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What Lies Beneath: Were Neanderthals the first EPs? : Emergency medicine news


compassion, caring for patients


One might wonder, what keeps emergency physicians coming back into the fray again and again? Of course, the salary, that salary and job security, health insurance and a retirement plan, and the other less tangible rewards: teaching the next generation, the thrill of intervening in the internal mutiny of the pathology, being an artisan of the body, spending your time among some of the best colleagues on the planet.

But much of the scrum isn’t that appealing right now. Emergency medicine is less and less attractive. Emergency departments around the world are becoming increasingly difficult places to work. The dangerous crowding, the violence, the demands, the bureaucratic incursions on the apocalyptic level – all those things that accumulate to cause moral injury and burnout. I suspect you’re in a tiny minority if you haven’t sat in your car wondering if you could cope with your shift, imagining what it might be like to just drive away.

I have often wondered this. What drives some of us in society to keep facing the coliseum? What makes us want to keep caring for our fellow human beings when sometimes it seems like they have no intention of caring for themselves or respecting us for trying?

Could it be hardwired into our DNA?

Caves and chasms

Let’s travel to Iraq for a moment. To a cave. Shanidar Cave in Kurdistan, to be precise, among the limestone folds of the Zagros Mountains. This cave is archaeological gold where inside its cool chambers seven well-preserved Neanderthal skeletons have been found. What the skeletons told us uprooted our ideas of what makes a civilized society and how far back it goes.

It’s an interesting question. What is the earliest evidence of “civilization”? Ask anthropologists, and they’ll probably get mixed answers. Evidence of tool use? Agriculture? Art? Some would say the answer lies in Shanidar’s cave.

One of the skeletons is called Shanidar One, or Nandy, for short. His bones are dated to somewhere between 60,000 and 45,000 BCE, and he was a relatively old Methuselan of 30 to 45 when he died. But what was fascinating were the injuries he had: a fractured arm, a broken neck, evidence of hemiparesis, and a left orbital fracture that is believed to have caused severe one-sided visual impairment. This guy was not great hunting gear.

What’s amazing about those injuries is that they happened about a decade before his death. It would mean he was taken care of, fed, cared for, included. His community kept him alive, though his immediate value to them may not have been great.

This scenario is repeated over and over again in the Neanderthal bones of the planet. In fact, evidence of caring goes back even further, a good half million years, to Neanderthal ancestors in Spain, with remains found in the evocatively named Bone Pit, where wounds could to get old.

‘Groundhog Day’

Of course, much of this is speculation. We don’t really know what happened. But it is certainly agreed that one of the hallmarks of civilized societies is caring for those who may not have much to give back simply because they are one of us, our brothers, connected.

And maybe we’re wired to do it. It’s just the way we were, as proto-humans, and are, as humans. Maybe that could explain why we keep coming back to work. Keep pointing, just like “Groundhog Day”.

Incidentally, a propensity to care for our fellow human beings is not the only thing Neanderthals and their ancestors gave us. You will remember that Homo sapiens are not directly descended from Neanderthals but from species that surpassed them, homo erectus.

The emphatic evidence now shows a good deal of cross-species partying (read: interbreeding), and modern humans have between one and four percent Neanderthal DNA. This DNA, oddly enough, codes for some of the most troubling autoimmune diseases we suffer from today (okay, debatable): biliary cirrhosis, Crohn’s disease, and even type 2 diabetes. Yin and yang.

What does all this mean? Probably nothing. Unless you want a reason to get out of the car and drive to work with the excuse that you’re coded to take care of others, no matter how primitive your department is at war. Anything that works, I guess.

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Dr Johnstonis a certified ER doctor, so the same as you but with a weird accent. She works at a trauma center in the old fashioned end of Perth, Western Australia. She is the author of the novel dust fall, available on his website, She is also a regular contributor to the Life in the Fast Lane blog at Follow her on Twitter@Eleytheriusand read its past columns at