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Supercomputer: “The answer to the great question of Life, the Universe and Everything is…”
Programmer: “Yes…?”
Supercomputer: “42. It was a tough assignment”.
Programmer: “42? Is that all you have got to show for seven and a half million years work?”

In this scene from the TV series The Hitchhiker’s Guide to the Galaxy (1981) adapted from the book by Douglas Adams, the supercomputer Deep Thought explains to its programmers that after 7.5 million years of computing, it has calculated that the answer to the question of Life, the Universe and Everything is 42.

When I watched this series in the early 80s, I was as dissatisfied with the answer as the programmers were. Many people tried to explain the answer “42” but Douglas Adams rejected them all. He eventually explained that when writing this scene, he decided that the answer should be “something that made no sense whatsoever – a number, and a mundane one at that”. It was clear to me in 1981, that unfortunately Douglas Adams had not provided me with any answers to the question “What is the meaning of life?”

I tell the medical students it is commonly known that there are two inescapable certainties in life: death and taxes. However, I also explain there is also a less widely known third which is presbyopia. My university friends and I, from the class of 1995, have all unfortunately reached the age of 50 this year and this milestone for me has also coincided with the annoying onset of presbyopia. Menus in dimly lit restaurants require a search for the +1.5 readers which I had previously mocked older friends for doing. This new requirement for reading glasses and the arrival of some grey hairs have reminded me that I am indeed ageing and, contrary to my hopes, not immortal. As Forrest (Tom Hanks) says in the movie Forrest Gump (1994) “Mama always said, dying was a part of life. I sure wish it wasn’t.”

With this in mind, I have recently started to question my existence on Earth, and what, if any, purpose I have in life. I therefore thought I would describe some of my thoughts on solving this riddle. My desire to try and find some meaning to life has become more important now I have realised I am ageing. Life for me is no longer “like a box of chocolates – you never know what you’re gonna get”, but more like a toilet roll – the closer you get to the end, the faster it goes.

One source of inspiration would have to be Monty Python’s film Meaning of Life (1983). However, the only real idea comes from a TV presenter (Michael Palin) stating that the meaning of life is “Nothing very special. Try and be nice to people, avoid eating fat, read a good book every now and then, get some walking in, and try and live together in peace and harmony with people of all creeds and nations.”

Meaning from ophthalmology

Since this is an ophthalmology magazine and my work does monopolise the majority of my waking hours, can I find any meaning to life in my career? Most of my work in medical retina involves the management of age-related macular degeneration (AMD), with the average age of my patients being 83. This age unfortunately also brings a multitude of other medical conditions and every day is a constant and unsettling reminder of what lies in store for me if I am fortunate enough to reach this age.

In many areas of ophthalmology, such as cataract surgery, oculoplastics and cornea, the respective specialists can bask in the postoperative glory and the gratitude of their patients. However, in the world of AMD, it is really a case of ongoing disaster management. The glittering and impressive one and two year visual acuity outcome gains from the anti-VEGF clinical trials do not translate into practice in the real world, which in the majority of patients is really just slowing the progressive loss of vision to blindness in the long term.

Certainly, the management of wet AMD has improved significantly over the past two decades with significantly reduced rates of blindness. But these benefits are not obviously visible to myself day-to-day in the clinics or indeed to my patients, many of whom perceive the treatment to be of little or no benefit, even though quite clearly it is.

 

 

Therefore, the meaning from my work does not come from the not-so-obvious clinical results but more from the interactions with the patients and staff. When there is time to engage in some meaningful conversation with AMD patients, it is clear that many enjoy the chance to talk about their lives, which have usually been much more interesting and eventful than my own. In my intravitreal injection nurse training lists I get the patients to select their own choice of music through a Spotify Bluetooth speaker system, which helps their anxiety and often results in some good banter and laughter. The day is much more enjoyable with interactions such as telling a favourite joke to an anxious patient to relax them (What do you get if you throw a piano down a mine shaft? A flat miner) or gently teasing a Hearts football fan nurse about their team’s most recent result, with cryptic comments such as “Is your mother well?” or “Do you like Dundee cake?” etc. Which leads me on to the Dalai Lama.

“If you contribute to other people’s happiness, you will find the true goal, the true meaning of life”

Dalai Lama quotes are usually good for a Facebook or Instagram meme by a self-righteous friend. However, with the risk of being sanctimonious myself, the closest I have come to something that I believe could be the answer to the meaning of life is indeed a quote from the 14th Dalai Lama:

“We are visitors on this planet, we are here for ninety or one hundred years at the very most. During that period, we must try to do something good, something useful, with our lives. If you contribute to other people’s happiness, you will find the true goal, the true meaning of life.”

Returning to the movies once more, I think Bill and Ted have summed up the Dalai Lama’s quote in their movie Bill and Ted’s Excellent Adventure (1989) with the line: “Be excellent to each other.” So, readers, although it can be challenging to keep this in mind, especially when the commute has been messed up by the council digging up yet another road (which brings out in me a Clarkson-style rant), or the hospital computer system has decided to have yet another stroke, or hospital security has stickered your car again for parking illegally, I will sign off with the thought that to find meaning to your life, be excellent to each other. On that note, have a wonderful Christmas and to quote Bill and Ted’s wisdom again, make sure over the festive period to “Party on, dudes.”

 

 

Comment from Sudha Somanathan
I enjoyed this blog by Pete Cackett thoroughly and as a fellow ophthalmologist reaching the half century mark this year and also looking for the meaning of life, can identify with every thought expressed.
It was warm, witty and a pleasure to read. And loved the quotes by Michael Palin and of course Dalai Lama. Good ones to remember!
Sudha Somanathan, Ophthalmologist, East and North Herts NHS Trust

 

 

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Peter Cackett

Princess Alexandra Eye Pavilion, Edinburgh, UK.

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