Grateful for Life

Information gets hammered into our heads every day of medical school. Trying to process and comprehend everything is, at times, overwhelming. Some subjects cause more suffering than others. Embryology, for instance, is a primordial stew of agony and misery. Pathology includes 3 of my favorite elements of medicine: a lack of direct patient contact, poor prognoses, and death. Strangely enough, my sincere aversion to these two subjects has generated a new found appreciation of how precious life is.

Learning about diseases, disorders, degenerations, and everything that can possibly go wrong during development (the subject of embryology) has instilled an appreciation of how we are more than lucky to not only be alive, but also be in good health. Embryology is a subject that is based on minutia, which makes it a dry subject and, occasionally, a challenge to learn. However, after studying all of the minutia in detail, it becomes immediately obvious at how many accurate gene transcriptions, productions of proper growth factors and proteins, cell replication, tissue development and migrations, etc. are necessary for every one of our limbs, organs, and overall structure to not only form, but also grow into something functional and capable of sustaining life. In fact, there is so much room for error, it is a minor miracle that more errors leading to birth defects do not occur. As an aside, I propose we rename the expression “miracle of birth” to the “miracle of development leading up to the actual birth.” Although more cumbersome, the latter statement is more accurate, but I doubt it will catch on in the popular vernacular.

Let us look at cleft lips for a moment. This is a very common birth defect of the face (occurring in approximately 1 out of every 1000 births in the U.S.) In 2009 there were an estimated 4,136,000 births [1]. This means 4,136 children born in 2009 had cleft lips. I personally do not even know that many people by name. This is just one example of how easy it is for something to go “wrong” during development, and is a relatively mild example of a birth defect of the face compared to agnathia (a condition where the lower jaw fails to develop and is incompatible with life). Of course there are multitudes of other development abnormalities that can occur. These are just two examples.

It is safe to presume that this article finds its way to fully functioning eyes capable of relaying what they see to fully developed brains that are able to interpret what the eyes are reading, and then translate these pixels in the shape of letters into a meaningful language. Otherwise, nothing that has been written will serve any useful purpose. If these words have made sense so far, it is safe to assume that we have properly developed, successfully navigated out of the birth canal, are capable of surfing the internet, have functioning vision, and a brain that works. The fact that we are here and capable of accomplishing all of this is absolutely amazing. (The ability to read does not assume anything about the function of lower extremities, however). However, there are still a multitude of diseases, disorders, and mutations that can afflict us – ignoring any trauma for the sake of simplicity.

Medicine essentially boils down to studying various organ systems and everything that could possibly go wrong with them. From studying problems, however, solutions are often formed. A perfect example of problem fixers are surgeons from any specialty. Their main goal is to physically remove or repair whatever is causing the patient harm. Non-surgical, medical specialties also have their own methods of treatment as well: if a patient suffers a pulmonary embolus, for instance, they are placed on Lovenox and Coumadin to break up the clot, thin the blood, and (hopefully) prevent any more clots from occurring and mobilizing to the lungs again. A chronic kidney failure patient undergoes weekly dialysis. A patient having a heart attack may undergo an emergency cardiac catheterization to dilate and stent the coronary artery causing the heart attack.

Pathology (and for that matter, radiology), is different in that it offers no solutions, but only diagnoses (and, in later stages of disease progression, offers the cause of death). Pathology is purely a study of disease. The word itself originates from the Greek word pathos meaning suffering. Most of a pathologist’s work relies on tissue sample analysis under a microscope in the hopes of not detecting any abnormal cellular changes. It is astonishing to think how changes on a basic cellular level can lead to systemic changes causing a patient to feel deathly ill. Just one of the processes that can create such a systemic manifestation is cancer. An accurate diagnosis of cancer can only occur under a pathologist’s microscope, and depending on how these cells appear, treatment may or may not be futile. Hence, a pathologist hopes to only see “normal” when given a tissue sample, because “abnormal” findings are quite often ominous. Hopefully this illustrates why studying pathology is not in my top 10 list of things to do.

Pathology is (mostly) a morbid profession. But by studying pathology and learning how many diseases, syndromes, autoimmune processes exist, and how many thousands of things can go wrong with us at any moment, we can begin to appreciate how incredible it is to be free of any such problems. Embryology is and will always be a dry field of study, but by learning how humans develop, we can begin to understand how lucky we are to be alive in the first place. Therefore, by realizing the not-so-simple fact that there are an incredible amount of factors that can cause us harm, death, or prevent us from even surviving birth, we should be grateful every day that we are alive, functional, and well.