It’s a sorry world

In the waning weeks of 2010 and with Thanksgiving around the corner, I became reminded it’s been a tough year. What was to become a true annus horribilis began when rheumatoid arthritis and the complications of its therapy finally took my mother. The hillside farmhouse in a remote part of central Vermont where she made her home didn’t make visits there for her Durham family easy, but thank God for Southwest Airlines and the Manchester New Hampshire airport. Despite having good medical care, she suffered mightily at the end, and as a physician it was difficult to stand by helplessly, or try in vain to make her better. As a son it was heartbreaking. Thank God, too, for hospice nurses.

Here at Duke University Medical Center it is increasingly difficult to adhere to the noble institutional missions of teaching, patient care and research as we try to do ever more with less resources, and struggle with the rules, regulations, never-ending paperwork and bureaucratic chores imposed by the apparatus. It is often difficult in my own little corner of the world here at Duke to confer sense, order and explanation to death and disease, with its horrific actors like childhood embryonal rhabdomyosarcomas (You don’t want one of these. Trust me.) that surface among the mundane from time to time. There’s the parade of reports, depositions and affidavits to file, subpoenas to respond to as thoracic pathologists become enmeshed and deeply involved in the country’s endless and ongoing asbestos litigation.

The country is in horrible shape, balkanized and bereft of leadership, with only the promise of more partisan bickering and infighting as our nation’s many problems remain unaddressed. The economy’s in shambles, unemployment and underemployment are at a disgraceful level and news from Iraq and Afghanistan remains bleak. There’s cholera in Haiti, and the Germans announce they have genug gehabt with multiculturalism. Our own populace seems restive and annoyed at the dawning of the holiday season. As if airline travel wasn’t stressful enough during these times, there’s now the prospect of full body scans or “aggressive pat-downs” and even longer delays at airport security as folks try to make their way home or to see loved ones. I don’t detect a collective sigh of relief at the news of TSA’s plans, or that anyone feels more safe in the knowledge that pensioners and the elderly will be scanned, patted down and frisked en route to see the grandchildren for the holidays. The travelers’ tales we’re likely to hear in the weeks to come will not likely be happy ones. It’s a sorry world.

The bicycle race season ended for me last Saturday, and the musings above were among the many thoughts I had in between minding the data I was generating as I completed the race, and trying to keep myself upright and turning the pedals over on the bike. The race itself was a 112 mile monster out of Wrightsville Beach, wending its way inland then back to the Cape Fear River and a grand finish at the USS North Carolina battleship in Wilmington. An individual event, there were no pacelines, no camaraderie or conversations in the pack to break up the tedium. The race provided a pastoral setting as the sun broke and warmed roads through the newly barren fields and forests of the Carolina coastal plain, the silence broken by the steady drone of the rear disk and deep dish front wheels, punctuated from time to time by the chirping and scolding reminders from my cycle computer to pick up the pace and jack up the heart rate. But there’s nothing like suffering, starkness and incipient lactic acidosis to spark thoughts in the realm of the existential, and somewhere around mile 50 there headed my own, and some of the less incoherent ones are described above.

On the trip home, rehydrated and equilibrium finally restored, I am finally reminded that there remains much to be thankful for. The rest of my family is healthy. I am privileged to work alongside great people and some of the finest and most skillful physicians on the planet here at Duke. And I am fortunate to occupy the preferred side of the glass slide and microscope, the pathologist rather than the specimen or its source, at least for today. Over in England, my old friend Mike Pressler and Team USA just won the Men’s World Lacrosse Championship, earning more than a measure of redemption and continuing to make those of us here at Duke who loved him and the Pressler family proud. It’s basketball season. Winter around here will come and go quickly. And finally, at least for me, we live in a state where middle-aged guys as well as younger men and women can still race their bicycles on quiet roads through the forests and fields down at the coast on a beautiful late autumn day in November.

Dr. Thomas Sporn is an associate professor in the Department of Pathology. His column runs every other Friday.