Docs can't save lives

We are born to die. Simple, death exist because birth is there. Without birth, there’s no death.

My master once told me a story, which I can’t hardly recall because it has been years ago. But, I still remember the conclusion of the story: the greatest uncertainty of life is when we are going to die; while the greatest certainty in life is we are going to die for sure.

Contemplate that you are going to die, every day first thing in the morning. My master told me.

Nevertheless, I abandoned my contemplation since I been too busy to study till I realized I’ve been far away from what my master taught me in Buddhism.

Today, I told a friend in MSN: we, as doctors, are just treating “illness”, it’s never about saving “lives”. Men are born to be death, thus it’s contrast for men to be gifted the ability to fight against death totally. Saving lives is just bullshit, but noble way of saying to be a doctor.

The key element here is: doctors are just treating illnesses, we can’t save lives.

And, here, I’m going to use medical points of views to prove that people are born to be death. We, as doctors in the future, are going to only treat illnesses, but death is certain.

To begin, let us contemplate of some genetic diseases. It’s too obvious that patients who are born with those genetic defects are going to die for sure. No matter whether it’s a single DNA substituition, or chromosomal aneuploidy, those patients are going to be killed by the genetic lesions they are born with. They carry the gene since they very fisrt sign of existance, the zygot, which is only a single cell formed by fusion of sperm and ovum. In another word, the patients are fated to die since the very first cell, how about when they are born with multiple cells with similar genetic composition? They are going to die for sure.

Genetic diseases still not enough to prove my point? Probably you may say that not everyone born with von-Hippel Lindau (VHL) or Fanconni’s anemia. Well, let me give you cancer.

Through years, it is becoming clearer and clearer that the pathogenesis of cancer basically involve mutation of two groups of gene: poto-onco genes and tumor suppression genes. The end point of the pathway is: neoplastic proliferation of cells which kill the patient.

Notice that? Proliferation.

Proliferation – mitotic replication of cells mostly – the very basic ability of human, which make us transform from a single cellular zygot to become a multicellular organism. In cancer, we are killed by the very basic ability that make us a human. Because the single cell of ourselves has the capability to do what-make-us-human, human die because of the cell, or to be more specific, the proliferation capability. Again, right here, we are born with the ability to proliferate, and we are killed by the ablity. Thus, it’s more than fair to put in a way that: we are born to die.

You might argue with me that not all oncogenic lesions that exist since birth, there are carcinogenic subctances that cause cancer. Well, you might be right, there are carcinogenic substances. But, the existance of carcinogenic substances doesn’t mean that out body should react with those things. However, instead, our DNA chose to have chemical relationship (reactions) with the carcinogenic subctancesm naturally, which results in the DNA damage that drive us to cancer. Do you realize that we (again) are born with a thing called deoxyribonucleic acids (DNA) that can react with exogenous (nonself) subcstances, and hence transformation of proto-oncogenes into oncogenes, and the damage of tumor suppression genes as well. We are born with something tht can ineveitably react with carcinogens, and then kill us.

Untill here, you might feel depressed knowing how vulnerable yourselves to death, but maybe you still see not everything that we are born with drive us to death. Immune system, you point out the defense system of our body – the good guys who protect us.

But, I say, com’on! You really believe that immune system is going to defense us? You got it all wrong. It’s just how your white blood cells react chemically to foreign hamful antigens that give us the picture that “our white blood cells are fighting against the bad guys – germs.” But, in fact, they are all just chemical reactions, that run like a signaling pathway, and “command” our white blood cells to react and eliminate the antigens. Most of the time, people are killed by infection, not because of the causative agent itself, but because of our stupid immune system reacts exaggeratly to the relatively not-so-harmful antigents. A very pure picture here is anaphylatic reaction, where our idiot immune system react to antigen that cause totally no harm to our body. Put it in another way, we are born with a troup of army (immune system) that we have been counting on them to protect us against enemy (antigens)… but the army that harbour inside us have every capability to kill us without mercy, whether it’s unintentional (e.g. septic shock), or intentional (autoimmune – e.g. my facourite lupus). Once again, while you are reading this, every vessels running in your body (including those supplying your eyes and brain for to enable you to read these words) is harbouring booms (WBCs) that going to esplode anytime. What they just need is a reason to start a war – doesn’t matter the enemy is harmful (microorganisms) or not (allergen); and they’ll do whatever it takes to explode, including killing the host – us.

Right now, it’s very clear that we are born to death. Every day we are living, we are getting closer and closer to death… the only question is when – the question that we are not being able to answer, even doctors.

Death is certain. If doctors cannot fight death away, they can’t be said that they are saving lives. Saving lives is an absolution that can never be achieved, while death is certainty.

So, as a doctors, we only treating illness – which, according to WHO, any deviation of health. But, is health really health? No. We’ll never know every single possibility of killing us beneath health. The genetics lesions, cancer cells, immune systems – they all exist even when we are in apparent health. So, it’s wrong to say that we are always being healthy.

So, you may ask what does docs do if there is really no health to be achived?

Doctors are just manipulating the chemical reactions in our body to maintain a balance with death. Death can be delayed (never prevented) with the knowledge that docs have. Through evolution, humans are using developing intelligence to try to keep death away, in medical field, specifically.

Too confusing?

Allow me to quote that there are forces in this universe.

The cartainty of death is a force that pull a life to the end of it (which basically mean death).

While doctors are another side of force that pull life away from its end. They use every knowledge hey have to pull, but they’ll never succeess. However, the safisfaction is gained in the process of pulling, not the result, because the result of this tug-of-war is always death wins.

But, how they gain safisfaction from the pull?

Back to the very beginning of this blog: the greatest certainty of life is we are going to die; the greatest uncertainty is when.

Death wins totally in the first one: the greatest certainty of life is we are going to die. But, death will never win in when. Why? Because, as doctors, we have a belief: no matter when this patient is going to die, he or she is not going to die now – not today, not this moment. Death fail to change the second uncertainty into certainty (which means now) because there are doctors there that make sure the balance of forces that death cannot always win in this game.

Sometimes, doctors loss; but sometimes, doctors win – in the particular moment when a near-death patient is arriving. Doctors can’t save lives, because lives are never meant to be saved as death is certain. But, even doctors can’t win in the end, but they can win in the moment. That’s more than enough reason to be a doctor – and that’s the reason why I’m determined to be an ER doctor – play tug-of-war with death, face-to-face, like a man!