Would I do it again?

I am almost sure you have asked yourself before on one or another occasion whether your life would have evolved differently, if you had made different decisions or taken an alternative action at some time in the past? Perhaps those different decisions would have changed not only your own life, but also that of your family, friends, and even your colleagues. Would you have met your significant other? Would you have kids? Would you live and work in Winnipeg, MB?  

A famous Swiss writer, Max Frisch, wrote a play about this (“Biography: A game”). He lets his protagonist go back in time and re-enact certain historic situations in his life. The question is whether the protagonist, with his acquired hindsight, is capable of choosing different actions, and whether those choices will change his biography and impact in any meaningful way. I am not going to disclose Max Frisch’s conclusion here. However, I recently asked myself on several occasions (not all linked to the pandemic) whether, if I could go back almost 50 years, I would go into medicine again.

For my harried contemporaries who just want the punch line: yes, I would do it again, but with the qualifier “under the same circumstances”. Which, of course, begs the question: have circumstances changed?  Well, I think they have changed, dramatically in some ways. But did they change in a way that would affect my decision making?

The science of Bio-Medicine has made tremendous progress and at a pace hardly ever seen in history. At the time of my training, there was no PCR, no expression cloning, no CRISPR/Cas, and cross-sectional imaging was in its infancy. Can you imagine medicine without routine ultrasound, CT and MRI? These and many other technical advances have added tremendously to our understanding of health and disease, revolutionized our diagnostic armamentarium, enabled to sequence the entire human genome, allowed to determine the cause of diseases, and develop cures and highly effective preventative measures within an unheard off short period of time. As a result, we can, for the first time, cure (not only suppress) a chronic viral infection like hepatitis C. With biologics such as anti-TNF antibodies we can maintain chronic inflammatory disease such IBD and RA in long-term remission. With modern immunosuppressives, e.g. calcineurin inhibitors, we can achieve long-term rejection free survival in solid organ transplantation. And with checkpoint inhibitors, we can enable an immunotherapy approach for cancer. Perhaps most stunningly, from their inception it took less than a year to bring RNA based SARS-COVE-2 vaccines to broad application. These innovations not only attest to the tremendous advances of bio-medical science, but will continue to shape the future of medicine and the environment in which we practice.

Apart for developments in biomedicine, there were many other often less exciting and at times ambiguous developments that profoundly changed how we as physicians do business. For the sake of remaining within the space constraints of this blog, I cannot expand on these here in any detail. Suffice it to mention IT based technologies. They allow us rapid access to lab, imaging and biopsy results or even the entire chart of our patients and to document in real time our assessment and management plan. They have on the other hand led to a shift of administrative type work to physicians and risk to distract us from engaging with our patients on a true person-to-person level. Who has not experienced the clinic patient dryly noting that today’s physicians spend more time staring at a computer screen than making eye contact with their patients?

 But these are not really the circumstances I was referring to.

The circumstances that led me to go into medicine were, on their surface, both simple and timeless:  I felt the urge to help mitigate human suffering. I sought to alleviate distress. As a physician caring for my fellow citizens, and as a scholar contributing humbly whatever small piece I could to the progress of Bio-Medicine, which in-turn would help individual patients. The common denominator is service, service to suffering fellow human beings, service to our communities, service to the system we are part of, service to our society. The draw of this difficult, but rewarding profession is not the job security, it is not the almost guaranteed above average, not infrequently very high income we enjoy (I avoid on purpose to say “earn”) as physicians. It is service.

In the context of praising the privilege of serving, I do not want to turn a blind eye on the fact that   providing service is often hard and appreciation may be scarce. The strain of the pandemic exhausted us all, but especially the physicians and nursing staff on the frontlines. Tirelessly picking up extra duties and overtime shifts is one thing. Being insulted by militant COVID deniers and anti-vaccine campaigners demonstrating on the front doors of hospitals, denying entry to staff and patients, and accusing us on social media of being bought by big pharma is disheartening, even if this group of ill-advised individuals is small.

Perhaps a soothing thought in situations like this is to remember one single individual in distress who was comforted, maybe even altered in the trajectory of their entire lives, by us caring and serving its needs.

To serve requires humility. It is not about you or me: it is about the greater good. It is about engagement for a common cause, not for one’s profit. It is about being there when individuals, our community, our society needs us. It is about trying to help making our world a better place. Not with big words, but with what we can do in our daily interactions with others, each of us at their place and in their respective position.

Service is timeless; service will always be a good decision. And that is why I would do it again.

Eberhard L. Renner MD FRCPC FAASLD, Professor and Head – Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba