In my first year as a medical student I thought I had a pretty good notion of what medicine was all about. I saw it as a branch of mechanical engineering, like building bridges, say, but inside the human body. If you want to build a bridge across a river, you’d have to take measurements and make calculations, choose building materials and then construct your bridge. Doesn’t matter whether you are working in Timbuktu, in Marseille, or on the moon.
Medicine is not like that at all. In Timbuktu it’s a completely different enterprise than in Marseille and on the moon there is no medicine. This multifariousness of medicine was brought home to me when Professor B., after describing a very complicated surgical procedure, concluded the demonstration by adding, “Of course I would never do this type of operation in a patient who is above eighty.”
I was shocked. What’s wrong with patients older than eighty? Aren’t they worth the trouble? It took me quite some time before I realized that that was not the point. Humans form a biological population, which means that every individual is a little different from all the others. Without this variety there would be nothing to select within the evolutionary process. Every face is different. Every fingerprint, every nose, every tone of voice—they are all different. The same goes for all the potatoes and roses of one kind. They are all different from each other.
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