The Unbelievers

Seen via Normblog, the Skeptics Circle.

The Skeptics' Circle is a biweekly carnival for bloggers who apply critical thought to questionable stories. Subjects include frequently repeated urban legends, quackery, pseudoscience, misinterpreted or denied history, analyses of misleading media, and any other articles or essays that fight misinformation with facts.

Lots of Bloggy goodness here. For example, at the very First Circle, there's an article on Holocaust Denial, as well as a particularly good Medblog, The Examining Room of Dr Charles. As some of my regular readers are in the Medical Profession (you know who you are), you may find this one particularly interesting. Though some of the particles are a bit icky.

But that's (black) comedy relief. It didn't take too much following of links to find this article on another aspect of Medicine.

If you are going to help someone with a terminal illness, you have to know their goals. Do they want to - no matter what - die at home? Do they want to fight until their last breath? Are they willing to trade some of their precious time to ensure that the time they do have left is quality time (example: would they rather take chemo to slow tumor growth, be sick most every day of the rest of their life, and live for about a year - or - quit chemo, feel good for a month or so, and die within six months)? Is the patient's only goal to walk his daughter down the aisle later this year even if that means that every day between now and then is lived in pain and discomfort? You don'™t know what the patient wants until you ask the questions and listen to the answers. Yes, you probably know what you would want if it was you, but the truth is that it is not you so your opinion is no longer important. It is your patient's life, so let them decide how it should be lived and help make that happen.

I think things like this make me a little impatient with much of Idiotarian Academe. There are plenty of, for want of a better term, Adults, out there who have to think about things like this every day. It's not some hypothetical, nor an abstract problem. And it's not just people who work in Intensive Care Units, nor Hospices or Oncology wards. There would be few General Practitioners who wouldn't at some stage of their careers have had an icy hollow in the pit of their stomach when doing a routine examination of a patient for some minor complaint, and unexpectedly finding one of Nature's Lethal Little Jokes.

If I was pondering what would be the ethical, the just thing to do in a difficult situation where thousands of lives were at stake - such as the Iraq War - I'd trust an Oncology Nurse far more than any Academic, no matter how widely-read.

In some ways it's ironic the career path that I've chosen. One of the reasons I didn't enter Medicine was because I'd had a good hard think about what I'd do the first time my incompetence, exhaustion, or sheer imperfection due to being human ended up with a patient dead. Because it happens, it's almost certain to happen. People, no matter how good, make mistakes. Sometimes there's not enough evidence to be sure of a conclusion, you have to make an informed guess, and sometimes you get it wrong.

Now when that means you lose a little money on the stock market or whatever, that's too bad. But in medicine, it means that someone may die.

Anyone not prepared to take the consequences of their own failure, to shake themselves off and move on to the next case, so as to do the most good, should never take up the practice of Medicine.

As a student just leaving High School, I had a good think, and decided I'd be unable to live with myself. So I took up Physics, hoping to get into Astronomy, before Computer Science got me hooked (but that's another story).

As for Ironic? Well, there must be several thousand people whose lives directly or indirectly depend on whether the work I did, sometimes as long as 20 years ago, was good enough. So far I've been lucky. The two people whose deaths are directly attributable to work I did were enemy pilots, killed as the result of war. And I'm told there's more than a handful saved by SAR (Search And Rescue) Algorithms I came up with when I realised that there were similarities with certain well-known and solved problems in Anti-Submarine Warfare search patterns.

But compared to, say, Ambulance drivers, or even Pathology Lab technicians, I've got it easy, and count my blessings.