The other day, I wrote about how several of the suspects arrested in the attempted car bombings in London and Glasgow were physicians or in training to be physicians. At the time, I expressed dismay at what I viewed to be a betrayal of the very basis of our profession, that we try to help people and make them better, not kill them. The post engendered a lot of discussion (and the expected amount of doctor-bashing based on my supposed naivete in stating that most physicians go into medicine to help people, a statement that I stand by).
In those who enter the medical profession there is almost always a curious mix of motivations. The motivation most often talked about (and believe me, I have read hundreds of prospective medical students’ essays on why they want to become doctors, and after a while they all merge into one long, treacly sentimental tract) is the desire to do good, to help people, and to ease suffering.
This is good and essential, obviously. But have you ever considered the reality that in order to do good; or to help people in physical pain, that you must sometimes (actually often) cause them even greater pain for a time? That, if you are a surgeon, you must find some enjoyment (or at least be able not to get sick) slicing people open or debriding wounds and mucking around in them? Even those of us who are psychiatrists must often lead the unsuspecting patient to experience (and hopefully to resolve) all the unbearable psychological pain that his psychological defenses have been mobilized to ward off.
This aspect of medicine is not talked about much, but it is very real nonetheless. The physician’s own cruel and sadistic impulses are never far below the surface. In the healthy person these impulses are generally sublimated and the instinctual energy derived from them can then be used to benefit society. Nevertheless, this is the dark side of altruism and the motivation to do good, and it is as human as the impulse to do good.
It is true that we as physicians must inure ourselves, at least to some extent, to the suffering of the patients that we observe and all too often cause in our efforts to eliminate whatever disease the patient suffers from. Not to do so is the path to burnout and even insanity. On the other hand, the doctor who doesn’t retain some empathy for the suffering of patients is not a doctor that too many people would want to have.
As a surgeon, I think Dr. Sanity misses the boat in his example of debriding wounds. When I “slice people open,” they are either asleep or heavily sedated and injected with as much local anaesthetic as I can get away with precisely because I do not want to cause them any more pain than is absolutely necessary to accomplish the task at hand. Indeed, it is the times when I must cause a patient unavoidable pain that are the parts of being a surgeon that I most dislike. For example, back when I used to do emergency room work, I would sometimes have to set bones or pop dislocations back in. No matter how much you dope up the patient before doing that it’s impossible, without general anesthesia, to do these things without causing considerable pain. The same is true for debriding wounds, which, I would point out, is probably the task that most surgeons enjoy least of all.
So what is the enjoyment we get in slicing into people to help them? I can’t speak for everyone, but as a cancer surgeon for me it is the ability to understand and view the anatomy well enough to remove a malignant tumor and save a person’s life. The pain that I cause my patients and how it disturbs me is, in effect, the price that I pay to be privileged to do that work. In that, I think that the “dark” side of surgery that I have to beware of would be the power. It was the love of the power to be able to act on his curiosity, I suspect, that drove Dr. Mengele to his heights of sadism. He viewed his victims as not human, as animals compared to him. I always try to remember that, alone among humans, we surgeons are granted by society the power to cut into people and forcibly rearrange their anatomy–with society’s blessings! The reward, at least in my case, is the ability to be a part of the only specialty that can cure certain cancers (breast cancer for example). Make no mistake, chemotherapy and radiation therapy are great adjuncts in treating breast cancer, but it is surgery that cures.
Consequently, upon thinking of things more since Tuesday, perhaps the reason that doctors are drawn to terrorism is the power. They are used to having power over the lives of their patients. Normally, we trust them to use that power for good and subsume that power into activities that benefit their patients and society, but I could see how the temptation might be there to become even more powerful in their own minds by killing in the name of their God, particularly if they fall into the trap of Mengele; that is, of viewing people not of their race or religion as being less than human.