In May of 2013, in the middle of a 14-hour flight from Chicago to New Delhi, I heard an overhead announcement in a voice rattled with anxiety, “Any doctor on board, please attend to a sick person.” I squeezed past my seatmate into the narrow aisle where a pale, middle-aged man sat several rows back.
When I asked him what was wrong, the man spoke sluggishly and complained of dizziness. I checked to make sure he was breathing without difficulty and was relieved to find that he was. But I tensed when I felt only a feeble pulse strike against my fingers through the cold, clammy skin of his wrist.
The man’s wife stood next to him, squeezing her fingers hard into the back of the seat. I kept my voice measured and calm as I spoke to her. After a quick survey of the man, I asked, “Have there been any recent major medical issues?” I suggested a few: “Heart disease, stroke, high blood pressure, diabetes, anything like that?” and braced for her response.
“He suffered a heart attack two years ago,” she explained. The man had a stent in his heart. Immediately, I went on high alert. On a typical day at the hospital where I work, I’m used to ordering tests, reviewing blood work, and measuring various bodily functions. This information is always instantly at my disposal. But there I was, 30,000 feet in the air, searching for clues about what’s going on inside the body of this hapless person in front of me as the flight attendant hurried to locate an emergency medical kit.
The few minutes that passed felt like an eternity, but finally I was handed a shabby stethoscope missing an ear piece and a dilapidated blood-pressure monitor. The pulse I’d been feeling with my own fingers was still faint. My stomach dropped when I realized the blood-pressure monitor was broken. I attempted to maintain my confidence, but my own palms were sweating now as I realized the remaining contents of the airplane’s emergency medical kit were of no use to me — a few bandages and alcohol wipes, but no basic equipment such as a blood sugar meter or even a thermometer.
I was on board one of the most marvelous creations of the human mind — the airplane — and I felt helpless. A host of questions ran through my mind. What if he’s having a stroke? What’s my plan if this is, indeed, a heart attack? If he’s bleeding internally from a ruptured aorta, what can I do to maintain his blood pressure until we land? What if, what if, what if.
Without instruments to measure the most basic vital parameters such as blood sugar or blood pressure, I had to assemble the meager clues available to me and then rely on my own experience and intuition to make an educated guess. “Does he have a blood sugar problem?” I asked.
“No,” his wife said, “but sometimes he feels dizzy if he misses a meal.” In the family’s rush to make their flight that morning, the man had skipped breakfast.
I didn’t want to cause pandemonium, but I also didn’t want to spread false hope. Though I couldn’t be certain, my gut told me it wasn’t his heart. I reassured the man’s family and the rest of the flight staff that I didn’t think the man was in mortal danger. I noticed a sigh of relief on the flight captain’s face while he looked up to me as I comforted the crowd. But without the aid of technology, tests, or instruments, only I knew how powerless I felt. I took a deep breath and reminded myself of my role in this situation. There are two timeless precepts of the medical profession that never change; first, do whatever it takes to the reassure and comfort the sick. Second, do my best to identify the sickness and relieve the individual’s distress.
Experience and a bit of luck pointed me toward an educated guess that my patient’s dizziness might be caused by low blood sugar. I asked the flight attendant for orange juice and instructed the man to slowly swallow down two cups of it. This was the least and the best I could offer in that situation. After the man finished the drink, I asked his row-mates to give up their seats so he could lie down.
Luckily, within a few minutes his color returned and his pulse felt stronger. When he started talking again, the rest of us on board shared a feeling of immense relief. I ran into the man again after we exited the flight in New Delhi, and by this time, he said he was feeling just fine.
This experience left me thinking about the power of measurement. For a physician, the key indicators used to assess a patient’s health are the vital parameters we’re able to measure: heart rate, respiratory rate, temperature, blood pressure, and so on. Without measurements, a doctor’s ability to accurately assess a patient becomes severely limited.
In the process of quantification of almost all aspects of human biology, doctors make systematic observations as a valid way of building knowledge about a patient’s health in order to then prognosticate the efficacy of treatments. Doctors are taught to think of a patient’s health in terms of numbers. A typical doctor’s visit ends by giving a patient a set of goals to meet: lowered cholesterol, controlled blood pressured or heart rate, a target blood sugar, or a measured thyroid or PSA level.
For centuries, healers depended solely on patients’ narratives, through which would guess what was wrong. It wasn’t until the seventeenth century that quantification became the primary factor in the study of human biology. This approach created a perceptual shift in how physicians “see” patients — using vital parameters, which are nothing but numbers — as a critical means to understanding and assessing one’s health.
Quantification became the driving force behind the modern scientist’s quest to reduce every entity to its simplest and most fundamental indivisible, measurable unit. The word “atom” was originally used as a metaphor. Derived from Greek, “a-tomos” means not-cuttable, as in, that which cannot be cut further — the building block of all matter. By applying this approach, every aspect of nature was sliced and probed to its most basic level: for light, photons; for biology, the cell; for temperature, degrees Celsius; for length, the meter; for sound, the decibel.
Physicians applied these metrics liberally to the human body, which gave them the ability to measure and experiment. Three centuries of perseverance to standardize these methods in medicine paid off. Physicians were enabled to distinguish a normal biological process from an abnormal one. They were also empowered with a numerical designation as a universal method communication that crossed geographical and language boundaries.
Our quest to divide, classify, and measure every aspect of life’s processes even stretched to the study of our intellect. George Boole believed that human logic could be quantified, and he dedicated his life to developing a “science of intellectual powers” of the mind. He believed that thinking and reasoning could be understood by applying laws of mathematics.
When it came to studying emotions, we initially ran into some difficulties applying experimental testing to our behavior. We first needed to develop a method to quantify human behavior.
Just like neurology was the study of the brain and nerves, psychology was emerging as the study of the mind. This separation pushed philosophers away from healing traditions and eventually made mainstream philosophy a thing of the past. The modern-day translation of philosopher is now simply a deep thinker.
The primary objective of a psychologist was to record and analyze sensations and thoughts by the same means a chemist used when assessing compounds. With the prominence of psychology, a progressive theory was born that consciousness could be broken down into various measurable aspects. The method of grouping and finding patterns was accomplished through quantified laboratory observation. Everything had to be anchored in evidence.
This method laid the foundation for future experiments on human emotions for the next two centuries. By the twentieth century, psychologists inferred that mental activities could be studied by recording measurable properties in our bodies. Mental stress, for instance, could be quantified by checking levels of stress hormones in the blood. Another modern example would be utilizing functional MRIs of the brain to study emotions.
Applying this approach, we explained emotions as a manifestation of chemical signaling: love hormones, for example, were nothing more than the result of neurotransmitters like dopamine and oxytocin fueling pair bonding. Scientists were even able to show proof; if oxytocin receptors were blocked, the pair-bonding response was cut off.
They went on to map the areas responsible for love and desire in the brain, and then researchers dug deeper. They found that the blood levels of specific chemicals were significantly higher in couples who had just fallen in love. Certain molecules apparently played an important role in the social chemistry of humans, or at least in the phenomenon known as “love at first sight.” Scientists declared these results were a confirmation of love’s scientific basis. The experiences that define who we are could now be explained as neurochemical exchanges in our biomechanical workshop.
And after this, we went further still. Evolutionary scientists announced that they could explain even the most elusive of all human attributes. They vouched that parental love was merely nature’s way of duping us into perpetuating our genes. The alchemy of bonding, they asserted, was simply acting out an aeon-old evolutionary script inked in our DNA. Sentiments such as empathy and altruism were deduced to nothing but the products of natural selection. The same went for intellect. Scientists further claimed to have identified where intelligence and problem-solving areas resided in the brain and set out to test their theories.
Experimental studies took much of the lure of the unknown from our exalted emotional responses. With such an approach, nearly all conceivable human expression was subjected to measurement. We’ve concluded that almost every aspect of the human mind can be explored by scientific methods. Scientists have provided insight into the psychological world, which, by convention, forbids entry. In body and mind, we found ourselves wholly within the jurisdiction of experimental study.
A renewed worldview emerged from the scientific revolution: if the human body is seen as a sort of machine, then searching for parallels between it and the indefinable concept of the soul is pointless. Since the adoption of this newfound outlook, spiritual beliefs have become a personal matter that have no place in the study of science. Many who believed in the existence of a soul sought alternative ways to represent this concept that didn’t conflict with the emerging science. Every aspect of study was secularized for one goal: freedom of thought.
This unemotional, purely objective approach meant philosophers and scientists no longer spoke a common language.
For clinicians, this move essentially meant casting aside 2,000 years of wisdom in favor of a new method. Such a radical overhaul meant future doctors would not even know what a “humor” was, and that Galen’s legacy in medicine would all but disappear. Pythagoras, the forefather of humoral theory would not be remembered for his contributions to medicine. Medical students of the future would not know that Hippocrates, famous for his oath and introducing rational thinking into medicine, actually practiced medicine based on the humoral theory and relied heavily on the healing power of nature. Almost all of the accepted wisdom of medicine would fade quietly into a forgotten past.
As a result, practitioners of scientific medicine underwent a radical makeover. It worked. By leaving behind the subjective idealism, doctors gained extraordinary new insights about bodily functions. In this metamorphosis, doctors, albeit reluctantly, disposed themselves of many elements that had defined their profession from the beginning of time. The result: no more metaphysics, no more cherished beliefs, and no more mysticism.
The vision of Hippocrates to separate the physician from the philosopher and priest was finally actualized. The medicine man became the person of science, his priesthood relinquished. Simultaneously, the authority and expertise of curing illnesses unconditionally shifted from the priest to the physician.
The physician was stripped of his robes and dressed in a white coat, removing the artist’s persona and ridding the lineage that had dominated the profession for centuries. Old taboos were washed away and a new healer emerged.
A condensed excerpt from Physician: How Science Transformed the Art of Medicine (GreenLeaf Press, 2018).