The Time of the Three Dynasties: Reflections on Imbalance in the Practice of Medicine

“From the time of the Three Dynasties men have been running in all directions. How can they find time to be human?”

Chuang Tzu [1]

My brother-in-law Robert died last week. He was 41.

No one knows exactly how the accident occurred, but his family, and other farmers, could guess the specifics and especially the cause. He had a wife and six young children, worked three crop farms, kept some cattle, looked after his mother and her place, and was the executor of his uncle's contested will. Even to a doctor he seemed enormously over-extended.

Robert's wife said his sleeping habits had suffered noticeably for months because of the pressures he felt, and he slept little the night before he died. Yet he worked all the next day, and on that midsummer evening-feeling that there was still more that had to be done-he took a tractor-mower and went to clear some thick brush around the fields of his mother's farm. A line of fence wire got caught in the large blade and at 8:30 p.m., knowing better, he positioned himself under the heavy piece of equipment to free the wire. Then something shifted and slipped, and he died. There could be no sophisticated medical intervention, not even a resuscitation. He was dead within a few horrible minutes, his chest crushed, his mother there to witness it after his agonized call. The sight of his lifeless body was so disturbing that people gathered at the scene would not allow his wife to look at him but only to hold his cold hand as it lay exposed at the edge of the tarp that covered him. It took six men to lift the mower off his body.

The pain of his family was indescribable, unknowable even in its essence except perhaps by …