When reading a book on ventilators* (mechanical breathing machines) to expand my knowledge of how to use them, I was struck by the author’s comment that ventilators are not curative but simply tools to buy the body time to cure itself. This factoid is known (at least subconsciously) by many physicians though not often so simply stated or at the forefront of our minds. The author’s bluntness made me wonder whether most of medicine is like that – interventions designed to keep death at bay until the body can mend itself, if such mending is possible. Or, if not mending, interventions that slow down damage to the body thereby allowing people to live longer than they would without the intervention.

The thought of medicine acting as a time warp – bending time to give the body space to mend– renewed my awe and appreciation of the body and its functioning. Without intervention the body is extremely resilient. With medicine available to help it along the way, it is incredible.

In primary care clinic, my patients and I frequently discuss the need for putting in time before results are realized. Medications and actions inherent to primary care are usually designed to prevent damage that would need mending. In that way, preventative medicine, as primary care is, is designed to give the body more time to live. Primary care time is composed of daily endeavors to live healthfully. It includes time spent doing physical therapy to optimize muscle function. Time spent sleeping, exercising, and eating well. Time – built from seconds – with each small action and decision along the way adding together, hopefully generating an outcome that may not have otherwise been possible.

In contrast to primary care, hospital time is more finite and about letting the body heal itself. In the hospital I also discuss time with my patients often. Common conversations include time left before patients can leave the hospital, time left to live, and time needed to recover. We discuss the shortcomings of the crystal ball I don’t have. We review the annoying truth that medicine isn’t magic and that sometimes it takes days to reduce leg swelling with pills that make one pee, to heal tissues that are infected, or to get medications to reach their therapeutic level in the body.

Bending time to let the body heal or to delay deadly damage is a simple concept but complex when applied to real life. The question remains: If time is bent will it change the outcome? And the more medicine I do the more muddied my answer to that question becomes. The answer is between sometimes and often. Medicine is based in research that investigates if behaviors, medications, and procedures help improve outcomes – survival, functionality, etc. Yet even the medical recommendations we are confident about are still probabilities and not certainties.

For example, there is no promise that if we control patients’ diabetes, they won’t die of a heart attack. They might. Research suggests that if we treat diabetes the chance of dying from a heart attack is lower for the person with diabetes. Similarly, we know that if we don’t place someone who can’t breathe for themselves on a ventilator, they will die. But we can’t promise that they won’t die after we place them on the ventilator. They might. In both examples, we are just giving the body a chance to pursue an alternative outcome from what is most likely at the time we act. It’s a chance, not a promise.

Even in the case of more definitive medical cures – like surgical removal of a tumor or chemotherapy – cure is not a guarantee. The body first must recover from surgery and avoid complications like infection to benefit from the surgery. The body first must survive chemotherapy before benefiting from the cure, and there is a risk of cancer returning.  Considering the limitations of even curative interventions, the argument that their primary role is to give the body an opportunity to heal itself remains. Fate is like magic, beyond medicine. Yet, the body is capable of astounding things. As such, even if medicine does nothing more than bend time for the body it is still a worthwhile pursuit. Because with medicine we might extend life and reduce suffering during whatever days remain in a person’s life. That opportunity, even if not guaranteed, is why people like me go into medicine.

*The Ventilator Book by William Owens