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The Dressing Station: A Surgeon's Chronicle of War and Medicineby Jonathan Kaplan
I am a surgeon, some of the time. In certain clinical situations?penetrating wounds, massive bleeding?there remains no treatment but the knife. I have been fortunate, at times, to have saved the lives of patients who reached me on the threshold of death. Much of my work has dealt with trauma; among people changed abruptly from wholeness to injury, with all the fear of sudden mortality. Some of it has taken place in extreme circumstances?with only the most basic of resources?against a backdrop of dislocation and despair. I have seen people die, of wounds or disease or deprivation, and been unable to help.
All doctors have their ghosts. Sometimes they jostle me: the ones I couldn?t save, the ones I killed. For all of us?even the most dedicated and skilled?the dead pile up, the results of decisions swayed by fatigue or hubris or blind bad luck. And there are those who are simply the inexorable casualties of the system, for medicine is not always benign or balanced, or even practised necessarily to the benefit of the suffering. Every loss diminishes us, yet with clinical detachment?and with exhilaration, fear and fatalism?we continue, always in the hope of redemption.
I have practised medicine in diverse fields: as a hospital surgeon, a flying doctor, a ship?s medical officer. I have operated on wounded straight off the battlefield, treated people with rich strains of tropical disease raging in their bloodstreams, and tried to help those afflicted by occupational illness from industrial toxins or work-place stress. I have run research programmes funded by corporate finance?that met the needs of shareholders before they benefited any patients?and I?ve cared for children wasted by the diseases of famine and war. Like most doctors, I have seen my craft used and abused; been a part of its successes and witnessed its failings. It is by the terms of this unforgiving arena that we struggle to define ourselves.
No clinician can give an objective account of that work: the interaction between doctor and patient is mutual and intimate, and in the end comes down to something between us that is a fragile thing, as fragile as life. All we can do is the best we can in the war against death and against despair, including our own. For at its extremes the practice of medicine is a succession of front lines, and each victory is only a temporary respite. Perhaps you wonder what it?s like to stand at that intense interface. Perhaps you believe in the existence of some profound morality, some metaphysical awareness that is vouchsafed by contact with the texture of suffering and the aura of pain. I guarantee nothing; you will have to find out for yourself. Come and see.
Copyright © 2002 by Jonathan Kaplan
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