Blade Runner

Sometimes it happens during sign-in rounds: I hear nurses and physicians experienced in caring for patients talking about “cystics.” There, I will say it only one more time. People have diseases, they are not defined by them. “Are you a smoker?” the novice sometimes asks a patient.

I tell them, “Smokers don't quit. People who smoke—they can quit.”

Five years ago, during morning sign-in rounds, we discussed a patient with cystic fibrosis: 35 years old; likely to die soon; not cooperative, not happy, often angry, sometimes lashing out at healthcare workers, clerks, and residents. Not a “good patient.”

“Thirty five is pretty good survival for a cystic,” someone said.

“Not really,” I replied. “I am over 35, have three young children, and am looking forward to seeing my grandchildren. Who would be satisfied to die at 35?”

So now, sometimes, when discussing the care of patients with cystic fibrosis I ask the house staff if they have seen the film Blade Runner, a hardboiled detective thriller set in the future. A small group of replicants, synthetically engineered humans created as soldiers and enormously gifted physically and intellectually, return to earth to find their “creator,” desperate not to die in the prime of their lives, at the age of 25. They find their creator and, overcome with rage at his inability or unwillingness to help them, kill him.

Perhaps in the future, if therapies capable of prolonging life become available to a rich and fortunate few, almost all of us shall feel the pain and frustration that comes from living with the knowledge that we will in some sense die prematurely. In the meantime, I shall continue to recommend Blade Runner to every person who uses the term “cystic.”