What Is Disease?

One side effect of disease is that it has a weird habit of getting us to ask big dumb questions. Big, because they are questions that strike at the meaning of it all. Dumb, because they have no answer. But still we ask.

What is Life?

We grow up with all sorts of ideas about what life is supposed to be. We are lead to believe that in the course of life health is ‘good’ and disease is ‘bad’. But life has never heard the words ‘good’ and ‘bad’. To it, disease is just part of the whole.

All of us, at some point in our lives, start to have things taken away. People we know die, and over time, our own health fades. Then, our perspective on what life is changes. We learn that nothing is promised, that ‘bad’ things happen, and that through it all, nature ticks on, cold and unfeeling. Eventually, hopefully, we realize that it simply is what it is.

Yet, some of us are stubborn, and refusing to accept the cards we are dealt, we try to intervene in the things that go wrong in life. Using what knowledge and ingenuity we have, we try to figure out a way out of the problems life presents.

“The universe seeks equilibriums; it prefers to disperse energy, disrupt organization, and maximize chaos. Life is designed to combat these forces. We slow down reactions, concentrate matter, and organize chemicals into compartments; we sort laundry on Wednesdays. “It sometimes seems as if curbing entropy is our quixotic purpose in the universe,” James Gleick wrote. We live in the loopholes of natural laws, seeking extensions, exceptions and excuses. The laws of nature still mark the outer boundaries of permissibility – but life, in all its idiosyncratic, mad weirdness, flourishes by reading between the lines.”
― Siddhartha Mukherjee, The Gene: An Intimate History

Our most successful weapon in this struggle with life is, if used properly, science.

What is Science?

“If you believe that science provides not basis for God, then you are almost obligated to conclude that science provides no basis for meaning and, there for, life itself doesn’t have any. In other words, existential claims have no weight; all knowledge is scientific knowledge. Yet the paradox is that scientific methodology is the product of human hands and thus cannot reach some permanent truth. We build scientific theories to organize and manipulate the world, to reduce phenomena into manageable units. Science is based on reproducibility and manufactured objectivity. As strong as that makes its ability to generate claims about matter and energy, it also makes scientific knowledge inapplicable to the existential, visceral nature or human life, which is unique and subjective and unpredictable. Science may provide the most useful way to organize empirical, reproducible data, but its power to do so is predicated on its inability to grasp the most central aspects of human life: hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering, virtue.”
― Paul Kalanithi, When Breath Becomes Air

“Science is often described as an iterative and cumulative process, a puzzle solved piece by piece, with each piece contributing a few hazy pixels of a much larger picture. But the arrival of a truly powerful new theory in science often feels far from iterative. Rather than explain one observation or phenomenon in a single, pixelated step, an entire field of observations suddenly seems to crystallize into a perfect whole. The effect is almost like watching a puzzle solve itself.”
― Siddhartha Mukherjee, The Emperor of All Maladies

Within Science the branch responsible for figuring out all that goes wrong inside us is medicine. It is our most powerful tool in our attempt to coax life into doing what we want.

What is Medicine?

“Medicine is not a science; it is empiricism founded on a network of blunders.”
― Emmet Densmore, How Nature Cures: Comprising A New System Of Hygiene

“We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.”
― Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science

What Should Medicine Be?

“It is more important to know what sort of person has a disease than to know what sort of disease a person has.”
– Hippocrates

“Medicine is in the midst of a vast reorganization of fundamental principles. Most of our models of illness are hybrid models; past knowledge is mishmashed with present knowledge. These hybrid models produce the illusion of a systematic understanding of a disease—but the understanding is, in fact, incomplete. Everything seems to work spectacularly, until one planet begins to move backward on the horizon. We have invented many rules to understand normalcy—but we still lack a deeper, more unified understanding of physiology and pathology.”
― Siddhartha Mukherjee, The Laws of Medicine: Field Notes from an Uncertain Science

“Being mortal is about the struggle to cope with the constraints of our biology, with the limits set by genes and cells and flesh and bone. Medical science has given us remarkable power to push against these limits, and the potential value of this power was a central reason I became a doctor. But again and again, I have seen the damage we in medicine do when we fail to acknowledge that such power is finite and always will be. We’ve been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well-being. And well-being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when debility comes, but all along the way. Whenever serious sickness or injury strikes and your body or mind breaks down, the vital questions are the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?”
― Atul Gawande, Being Mortal: Medicine and What Matters in the End

“You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.” 
― Paul Kalanithi, When Breath Becomes Air

What is the point in all this? Death is the point.

What is Death?

“Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war that you cannot win, you don’t want a general who fights to the point of total annihilation. You don’t want Custer. You want Robert E. Lee, someone who knows how to fight for territory that can be won and how to surrender it when it can’t, someone who understands that the damage is greatest if all you do is battle to the bitter end.”
― Atul Gawande, Being Mortal: Medicine and What Matters in the End

“I began to realize that coming in such close contact with my own mortality had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew it acutely. The problem wasn’t really a scientific one. The fact of death is unsettling. Yet there is no other way to live.”
― Paul Kalanithi, When Breath Becomes Air

“There will be no one like us when we are gone, but then there is no one like anyone else, ever. When people die, they cannot be replaced. They leave holes that cannot be filled, for it is the fate – the genetic and neural fate – of every human being to be a unique individual, to find his own path, to live his own life, to die his own death.”
– Oliver Sacks, My Own Life

So what is Disease?

Disease is our reminder that things go wrong, and that one day, this will all end.

 “Diseases are molecules misbehaving; the basic requirement of life is metabolism, and death its cessation.” 
― Paul Kalanithi, When Breath Becomes Air

“In examining disease, we gain wisdom about anatomy and physiology and biology. In examining the person with disease, we gain wisdom about life.” 
― Oliver Sacks, The Man Who Mistook His Wife For A Hat

Above all, I have been a sentient being, a thinking animal, on this beautiful planet, and that in itself has been an enormous privilege and adventure.
– Oliver Sacks, My Own Life