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We
talk about medical ethics and medical science, but forget
the most important aspect of medicine, the "medical
humanism". You would be wondering what is it
that I am talking about. I am talking about man (
used for the species and not for the sex ) and not mankind.
Talking about the human being and not humanity.
Daily I get reminded that we, in our profession, are
forgetting the man while thinking of mankind. It is like
losing the woods while counting the trees. I was a
conventional thinker, and was proud of our
"scientific" achievements, and my personal
pride and ego, practising my art in the same old fashion
like my teachers and predecessors in the medical
fraternity, until one night, when I was rudely awakened
from my euphoria and slumber!
It was in the early hours of the morning in October,
fifteen years ago, that we lost a young man, who had a
massive heart attack; despite our best efforts.
Scientifically, we had done everything possible at that
point in time-nay, may be even now! He was a picture of
perfect health hours before the actual heart attack, and
had gone to bed as usual after his dinner, only to be
woken up with severe pain, and soon collapsed into coma.
The young bereaved widow asked me the most profound
question then " why my husband doctor?".
I tried my best to explain his heart attack with the help
of our conventional risk factor hypotheses, but he had
none of the multitude of risk factors mentioned in the
textbooks. It was only years later that a thinking
medical scientist, Professor Stehbans of NewZealand (1),
writing in his book "The Fat theory of
Atherosclerosis", made me realise how fragile
were the risk factor hypotheses. Reading Nobel Laureate
McFarlane Burnet’s book "Genes, Dreams, and
Realities" further demystified the atmosphere(2).
The results of the Multiple Risk Factor Study (3)
and the last week’s study from the Harvard
Medical School(4), the largest of all the risk
factor studies to date, on the " relation between
dietary fat and the risk of coronary heart disease"
further cleared the air in this field. Fractals and Chaos
in medicine have a lot to teach us, but unfortunately,
they are not very easy to understand(5). So I
failed to answer her question at that time. That made me
to start thinking.
Clinical research, I was taught by my teachers, is
" asking questions on the bedside and going as
far away from the bed as you can to get an answer". The
question, in this case, was asked by the patient’s
wife, instead of my generating the question in my mind. I
went into all the medical literature to get an answer. We
have many theories as to why mankind gets this or
that disease but we have no idea as to why this or that man
gets a disease at a given time. All risk factor theories
apply to cohorts of men - a good scientific
jargon- but of no practical importance when applied to
the man sitting across the table in your clinic
with a problem. Having thus failed, I then went into
philosophy starting from Plato, Jung, Kant, Karl
Marx,even people like Koestler, Orwell, Kafka, Bertrand
Russell, and many others, without any answer to the
question.Even the logic or anti-logic of Karl Popper did
not help. Russell’s and Dr. S. Radhakrishnan’s
treatise did not help much.
Having failed in the Occident, I turned my attention to
the Orient, and specially to the eastern ancient wisdom.
My inability to fully understand the Sanskrit language
was a great handicap, I had to rely mostly on English
commentaries of our ancient wisdom. From theology (
divine wisdom ) I went into religion. I studied Hinduism,
Bhuddism, Christianity, and Islam, superficially though,
mainly from translations. I used to discuss with people I
knew to be authentic, and this process is going on. I
have not got a good answer, although I could now reassure
that wife and her kind, by saying that the human soul has
no death, it is only the material body that apparently
dies, the soul is immortal and so on and on. Whether that
satisfies them or not is another question altogether. My
education in this field is still incomplete and I am
still an ardent student.
In a lighter vain, I could answer that question in a
different way. I once read a short autobiography of an
English family doctor, ( which went somewhat like this)
who, as a medical student in one of London’s leading
medical schools in the early part of this century, had an
itchy skin lesion on his thigh. He went to see a junior
lecturer first, who casually dismissed him with an
ointment. The itch increased and it was bothering him. He
went to see the great dermatology professor, who was a
big name in his field in those days. The professor
examined him in detail and again prescribed another
ointment, without much benefit. He had this lesion all
his life anyway! One day he took all the courage to ask
the great professor as to "why he got that eczema (
that was the diagnosis, incidentally) and why is it not
going away easily?" The professor became very
pensive and patted the young student on the back saying "
Young man, if only I had known the answer to your two
profound questions, they would have erected my statue in
the Trafalgar Square.!" How true!
We are back to the square one! What happens to man
can never be predicted with confidence despite all the
newer gadgets and tests. We still have to depend on the
stanza written by D.H.Lawrence years ago:Our ingress
into this world was naked and bare,
Our progress in this world is trouble and care,
Our egress from this world will be nobody knows where,
(May I add when and how also )
If we do well here, we will do well there.!
Medical science has been
able to label the various exits through which we go out
to meet our maker by awe inspiring names, like cancer,
heart attack etc.; the end result being no better than
our ancestors’ labels like God’s anger, curse,
and what have you. Human life span has not changed. With
the fall in perinatal mortality, better hygienic
surroundings, better nutrition, and some degree of
success in the control of communicable diseases, the life
expectancy at birth has gone up markedly in the West, and
to a significant, but lesser, degree in the developing
world as well. This has resulted in more elderly people
living in society, with all the new problems of geriatric
medicine. Life is the only condition known to man with
one hundred per cent mortality. Life is a Que. for people
to go away to meet their maker, but as in any other Que.
people sometimes jump the Que.
When the end comes, the bereaved family needs the succour
of the presence of God. Does God exist? How I wish I
knew!! However, I am inclined to agree with Voltaire,
when he said " If God did not exist, it is
necessary that we should create one."! The
concept of God must have saved more people in this world
from suicide than all the hi-tech stuff in other areas of
medicine, put together. " Medical humanism" is
a new concept, where the kingpin is the man, and
not mankind.
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