A society that grows its own organs still can't grow patience

There is a ward on the third floor of the Lisbon Medical Commons where we grow hearts. Not metaphorically. In tanks the size of a wine cask, on scaffolds seeded from a patient's own cells, we culture the organ that a generation ago you could only inherit from the recently dead. The waiting list that once ran to five figures is gone. I trained in the last cohort that still remembered it, and I'll say plainly: this is the best thing my profession has ever done.

Now walk down one flight, to the offices with the good windows.

The chart tells a different story down there. The average tenure of a department chair at this Commons has climbed past thirty years on the same post. Cardiothoracic has had one head since before the grown-heart program existed. Nephrology's chair took the room when I was a resident and intends, by her own cheerful admission, to keep it "as long as I'm useful" — a standard that conveniently only she gets to grade.

I want to be fair to these people, because I am one of them, or was. They are not incompetent. Several are the best in the field. That's exactly the problem. The most persuasive case for never leaving is always made by the person most qualified to stay.

The queue we forgot to abolish

We solved the biological bottleneck and left the institutional one standing. Somewhere in this building are a dozen or so surgeons in their fifties (I use the word loosely; the Meridian therapies have made fifty a fluid thing) who trained for rooms that never open. They are attending physicians who will attend forever. One of them told me she's stopped counting the years she's been "next in line," because the line, she's realized, was a courtesy, not a promise.

We built a medicine that refuses to let the old parts fail on schedule, then handed the same refusal to the org chart. A body that never replaces its aging cells develops something with a name we all know. An institution that never replaces its aging leaders develops the administrative equivalent, and we haven't grown a therapy for that. I suspect we could. I also suspect the people who'd have to approve the trial are exactly the ones it would remove.

The defenders of long tenure make an argument that sounds like stewardship: continuity, memory, the hard-won judgment you can't fast-track. Fair enough — those things are real. What isn't real is the notion that the only vessel for them is a person who refuses to leave the room. We have archives for memory. We have succession for judgment — that's what succession is for, the deliberate transfer of a hard-won thing to someone who didn't have to bury a predecessor to receive it.

My colleague Noor Haddad has been writing about the sit-in outside the longevity clinic, the young people demanding the incumbents age out. Same disease, different ward. Here the incumbents wear white coats and speak in the reasonable tones of people who have never once been told no.

I asked the nephrology chair when she thought a good time to step down might be. She laughed, warmly, and said: "When someone's ready." Three floors of ready surgeons would like a word.