Medicine, Extending Life – Part I

The aim is to postpone frailty, postpone degenerative disease, debilitation and so on and thereby shorten the period at the end of life, which is passed in a decrepit or disabled state, while extending life as a whole.

Aubrey de Grey, Author of Ending Aging

Doctors serve. They work to extend life and improve its quality.

Doctors become doctors for the same variety of reasons any of us do anything we do – interest, passion, fear, greed, ego, altruism. But more than in any other profession, there is in almost all medical professionals, some modicum of interest in serving fellow humans. Considered the founder of Western Medicine, Hippocrates is said to have developed the oath which bears his name and some form of which continues to be the basic framework for Western Medical Ethics. The oath is structured first to acknowledge healing is beyond just the human ability of the healer – entreating the Gods of the day to help guide the physician’s hands. The oath lays out the best known Hippocratic principle of “do no harm” as the starting point for putting others interests ahead of one’s own. It goes further saying, “whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient.” The commitment is entirely to service of others above self. Hippocrates recognized sick patients are at their most vulnerable and as such there are myriad opportunities to take advantage. As a result, medical professionals commit to “keep sacred and secret” any information gained in the course of their work. This is the context in which health professionals engage people – a place of unprecedented vulnerability that affords great influence. 

Pain and fear are great equalizers. They have no respect for wealth and power and no sympathy for poverty and weakness. I am almost ashamed to even talk about pain and fear in part because they are both intensely personal. But also because I know my experience with pain and fear in no way compares to the horrible pain and fear I’m able to imagine.  Similarly, it’s because I don’t want to imply my engagement is in any way comparable to someone else’s. No one has the same scale of 1 to 10 for pain or fear.

My experience with physical pain has not been in the extremity of it, but more in its constancy. Over a period of nearly thirty years, I’ve become more comfortable with it – like an old friend. Doctors do everything they can to avoid back surgery for a fifteen-year-old kid because they know he’s still developing and the body has an unfathomable ability to heal itself. However, in my case, it was the only option. I had lost feeling in my left shin and toes. I couldn’t raise my left foot. The disc material in my lower back was protruding two inches into the spinal canal on the way to causing permanent nerve damage if not complete paralysis of the limb. The most acute pain was that first night after surgery, forcing myself to use those lacerated muscles to move.

For most of my life, I’ve never not thought about my back. A couple times per year, I find myself incapacitated for two or three days, laying on the floor in whatever room I was in when I shifted my weight the wrong way, making my way on hands and knees to the first dose of 800 milligrams of motrin and an ice pack, then continuing the regimen until the swelling and pain recede. Out of habit and to mitigate discomfort, I am never not conscious of how I sit or lie down. Throughout much of college I slept on blankets on the tile floor because the beds were too soft. My beautiful wife has kept me more in bed than on the floor since being married. But even with a high quality mattress, I toss and turn most of most nights and wake up every single morning with some low-level pain.

Anyone who has ever had a headache or earache or toothache knows that pain consumes an inordinate amount of energy and mental space. It makes it hard to parent, to play or to work. Even the most basic human needs begin to pale in comparison – we don’t want to eat when we’re in pain. Depending on the intensity, we would do or say just about anything – lie, cheat and steal; risk addiction – all we want is for the pain to go away. American poet, Emily Dickinson describes pain succinctly in her poem, The Mystery of Pain.