The late surgeon Sherwin Nuland, in his classic book
HowWeDie,lamented,“Thenecessityofnature’sfinal
victorywasexpectedandacceptedingenerationsbefore
ourown.Doctorswerefarmorewillingtorecognizethe
signsofdefeatandfarlessarrogantaboutdenyingthem.”
ButasIridedowntherunwayofthetwenty-firstcentury,
trained in the deployment of our awesome arsenal of
technology, I wonder exactlywhat beingless arrogant
really means.
Youbecome a doctorfor what youimagine to bethe
satisfaction of the work, and that turns out to be the
satisfactionofcompetence.Itisadeepsatisfactionvery
much like the one that a carpenter experiences in
restoringafragileantiquechestorthatascienceteacher
experiences in bringing a fifth grader to that sudden,
mind-shifting recognition of what atoms are.It comes
partly from beinghelpful to others. But italso comes
frombeingtechnicallyskilledandabletosolvedifficult,
intricateproblems.Yourcompetencegivesyouasecure
sense of identity.Fora clinician, therefore, nothingis
morethreateningtowhoyouthinkyouarethanapatient
with a problem you cannot solve.
There’snoescapingthetragedyoflife,whichisthatwe
areallagingfromthedayweareborn.Onemayeven
cometo understandand acceptthisfact. Mydeadand
dying patients don’t haunt my dreams anymore. But
that’snotthesameassayingoneknowshowtocopewith
what cannotbe mended.I amin aprofession thathas
succeededbecauseofitsabilitytofix.Ifyourproblemis
fixable,weknowjustwhattodo.Butifit’snot?Thefact
thatwehavehadnoadequateanswerstothisquestionis