It was in the early hours of the morning in October, fifteen years ago, that we lost a young man, who had a massive heart attack; despite our best efforts. Scientifically, we had done everything possible at that point in time-nay, may be even now! He was a picture of perfect health hours before the actual heart attack, and had gone to bed as usual after his dinner, only to be woken up with severe pain, and soon collapsed into coma. The young bereaved widow asked me the most profound question then " why my husband doctor?".

I tried my best to explain his heart attack with the help of our conventional risk factor hypotheses, but he had none of the multitude of risk factors mentioned in the textbooks. It was only years later that a thinking medical scientist, Professor Stehbans of NewZealand (1), writing in his book "The Fat theory of Atherosclerosis", made me realise how fragile were the risk factor hypotheses. Reading Nobel Laureate McFarlane Burnet’s book "Genes, Dreams, and Realities" further demystified the atmosphere(2). The results of the Multiple Risk Factor Study (3) and the last week’s study from the Harvard Medical School(4), the largest of all the risk factor studies to date, on the " relation between dietary fat and the risk of coronary heart disease" further cleared the air in this field. Fractals and Chaos in medicine have a lot to teach us, but unfortunately, they are not very easy to understand(5). So I failed to answer her question at that time. That made me to start thinking.

Clinical research, I was taught by my teachers, is " asking questions on the bedside and going as far away from the bed as you can to get an answer". The question, in this case, was asked by the patient’s wife, instead of my generating the question in my mind. I went into all the medical literature to get an answer. We have many theories as to why mankind gets this or that disease but we have no idea as to why this or that man gets a disease at a given time. All risk factor theories apply to cohorts of men - a good scientific jargon- but of no practical importance when applied to the man sitting across the table in your clinic with a problem. Having thus failed, I then went into philosophy starting from Plato, Jung, Kant, Karl Marx,even people like Koestler, Orwell, Kafka, Bertrand Russell, and many others, without any answer to the question.Even the logic or anti-logic of Karl Popper did not help. Russell’s and Dr. S. Radhakrishnan’s treatise did not help much.

Having failed in the Occident, I turned my attention to the Orient, and specially to the eastern ancient wisdom. My inability to fully understand the Sanskrit language was a great handicap, I had to rely mostly on English commentaries of our ancient wisdom. From theology ( divine wisdom ) I went into religion. I studied Hinduism, Bhuddism, Christianity, and Islam, superficially though, mainly from translations. I used to discuss with people I knew to be authentic, and this process is going on. I have not got a good answer, although I could now reassure that wife and her kind, by saying that the human soul has no death, it is only the material body that apparently dies, the soul is immortal and so on and on. Whether that satisfies them or not is another question altogether. My education in this field is still incomplete and I am still an ardent student.

In a lighter vain, I could answer that question in a different way. I once read a short autobiography of an English family doctor, ( which went somewhat like this) who, as a medical student in one of London’s leading medical schools in the early part of this century, had an itchy skin lesion on his thigh. He went to see a junior lecturer first, who casually dismissed him with an ointment. The itch increased and it was bothering him. He went to see the great dermatology professor, who was a big name in his field in those days. The professor examined him in detail and again prescribed another ointment, without much benefit. He had this lesion all his life anyway! One day he took all the courage to ask the great professor as to "why he got that eczema ( that was the diagnosis, incidentally) and why is it not going away easily?" The professor became very pensive and patted the young student on the back saying " Young man, if only I had known the answer to your two profound questions, they would have erected my statue in the Trafalgar Square.!" How true!

We are back to the square one! What happens to man can never be predicted with confidence despite all the newer gadgets and tests. We still have to depend on the stanza written by D.H.Lawrence years ago:

Medical science has been able to label the various exits through which we go out to meet our maker by awe inspiring names, like cancer, heart attack etc.; the end result being no better than our ancestors’ labels like God’s anger, curse, and what have you. Human life span has not changed. With the fall in perinatal mortality, better hygienic surroundings, better nutrition, and some degree of success in the control of communicable diseases, the life expectancy at birth has gone up markedly in the West, and to a significant, but lesser, degree in the developing world as well. This has resulted in more elderly people living in society, with all the new problems of geriatric medicine. Life is the only condition known to man with one hundred per cent mortality. Life is a Que. for people to go away to meet their maker, but as in any other Que. people sometimes jump the Que.

When the end comes, the bereaved family needs the succour of the presence of God. Does God exist? How I wish I knew!! However, I am inclined to agree with Voltaire, when he said " If God did not exist, it is necessary that we should create one."! The concept of God must have saved more people in this world from suicide than all the hi-tech stuff in other areas of medicine, put together. " Medical humanism" is a new concept, where the kingpin is the man, and not mankind.