From Here and Now to Infinity and Eternity: A Message to New Medical Doctors*

Introduction: Post-Mortem or Pre-Mortem? (Klein, 2007[5])

Once upon a time, a teacher who finally obtained her doctorate degree in education proudly started introducing herself as “doctora” to anyone and everyone she encountered in their barrio. One day, she was urgently sought for a medical emergency, and as she confessed that she was not that kind of doctor, people shook their heads and said, “Oh, you’re not a REAL doctor.”

Without meaning to put down any other kind of doctor, allow me to address you as new medical doctors.

Doctor of Medicine, MD, “Doctor,” “Doc.” Physician. Healer. Surgeon. Medic. You will be known by these titles and exercise awesome power over life and death.

As a surgeon, I am truly blessed to have been given the opportunity to have healed many people. From creating an airway in babies a few hours old gasping for their first breath of life, to maintaining an airway in great grandparents in their 80’s breathing their last. From correcting congenital clefts and malformations to extirpating cancers, fixing maxillofacial fractures to reconstructing tumour defects. In patients from well-to-do families, to the poorest of the poor. What a privilege to bring the gift of life!

But there is the other side to our calling. I will never forget my first ward patient as a medical student — I was talking with him one morning, and attending his autopsy that afternoon. I still cry each time I lose a patient — on the operating table, in the ward, or at home. And I still attend the wakes of my patients when they die, to condole with their grieving families. Sir William Osler did say that our goal as physicians is “to cure sometimes, to relieve often, and to comfort always.” (Osler, 1912[8])

Your capacity to promote life all began with the study of death, as you dissected your nameless cadavers, peered at cells, tissues and organisms under microscopes. Then you studied disease after disease, catalysed biochemical reactions in test tubes and grew cultures on petri dishes, and memorized the endless armamentarium of the pharmacopoeia. Slowly, you learned the different diagnostic and therapeutic approaches to various illnesses, from the perspective of different specialities, covering the whole range of life and death, from womb to tomb. Indeed, again quoting Osler, “he who studies medicine without books, sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” (Osler, 1912[8])

Remember the first baby you delivered? Or the first person you resuscitated? I will never forget such experiences. Nor will I ever forget my first death. Yes, life and death are our calling, and our profession. You promote one against the other. Hopefully, you will help others live a lot more than you will witness them die. And each life-giving decision and action you take is its own reward.

Our medical training has undoubtedly taught us that the final, indisputable word in a clinico-pathologic case conference is the post-mortem. Indeed, death is the final measure of life — no more, no less. It is only at the moment of death that one’s fate is sealed with finality — no more changes are allowed, no more dreams can come true, no more plans can ensue. Why do I discuss death on such a happy occasion? Commencement means both an end and a beginning. It marks the end of the academic year; and the beginning of the rest of your life. And to begin the rest of your life, it is useful to view it in retrospect, from the point of view of the end. In other words, have you ever conducted a pre-mortem on your life? Or would you rather wait until someone else conducts the post-mortem on you?

What is your Space and Time Context? (Heidegger, 1977[3]; Jaspers, 1956[4])

To begin with, all of us exist (ex sistere, to stand forth) in a certain space, at a certain time. But in a less-literal, more figurative manner of speaking, each of us can be existentially classified into one of four basic types of person, based on our characteristic space and time (or spatio-temporal) context, our horizon.

How wide and long is your horizon? Close your eyes. Breathe deeply, slowly. Look within.

Pre-Mortem and Post-Mortem

So, what and where will you be in 10 years? 25 years? 50 years? Most of you will live out the horizon of your turf and your lifetime. And that is good. Go ahead and live your life. Work and study, raise a family. Make friends. Serve others with the gift of healing you have been given. Be the doctor who takes care of his or her patients, cares for them, and is cared for by them. Be good and avoid evil. Be happy and make others well. But “physician, heal thyself” (Luke 4:23[7]) too. Relax and recreate. Hopefully, you will not end up too jaded or callous, or discouraged or depressed by regressing into the here and now world with a population of one.

Some of you will not be satisfied with the horizon of habitat and a lifetime. Whether you realize it now, or much later at that so-called “midlife crisis,” you want to do more, to be more. It is not too late, unless you are dead, to spread your wings and fly. Explore that which fascinates you. Study again. Research and share your discoveries. Teach. Train others. Write and publish. Build. Invent. Innovate. Solve. Make history. Live beyond your lifetime. Make a difference in the world. Become a person of the world and history.

Maybe, just maybe, one of you will transcend even this, and break out into the realm of eternity, resonating in infinity. All those who did this were once upon a time unknown and unrecognised faces in a crowd. Some were even mocked or ridiculed, but all persisted and followed their lights. Jesus and Mohammed, Gautama Siddhartha and Lao Tse, Albacusis and Hippocrates, Plato and Shakespeare, Galileo and Einstein, da Vinci and Beethoven. Now, they shine as stars for us to follow.

Listen. Reflect. Meditate. Discover. Compose. Create. Contemplate the possibility of infinity and eternity.

We all will eventually follow your footsteps someday.

Concluding Remarks [See also Figure 1: Flowchart of paper]

Which of the four will you be? As the song goes, “Que sera, sera, the future’s not ours to see.” (Livingston and Evans, 1956[6]) But the future begins today, with each step you take. The journey is far from over, and you have a long, hard road ahead, through internship, board exams, residency, and fellowship. So far you have reached this point not only because of your work, but also because of the support of your families, your friends, your mentors and most of all, your patients. It is with their continued support that you will succeed in this amazing and fulfilling calling that you have chosen. And you will have to make it happen. Yes, you. In the words of the bard, “but this, above all: to thine own self be true.”(Shakespeare, Hamlet I.III.78[9])

At my first commencement exercises a long time ago, my classmates and I sang:

“in the morning of my life I shall look to the sunrise,

at the moment in my life when the world is new.

And the blessing I shall ask is that God will grant me,

to be brave and strong and true,

and to fill the world with love my whole life through.” (Bricusse, 1969[1])

Now, many commencement exercises later, the last stanza of the song still rings in my ears:

“in the evening of my life I shall look to the sunset,

at a moment in my life when the night is due.

And the question I shall ask only I can answer.

Was I brave and strong and true?

Did I fill the world with love my whole life through?” (Bricusse, 1969[1])

Do not wait for your post-mortem. Stand forth. Live. Give Life. Look to the sunrise, draw strength from the sunshine, be brave, and strong and true.

Take Home Message

1. Conduct a pre-mortem on your life; do not wait for your post-mortem.

2. What is your space and time context or horizon?

3. From the “here and now” and “turf and lifetime” contexts, expand your horizons to encompass the “world and history,” and perhaps, “infinity and eternity.”

4. Realize your full potential; be brave, and strong and true.

Questions that this Paper Raises

1. Why should a pre-mortem be conducted at the start of a life-journey?

2. Where and when are you in terms of space and time context; where and when will you be in the future?

3. How do the four basic space and time contexts apply to life and living, from the perspectives of the personal and professional dimensions of physicians and other people?

4. How can you expand your horizons and realize your full potential?

About the Author

José Florencio F. Lapeña, Jr. (Joey Lapeña) is a tenured Professor of Otorhinolaryngology and University Scientist of the University of the Philippines and Attending Pediatric Otolaryngologist at the Philippine General Hospital with special interests in pediatric aero-digestive surgery, pediatric cleft surgery, medical education, mentoring and journalology. He holds a B.A. Honours in Philosophy and Letters, an M.A. Social Sciences in Sociology, and an M.D., with Postgraduate Clinical Fellowships in Paediatric Otolaryngology, Cleft and Craniofacial Plastic Surgery. He is a Diplomat of the Philippine Board of Otolaryngology Head and Neck Surgery and Fellow of the Philippine Society of Otolaryngology Head and Neck Surgery, Philippine College of Surgeons and Philippine Academy for Head and Neck Surgery. He is actively engaged in the teaching, training, and continuing education of medical students, residents, consultants and other health providers in the Philippines and Asia-Pacific Region; and is a prolific author, reviewer and editorial board member for various international publications.