Oh, to be obsolete!

Steps echoing in an empty corridor

A hope for obsolescence

I hope to be obsolete. This is perhaps an odd statement coming from a physician. But I realized this once, while lecturing at a major teaching center.  No academic myself,  I practice Emergency Medicine at Oconee Medical Center, a community hospital in Seneca, South Carolina. But it is instructive for me to occasionally be reminded of what a research center looks like. It is useful to rediscover the fact that my profession is supported and advanced by the efforts of researchers around the world. It is uplifting and a little disturbing to recognize that medicine is constantly moving forward, and that even the best effort at continuing education leaves a physician practicing with knowledge a mere several years behind the times.

As emergency physicians, my colleagues and I practice a type of medicine that makes us “jacks of all trades, masters of none”. We operate in a limited window of time, and make decisions based on a limited amount of information available on each patient. I believe we give excellent care.

But sometimes, as I step back and look at what we do, I am stricken dumb by the sheer inadequacy of modern medicine as a whole. Like all sciences, medicine must be constantly advanced, the void of ignorance filled with new knowledge. Like all arts, it must sometimes take off in completely unexpected directions. There is no holding steady. All pauses in learning are losses. Even though I do not conduct any research (except the constant accumulation of anecdotal experiences), I recognize the immense value of research and scientific pursuit.

I see its value in the needs of my patients to overcome complex and life-altering illnesses. I see its value in the eyes of my family as I worry what I will do if illness befalls them. And every year as I age, and feel another pain, I know that the time will come when I too hope for some breakthrough, perhaps for Parkinson’s Disease which made my grandfather shake, and may lie in wait for me.

So often we are at a loss in patient care. How does one treat pain in the cancer patient, yet allow them the clarity to enjoy their loved ones? How does one tell a mill worker that his hand cannot be reattached and will touch his child no longer? What do we say to reassure the stroke victim, whose treatment with “clot busting” thrombolytic drugs may prove fatal?

The thing is, we are not ignorant, we are only blind-folded by time. I hope for a day, I dream of a day, when medicine will have made great strides; great enough that needles and scalpels are the stuff of museums. A day when cancer is diagnosed and eradicated on the same office visit, and when pain no longer holds its place in our psychic pantheon of fear, second only to death. I hope that if my children enter medicine as a profession, I will be virtually unable to recognize the knowledge, techniques, devices and drugs at their disposal, so that I will shake my gray head and think with nostalgia about how it was in “the good old days.”

The more I think of it all, the more clearly I develop  an image in my mind of hospitals and clinics, empty, and of my steps echoing as I tour down long, empty white halls that smell of years of antiseptic, an aged veteran of a long forgotten war. Of walking past empty ICU’s, where patients no longer hold to the faint thread of life cast by imperfect medicine. Of opening the door of a chapel that no longer rings with the sobs of families, suddenly empty from the loss of a loved one to unstoppable illness or injury.

I believe that day will come; I suspect that the ultimate fulfillment of my vision will have more to do with the Kingdom of God on earth than with the skill of science. But one can hope.  ‘Dum Spiro, Spero,’ is our SC State Motto:  ‘While I breath, I hope.’

Medicine must persevere and struggle, so that a thousand years hence, our professional descendants will look back on our practice with a shudder and a chill, and whisper in hallowed classrooms the word “barbarians.” Then we will have done the right thing as a science, as an art, and as lovers of humankind.

I may not live that long, but I would certainly love to be a last living oddity, one of the last to see a preventable death, to have to cut skin to save life.  I would love to hang around the planet long enough to enjoy my own obsolescence.

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