I don’t really have words for how much I admire the people at Partners in Health, who bring high-quality medical care to people throughout the world who desperately need it and if not for PIH wouldn’t have it. In a recent blog post, Adam Levine wrote about his recent successful resuscitation of a five-day-old girl — a powerful and moving story, but by no means merely triumphant.
The revived child is still very ill, and may not survive the infections that until Levine intervened had taken her life. And in that environment successes are always accompanied by failures. In the same blog post he tells this sobering story:
Just last week, while rounding with a Rwandan doctor on the inpatient ward at another hospital, one of the patients passed away while we were chatting with another man just a few beds down from him. The man who died had serious heart disease, but had been doing well when we saw him the prior day. We had begun seeing patients that morning on the far side of the large ward, three long rows of evenly lined beds away, and by the time we got to his row around noon he was already dead. Without the loud, shrill beeps and flashing of colored numbers that punctuate hospital life back home, we hadn’t noticed as his lungs filled with fluid, his breathing got faster, and the oxygen level in his blood began to fall. Nor had the patients and family members in the beds surrounding him wanted to interrupt us to let us know. We were two beds away when we finally noticed him, but by that time it was too late. Had we started our rounds on his side of the room that morning, he would have been one of the first patients seen, and we probably would have been able to intervene with some simple medications to stave off death. But by random chance, we hadn’t.
From these two experiences Levine draws, I think, the proper conclusion:
I can’t take credit for saving the girl’s life today without taking responsibility for the man’s death last week, so I choose to do neither. Instead, I prefer to simply keep working to improve the system as a whole: training more nurses and doctors, increasing the efficiency and effectiveness of care through improved triage and other basic structures, pushing for steady supplies of basic drugs and equipment, and conducting research into new methods to improve the delivery of emergency care in poor settings such as this.
I prefer to do neither: no assuming of credit or blame. Instead, Levine just focuses on his job, on what he can control, on trying to make things a little better for the sick people in that part of Rwanda, day by day.
In this he’s following the example of the co-founder of PIH, Paul Farmer, about whom I have written before. From his reading of The Lord of the Rings Farmer learned the phrase “the long defeat,” and the power of that idea to sustain people who are doing impossible jobs:
I have fought the long defeat and brought other people on to fight the long defeat, and I’m not going to stop because we keep losing. Now I actually think sometimes we may win. I don’t dislike victory…. You know, people from our background — like you, like most PIH-ers, like me — we’re used to being on a victory team, and actually what we’re really trying to do in PIH is to make common cause with the losers. Those are two very different things. We want to be on the winning team, but at the risk of turning our backs on the losers, no, it’s not worth it. So you fight the long defeat.
You fight the long defeat. No credit, no blame, just today’s work to be done as well as you can do it. It’s a creed for saints and heroes — and for everyone else wise enough to practice it.