Magazine article Medical Economics

Medicine, After

Magazine article Medical Economics

Medicine, After

Article excerpt

FROM THE EDITOR'S GUEST

Quit smoking, I always told my patients. Of course I said that; every physician says it. Exercise; eat fewer calories. Take your medicines. Get these tests done.

I was so full of advice. I knew so much about how people should live. But that was before Sept. 11. That was before we all watched the world change forever. And if the world has changed, then surely the practice of medicine must change, also. Surely my practice must change.

Four weeks earlier, exactly, I had given a lecture about aging to a group of older women. I talked about normal aging patterns, about how some organ systems lose their ability to restore homeostasis after an insult, while other functions do not change much at all.

I also tried to put that information into perspective. I gave figures on life expectancy now and a century ago, here and around the world. I tried to show that our long lives are not a natural and inevitable aspect of human existence, but something exceptional, a gift.

I expect my audience knew this, just as I did-- intellectually. We all know that we could die this evening in a car accident, or tomorrow show the first symptoms of disease. We know this, but we live as though we believe bad things will not happen to us, as though we will not suffer intolerably, as though we will just go on living.

Since Sept. 11, it has become more difficult to go about living with the conviction that bad things will not happen to us, should not happen to us-or at least that they will not happen to us today.

I find that I am no longer so sure how people-my patients, for instance-should live in the face of the tragedies that have come to them, unexpected and undeserved. I am no longer so sure how people should live now that we can feel in our bones that we may not be alive and well tomorrow.

We do not know, either, if or when we will be called upon to be heroes. …

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