Find the balance.

so much depends 

upon 

 

a red wheel 

barrow

 

glazed with rain

water

 

beside the white

chickens

 

-William Carlos Williams

 

The human psyche is a fragile thing, susceptible to all means of threat. Yet, only by facing the fear of destruction is man able to amass strength and conquer. This transcendence necessitates brutal honesty. It requires one to boldly look at weaknesses and admit shortcomings, to acknowledge when someone else is more capable and when we are not enough. Through anecdotes and experiences, Atul Gawande explores the courageous choices and capitulations one makes to become Better: A Surgeon’s Notes on Performance.

“People underestimate the importance of diligence as a virtue…’the constant and earnest effort to accomplish what is undertaken’…however, as the prerequisite of great accomplishment, diligence stands as one of the most difficult challenges facing any group of people who take on tasks of risk and consequence” (29). Loaded with implications, one who diligently pursues a goal must do so consistently and relentlessly, always refining and recalibrating to new baselines. What happens though, when the realization strikes, that the purpose is no longer worthy? How can one navigate the landmines of truth that pose existential risks to one’s identity forged through years of work towards achieving a misguided purpose?

Gawande presents exactly this dilemma in a chapter accounting for declining numbers of war casualties. Whereas once huge numbers of soldiers died on the battlefield due to injuries not expediently treated, the US Military has remedied that weak link in an effort to do better. Forward Surgical Teams (FSTs) and Deployable Rapid-Assembly Shelters (“drash” tents) are now on hand and equipped to deal with the myriad traumatic injuries soldiers sustain in the field. Doctors and nurses stand ready to tend to wounded soldiers immediately and hasten their release to the next phase of care. The result is that “[a]lthough more U.S. soldiers have been wounded in combat in the current war than in the Revolutionary War, the War of 1812, and the Spanish-American War combined, and more than in the first four years of military involvement in Vietnam, we have substantially fewer deaths. Just 10 percent of wounded Americans have died [compared to 42% in the Revolutionary War and 24% percent in Vietnam]” (52). But at what cost?

As military technology advances, so too does its devastating aftermath. We have the capacity to save these brave men and women from becoming a statistic, but have we really become better, or made them better, by doing so? Gawande recounts “One airman [he] met during [his] visit to Washington had experienced a mortar attack outside Balad on September 11, 2004, and ended up on a Walter Reed operating table just thirty-six hours later…The airman lost one leg above the knee, the other at the hip, his right hand, and part of his face. How he and others like him will be able to live and function remains an open question. His abdominal injuries prevented him from being able to lift himself out of bed or into a wheelchair. With only one hand, he could not manage his colostomy. We have never faced having to rehabilitate people with such extensive wounds. We are only beginning to learn what to do to make a life worth living possible for them” (60-61). A situation such as this elicits scrutiny and demands courage to expose ourselves to the erroneous belief that preventing battlefield casualties at any cost is the most virtuous thing.

Indeed, it is a noble endeavor to return soldiers home to their loving families. To enable young men and women to rejoin and enjoy the society for which they fought, is right and just. Yet the intentions surrounding that purpose were born of another time, one when soldiers who sustained life altering wounds would not have survived. If we truly want to be better, we must internalize the new paradigms of war. We must look at the framework of humanity. Physical, spiritual, emotional, and mental health are all necessary for the human psyche to thrive.* It is dangerous to ignore the ramifications by lying to ourselves. We must consider what it means to truly live, and question whether we have the capacity to ensure our injured veterans do so upon their return.

Gawande, Atul. Better: A Surgeon’s Notes on Performance. Picador, 2007.

*After watching my father’s deterioration from cancer, I firmly believe we need to allow for more Death with Dignity legislation. When one lacks independence, self-actualization, and dignity, it is shameful to keep them alive for the sake of “preserving life”. During my father’s last days I saw much distress and suffering. I will be forever haunted by his question, “Why is it taking so long?” We could have alleviated his suffering. We could have done better.