Space travel and the art of medicine

by Doug Curran, M.D.

I was sitting in a hotel room on Feb. 1, 2003, at about 8 a.m. I had just put on some coffee and turned the TV on low, so it wouldn’t wake Sandy, who was still asleep. We had taken a long weekend to rest and recover from the holidays and work activities. I was watching the Columbia prepare for landing. I watched a small spot of light as it traveled over the Southwest and then suddenly, an obvious change, a disaster, a tragedy.

Then came the news media with their never-ending speculation, innuendo and “how-could-this-happen” coverage. I immediately thought about the obvious risks and dangers of such a daring endeavor as space travel. What were people thinking? How could anyone not know there is danger in that sort of activity? Certainly the individuals involved in this fabulous activity realized full well the risks and dangers involved in their mission.

Unfortunately, our society expects perfection, no problems, no difficulties. And if problems occur, there must be someone to blame. Somebody is at fault and they need to pay.

The practice of medicine is truly an adventure, full of frontiers and opportunities. It is dynamic, it is dangerous. In just the few weeks before writing this column, I have seen hundreds of patients whose problems range from the simple to the complex, from the common to the extraordinary. I’ve seen acute myocardial infarctions, diabetic ketoacidosis, cerebral vascular accidents with paralysis, expressive aphasia and several problems related to pregnancy, debatably a normal experience, but it certainly has a lot of problems that seem to make life very dangerous. I have also seen respiratory failure, asthma, a ruptured abdominal aortic aneurysm, seizures, peripheral vascular disease with potential loss of extremity, drug overdose, peptic ulcer disease, GI bleeding, and a young child with pyloric stenosis. I’ve seen cancer of all types and families distressed because of the inevitable trials and tribulations associated with that disease process.

I just recently treated a lady with a very rare blood disorder, Acquired Coagulopathy Syndrome-Factor VII Inhibitor. She presented to our office bleeding on chronic Coumadin therapy, which disguised her disease process. It was very difficult to figure out, but with the help of my hematology colleague and the expertise of the Mayo Clinic, we were able to diagnose her disease process and treat her with what turned out to be a very expensive drug. Her treatment was lifesaving, but her Medicaid status limits the financial resources available to her.

There are also problems with symptoms and signs that you see every day in your practice. These include headaches, earaches, neck pain, back pain, chest pain, abdominal pain, pelvic pain, foot pain and pains in places that I didn’t even know existed before I began my study of medicine. Then there are problems with sleeping, depression, tragedies of life and changes that occur as time passes. There are problems with families, jobs and communities.

As we encounter patients and all of their “stuff,” it is our job to find and to fix — expectations are high. A doctor should be able to fix everything, figure everything out and be sure nothing bad happens along the way. Certainly, if something untoward occurs, someone must be to blame. The problem should have been found sooner and there has to be something that someone can do. Everything should be okay and turn out great and we expect no problems.

We are able to do so many amazing things in our profession. We manage so many illnesses and maladies very well. However, what we do has great risks. As doctors, we cannot control every eventuality nor eliminate all the problems and dangers of living.

A man frustrated by life once asked Norman Vincent Peale if he could find a place in life where there were no problems. Peale responded that he could show him where there were about 250 people who absolutely had no problems. He directed him to the local cemetery.

We can make our lives much better by helping our patients understand the limits of our medical capabilities. Some things we cannot fix, and that’s okay. To paraphrase Lt. Col. Henry Blake of M.A.S.H. fame, there are two rules in life. Rule No. 1 is that all people die. Red, yellow, black, white, brown, male or female, they all die. Rule No. 2 is that no matter how hard doctors try, they can’t change Rule No. 1. We need to do a better job of helping our patients have more realistic expectations by understanding that the risks of living and the certainty of death are okay. We should grab hold of the opportunities that are out there, despite the risks, and live each day, loving and enjoying our family, friends and communities. Medicine is not a perfect science, but it is a miraculous and dynamic art.