The Qualitative Dilemma
"The only questions worth asking today are whether humans are
going to have any emotions tomorrow, and what the quality of life
will be if the answer is no."
by Lester Bangs
Each day is different ... and yet the same as all those
throughout time ... like all the days gone by and all the days to
come. Each day recreates the universe. Each is uniquely poised on
the brink of promises, and every tomorrow is destined to fulfill
the potential of all our yesterdays. Each day is what it has
always been, will always be, becoming by mysterious means what we
can only know as circumstance or chaos ... frightening and
fascinating by turns.
Dawn broke, the way it always did at this time of year, with a
kiss of the sun on the glistening leaves and mist in the draws as
birds raucously proclaimed their domains. Colors transformed my
landscape of mottled graytones to vibrant hues of shifting
intensities as the wildlife took its turn at the chuckling rill
running past my windows, an aperture onto nature's stage. An eddy
brought a whiff of evergreens into my room. The scent of coffee
and toast drifted in from the kitchen, so I knew my mother had
already begun her day. Another day of paralysis stretched before
me like a carpet runner disappearing into the distance, woven
with a repetitive pattern in tones to make the inevitable wear
less noticeable.
I thought about an interview that had recently been broadcast,
featuring a uniformed physician in Iraq, who complained to the
sympathetic journalist about the state of medical technology ...
not that it was substandard, but that it was too good!
He argued to an audience that had sons and daughters in the
combat zone that medical practice was so advanced that there was
literally almost no one who could not be saved from
their injuries ... that no matter how badly they'd been wounded,
medical technology could keep them alive ... and that this was,
for him, a licensed medical doctor, a problem of medical ethics,
because some of these people would not enjoy a life of quality.
He would not, or perhaps could not, deign an exposition on what
constituted a meaningful life that's worthy of his
talents, and would warrant the resources necessary to preserve
the life of a countryman wounded by our nation's enemy ... or
perhaps, as they have done with so many other reports, the media
simply censored that portion of his opinion.
I was not surprised to see this broadcast, since the media has
been lending aid and comfort to our nation's opponents
for decades, but this expression of inhumanity from a
physician in uniform did surprise me. Perhaps it should not,
given the accommodations made in schools and churches, the
military and other public institutions to enable the anti-American agenda of the counterculture; but then I remembered my
last medical exam at the veteran's hospital. It is difficult at
best to transport me, from home to van to facility, for a
scheduled appointment. I wait in a crowded room that cannot
conveniently accept my appliances, and so am shunted like a too
large lump of lesser-grade beef into an examination that takes
less time than the trip from the van through the parking lot into
the hospital. The luck of the draw last time paired me with a
foreign doctor who barely spoke English, and used my appointment
period to call his bank and his broker to check on his
investments. The visit before was not dissimilar except that the
doctor was female and called to check on her children and a time-share vacation. It would probably detract from their performance
rating if they acted professionally by using some personal
time between patients to conduct their private affairs, but
I am reliably informed that the well rounded care-giver
is now preferable to the dedicated workaholic. They don't think
they're abusing the system, since they believe that they are the
kingpins of the system, and the patients have no choice!
Given the fact that this is the way it is at the dawn of
the new millennium, where our military can be winning a foreign
war while politicians and their confederates proclaim it to be a
loss, where the counterculture has infected every traditional
institution so it can erode from inertia, and where objection or
disagreement is categorized as hate speech, we must
still consider how a practicing physician, who's repaying his
educational assistance with military service, could possibly
graduate with such an inhumane attitude. First is the
practical matter of obligation, such that if someone accepts the
privileges of an association that one is required to perform the
bidding of that contract, and not bite the hand that
feeds him. I suspect the character of anyone who makes a
commitment but reneges after enjoying its benefits. But such
defaulting has become normative for irresponsible libertines.
Most Americans are given a free pass to self-indulgence,
with everything from minimum wage and unemployment compensation
to voting rights and presumption of innocence; and most people
are either ungrateful or demanding of preferential treatment.
With the exception of soldiers and sailors, police and
firefighters, who constitute a distinct minority of the
citizenry, Americans are not required to pledge allegiance or
swear an oath of loyalty. Whether we, like other nationals,
should be so required is debatable, and probably unenforceable,
given the tenor of modern society. A cursory survey of medical
schools and their programs on ethics reveals that a physician's
oath is not required, and that where one is used, the graduates
may select from a score of recognized oaths, from Asclepius and
Sun Ssu-miao to Hippocrates and Maimonides, or they can write
their own. This hyperextension of individualism has been
expressed in marriage vows for decades, but, as usual, these
super-autonomous entities are missing the point of creeds, which
is to unite the commonality of fellow believers. There has never
been a majority of honorable men! ... nor a plentitude
of brave men! ... which is why, even in this
sophisticated era, we continue to esteem these traits. That a
young physician, privileged in every way, and availed of the
opportunity to associate with the heroes in our midst,
elects otherwise by spurning the trust of his office is shameful.
Perhaps I'm unreasonably sensitive about these decisions because
I'm one of the people they're talking about ... one of the ones
who's supposedly without a qualitative life. The poorest
American today lives better than royalty did a century ago, and
that probably distorts our perspective on the impoverished
conditions extant in some foreign lands, some not too distant.
There is no ascription of credit or blame for this situation, for
we have all inherited our own plight and contributed to it in our
own ways. But it is unrealistic to presume perfection in
all things, everywhere at once, as a humanistic usurpation of
God, simply as a presumption of rearranged priorities. As has
been proven around the world with socialism, redistribution
increases suffering and bankrupts the system.
The allocation of limited medical resources is not a new concept
... during war and other calamities, triage is a necessary
procedure, and the lore is replete with accounts of survival
after abandonment ... even enroute to burial. But the presenting
problem for the battlefield surgeon is not the race or creed or
color or lifestyle of the patient, but his condition at the time
of in-processing ... when someone like me would be set aside
during mass casualties, but was given immediate care on a
slow day in the war. The evident dilemma, which
is defined as a choice between equally undesirable results,
should never be the physical result or the social value of the
patient's life ... for no matter how arrogant physicians may
become in their desire to engineer a politically-correct result,
to pander to consumerism, to fiscally aggrandize their
profession, they are not gods! ... as close as they come is being
empowered to save lives. Any fool can kill with much less
training!
When I was transported to a sanitarium, it happened to be one
that also specialized in blind rehabilitation ... and if you
don't think that's funny then you don't understand the military
mind ... only Uncle Sugar would send a bunch of guys who can't
see to bump into a bunch of guys who can't move! They say that
misery loves company and it was probably the best thing
they could've done with us, because we were compelled to
recognize that we were not alone, that some of us were better or
worse off than others, and that self-pity had no role in the
equation. We shared the swimming pool with the blinks
and would gather outside the messhall, which was one of the first
indoor travel assignments for the blinks, and hold
discussions in the vestibular atrium ... which they called the
quad quadrangle in retaliation. Some of our guys who
could still sing formed an informal glee club that also met in
the quad quad because of its excellent acoustics, and
some of the blinks joined us, two of them playing
instruments. It was a good place to get your head screwed
on while your body healed after undergoing a life changing
episode.
We weren't disheartened by our plight. We were young and
enthusiastic and positive, recognizing that whatever the rest of
our lives held for us, it would have to be done differently than
everybody else. The most frequent phrase heard by everyone was:
there but for the grace of God ... and we witnessed it
everyday in every way. On our side of the quad, a guy who
couldn't lift his head and so viewed everything through a mirror.
On their side, a triple amputee who was learning cane travel from
his wheelchair. We had a guy with a severed spine who had to keep
going back for more surgery. And they had a guy who'd been burned
with white phosphorous who was having eyelids and ears grafted.
Ironically, some of them felt sorry for us, and some of us felt
sorry for them; and amazingly whenever the discussion got around
to what if, we all felt that we could handle our own
condition, but weren't sure if we could endure being deaf or
brain damaged or whatever malignancy tormented any one of us.
There was always some further or greater nightmare lurking around
the corner, hiding in the shadows, or hanging in the rafters.
Eventually we recovered enough to venture forth.
I haven't kept in touch with most of those guys, so I don't have
statistical data to refute the contention concerning quality
of life, but I know myself. I could give a few anecdotal
accounts of veterans who have succeeded despite their handicaps,
ones who have even managed to recover from divorce or
professional failure to make another start at fulfilled
personhood, but multiplied truth doesn't make it more
valid ... or as a friend has said, if you reject one miracle
then you must reject them all, and if you accept one miracle then
you must accept them all. I am grateful for the love and
care of the Army doctors who saved my life. I'm glad that they
did not euthanize me out of some misguided estimate of my
ultimate worth, of my socioeconomic potential, of my presumed
quality of life. Each day is a blessing ... new and
different and full of the universe.
"Do not take any reward [which may be offered in order to induce
you] to destroy and to ruin, Do not harden your heart [and turn
it away] from pitying the poor and healing the needy, Do not say
of [what is] good; it is bad, nor of [what is] bad: it is good
... And to cleave to the name of the Lord God of spirits for all
flesh, And the soul of every living being is in His hand to kill
and to make live, And there is none that can deliver out of His
hand."
by Asaph ben Berakhyahu and Yohanan ben Zabda [6-8 and
25-27 of the pact in The Book of Medicines, cited in "The
Oath of Asaph the Physician and Yohanan Ben Zabda, Its Relation
to the Hippocratic Oath and the Doctrina Duarum Viarum of the
Didache" by Shlomo Pines, pp223-64 Proceedings of the
Israel Academy of Sciences and Humanities
(9/1975)]
by Bill Cummings
... who is a disabled veteran and freelance writer, whose work
has appeared previously in this magazine.
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