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“Life is short, the art long, opportunity fleeting, experience treacherous, judgement difficult.” [...]on the evidence of referrals to our hospital's ethics committee, he would be right: each case presenting many versions of the good. By these lights, medicine's reasoned debates can seem trivial, almost drawing-room squabbles about life's thermostatic settings, not pressing conversations about what it means to be human, breakable, and only briefly alive on a troubled planet.

On May 13, 2023, Medicine Unboxed: Matter will be held in Kings Place, London, UK. The idea for this event was seeded in 2015 at our event on Mortality when Nick Lane, a biochemist, argued that the last common ancestor of life on earth was likely to have been a porous rock. That life arises from and is continuous with the world's matter ought not to come as a surprise, certainly not to practitioners of medicine who routinely attach scalpels or compounds to material flesh. But I wonder really how conscious of it we are. Because surely clear sight would garner better care—to all life, all humanity, its precarity, and to the earth that permits it. As it is, we emerge from a global pandemic, blinking at a world still steeped in injustices, war, and planetary attrition, all the while medicine focusing doggedly on the lengthening of human life—and then only for a select few.

Someone says the work must be very sad—the bad news, all the deaths—too sad to weather, day to day, for a career, to not burn out. Their face wrinkles to a shape of fatigue or grand wisdom or distaste, and their voice breaks from its singsong sympathy into other notes: embarrassment, disappointment, even rage—that sorrowful events intrude in this way, here at the business of progress. That they're wider than we hold them to be, more than just aberrations turned from at life's sharp edges, the way we turn our eyes from an eclipse. That the world, parallel to its joys, brims with sorrow. George Saunders, a novelist, sees this, sees us all labouring “under some burden of sorrow…that…its like had been felt, would be felt, by scores of others, in all times, in every time”. And we see it too, in medicine, in our topography of loss, but we are at odds with it. As surely we should be? At odds, not just accepting? Surely this is required of us, for the very conception of medicine? And surely it's necessary, and understandable, caught here in drifts of sorrow, that we move with caution? Perhaps, but not like this. Not through a culture that parades Lady Macbeth's maxim to “consider it not so deeply”; that favours its own analgesia over the attendant ache of caring well; that even diminishes care into some decorative frill.

[...]you, our patient, are: delightful; a tricky customer; hit hard with steroids; offered one last throw of the dice; a fascinating case; not at all chemotherapy material; the third glioma today; an oesophagus; a frequent flyer; and entering the terminal stages. Possibly, but any inadequacy of tools cannot justify the abdication of rigour, or a smug arrival at the frivolous—be it at a bedside, in the declaration of a hospital mission statement, or in an endless reel of saccharine hashtags. Human body with anatomical terms, Persian, 1893/Wellcome Collection CC-BY Sam Guglani is the author of Histories (Quercus, 2017) and the Curator and Director of Medicine Unboxed

[...]even in the throes of our tussle—surgeon mid-laparotomy, palliative care nurse titrating opiates, paediatrician resuscitating a child—we retreat behind a fence of knowledge and fear, safe from the fact and ache of our finitude; both ours and others'.To how death and life surface arbitrarily across differing luck, privilege, and geography—on a ventilator in old age or in the seconds after birth; punctured by bullets in a classroom or on the rubble of a street; starved or intravenously fed; waiting for simple analgesia or infused with precision drugs.How is it possible in the clamour of such progress that Berger's words, decades old, remain still true today? “We have been spared the obligation”, he wrote, “to commit ourselves to a choice concerning any of the issues which occupy three-quarters of the world as matters of life and death: such issues as racial inequality, the right to national and economic independence, the ending of class exploitation, the struggle for freedom (and survival) in a police state, [and] the abolition of famine.”