Producing a Deus ex Machina is an ancient literary device whereby insoluble problems in a story are rapidly resolved following the unexpected arrival of a god catapulted into the action by a machine. This god can perform miracles or rewrite the script so that the anxieties and uncertainties of the protagonists and playwright, if not the spectators, can be easily allayed enabling equilibrium, calm and certainty to be restored with little or better still, no effort. Like Atlas, much rests on the god’s shoulders. Woe betide the god who fails to function leaving the problems to persist and the participants remaining in a state of turmoil; the sooner the gods arrive and act the better.
In medicine, as in life, we both create and are these ‘gods from the machine’ sometimes imposed, sometimes by choice. In my own field of paediatrics, there are numerous examples. The government expects me to be able to identify those youngsters at risk of being radicalised, even though I am seeing them for enuresis, I am expected to identify children at risk of significant abuse merely by them not attending my appointments. The belief in me is so great that when things do not go to plan, it is invariably my fault. Recent local serious case reviews highlight the shortcomings of health even when the victims contact with us has been, at most, tangential. Nevertheless, I failed to spring from my machine to provide the solution. Safeguarding agencies expect me, when seeing a single bruise, to know who inflicted it, how and when. My stuttering words carrying more weight than years of evidence from the school and health visitor. Colleagues in primary care expect me to be able to resolve most problems with children, even those well beyond my experience, parents expect me to be able to anticipate the future and ward staff expect me to provide a balm to challenging parents. The list goes on. If I appear to succeed in my role, it is wonderful – doctors are often accused of believing themselves gods; when I fail, I have to deal both with the disappointment of my worshippers and acknowledge that I am indeed mortal.
In turn, I have my own gods. In a child with challenging behaviour, I expect the gods of child and adolescent mental health, social care and developmental paediatrics to convene and send a representative to deal with a problem I cannot resolve. I call on my tertiary centre colleagues to confirm a difficult diagnosis and certainly to manage impending sudden death. I depend on my juniors to see evermore patients and most frequently I create a god called IT which, if it functioned properly would solve most if not all of my personal and professional problems.
Zeus, or Jupiter, the king of the gods – is the Hospital and especially it is Emergency Department. It is here that all insoluble problems come, whether or not they have a medical cause. Every service calls upon the emergency department when all else is lost or all other services are closed and unresponsive. Reassuringly, the gods are expected to function in all walks of life, they are particularly required in education with schools and teachers expected to resolve all of the mental, sexual, emotional and physical health problems of their students.
I create my gods for a number of reasons, largely to appease a growing anxiety when I am unable to fulfil expectations, either my own or those put upon me by others. Their beneficent intervention allows my pride to be restored – it was me that called them after all. If things go wrong – and given that in reality the gods are merely actors like myself and the machinery man made, this is not uncommon, it is easier to blame the gods than to try and work out why I needed to call them in the first place.
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AC
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