. Many hours of exhausting travel brought me to my parents’ home for a brief Christmas visit. Given their advanced age, the trans-Atlantic trip was too arduous for my parents to undertake—so now I traveled to them.

Theseus was a Greek demigod, son of the mighty Poseidon (god of the sea), and cousin of Hercules. Known for his countless feats of strength and divine wisdom, Theseus was a founding hero for the Athenians. Many myths surrounded this mighty king. He conquered armies of powerful foes and slayed mythical and formidable beasts, such as the frightful Minotaur—half-man, half-bull. He even vanquished Eurytus, the fiercest of the most-fierce centaurs.

Theseus’s ship—in which he triumphantly returned after defeating Eurytus—was just as imposing and impressive as its owner, and was kept in the Athenian harbor for many centuries. According to legend, it was preserved until about 300 bc. As wooden boards rotted, they were constantly replaced and exchanged, keeping the ship afloat—until at one point, each and every part of the mighty ship had been replaced.

Famously, over the next few centuries, ancient philosophers argued incessantly about the ship of Theseus. The question of identity they debated became known as Theseus’s Paradox. It asks “whether an object which has had all of its components replaced remains fundamentally the same object,”2 or whether it has become different altogether.

Now, travel with me to a different place, a different time. Travel with me across the Mediterranean to our modern time to meet a man. You will not find him impressive. You will see an old man—his back severely bent with disease, his shuffled steps slow, his paper-thin skin crinkled and bruised.

But all those who have long known my father agree: He was once highly influential, exceptionally gifted, an accomplished engineer and entrepreneur. His wit and mental agility were unparalleled, and his soul beautifully kind and generous.

Pause and talk to him now, and you will discover a mind still as sharp as any bright young man’s, an intellect and brilliance deceptively concealed by his fading outer appearance. To outsiders, this is not a Theseus. But to those who know him—although his body is transformed—he is still the same: strong, capable, accomplished.

As with Theseus’s ship, the conundrum of the changing years is of philosophical and real interest. Are people, like my father—now almost unrecognizable with the passage of time—the same or have they become another version of their prior selves? The sixth-century bc philosopher Heraclitus of Ephesus articulately noted that a river whose waters are constantly replenished is never the same, yet remains: “Upon those who step into the same rivers, different and again different waters flow.”3

I do not know the precise answer to the paradox.

We do not know the answer to many things. I remind my students and residents of that every day. In medicine—as in life—“We don’t know,” as Thomas Edison eloquently put it, “a millionth of one percent about anything.” I find that at once humbling, intriguing, challenging, and exciting.

Making connections among the puzzles and ambiguities of medicine, life, and aging—among the mysteries of our future, present, and past—helps us physicians better appreciate “the parts of the medical experience that don’t make it into textbooks.”4 Pondering and connection-making can be of immense value to doctors. Much of the burnout in medicine—at the level of learners and more seasoned clinicians alike—is, I believe, linked to the everyday uncertainty of our work: the gray zones, the unknowns, the daily humanitarian challenges that our best evidence-based gurus cannot answer. We are just beginning to understand and esteem the concept of tolerance of ambiguity.

Osler wrote of ambiguity and uncertainty as an unavoidable, integral part of what we do in the art of medicine:

A distressing feature in the life which you are about to enter, a feature which will press hardly upon the finer spirits among you and ruffle their equanimity, is the uncertainty which pertains not alone to our science and arts but to the very hopes and fears which make us men. In seeking absolute truth we aim at the unattainable, and must be content with finding broken portions.1

Educating learners about the evidence, the research, the expert opinions, and the guidelines is the cornerstone of what we do, and good medicine certainly requires a solid foundation in science. Do not, however, underestimate the power of discussing and exploring the unknown, the yet-to-be-understood, and the difficult challenges for which the literature holds no answers—all of which make up much of what we do every day.

Being cognizant of—and becoming comfortable with—our limitations as physicians is powerful in a practice known as an art to those who understand it best. The art of medicine.

In medicine—as in life—uncertainty and paradox will meet you again and differently again. Meet them with a smile and a nod of acknowledgment.

Dedication:

Since the writing of this poem and commentary, Dr. Salib’s father has passed away. She is thankful for his rich life and the joy he brought to so many.

References

1. Osler W. Aequanimitas. 1905.Philadelphia, PA: Blakiston’s Son & Co..
2. “Theseus’s paradox.” The Logical Place. August 17, 2003. https://yandoo.wordpress.com/2013/08/17/theseuss-paradox. Accessed May 14, 2019.
3. Cohen M. Heraclitus of Ephesus. In: Lecture on Heraclitus. https://faculty.washington.edu/smcohen/320/heracli.htm. Updated September 21, 2016. Accessed May 14, 2019.
4. Ofri D. Poetry in medicine. https://danielleofri.com/poetry-in-medicine-2. Published 2019. Accessed May 14, 2019.
Copyright © 2019 by the Association of American Medical Colleges