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What Lies Beneath

2022; Lippincott Williams & Wilkins; Volume: 44; Issue: 10 Linguagem: Inglês

10.1097/01.eem.0000891124.44020.82

1552-3624

Michelle Johnston,

Health and Conflict Studies

Figure: compassion, caring for patientsFigureOne may well ask, what drives emergency physicians to keep returning to the fray? Sure, the wages, that pay-packet and security of employment, medical insurance, and a plan for retirement, and the other less tangible rewards: teaching the next generation, the thrill of intervening in the internal mutiny of pathology, being a bodily tradesman, spending your time among some of the best colleagues on the planet. But a lot of the fray is not all that attractive right now. Emergency medicine is less and less enticing. EDs, the whole world over, are becoming more difficult places to work. The dangerous crowding, the violence, the demands, the apocalyptic-level bureaucratic incursions—all of these things accruing to cause moral injury and burnout. I suspect you are in a tiny minority if you haven't sat in your car wondering whether you could face your shift, imagining what it might be like to just walk away. I have wondered this often. What is it that drives some of us in society to keep fronting up to the coliseum? What makes us want to keep caring for our fellow humans when sometimes it seems they have no intention of caring for themselves or respecting us for trying? Could it be hardwired into our DNA? Of Caves and Pits Let us travel for a moment to Iraq. To a cave. Shanidar cave in Kurdistan, to be precise, among the limestone folds of the Zagros Mountains. This cave is archaeological gold where, inside its cool chambers, seven well-preserved Neanderthal skeletons were found. What the skeletons told us uprooted our ideas about what makes a civilized society and how far back it goes. It's an interesting question. What is the first evidence of “civilization?” Ask anthropologists, and they are likely to have disparate answers. Evidence of tool use? Agriculture? Art? Some would argue that the answer can be found in the Shanidar Cave. One of the skeletons is named Shanidar One, or Nandy, for short. His bones are dated to come from somewhere between 60,000 and 45,000 BCE, and he was a relatively methuselan 30 to 45 years old when he died. But what was fascinating were the injuries he had: a fractured arm, a broken neck, evidence of a hemiparesis, and a left orbital fracture that would have caused a severe unilateral visual impairment. This guy was not great hunting material. The incredible thing about these injuries was that they occurred approximately a decade before his death. This would mean that he was taken care of, fed, ministered to, included. His community kept him alive, even though his immediate value to them may not have been great. This scenario plays out again and again in Neanderthal bones the planet over. Evidence of caring for others, in fact, goes back even further, a good half-million years, to Neanderthal's ancestors in Spain, with remains found in the evocatively named Pit of Bones, where injuries were permitted to grow old. ‘Groundhog Day’ Of course, so much of this is speculation. We don't really know what went on. But it is certainly agreed that one of the markers of civilized societies is caring for those who may not have much to give in return simply because they are one of us, our brothers, connected. And perhaps we are wired to do so. It's just the way we were, as proto-humans, and are, as humans. It could possibly explain why we just keep coming back to work. Keep clocking in, just like “Groundhog Day.” Incidentally, a propensity for looking after our fellow creatures is not the only thing Neanderthals and their forebears have given us. You will recall that Homo sapiens did not descend directly from Neanderthals but from the species that out-evolutioned them, Homo erectus. Categorical evidence now shows a good deal of cross-species partying (read: interbreeding), and modern humans have anywhere from one to four percent Neanderthal DNA. This DNA, oddly, codes for some of the most troubling autoimmune diseases we modern (OK, debatable) humans suffer: biliary cirrhosis, Crohn's disease, and even type 2 diabetes. The yin and the yang. What does any of this mean? Likely nothing. Unless you want a reason to get out of the car and stride into work with the excuse that you are coded to care for others, no matter the primitive war-like state of your department. Anything that works, I guess. Share this article on Twitter and Facebook. Access the links in EMN by reading this on our website: www.EM-News.com. Comments? Write to us at [email protected]. Dr. Johnstonis a board-certified emergency physician, thus the same as you but with a weird accent. She works in a trauma center situated down the unfashionable end of Perth, Western Australia. She is the author of the novel Dustfall, available on her website, http://michellejohnston.com.au. She also contributes regularly to the blog Life in the Fast Lane athttps://litfl.com. Follow her on Twitter@Eleytheriusand read her past columns athttp://bit.ly/EMN-WhatLiesBeneath.