Medical Powerlessness [Final]

            Medicine is celebrated in the glory of its success. Yet the focus on medical potency overshadows the social effects caused by medical failure. Doctors take pride in their ability to treat patients. Thus when faced with an incurable disease, doctors feel a profound sense of uselessness. This applies the same to both the doctors of the 19^th century as well as the doctors of the 20^th century. For 19^th century doctors their general inability to treat basic diseases such as dysentery threw them into the mire of despair. For 20^th century doctors the fearful scourge of AIDS proved equally disheartening. Therapeutic failure shattered the doctors’ faith in medical progress causing them to return to bedside medicine and take drastic measures on behalf of their patients.

            Failure to successfully treat patients destroyed the self-esteem of doctors in the 19^th century and pushed them towards a more sacerdotal role. Physicians of the time were expecting advances in medical science to allow them to cure patients with greater success. In theory, the newfound effectiveness of medicine was supposed to give doctors a new level of professionalism.[1] However failure to consistently cure patients threw a shadow of doubt on the doctor’s beliefs. Dr. Lunsford Pitts Yandell’s tragic experience of the death of his six-year-old son perfectly illustrates how physicians were demoralized by their powerlessness. He outrights claims that standard treatments were “utterly futile” and that these standards should be tested to understand why they failed.[2] He was not alone. There were numerous cases of other doctors crying out for help, trying to come to terms with both the death of their patients and the failure of their treatments.[3] Often the best a physician could do was provide social support by simply being present on site to hear about the patients’ suffering.[4] This bedside medicine gave the doctor a sacerdotal role of alleviating patient distress through conversation.

            Therapeutic failures divided medical communities into different sects each trying to prove the efficaciousness of their practice. Competition was driven partially by the patients’ ability to choose what type of treatment they wanted and partially by doctors themselves struggling to find cures. Heroic medicine proved tempting as a method of treatment because doctors could feel like they were doing something. Powerless doctors were left paralyzed by uncertainty. Heroic medicine removed this paralysis by providing dramatic procedures that could be done regardless of whether or not they worked. This allure of heroic medicine was on full display in Benjamin Rush’s speech, “On the Pains and Pleasures of Medical Life.” In his speech, Rush champions heroic medicine, not as an effective treatment, but as a noble cause for doctors looking to help families in distress.[5] Unfortunately, heroic medicine, while noble in intentions, exacerbated patient conditions and was more often than not fatal. Other opposing sects such as Thomsonianism and Water Cure took note of the detrimental effects of heroic medicine’s “deadly poisons” and proposed their own therapeutic treatments in response.[6]

            Fast forward a century into the future, the AIDS outbreak and failure to treat those infected once again threw doctors into a panic during the 1980s. Like their counterparts in the past, the doctors of the 1980s were confident in their ability to conquer diseases. Abraham Verghese reflects the optimism of the era when states “we felt this new disease, this mysterious immune deficiency, would soon be understood and conquered.”[7] The arrival of AIDS to Johnson City destroyed these visions of medical dominance. For Dr. Verghese, a sense of hopelessness sank in as patient after patient succumbed to AIDS. Without a treatment he was powerless.[8] The best he was capable of was treating the symptoms caused by opportunistic infections. In these times of despair, he too turned to a doctor’s sacerdotal role by keeping a close interaction with his patients. His book is proof of his close contacts as it contains the meetings he has with different AIDS patients as well as a thick description of their prior life before the AIDS diagnosis.

            The medical reaction against AIDS was one of pure chaos. Unlike the past, there were not multiple different medical sects proposing their own cures. However, there were various questionable drugs offered as treatment for AIDS. Doctors were practically grasping at straws, trying to figure out whether or not certain medications were actually potent. In pure desperation, Dr. Verghese provided patients with doses of vitamin C to get the satisfaction of at least writing a prescription.[9] His actions were similar to heroic medicine advocates who called for drastic action to be taken against illness.

             The Whig history vision of a path of straightforward progress clashed with the realities therapeutic failure. Despair from powerlessness drove doctors back to the old comforts of bedside medicine. By providing some sense of consolation, doctors could at least feel partly relieved of their medical responsibilities. Of course, not all doctors were satisfied with just providing social therapy. They strove to provide treatment for their patients’ aliments in a hasty and perhaps even foolhardy manner. Failure both depressed and emboldened doctors.

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[1] Steven M. Stowe, “Seeing Themselves at Work: Physicians and the Case Narrative in the Mid-Nineteenth Century American South,” American Historical Review, Vol. 101, No. 1 (Feb., 1996), pp. 44 [J-Stor].

[2] Ibid., 41,50.

[3] Ibid., 55.

[4] Ibid., 65-66.

[5] John Harley Warner and Janet A. Tighe, Major Problems in the History of American Medicine and Public Health (Boston: Cengage Learning, 2001), 58-60.

[6] Ibid., 71-73.

[7] Abraham Verghese, My Own Country (New York: Vintage Books, 1995), 24.

[8] Verghese compares his situation to a one-sided game of tennis. Ibid., 275.

[9] Ibid., 281.