Alchemy
I.III.III
ALCHEMY
Alchemy can be defined as the esoteric, magical means by which an object is brought to its original, divine form or, alternatively, the exoteric, proto-scientific process of transmuting one thing into another. This was all the rage a few eons ago. Alchemy was believed to lead the way to infinite riches, knowledge, and even immortality.
It was said to be governed by one simple rule: the law of equivalent exchange – that something of equal value must be sacrificed in order to obtain another thing. This should come as no surprise to any scientist, as one of the very first things we’re taught is that mass (and energy) can neither be created nor destroyed (unless you study nuclear physics, that is). However, there is one thing said to override this law: the magnum opus of alchemy – the philosopher’s stone. A mythical substance that allows all forms of transmutation without sacrifice. Or at least that’s how it goes in Fullmetal Alchemist, a Japanese manga built entirely around this concept.
It all makes for a nice story. Especially the law of equivalent exchange. A very familiar concept, no? We’re brought up being told to give as much as we take, to repay our debts, to even the odds. An eye for an eye, a tooth for a tooth. But when you really think about it, the law of equivalent exchange is simply ruthless. It always evens the score. Somehow, some way, it always does. One life for another. Death for life. Life for death. A cycle that never ends.
The ouroboros – a serpent eating its own tail – represents exactly that. An eternal cycle of life and loss, repeating itself over and over. An endless cycle, one that can only be broken by the philosopher’s stone. I used to think medicine was science’s philosopher’s stone.
I couldn’t have been more wrong. As days went by and I saw more death and suffering in my day-to-day life as a doctor, it occurred to me that all we do is ultimately futile. You save one patient only for the next to die. Equivalent exchange. And the worst part is, there is no finality to it. It never ends. People keep on dying. They always do. They always find a way.
There’s the same old, same olds – the heart attacks, the strokes, the cancers. And then there are the creative ones. The guy who covered himself in boiling wax while meditating, high as a kite. The 250-kilogram woman who was practically force-fed to death by her own mother. The guy who overdosed on heroin, lived to tell the tale, only to be run down by a bus the moment he left hospital. No matter how, people always find a way to die. There is no cure for death. Every. Single. Day. One after the other – without break, without pause. Time and time again, I found myself wondering, “What’s the point? Why do we keep fighting a lost battle?”.
One such moment I remember very clearly was when Mr Hope, a previously healthy seventy-year-old man, was admitted with COVID-19 pneumonia under Dr Sugar’s care. He spent a month in ICU, hooked up to a ventilator, with all kinds of tubes and wires going in and out of his body, constantly poked and prodded, pricked and punctured. Then, miraculously, he started to improve. He was weaned off sedation and successfully extubated. For the first time in a month, he was alert. Disoriented and confused, unable to speak or move, but alert. Recovery was slow and painful. A month later, his tracheostomy was closed and he could speak. Physiotherapists worked like crazy trying to get him moving again, and somehow, impossibly, they were managing.
His family, completely resigned until then, could finally see the light at the end of a very long, very dark tunnel. There was hope. Hope of a husband returning to his wife. Hope of a father going back to his children. Hope. Kind of incredible, right? Also kind of unjust. Inhumane. Unfair. A previously healthy seventy-year-old now reduced to this. A man who never smoked and never drank. A man who didn’t bring this upon himself. And I do know – I know that things happen. To everyone. Bad things happen to good people all the time. Blame the randomness of the universe for that.
But at least he was alive. And maybe, just maybe, he could return to something resembling his old self. Even so, it forces you to acknowledge that we’re all living on borrowed time. Your life can be put on pause without you having any say in it. And that’s only the best-case scenario. A comma can very easily turn into a full stop.
And that’s exactly what happened to Mr Hope. Back when he first came in, no one thought he’d ever leave hospital alive. He was on the brink of death. And somehow, we brought him back. Two months in, he was well on his way to recovery. Until he spiked a fever and died within a couple of days from a secondary bacterial pneumonia.
Kinda makes you wonder, “What’s the point?”, right? Why did he have to endure all that suffering if it didn’t get him anywhere? Why was his family given such a cruel illusion of hope? Why were so many resources spent? All those antibiotics, fluids, and drugs. A priceless ICU bed and ventilator. The medical input, nursing care, physiotherapy, speech and language therapy, dietetics, geriatrics, occupational therapy, and God knows who else. So many resources. All down the drain. So what the hell is the point? And I don’t mean that in the philosophical, “everything happens for a reason” way. I mean it in the “why bother?” kinda way. It’s just delaying the inevitable. At an enormous cost.
Over time, I think I’ve come to make some sense of it, though. I don’t think there’s a grand reason for why we do what we do. People will die regardless – with or without our intervention. Our job, I believe, is to push each loss as far away as we can. For the patient’s sake. For their friends and family. And for ourselves. Because, as the old adage goes, death is hardest on the living. All our efforts come down to one thing: being able to tell a patient’s relatives that we did everything we could. That we didn’t give up hope. That their loved one died despite our best efforts. That’s how we cope. That’s how we get to sleep at night.
It took me a while to get to that frame of mind. Hell, I’m still learning, and I doubt I’ll ever be fully at peace with it. But my perspective has changed. For every death we see, we help countless others. The menial heart failure exacerbation. The boring old urinary tract infection. The mini-strokes and mini-heart attacks and whatever pathology happens to be trending that day.
As boring as they might seem… we change lives. So it’s not just death that never stops. It’s also life. “Life will out.” as the great Amelia Shepherd once professed in one of her most inspiring speeches. Life will always out. As will death. And that’s something we all gotta get used to.
