The Plague
Authors: Jerome Kassirer
Journal: BMJ (2007)

Camus's classic account of the plague in Oran, a coastal city in Algeria, is a moving portrayal of love, longing, exile, abandonment, loneliness, and the tragedy of separation. Some consider it an allegory of Nazi totalitarianism; others as a commentary on existentialism, the absurdity of life itself. Yet it is a lifelike description of the scourge of an epidemic and the futile efforts of Dr Bernard Rieux to cope with horrendously ill individuals and the spread of disease. Rieux, who had no effective treatment, often stayed at his patients' bedsides through their entire excruciatingly painful and prolonged deaths. The narrator (Rieux himself) sums up his thoughts thus: 

The tale he had to tell could not be a final victory. It could only be the record of what had to be done, and what assuredly would have to be done again in the never ending fight against terror and its relentless onslaughts, despite their personal afflictions, by all who, unable to be saints but refusing to bow down to pestilences, strive their utmost to be healers.

Would today's professionalism match Rieux's unselfish, dogged persistence and the personal risks he took in treating highly infectious patients? If anything we now seem to have far more opportunities to deal with pestilence. Examples readily spring to mind: HIV, bird flu, Ebola, anthrax, smallpox, and recrudescent polio. In these outbreaks most doctors never faltered in their professional commitment to treat highly contagious patients; many took risks of transmissible infections, needle sticks, and handling of contaminated specimens.

I wonder whether this time honoured spirit of professionalism will survive the social and organisational changes of modern medicine. Rather than stick with patients through thick and thin, many doctors work exclusively by the clock and, like Cinderella, morph out of their doctor role when their shift ends. The list of these new medical “shift workers,” including intensivists, emergency physicians, and hospitalists, keeps growing. It also encompasses the latest generation of house officers, who become excellent short term problem solvers but rarely see other doctors sticking with patients throughout their battle with illness and are rarely able to do so themselves. Will a new “shift mentality” impede doctors' commitment to the venerable tenet of the profession to serve the sick? Have we adequately pondered the unintended consequences of a medical system that forces house officers to leave their patients' bedside and to turn their care over to someone who may have less personal investment in their recovery? Will these changes usher in an altered professionalism that we had never anticipated, or will a new form of commitment emerge?

Camus reminds us that there are dead rats everywhere, that epidemics, wars, hurricanes, floods, and tsunamis create refugees, illness, and untold human suffering. Despite our modern social, political, and scientific progress these threats never end. All require an enormous cadre of physicians who will ignore the clock, grab a bottle of penicillin, and rise to the challenge. Will they show up?