The grace of humility

Those of us who began practicing in the era after HAART have not experienced the powerlessness of medicine on this scale.

In some ways, COVID-19 seems made for our times: a disease that actually moves faster than the news cycle.

And yet treating patients with COVID-19 is what I imagine practicing medicine at the end of the 19th century was like—illnesses partially understood, every physician a half-scientist, and limited (sometimes questionable) therapeutics. Then, as now, our crude clinical tools were on the cusp of being replaced with life-changing treatments.

Today, I can support my hospitalized COVID-19 patients physiologically, but they improve or decline with seemingly little regard for my interventions. By way of example, a 64-year-old man with COVID-19 and minimal comorbidities was recently admitted to my team. He went from breathing room air to intubated in four days despite receiving remdesivir, dexamethasone, convalescent plasma, and a clinical trial intervention aimed at blunting the cytokine storm. He died six days after admission. That same week, a highly comorbid 86-year-old man needed little more than 2 L of supplemental oxygen per minute and was discharged without any immediately apparent sequelae. I am not sure if our interventions changed either patient's outcome.

Curious how my predecessors on the cusp of the modern era navigated similar waters, I have been rereading William Osler. In an 1892 essay titled “Teacher and Student,” Osler writes about the qualities a physician needs to succeed—the “Art of Detachment,” the “Virtue of Method,” and the “Quality of Thoroughness.” I recall reading this essay during medical school. I took away an understanding of how to develop clinical distance, the importance of learning an approach to a disease, and what it meant to be properly thorough.

But in my initial reading I missed a fourth quality. Osler writes that the first three qualities “may make you students, in the true sense of the word, successful practitioners, or even great investigators; but your characters may still lack that which can alone give permanence to powers—the Grace of Humility.”

I think for many of us, our experience with COVID-19 has been nothing if not humbling. Those of us who began practicing in the era after HAART have not experienced the powerlessness of medicine on this scale.

But, as it did in the late 19th century, the hum of possibility charges the air. There are a staggering number of clinical trials underway. And what would have taken a decade to accomplish at the beginning of this young century has been achieved in less than a year.

With COVID-19, we are on the threshold of discovery. Yet medicine will always have knowledge just beyond reach. And for that, we will need to marshal the grace of humility regardless of the century we find ourselves practicing in.