This article is the 1000th published here since the site went live in December of 2007. I don’t keep track of this sort of thing, but the computer does and I couldn’t help noticing that the previous one had number 999 attached to it. So, big deal! All this proves is that if you’re persistent a lot of small numbers can add up to a bigger one, hardly a startling observation. But, it did stimulate a few random thoughts.
I’m not going to rehash If at first you don’t succeed or The tortoise and the hare or Slow but steady wins the race or Churchill’s Never give in, never give in, never, never, never, never—in nothing, … Rather, I’d like to consider ordinary getting on with the job. Woody Allen said that showing up was 90% of life. But you’ve got to do something after you’ve arrived otherwise you’d might as well have stayed in bed.
Consider the spectacularly gifted who lack persistence. Marlon Brando is a good start. It’s hard to think of an another actor with his innate talent. Yet he didn’t seem to value his craft and wasted the last half of his life with self indulgence. Leonard Bernstein is another example. He certainly persisted as a conductor, a craft he seemed to use as an excuse to avoid composing. Conducting is certainly an honorable and important profession, but there are always a lot of good ones out there to the point that one more or less makes no difference. Great American composers, which Bernstein might have been had he written music at a steady rate, are as rare as oganesson. Orson Welles is yet another grandly gifted but out of focus talent who would done a lot better had he been more persistent. Of course, the most incredible combination of genius and failure to follow through is Leonardo. He makes all shirkers of genius look like cavemen.
You could argue that people with this degree of ability are by nature diffuse, but consider some who were gifted beyond description, but whose persistence equaled their gift and thus yielded astounding results. Franz Schubert died at 31 leaving 1500 composition to posterity. Among these are a trove that include some of the greatest music ever conceived. One wonders how he found the time to put all these compositions to paper much less think them up. Obviously, there was no time for revision. His manuscripts look as if they came from the copyist.
There’s no surprise that the combination of genius and steady hard work produces results that are almost beyond comprehension. But what about lesser mortals? The world is full of artists and craftsmen who had little to say but continued to turn out stuff upon which nobody put great value. The world of limitless storage has made the music of composers who almost nobody has ever heard off instantly available. You want to listen to the music of Johann Georg Albrechtsberger? Somebody’s recorded some of it. Same for Reiner Bredemeyer. And I haven’t gotten to C.
Did they labor in vain? Aim too high? What about the rest of us who weren’t aiming at anything other than getting through the day or week. Are we living a life without a whiff of meaning? I don’t think so. Persistence and not giving up are not necessarily antithetical. There are also different varieties of persistence.
There are times when persistence is futile and recognizably so. Not to give up is foolish. Time to move on to something else. Sometimes persistence is less of a virtue than you might think. Consider the Empire State Building and then One World Trade Center. The former was built from start to completion in 13.5 months. The latter, which replaced the Twin Towers destroyed in the 9-11 attack, took about 11 years to build from the start of planning to completion. Obviously, construction technology had improved in the three quarters of a century that separated the building of the two structures. So, a lot more persistence was needed to overcome the bureaucratic inertia that had evolved in the interval and which was more formidable than technology .
Let’s move to medicine. It’s the only subject say about which I truly can say that I know more than most people. Both persistence and giving up are intrinsic to success in this profession. As I’ve said here several times, the purpose of medicine is twofold – to prevent premature death and to relieve pain and suffering. The first of these requires both persistence and knowing when it’s time to focus solely on the second. No matter how persistent we may be, all our patients are going to die. Even if they outlast their current set of physicians, they will die on someone else’s watch. I don’t wish to be overly morbid, but Ben Franklin’s observation about life’s only two certainties still prevails, though modern science has introduced a faint suspicion that the first of these might be adjustable. The second is more firmly based than the inevitable heat death of the universe.
Persistence in medicine is essential because its modern incarnation has become so complicated that that misadventure is, alas, the rule not the exception. The profession is inching closer to randomness, by which I mean that no one is in charge. Accordingly, no one takes responsibility for what goes on other than to mouth or display trendy slogans advertising the opposite of what is really happening. Stuff like: Service is Our Passion or We Care for the whole person – body, mind and spirit. The only hope to overcome the beast that is the medical machine is the individual physician, provided he is willing to place himself in the middle of heavy traffic and try to direct it into the right lanes.
Do not think that the barriers to effectiveness in medicine are deliberate. They are not. Rather all of us have contributed to the complexity of the delivery of modern medical care. We tried to make care available to all, when it already was. We had a large system of public hospitals funded at the local level. There was a substantial donation of free care by local physicians. In place of local arrangements, we’ve created a monster that devours time, money, and individualized care. And many if not most want to clone the monster. It’s such a behemoth that even the most persistent physician may not be able to protect his patients. Besides its very hard to live a life of constant persistence. One wears out.
The boundaries between persistence and obsessive-compulsive behavior may overlap. The trick is to know when to back off. In fact the former may morph into the latter when the locale changes. So, dear reader, it’s up to you to decide whether my continuing publication of articles nobody asked for in advance of their appearance is which of the two conditions just mentioned. Regardless, I’m still at it. You could ask for ask refund.