Archive for September, 2010

God, medicine and suffering

Myself and a friend are hosting a Forum in our church in a few weeks looking at the topic “playing God in the end of life”. We’ll be talking largely about ethical issues regarding end of life in regards to modern medicine.

Thinking about this scares me. When I think of its importance to those dying and bereaved, I see it contrasted with so much of what we do as doctors. I am increasingly coming to the opinion that we are losing our way in our aims and goals in medicine. The responsibility for this lies with both society and the medical establishment.

As usual it appears that someone else has thought these thoughts much better before I did.

In God, medicine and suffering, Hauerwas talks a lot about how we talk and act around suffering and what we have come to believe – both as a society and a church.

It’s a dangerous book to read as a medic, it just might change how you look at what you do. Books are like that. Christianity is like that.

I’ll leave you a few quotes to mull over as I continue to do so. No doubt you’ll hear more on this.

Sickness is a problem because it challenges our most precious and profound belief that humanity as in fact become a god.

and

I think childhood suffering bothers us so deeply because we assume that children lack a life story which potentially gives their illness some meaning.

and

Our medical technologies have outrun the spiritual resources of our society, which lacks all sense of how life might properly end.

Thinking about this is no abstract theological exercise. Hauerwas contends that that is the whole problem with how people talk about the problem of evil – they fabricate an abstract god and abstract suffering to puzzle the brain.

The God we worship and the Bible we read talks about it and struggles with it. We have actual people, actual suffering, actual incarnation. It forms a very different question.

Kevin spoke really lucidly on this a few weeks ago while I was in the midst of reading the book.

Anyhow. My contention is that we are more interested in curing rather than caring. Even if curing will often one of the best ways to care we far too often start at the wrong place.

Muscle Museum

I’m trying to figure out what it is that I like so much about dissection.

For two weeks now that’s what I’ve done. I get up, go to work and sit on a stool hunched over a donor’s remains with my headphones playing medical podcasts. Sometimes I’m the only one in the department.

My head feels at rest doing this. I hesitate to devalue the word peace by using it here when I’m describing a situation where I’m merely focused doing something with my hands and not being interrupted every 2 minutes.

I enjoy the privilege of what I get to do. I enjoy that I am effectively paid to learn at the minute. I enjoy teasing out nerves from behind muscles. I love leaving a dissection when it looks like something from netter’s.

I suppose I feel I’m being somehow creative with the remains of the dead. The human body is superbly well put together and extravagant in it’s function. It’s nice to help make that clearer and easier to see.

Commuter love – #7

Winter has arrived. Even if it’s only early autumn I feel the change so abruptly that I over dramatise it. I have draft proofed the house and added a curtain over the front door. I’m thinking of retrieving the slippers out of the cupboard

Sitting on the train platform I feel the gust blow down by neck and I feel cold. Cold in a way I haven’t felt for 6 months or so. I zip up the top of my fleece and pull the collar of the jacket around me.

Maybe I should take up smoking. It makes sense shivering on a platform and inhaling warm air/smoke. It seems like a good idea despite the obvious limitations if I think about thermodynamics. Best not to think.

I like the cold. When it’s a passing experience, when I know there’s a train coming or a warm house at the end.

My bag will get even heavier. Not just the book, the laptop, the coffee and my lunch. Now I’ll he carrying around hat and scarf. Like a snail carrying his house on his back. Though it’s more akin to a snail carrying his home entertainment system on his back. And a snail would never do anything that silly.

The Black Swan

I read the Black Swan largely at the result of Jerry Hoffman, an emergency doc who helps run my favourite medical podcast.

He’s a smart guy so i trust his book recommendations.

As a brief outline it’s about unpredictability and not how to predict it but how to at least think seriously about it and take it into your decision making.

It’s the kind of thing that should be bread and butter to all emergency docs. For example:

If you work in a randomness-laden profession as we see, you are likely to suffer burn out effects from the constant second guessing of your past actions in terms of what played out subsequently

That fairly accurately describes the weight on my shoulders that I feel as I walk out of work.

The idea of “the Black Swan” refers to the fact that the western world wasn’t aware of the existence of black swans till the discovery of the Antipodes. Centuries of empirical evidence proclaiming that all swans are white was destroyed by the discovery of black swans.

Incidentally I was once attacked by a black swan while on a kayak in NZ. It’s probably funnier than this blog so go read it if you want.

The same thing happens with the turkey who is well fed and looked after every day. Each new day brings positive reinforcement to the idea that its life is sound. Until one day near thanksgiving.

Taleb is understandably a skeptic.

I am most often irritated by those who exercise their skepticism against religion but not against economists, social scientists and phony statisticians. We no longer believe in papal infallibility but we seem to believe in the infallibility of the Nobel

and this one

Physics has been successful but it is a narrow field of hard science in which we have been successful. And people tend to generalise that success to all science. It would be preferable if we were better at understanding cancer or the (highly non-linear) weather than the origin of the universe.

It’s always nice to find a book to confirm your biases – that life is full of unpredictable events and that we’d be wise not to be sure of what we think we know.

All that you can’t leave behind

What was lacking in my medical education that I’ve never even heard of half the muscles represented in this plate.

I have a lot of work to do.

Which explains the blogging in work naturally…

I don’t need no doctor

Doctors like illness. They like diagnosing and managing it even if they don’t fix it. It’s a puzzle to be be played with and solved.

I suspect the fact that the illness is attached to a patient is being increasingly forgotten or pushed aside in the pursuit of the illness.

We would learn more how best to serve our patients by reading more novels than textbooks.

We have lost our way in caring and our “success” in medicine has led us to pursue curing instead.

There are terribly dull courses in medical schools taught by sociologists who try to address the ideas of humanity with terms such as “the biopsychosocial model of health”. This seems to be the art of making the incredibly obvious increasingly complicated and interminably dull.

Having said this I believe we are raising a generation of doctors with great knowledge and decision making but with barely a trace of humanity, and I believe this is happening because we train children to be doctors.

Or maybe they are more fairly called adolescents more interested in drinking, parties and fucking than they are in understanding what they are entering into.

The patients that they deal with come from a world that they have no comprehension of – one filled with fear, pain suffering and loss. This is a world that they will come to understand in their own lives but by careers and personalities they will defend themselves from it till it can no longer be avoided. Many patients will pass through their hands before then.

I know this because I was that child training to be a doctor. I still am in many ways.

Two of my best friends trained as doctors in their mid/late twenties with a degree and some life and some pain and comprehension of beauty behind them. I am immensely proud of them for the way they have approached it and the humanity and understanding that they so clearly bring.

I’m not sure what the answer is to this (though a fundamental re-understanding both by society and the medical profession about what medicine is and should be would help…)  but I wonder if graduate entry would make an impact.

Commuter love – #6

Are the folk on the train listening to music with their DJ cans on carrying Bose CD players tucked inside their denims? If they’re listening to 128 Kbps mp3s on their iPod then it’s a bit like drinking 2.99 Tesco Chardonnay from a crystal goblet.

Or maybe they just think they look cool. Blimey I should probably let them know they don’t.


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