Medicine For People!
- Health, Memorial Day, and the Environment
- Spaceship Earth and Future Shock
- Sentiment and Memorial Day
- Nature Knows No Sentiment
- The Pragmatic View
- No Exceptions
- Memorial Day
- With Gratitude
Since ancient times we humans have honored the graves of those who died in our wars. Today's Memorial Day fulfills that obligation, and many spend part of the day in those ceremonies. Veteran's Day honors all military veterans, but Memorial Day has been especially set aside to respect those who did not come back alive from the battlefield.
Health, Memorial Day, and the Environment
Continuing our theme of health and the environment, in today's newsletter I want to discuss the overlap between those war dead, healthcare, and our responsibility to our environment.
Spaceship Earth and Future Shock
My generation was born into a world that seemed infinite. A long distance call was time-consuming and expensive. There were no satellites in the sky. Our cities were smaller, the countryside almost limitless, and the exhaust coming out of the family car simply disappeared into space.
Today we have pictures of our spaceship Earth as seen from the moon. Stories about our endangered habitat appear in the newspapers: the Arctic ice is melting, oceans are warming, and drought in the Fertile Crescent of Mesopotamia with its consequent political consequences drives refugees into Europe. Suddenly the earth appears very small.
Some in my generation profess disinterest towards the issue of climate change and the horrible consequences in store for younger generations. For those of a parochial bent, this may make sense. We will not survive to participate in the trials to come, and our monetary resources provide the ability to avoid disruption. If people living in low areas such as Bangladesh suffer, we may convince ourselves that that is no fault or business of ours.
Thinking back again to the world I was born into, we read science fiction stories depicting future civilizations facing daunting challenges on struggling planets. The people in those science fiction stories did not have the luxury of sentiment. Like the legend of Eskimo grandparents going to sit on the ice when they could no longer contribute to the family, sacrifices had to be made for the greater good.
Looking at the news today reminds me of the people in those science fiction stories. Sentiment seems an expensive luxury.
Sentiment and Memorial Day
Because we humans feel passion, we can allow emotion to color our view of the world. The American Civil War may seem romantic from this distance, but it was horrible to those living through it. Real blood washes away our dramatic illusions, as I'd like to remind you this Memorial Day.
Today we honor the nonfictional, the once living and breathing real brothers and sisters, parents and uncles who did actually die in a conflict they believed important to the survival of their families, neighbors, and country.
There is drama in the cinematic versions of war. There was no drama on the day our neighbors and relatives died. Drama pales next to real injury and death. When you are in the room with real injury and death you find yourself stunned with their immutability; whatever sentiment is in the room, clearly we have brought it with us.
Nature Knows No Sentiment
Most of the time when the chips are down, we readily give up the sentiment. I see this in my practice. A few months ago, George (not his real name, of course), showed up with an inoperable cancer on a routine diagnostic test for what appeared to be gallbladder trouble. The sentiment you see on the soap operas was nowhere in the room when I gave him and his wife the bad news. He accepted it without protest, a not uncommon violation of Kubler-Ross' stages of loss and grieving. Another patient, Diane, moved to town and entered our practice, having learned elsewhere that she has a cancer for which no medical center has a treatment. And she too is matter-of-fact and without drama, her chief concern being details of maintaining comfort as the cancer progresses.
A childhood friend and I are still in touch and occasionally have the same argument. He is an engineer whose wife died of ovarian cancer, a cancer for which we do not screen; by the time we detect this cancer, through screening or not, it is usually too late for our treatments to make a difference. Yet my friend says "but if we scanned everyone frequently enough, we could find these cancers and save lives."
I respond that we don't know how frequently to screen, that we've no indication that were we to find the cancer early we could make a difference, and that the billions of dollars spent on such screening would be much more productive were we to spend them elsewhere. But because of his wife, he has an emotional investment in this argument. "If it saves one life, it's worth it," he argues. Just the last month he triumphantly emailed me that such a study is being initiated, and I join him in hoping that it is found to be cost-effective and helpful. Time will tell, and she will do so in a no-nonsense way with no concern for our wishes and emotions.
Many years have passed and my friend still misses his wife. Grieving has its place, and I don't seek to change that. Yet if we are to prevent others from following her path, we will achieve that using dispassionate reason.
The Pragmatic View
If we are to save our planet, we must overcome the tribalism that drives our divisions and prevents equitable solutions. We castigated the Japanese for their no-surrender tactics in the Pacific and their suicide pilots. And today we in our country reserve special honor for our own individual war heroes who marched off into danger with the least certainty of safe return. Can we not see how we and our enemies had courage and selflessness in their own way, that we can now let go of our emotions?
I know nothing of war except what I have read. What I read is that there isn't much sentiment in a trench, warplane, or warship. There is mainly attention to the details that might keep one alive and an unspoken prayer that this attention and these actions might spare us for one more day. Attention and action don't always work, and that is why we have Memorial Day.
Certain movies can bring tears to my eyes. I don't pretend to be immune to sentiment.
Still, when I walk out to the theater into this world we all share, the bright light can be blinding. This reminds me that Nature has benign indifference to us as individuals. Despite the miracles medicine can achieve, George and Diane will soberly attest that nature's limits come surely and without announcement.
On Memorial Day we acknowledge that life is not risk free. The deaths we honor promoted the greater good. We face risks together today, whether we address our environmental challenges, whether we ignore them or whether we stonewall solutions. Many of those risks and solutions impact health. As well, because behavioral science falls within the realm of medicine, medicine properly has a role to play in our community response and how that occurs.
Nature has given us emotion and sentiment, which give us energy for life. And she has given us reason and intelligence, so we can choose which battles to fight. Next month I'll share some medical aspects of these problems.
For those of you who have served our country and survived, let me offer you my thanks and respect. For those of you who have lost loved ones to war, let me offer my condolences.
And let us give thanks for this day made more bright by strangers who gave their lives for us.
Newsletter edited by Jody Bower.
Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.