Monday, June 29, 2009

Reluctant Fisherman, part II

And so, hook him up we would to a ventilator. Start Total Parenteral Nutrition wherein all the nutritional requirements would be met through IV fluids. Use special auto-inflatable mattresses that avoid any one contact point from having to bear too much pressure, preventing bed sores.

In short, the machines would do the work of living for him. All he'd need to do is to play ball and to consent not to die.

And then, the waiting game. The participants in this game would be:

1) Us, the doctors, who think we are doing one hell of a job.
2) The patient, who is really only a spectator from now on. Or rather like the King piece in chess, around whom the game evolves, without doing much himself.
3)The patient's party, who have to pay for this entire circus.
4)Death, like Ingmar Bergmann's character from 'The Seventh Seal'.

Over the past few decades, the definition of death, the point of no return, has undergone revolutionary changes, thanks to the advent of newer treatment modalities, better access to healthcare, faster and safer methods of transferring patients to higher centres (like air-ambulance), and of course better paying capacity of the people allowing for protracted and expensive treatment.

Gone are the days when any patient without a palpable pulse was declared as dead. End-organ failure from chronic diseases have all been gradually challenged, more so with the advent of organ transplant. With plasma expanders and better networks of blood banks emergency surgeries in Road traffic accidents have become feasible and are increasingly commonplace. Now, stem cell research is being offered to us to push the frontiers even further.

Fascinating possibilities.

But what has sadly been missing is public debate on the same, apart from the occassional moralistic hue and cry over stem cell research and the possibility of human cloning. For the most part, our ability to protract death has increased at a much faster pace than our ability to subject them to scrutiny and debate by social institutions.

And the situation is only worsened by our reluctance to do so.

Post World-War II, the world was immersed in shocked disbelief at the massive scale of death and destruction. Suddenly, 'Empire' became a despised word. 'Nationalism' went out of fashion in a big way. Even 'Free Market' took a massive hit, and is yet to recover fully the lost grace.

But far more powerful was the change of public opinion against Eugenics, the science of improving (human) race by selective breeding, and Euthanasia, the act of offering painless death to patients who willed such, was suddently frowned upon: Thanks to horrendous barbarity perpetuated by the Nazis including doctors, in the name of science and racial purity.

And so we are, frightened shitless to talk about some sort of compulsory population control, even as grain stocks the world over are depleting at ever faster rates.
By voluntary population control as is practiced in my country we have a peculiar situation, wherein anyone with social concern and responsibility - precisely the kind of citizenry we need more of - abstains from having more than an offspring, or two at the most. On the other hand we have people openly proclaiming as their heavenly duty, to have all the sex they can in the world, and bring forth more of their kind. And having a welfare state firmly in place, the responsible citizen pays for the upbringing of the offspring of the one that couldn't care less if the country goes to the dogs. Those who proclaim as their heavenly duty to have all the offsping they can, do forget one basic fact: Nature has a population control strategy too.

It is called starvation.

Massive death from hunger would be a real possility before much of the world in future.

The very near future.

And hunger, it has long been understood, is not a problem for the agriculturist alone.

There can be no peace in a world with hunger. In recognition of this very fact was Norman Bourloug, the Brazilian scientist who made discoveries that led to the green revolution, awarded the Nobel Prize for Peace.

But as doctors, we are merely glorified technicians, and while we may think these thoughts, It is certainly not up to us to decide which life is worth living.

Who can say at what point a life becomes unworthy of living?

Who can say where a dream ends?

to be continued..


  1. Suggest you read 'Whose life is it anyway?' a play by Brian Clark. Or watch the movie by the same name, with Richard Dreyfuss in the lead role.

    I would rather read your real life experiences, Gopu, that too in your clinical style.

  2. How does it feel at the end of the day? All the medical marvels and advancements cannot surpass the correct diagnosis that a doctor makes at a correct time can it? Now a days the doctor doesnt even look at you properly, the moment we start to speak they get busy writing a series of tests that need to be done, I remember my childhood days when the family doctor was such a friendly guy, with his compunder mixing colourful tablets. I am sure with such a choc a bloc day it gets too tiring to get personally involved. But I still believe a good doctor is a true God.

  3. Thanks Bala, for the critique. Will keep in mind.

    @Sujatha, clinical medicine is an intuitive art more than a science. Its by no way perfect, and impossible to standardize. More over, it is only gained through long years of practice. In today's world of consumer-client relationship, qualifications are increasingly becoming more imp than experience. it becomes important not to leave out an investigation, for fear of litigation later on. Refer to my post about Evidence Based Medicine. After a while, many doctors come to rely upon a panel of investigations that would give them all the information that could lead them to a pin-point diagnosis, something seldom if ever possible for a clinician. Clinical medicine is increasingly becoming a lost art in advanced societies, and often we have exchange students from european medical colleges being awed by the ability of our experienced doctors to narrow the spectrum of possibilities to a very short list, with the aid of only a couple of carefully chosen, inexpensive investigations.


Thanks for giving me this moment of your life.