San José, Costa Rica, since 1956

Would I Do It Again?

The daily turmoil of a clinical practice leaves little room for reflection, but plenty for self-doubt. Did I get that melanoma in time; what in the world is really wrong with old Mr.Hammer; or was I too brusque with Sarah Hughes who comes in every month with a different complaint?

But I am retired now and can afford to get my thoughts together, and to wonder whether I ever did the kind of good I hoped for that bitter December morning outside St. Mary’s.

We are trained to examine, to diagnose and to treat, but we are not trained to sympathize. To enter into the tragedy of a mother about to lose her only child is to go down  a path with no ending, to forfeit the objectivity we must reserve for diagnosis.

Nevertheless, it is impossible to think of the sick as mere machines in need of a spare part; it doesn’t work like that. So every night I collapsed into bed with a host of unsolved problems, and how I ever got my sleep is a mystery.

Anyhow, it’s all history now, and for the first time I can begin to see a certain pattern to it all, and to understand what I was really doing. So firstly I would say that my patients fell into three broad categories.

About one-third had nothing physically wrong with them but needed my attention. Ignored by the world for any of the hundred reasons that make us unattractive to our fellow men, they came to see in me their last hope for keeping some kind of a toehold on a life that had lost all meaning for them. In a way they were the most difficult of all, as they craved the sympathy I could not or would not give, and so served as a constant reproach to my conscience.

The second third were those who had a clearly defined and curable physical disease. I have always been a problem solver, and the intellectual exercise of arriving at a successful diagnosis, using all the powers conferred by training and experience, is probably what kept me going all those years. One makes mistakes, of course – they call it a practice, after all – and one is not always successful, but there is something almost sacred about effecting a permanent cure for an elusive ailment.

The last third were those who had a definable disease, but with no hope of a cure. You can often spot these unfortunates as soon as they walk in the room: you can see the hand of Death on them, and you know you are going to have to tell them sooner or later. Fortunately, many of them already know it, and they merely want confirmation of a painful truth they have already come to terms with. Even so, destroying hope is not a fit occupation for a decent man.

But yes, I believe I would do it again, though it might be more fun robbing banks for a living.


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