General Douglas McArthur said: “However horrible the incidents of war may be, the soldier who is called upon to offer and give his life for his country, is the noblest development of mankind.”
The soldier is trained to kill, and they learn to kill well, they have endured great physical and psychologic trauma and horror of such killing to give us freedom. They followed Washington, stood next to and shoulder to shoulder with Crockett and Travis at the Alamo, they righted the wrongs of slavery and stopped the murderous evil of Hitler. They heeded not the cost. Yet throughout this, they killed of necessity.
I, too, have “killed,” not of necessity but as a physician in pursuit of the Tyranny of Perfection. I fail, and my patients die. I was not perfect; I did not have the skills that day, I did not have the resources, and death ensued. The disease was better than I can ever hope to be. For some, it was as if I pulled the trigger, dropped the bomb, and like the victim of the soldier, the patient too sight unseen pass without my full knowledge that I was responsible.
Often, like the soldier, dealing with these deaths’ hidden aspect is not addressed or even attempted to be processed. The scars this leaves, the life-long pursuit of the Tyranny of Perfection in Medicine never ceases. Then comes something that tips the scales, a pandemic, a great butcher bill of our time that has gripped our world and society’s consciousness. Not only can I not be perfect, I cannot even enter the arena to try to be. Our failure to emotionally deal with this is wrapped up in our failure to even face up to it. We condemn and repress these issues rather than look at them squarely and try in some manner to understand them. Our own knowledge of this allows us to come to some degree of resolution and resolve it in some manner.
The pain that I, as the provider, has does pale in comparison to the victims of such an event. Their angst and the loss they endure are far greater than that I hold. It is, however, forever enshrined in the soul of the caregiver. That truly is the heart and lifeblood of such pain. We must overcome our revulsion to death that is inevitable in so many instances. By this, we start to deal with and move toward our own resolution and move on to reach full compassionate humanity and maintain our own sanity. In such a moment, we become the physician we ought to be, and as Thomas Sydenham so aptly said are the one who achieves “primum non nocere.”
David H. Lindner is a pulmonary and critical care physician.
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