Kudos to the Chemists, Engineers and Factor Workers who make medicine possible

Thanks, Osler, but Kudos to the Chemists, Engineers, and Factory Workers

This is my column in the January edition of Emergency Medicine News.

https://journals.lww.com/em-news/Fulltext/2014/01000/Second_Opinion__Thanks,_Osler,_but_Kudos_to_the.6.aspx

Think for a second about the most treasured drug or device in your ‘medical bag.’  Or about the procedure you find most appealing, the disease or injury you most enjoy treating.  Personally, I really enjoy doing lumbar punctures, opening abscesses, placing IO lines and applying splints.  And because I’m an emergency physician, I am duty bound to say that I love to intubate…and I do.

I also enjoy doing nerve blocks, whether dental, regional or digital.  In fact, I did my own digital block on my very painful great toe, wherein there was an ingrown nail.  I endured it for about one month, believe it or not, but ultimately I was too cheap to go to my doctor or any other doctor. So I sat down in my bathroom with my wife and kids in attendance. Just before I started, I said, ‘I don’t think I can do this to myself!’  To which my insulin-dependent son, Seth, replied ‘Are you kidding me?’  The shame worked and the needle and bupivicaine left my toe tingling for at least 12 hours.

The point I want to make isn’t that I’m good at blocks or you’re good at chest tubes or any other such window-dressing or self-congratulatory drivel. The point is this.  I may be able to do a darn good nerve block.  But I didn’t invent syringes, I don’t manufacture needles and I haven’t the foggiest idea how to make a local anesthetic.

And as proud and puffed up as we may all be at times, with our advanced techniques and our nifty procedures and tools, the plain truth is that as physicians, we stand on the shoulders of some very brilliant people.  It’s all about perspective, you see.

I am reminded of my relative incapacity whenver I’m asked to check on a sick or injured person outside the device and drug filled walls of the emergency department; at church, perhaps, or at a party.  I’ll gladly check a pulse, feel for a fracture, assess breathing and neurologic status.  I’ll happily do chin lifts and jaw thrusts and even do CPR if needed.  But in the end, I call 911, or say ‘you better go to the ER.’  Because much of what I can do, and you can do, is dependent on a whole host of tests, drugs and devices that we seldom have tucked in our back pockets at any given time.

You see, our compassion for the sick and injured and dying has been around since the first ‘physician’ knelt beside someone he cared for, and decided to stay by their side to help them.  Our diagnostics have evolved since that time.  Our medical ancestors were darn good at looking, listening, touching and smelling, then pronouncing hope or doom.  I imagine, in an age in which we are increasingly separate from the bedside, that those same medical ancestors could give us a run for our modern (increasingly inflated) money when it comes to diagnostic prognostication.  But the things we use every day to increase or diagnostic skills (labs and xrays and cardiograms and ultrasound), and the things we use to save life, prolong life and ease suffering, well those things have changed dramatically in the last century.  And we surely do need them.

So we may go on and on about Osler and Halstead and all of the other greats of medicine. But we must also nod to Roentgen and Fleming, to Pasteur and to Salk and to untold others whose research, whose attention to science, allowed the evolution of what we call modern medicine.  And it’s not just those ‘oldies but goodies.’  Science and technology have exploded so rapidly and with such complexity that we would be hard-pressed to even begin to name the countless men and women who have lifted us up in order that we may practice medicine as we do today.

Think about the Sonar researchers who gave us ultrasound.  Think about the chemists and biochemists who gave us newer, better antibiotics; and those who are now exploring antibody directed therapies.  Consider the engineers who design systems to make plastic into the life saving tubes we place in airways or collapsed pleural spaces!  Consider the dietary researchers who gave us TPN, and the brilliant folks who designed radiation therapy machines, CT and MRI!  Stand in awe of those who laboriously invented machines to count cells, and lab media to detect Troponin levels, the products of blood clots or the hormone HCG.  Nod in gratitude to those who designed, then crafted steel and titanium for fractures; and those who created tiny coils and stents to be placed in small blood vessels.  Be thankful for those who took their knowledge of the human brain and their compassion for human suffering and created the amazing pain medications we have today; so amazing people will do almost anything to have them!  As a man whose wife survived a massive saddle embolus, I’m eternally grateful to the folks who devoted years to developing thrombolytics and anticoagulants; and to those who discovered how to make the chemotherapy agents she received for her cancer as well.

But let us not be rude.  Consider all those who work in labs and factories, doing often dull and repetitive work in assembly and packaging, to satisfy our need, our desire, for drugs old and new, for needles and test-tubes, for Foley catheters and Word Catheters, for central lines and the drills to place IO lines.  And what about ultrasound?  Those machines don’t assemble themselves; and we certainly don’t put them together, do we?

Wait, there’s more!  There are those who are in design and marketing.  Those who sell and ship.  Those who track supply and try to make production more efficient.  There are untold numbers of men and women who give us the ability to ease pain and save lives.

Good heavens I could go on and on. But you get the picture.  What we do, in modern emergency medicine, is amazing and sometimes borders on the miraculous.  We have every reason to be proud.  But just as the college grad should honor the sacrifice her parents made for her, so we as clinicians must honor the gift, the effort, the brilliance and dedication of those who imagine, create and produce the very stuff that makes our work more than a series of apologies and misery.

Hats off to all of you!  And thanks for sharing your brilliance and dedication with those of us who can look our patients in their eyes and say, ‘I think we can fix this.’