Terminal Paradox

Come to think of it…
Is terminal an end—
or a beginning?

© Tein79

With open-collared shirts, pressed trousers, and concise luggage, a pair of docs stood under the portico of City Medical Center, looking as antiseptic as the building they had simultaneously exited.

“Donovan!” Looking like a Viking, the tall, bald, and red-bearded doctor grabbed the free hand of his colleague and pumped it with vigor. “How the hell are you?”

“Helmer!” His smaller, swarthy colleague accepted the hearty grasp, but withdrew his hand after the initial shake. “Long time, huh. Ironic isn’t it, we work in the same facility but never see each other. What are you up to?”

Donovan shifted his dark eyes away from his former medical school buddy in search of rescue. An oncologist, he regarded the future as a series of lesions. It was immensely more interesting than the present, which was full of consequential decisions, and lug-heads like Helmet. “I’m heading to a conference. Bioethics. Johns Hopkins.” 

“No shit.” Helmer, a gastroenterologist, never tired of body-part humor. “Me too.” His blue eyes scanned the driveway as if it were the North Sea. “I’m waiting for an Uber. What about you?” 

“Same.” Donovan pulled out his phone. “My car’s five minutes out.”

Checking his phone, Helmer shrugged and smiled. “Fifteen. But you probably ordered yours last night.” He was right. If nothing else, Donovan was predictable. “Let me cancel mine. We can share the ride. Catch up, you know.” He punched a few settings on his phone and then slipped it into his pocket. “Done.”

“I didn’t know you were interested in bioethics,” Donovan said, wishing his car had arrived before Helmet did.

“I wasn’t. Until two months ago. Got invited to sit on the God Committee.” Donovan winced at the slangy reference to the bioethics team that set parameters and screened candidates for critical procedures. Twice he had applied to sit on it. Twice he had been rejected. Infuriated at the perceived injustice, he barely heard Helmet continue. “So, I took it, thinking it would be interesting to have a say in who’s going to live or die.”

Resentment pulled at the corners of Donovan’s mouth. He faced the paradox of lifesaving treatments every day. Pump fragile people full of poison in order to extend their lives, or pump them full of other poisons to end their lives painlessly. An oncologist and atheist, he’d longed to be—deserved to be—on that committee. He represented the dispassionate perspective he deemed necessary to participate in life-and-death decisions. Helmer was too headstrong, too mundane, too ….

Donovan searched for the right word. Pedestrian! Too pedestrian for such consequential decisions. He was, after all, a gut guy.

A dented compact sedan pulled into his thoughts. Helmet pointed to the stylized U decal on the window and smirked. He was a stickler for definitions. “Uber.” He tapped the side panel. “Hardly something that exceeds the limits of its class.”

After settling themselves in the cramped car, conversation focused on bioethics. The field had grown tremendously since the first Life or Death Committee convened in Seattle in 1961 to determine which patients would be saved by a new kidney-dialysis machine. Since then, the role of ethics committees had evolved to address other challenging questions about preferred courses of medical intervention, including drug trials and transplants. 

“Did you sign up for the session on ethics and religion?” Helmet asked.

“Hell no,” Donovan jeered. Living up to his name—dark warrior—he didn’t laugh at much. He was too objective, too logical, too grounded. “I believe in science. Not metaphysics. I don’t need to tie up my brain with that paradox, of using the unseen or unknown to define the seen and the known.”

With his Viking profile held high, as if testing the wind, Helmet pondered the conundrum.

“I beg to differ. I find the intersection of metaphysics and medicine fascinating. But neither metaphysics nor ethics is religion. Religion is personal. It’s for me. My moral principles that govern my behavior. Medical ethics is for governing what happens to other people.” Sensing he was about to breach an ideological chasm, he paused to clear his throat. “But I do believe in God. And that personal belief provides a framework for dealing with the moral burdens we face in our practices. Deciding who gets a chance to live, or when to pull the plug. Which is why I’m interested in the religion session.”

“Fascinating, maybe,” Donovan said. “But irrelevant. We don’t decide who lives and dies. That’s already decided. We determine who benefits from access to procedures and processes.” This is why he needed to be on the God Committee, for god’s sake. Not a lamebrain deist. “That has nothing to do with religion.”

As they neared the airport, they fell quiet. The driver broke the silence to confirm their airline and terminal.

“Speaking of terminal, Helmet, did you sign up for the bioethics of terminal illnesses?”

Helmet nodded. “I need to learn more about weighing end-of-life options. When to implement palliative care and when to withdraw life support, don’t you agree?

Donovan did. But he already knew that.

Exiting the puny Uber, the pair of docs looked as sterile as the terminal, which looked as sterile as a surgical suite. And like a surgical suite, it crawled with invisible bugs—those imperceptible things that undermine predictable outcomes.

“Paradoxical, isn’t it?” Helmet pointed upward. “Terminal is not just the end of life, but the beginning of a journey.”

“I don’t know.” Donovan shrugged, looking down and feeling superior. “As far as I’m concerned, that’s up in the air.”

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