I remember the early trials of thrombolytics, not for stroke but for MI. We were still comparing tPA with streptokinase during my residency. It was pretty incredible stuff. Now we've moved beyond that positively medieval method of treating heart attacks and advanced to incredible interventions in coronary and cerebrovascular disease. We are able to rescue more people from the brink of death with advanced medications and techniques like ECMO that our medical forebears couldn't even imagine. People these days can say things like, “I had severe sepsis last year, but I recovered,” or “A few years ago, I nearly died of Stage 4 cancer, but here I am!” Twenty years ago, their families would have told their stories with sadness.
What we do is amazing. The science behind our saves, coupled with our training and passion, make medicine all but miraculous. I am proud of what I know, proud of what I do. I am so impressed with my colleagues, and I am often awestruck by scientists and engineers, without whom we would be apes poking bodies with sticks (good-looking apes in scrubs, mind you).
At the end of our lives, we can look back at the gifts we gave to the sick and injured and see that they far outweigh our mistakes, losses, and failures. But we have limits, for all our modern innovations. We can ask and answer a constellation of questions, and we can fix untold problems. But some questions defy us; some problems leave us shaking our heads.
Suffering remains, and we can't answer why in spite of our pride in science and our common dismissal of all that is unscientific. Who knows this better than those of us who have dedicated ourselves to emergency care?
Men and women, boys and girls, still suffer horrible injuries and have cardiac arrests and fatal pulmonary emboli. They still die at the scene of car crashes. They still develop mental illness and kill themselves. Addiction still separates families and leaves parents weeping for children, lost from life or lost in the jungle of drugs and desperate lives.
Even the healthiest men and women will, at some point pass away from this life. Knowing this does nothing to ease the pain of loss. The most ancient husband or wife still shudders and weeps with the loss of a spouse the way a newlywed would, perhaps more bitterly, knowing love more deeply at 85 than they did at 25. Yet, for all our scientific wonders, we can't say what lies beyond this life.
There are just questions we can't answer and things we can't fix. It is likely that our science, however wondrous, will never have that capacity.
We know it. It's why we cry after failed resuscitations and why we call our children when they travel, frantic to know they have arrived. It's why every EMS tone terrifies the parents of teens and every scan of a loved one is terrifying to those of us in medicine. We can't control the troubles of this life nearly as much as we think.
Mankind has always known this. Ancient physicians, as limited as they were, did their best and wanted more. They saw the dangers of this life and their own incapacity with what was likely more immediacy than we do. Sick, injured humans have always known the fear of loss, the questions of suffering, the pain of death.
Into this vale of tears we proceed every shift. This is why I often tell young physicians that they should read and understand more than medicine. I favor religious faith, but they must have a philosophy of some kind. Or they should read great novels, stories, and poetry or reach into the depths of music for some kind of solace in this mess of the unknown.
For me, Christmas offers hope to the hopeless and answers to the hardest of questions. Some of us believe its message with all our broken hearts, but even those who find it a charming myth can surely see beauty in the story Jesus suffering with men and women and rescuing them.
The pain of this life is enormous. We try so hard, but we can do only so much. The manger in Bethlehem is, if nothing else, a beautiful story to remind us that just maybe there is healing for the wounds that lie beyond our science. Perhaps the very dream that there is meaning, that there is hope, is a suggestion that there is more here than meets the eye.
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