the t ych ologis t res tor ing d i g n i t y to man and m e d i c i n e

by Stanley R. Gold, MD Fullerton, California

Emergency Medicine! Enthusiasm abounds for emergency medicine. Emergency medicine excites, colors and titillates the imagination. Emer- gency medicine reorients com- munities, reanimates hospitals, re- juvenates nursing, restimulates par- amedics, and rededicates physi- cians.

This new design in the medical art, this exciting awareness, this dramatic growth, this "emergence" of emergency medicine poses puz- zling and disturbing questions.

Why the phenomenal interest, the zeal, the fervor for this brand of medicine? What is its structure, its character, its method? What are its goals, its performance, its achievements?

We scrutinize its adherents. Who are these new converts? What is their caliber, their training, their standard ?

And what of its permanence? Is its existence threatened? Is this

burgeoning and proliferating new specialty too transitory, too nebu- lous, too perishable? Will it perse- Vere despite sweeping transition in the forms of medical care? And Should it survive, will it achieve Prominence?

All these questions yield to a simple answer, perhaps the more profound because it is so simple. It is embodied in the fact that emergency medicine is restoring dignity to a medical world filled with indignities.

GREAT INDIGNITIES

There are clearly no greater in- dignities heaped upon man than the calamities which produce con- fusion, pain, anguish and anxiety. Not frequently primary afflictions, these insults are a common de- nominator in patients with heart disease, trauma, sepsis, diabetes, hemorrhage, stroke. One could add an endless fist of additional indig- nities including those experienced when a cry of help goes unan- swered, a groan of pain unheeded. The indignity experienced on being forced to accept help from those untrained or ill equipped to pro- vide it must be set down. Or, more frightening, the prolonged agony and disability arising through ne- glect Or w.ant of proper support cannot be ignored.

Emergency medicine marshals those who would put an end to such indignities. It would see an end to the tendency to refer to an accident as a tl~l~g that "wil l hap- pen" and to ignore its definition as a disease with etiology, pathogen-

esis and pathophysiology, respond- ing to realistic therapeutic mod- alities and preventive measures.

Emergency medicine would see an end to the tendency to dissect patients into disease categories in time of trial. It would see an end to the treatment of parts and sys- tems, while ignoring the body in which these elements are con- tained. It would see a return to a holistic approach to medicine and the patients served by it.

Emergency medicine would dis- till the vital substance of all spe- cialties into a regimen for action. Such a regimen would emphasize what is common, rather than what is disparate, as the maintenance of an adequate airway is common, whatever the affiliction, or indeed, whether or not there is one.

Emergency medicine would seek, uniquely, and in stark contrast to all other specialties, to emphasize, in microcosm, "the essence" of human needs. It would sort and order these needs into priorities, satisfying those deemed to be highest, both within and between individuals, both within and without the hospital. It would develop and provide a logic in the service of such priorities.

RECOGNITION OF SPECIALTY

The recognition of a new logic, an order, a meaning, gives exist- ence to a specialty. Those who serve emergency medicine, who recognize this existence, are con- cerned with the dvelopment of its good name. As an appellation, "Emergency Medicine" has a most pleasing sound and there are few who espouse its interests who would quarrel with the title, "Emer- gency Physician." Yet already one finds much tampering with it. Most of this meddling arises from a de-

May/June 1972 Journal of the American College of Emergency Physicians Page 25

THE TYCHOLOGIST

sire to provide, in one name, the means to characterize a modern specialty while emphasizing a clas- sic heritage. Such Germanic atro- cities against the Greek as Oto- rhinolaryngologist surely arose in this fashion. Specialists in that field must shudder at its use as well as with the more popular and equally preposterous nickname,"ENT man."

Some specialists lean on the isolated organ or organ system for their name, as in the case of the Ophthalmologist or Gastroen- terologist. Others depend upon age as does the Pediatrician or on sex as does the Gynecologist. Still others set their name in social units: witness the newly named specialty of Family Medicine. And then there are those who are de- scribed by the methods they em- ploy and the goals they seek as in Physical Medicine and Rehabilita- tion.

Samuel Taylor emphasized the value of a good title and a good name when he said, with remark- able understatement, of Coleridge's poem, "The Ancient Mariner would not have taken so well if it had been called 'The Old Sailor.'"

DIFFERENT NAMES

Recently a residency program under the first Department of Emer- gency Medicine was funded for the purpose of training "Emergentolo- gists." This satyr-like neologism, juxtaposing the Latin "emergere" with the Greek "logos" creates, to many ears, a Greco-aoman war. Another bastard c o n s t r u c t i o n "Emergiatrician" has arisen with similar linguistic grafting. Shorten- ing the latter leads to "Emergician" which punningly alludes to the pos- session of the qualities of a ma- gician. Among other approaches, the frenetic activity in some de- partments has provided the hint that "Franticologist" should be considered. The quality of critical care in others promotes "Criticolo- gist." The primacy of care pro- vides "Primatologist." And the na-

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Out of the disparate past comes the incongruous Greco-Roman appella.. tion: the Tychologist.

ture of frequent patient complaints elicits "Trau matolog ist."

Aside from other gross deficien- cies, none of these names would enunciate what is unique to the specialty of emergency medicine. Nor does any possess a pleasing euphonious ring. This disturbing, endless, factious search for names seemed to yield only those that might detract from, ra ther than reinforce, present gains in the stature of emergency medicine. Communicating this dismal pros- pect to a kindly, elderly classics

scholar brought forth the response. "The Greeks always have a nam~ for it."

TYCHE AND THE GREEKS

And so they do! From the pages of Greek Mythology, after a brief but diligent search, emerges the goddess, Tyche, one of the Fates, daughter of Zeus, though there may be some dispute about her origin. She was represented in various ways by different cities, each of which had its own Tyche. She was regarded as a local

A charter member of ACEP, Dr. Gold is a member of the staff of the LAC-USC Medical Center's Department of Emergency Medicine. He is responsible for the training of allied professional people in EMS. Dr . Gold was graduated from Columbia University's School of Electrical Engineering and New York Uni- versity School of Medicine.

Page 26 Journal of the American College of Emergency Physicians May/June 1975

THE TYCHOLOGIST

guardian of the luck of a city for which she was worshipped.

The cult of Tyche was quite popular in early Hellenistic days, adherents recognizing in it promise of relief of Man's helplessness. A good Greek lexicon gives us for Tyche and its various forms: for- tune; by chance, by lot, by acci- dent; good luck or ill luck; what man obtains from the Gods--good fortune or ill fortune; event; oc- currence; hazard; being on the edge of fortune, ie, in extreme danger; calamities; misfortunes; disasters; and happy results.

With this breadth of meaning then, the word "Tychology" was coined. It is short, pleasing to the ear, and seems admirably suited to adaptation to any and all of

the concerns, i n te res ts , and achievements of emergency medi- cine. It should take the lead over "Otorhinolaryngology" by miles, if not by letters.

The popular tendency to ignore or even denigrate the classic back- ground of our arts and science may minimize excitement for words minted from classical forms that no one recognizes. It becomes something of a chore to identify oneself by a name with a recon- dite heritage. It consistently raises questions and always demands ex- tensive clarification. The pace of our society, and indeed, of our specialty, may deny such esoteric pleasures. For this reason, Tychol- ogy, unlike the Ancient Mariner, "may not take so well."

The names "Emergency Medi- cine" and "Emergency Physician" share this problem, though in les- ser degree. If they are to acquire both clarity and dignity, the spe- cialty must be ever responsive to patients and their pressing needs. It must place the immediate alle- viation of their suffering and the protection of their well being above all other concerns. It was with this goal, the promise of relief from helplessness, that the cult of Tyche was born in Ancient Greece. And, by whatever name, with this goal, emergency medicine will achieve eminence in modern times. [ ]

For reprints of this article write Dr. Gold at 1500 N Lindendale Ave, Fullerton, Calif 92631.

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May/June 1972 Journal of the American College of Emergency Physicians Page 27