Nor bring, to see me cease to live,
Some doctors full of phrase and fame,
To shake his sapient head and give
The ill he cannot cure a name.MATHEW ARNOLD
Medical Treatment is based on the ethical principle that nothing should be more important to a doctor than the ‘best interests’ of the patient he is trying to cure. This is particularly relevant in respect of diseases like cancer where a combination of measures like surgery, radiation and clinical therapy results in agony or debility. (of course, if the type of cancer is potentially curable one cannot avoid trying out such options even if they are painful.)
A person decides to become a doctor.
- for the sake of having a decent job or
- because he has a special aptitude , for becoming a practitioner, or
- because it is a very lucrative profession.
The order in which these criteria have been listed is no reflection of their relative importance. Any two or all three of the above may provide the necessary motivation in any particular individual. However, more than all these is the ‘satisfaction’ that the very nature of the work provides—the light of gratitude in a frightened patient’s eyes.
For is there anything to rival the hope that a physician’s mere presence in the room of a sick person brings to a worried family? The simple piece of information that the doctor is on his way dramatically alters the atmosphere in a house from helpless terror to a sense of security that somehow the crisis will be overcome. There is something about the angel who walks into a house with a smile and confidence and whose very entrance into the patient’s room reassures everyone,
The aim of every doctor is to correctly diagnose a patient’s illness and effect a cure. (every doctor takes this as a ‘challenge’ and employs the entire arsenal at his command, the instruments with which he measures all the physiological parameters related to the sick person and compares them with the physiological ‘constants’ to arrive at a diagnosis. The more complicated the disease is the greater the ‘challenge’, a factor that motivates the doctor to constantly improve his clinical ability. But often the process of improving his skills leads the doctor to a ‘paradoxical situation’ where the emphasis shifts from ‘curing the patient” to “overcoming the challenge”
Dealing with the ‘challenge’ becomes an ‘end’ in itself, and even in situations where the doctor finds himself losing the battle with the disease and the chances of success seem remote, the addiction to try out every option is too strong for him to give up the struggle.
At the same time, the patient having developed a psychological dependence on the doctor not only believes implicitly in his competence, but also accepts any suggestion made by the doctor partly in the belief that he must have some genuine reason and partly out of his fear of offending him. All the sophisticated instruments and the electronic gadgets in the intensive care unit, represent to the dying man the determination of his doctor not to yield, whereas to the doctor himself, the dying person and the panoply of medical instruments only represent the test of his efficiency. If he fails, it is a blow to his self-esteem and a sign of weakness and impotence. The only course open for him is to disappear emotionally as well as ‘physically’—a phenomenon known as ” ABANDONMENT” of the patient by the doctor.
Now why does this happen? As long as a doctor has even the slightest hope of saving a dying man, he has the zeal to try out every weapon in his armoury. He is the visible symbol of strength and the power of modern medicine. The moment he becomes certain that he is fighting a losing battle he is reluctant to admit defeat and face a situation where his own power and skill and the triumphs of modern medical technology are useless against the forces of nature. The challenge no longer exists and his power has no meaning. His inability to face the consequences leaves him with no option but to disappear unobtrusively. He is afraid of heaven making him
” A fixed figure for the time of scorn
And point his slow unmoving finger at.”as Othello said in Shakespeare’s immortal play, in a different context
The hope of overcoming the challenge against all odds created by this hi-tech, bio-medical era turns out to be an illusion and a deception. It is better to call it a day at a much earlier stage, giving the confused patient enough time to attend to ‘intensely private and unfinished matters’ relating to conflicts, relationships and business. For in the absence of false hopes he can have one ‘longing lingering look’ at life and a chance to say in the immortal words of Robert Frost:
I have promises to keep
And miles to go before I sleep.Robert Frost