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Poetry and Medicine XIX: Guided by my gut


 

 Cycling with friends recently, I suddenly gripped both brake levers, skidded sideways on the dry smooth seal, then released the brakes to abruptly straighten up and regain balance. I remember seeing my front wheel just miss the rear of the bike that had been on my right before unexpectedly turning left across my path. It was all so quick. As we rode on, I reflected on what had just happened, seemingly aware of it for the first time.

      I’ve fallen many times, but mainly in the first years of cycling. Once previously, a rider on my right had engaged me in conversation while assuming we intended to turn left at the intersection. I was nudged, wobbled and crashed, with hip, hand, elbow, shoulder, and helmet sharing the impact with the road.

      Reflex responses, like generative artificial intelligence, draw on data from all that has gone before. There’s no time for conscious decision making.

 

You shall not kill. Murder is wrong. Even if some wars can be justified, the deliberate bombing of apartment blocks, schools and hospitals must be wrong. The very existence of nuclear weapons feels abhorrent to me, and the targeting of Japanese cities rather than military installations in 1945, a war crime.

      Capital punishment also feels wrong, barbaric, yet it has been widely accepted in many societies until recently. Where the Mosaic laws of the Old Testament prescribe stoning to death for adultery, homosexuality and certain antisocial behaviours, my instinct says, ‘no!’ When Joshua took over from Moses as leader of the children of Israel, he believed he was following God’s instructions in leading his men from town to town, seeking to kill every man, woman and child in the land of Canaan. My gut instinct tells me either Joshua got it wrong or his God was not a god I have any time for. Genocide to make way for a chosen race does not fit my intuitive moral code, even if the stem cells of my beliefs and values derive from the Judaeo-Christian tradition.

      As a GP, I was careful to conform to legal and professional standards of practice. Many years ago, an elderly patient with an incurable malignancy informed me he was a longstanding member of the Voluntary Euthanasia Society, and he asked that I not allow him to suffer for long. I said I would care for him as well as I could, and not strive to prolong the end, but I couldn’t actively take his life.

      Later, when I visited him in his home, frail, bedbound and miserable, he pleaded with me to ‘chop him off.’ He was adamant that he had already lived too long. His wife handed me a page torn from a notebook, on which my patient had recently handwritten the following brief but potent poem. His use of repetition in and yet – and yet – followed by they wait/ and wait, reinforces the sense of time dragging slowly.

 

For some, the final night can’t come too fast,

and yet – and yet –

and holding on, they wait

and wait too long.

 

      At that time, I decided the right thing to do, all things considered, was to prescribe sedation in the form of rectal diazepam tubes in a dose sufficient to keep him asleep or semi-conscious for the next few days until he slipped away. At the time, this felt the most compassionate of my legal options, and the man and his family gratefully saw it that way, but later my gut feeling questioned whether I would have been wiser to have delayed intervening long enough to first discuss the situation with a respected colleague from general practice or palliative care.

 

I sense that my moral compass has, during my lifetime, gradually evolved from perceived external sources of truth such as Christian faith, to an intuition distilled from reflective experience. A gut reaction that reflexively helps me to keep balance and to remain upright in unsettling circumstances.

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