'The Health Care System: Part 4'
CAERS SUBSTACK ARTICLE #60
‘The Health Care System: Part 4’
CAERS Substack Article #60
I entered medical school in 1978 and retired from practice in 2019, just before the pandemic. I accumulated a lot of memories during those 41 years, most pleasant, but not all. I guess that is to be expected when you deal on a daily basis with people who are not always feeling their best.
Most of us can perform regular minor maintenance on our cars, like putting on winter tires and topping up fluid levels. But if the head gasket on the engine is blown or the transmission is on the fritz most of us seek a highly trained mechanic. The better we take care of our cars, the better they run and longer they last, in general. But no car lasts forever, and some models don’t last as long no matter how well maintained. I think something similar applied during my career.
I remember many of the happier experiences, of course: the birth of a young couple’s first child, or the discovery that a mass on a patient’s chest x-ray was benign not malignant. But what often stands out for me are the scary, painful and tragic ones. The person who suffered with multiple sclerosis for decades. The neonate born with anencephaly (lacking the upper part of the brain). The child who died of a rare form of cancer. The adolescent who succumbed to a genetic disease diagnosed when they were two years of age. The patient with bacterial meningitis who had me so worried that I slept in the hospital overnight partly to keep an eye on him, and partly not to expose my pregnant wife to the germs to which I had been exposed. The youth left quadriplegic after a car accident. The teenager for whom I provided an anaesthetic for lifesaving removal of a spontaneously ruptured spleen bursting from infectious mononucleosis. The ‘stat’ Caesarian sections for things like placental abruption in the middle of frigid winter nights. The young adult on a Friday night with their first episode of psychosis in a life that would be plagued by schizophrenia; or another on a Saturday with their first manic episode in a future besieged by bipolar illness. The young mother perishing from breast cancer. The patient debilitated by an autoimmune disease who required home visits. The middle-aged wife who died of an inoperable congenital giant berry aneurysm. The many elderly patients in nursing homes who slipped into severe dementia, unable to recognize their loved ones.
Not surprisingly, many of the interactions I had with such patients did not occur between the hours of nine and five, Monday through Friday. One of the busiest ‘days’ I had in practice spanned Christmas Day and Boxing Day one year because I didn’t leave the hospital. The list of tragedies that have befallen patients has at times seemed endless, and so many of their stories have no explanation for their cause, no sure-fire way to predict or prevent them.
Some of us deal with that kind of pain and stress by pretending that such miseries don’t occur (until we face them ourselves). Others cope by trying to convince themselves that such unfortunate scenarios are all avoidable if people just focused more on health than disease and took better care of themselves. But from the seat I have occupied in the grand theatre of life, these tragic things do exist and many are not easily preventable or foreseeable. Perhaps things are different on a planet far distant in time and space from our own, but at present I think our understanding of the human body and ability to predict the future are highly limited. I suspect that fear drives much of our overconfidence to think otherwise.
In fact, as I trundled along in my career, I became less sure of many things; I felt as though I knew fewer things for certain. My youthful excitement faded into a humble realization that the universe is far more complicated and complex than I ever gave it credit. But there are a few things of which I became much surer. I know that bad things can happen to good people no matter how well they take care of themselves, that we can’t fix all of them either, and that I am not immune. I know that I have worked hard and helped some people, but likely harmed others unwittingly as well. I know that simply being there for a patient can sometimes be as helpful as actually doing something, especially if you don’t know exactly what to do. I know that I have made sacrifices, and I know that I have paid a price—physically, mentally, emotionally—during my career, and indirectly so has my family. But most of all I know that if I had to do it all over again, I would do so in a heartbeat because it was all so very real and most of all it mattered.
For as long as I was in practice, the traditional Health Care system has always seemed to be under fire—it never quite satisfies everyone’s expectations. Maybe that is to be expected when there is so much at stake, and we often promise more than we can deliver. The higher the summit for which we strive, the further we may fall.
The pandemic may provide an opportunity for us to re-evaluate the limitations of the traditional HCS and make its goals more realistic. It would be best if all of us accepted our fair share of responsibility for that. Promoting the importance of self-care, and at the same time acknowledging the frequently severe limitations of what that can accomplish, would be a good start. If we succeed, we might find ourselves becoming humbler and more grateful for the gifts mysteriously bestowed upon us, and more compassionate towards those less fortunate.
J. Barry Engelhardt MD (retired) MHSc (bioethics)
CAERS Health Intake Facilitator