Diseases are ruthless. The real ones. Those that afflict human beings, persons. Someone's loved ones, someone's children. Not necessarily those in the textbooks; those are too neatly folded. Too precise. Too predictable. This is a lesson we physicians learn rather late into our training, at least that was the case with me. Brash certainty borne of assiduously memorized facts are challenged by reality. Completely convinced of a particular diagnosis after an elaborate history and physical exam, a puny blood test with normal result delivers a noxious blow to the plump ego of a diagnostician. An ego caressed by superior performance in classrooms, knowledge tests. A missed critical piece of information leads to an unwarranted pursuit that is a waste of everything good. An arrogant dismissal of some other colleague's ability blurs a perfectly rational treatment choice and on subsequent introspection flames an agonizing humiliation. Time and again personal hubris collides with objective reality that does not fit the smoothness of knowledge, certainty. It forces you to factor in uncertainty. It forces you to factor in non-conformity.
To perform well, we still need knowledge, more the better. We still need to memorize colossal amount of facts. But certitude is best left behind. Our treatment decisions are ultimately probabilities that have to dance with the unknowns of a complex human being. Those among us who are exemplary physicians are skilled at ranking facts, humble of the uncertainties that lie ahead, masterful at sensing patient's priorities and fears, motivated by utmost good faith in assuaging suffering. Ultimately, treatment we do is still a best effort. Not a guaranteed intervention. Reality continues to offer disappointments, surprises, gratification. Our personal hubris is clobbered, hopefully, in the process. We learn of a newer reality where our performance and expectations are appraised in relative certainties, relative successes.
We surrender our hubris to the ruthlessness of diseases. And try to cajole, trick, fool the disease wherever we find its weakness. It is not really a heroic job. A rather cunning and tedious one.
COVID-19 pandemic is ravaging the world. As of today, over 200,000 people are recorded deceased from the disease. The actual mortality is likely much higher as not all who died from the disease are tested, particularly in resource-starved countries. Newspapers report heart wrenching stories of lives lost. Young, old. Colleagues working heroically in healthcare settings.
While a pandemic is beyond the scope of my expertise, certain characteristics do not feel far off from what we see in clinical care- just magnified at a staggering scale. At this phase, uncertainty is the emphatic attribute of the disease. And we are best served recognizing this. All the understanding we have of the disease is based on very short-duration information. This disease has not played out in its full extent yet. So we do not even have a tangible data set of disease characteristics. Our interventions are guided by interpretations of these limited information that are likely to evolve continuously as more information is gathered. So the prime question is how best to make decisions when best practices are not known.
This quandary is a familiar sentiment for medical trainees (which we are lifelong to a varying extent) when confronted with a clinical situation where we have no previous experience or knowledge base to tap into. The usual remedy to this predicament is we draw on the wisdom of someone who has dealt with the situation before. Or someone who studies or researches these problems on a daily basis. Sometimes these are known problems to them and a simple resolution occurs with gratifying result. At other times, this is equally perplexing problem but they have broader insights into the overarching patterns and nuances. Their hunches are more likely to be successful than ours. Recognizing and trusting these skilled persons is an art form as well. Better ones among us are better at doing it.
As we look at the global response to pandemics it is not hard to see who are doing better than others. And it is clear where the disease is met with hubris, society has not fared well. Unfortunately, the country I currently live in, my second home, falls into the category where disease was met with an utterly incapable political leadership crippled by cocksure callousness nurtured by sheer stupidity. It is painful to read or watch the news of the political response from the federal level. Conspicuously absent is a notion of grief in this ongoing daily devastation of human lives. Happening in thousands. In this nation, currently, grieving for others is a personal enterprise. It is not happening at a collective level. Shamelessness of political leadership is just stunning.
The devastation that could have been has probably been mollified somewhat by heroic efforts happening at local levels. But there is no doubt that lack of an organized humble leadership at the national level, that could avail the extraordinary expertise of extremely capable people who think about these issues everyday, has cost a lot of lives.
When a ruthless disease demands an agile response, a leadership whose sole qualification is brazen contempt for the lives and dignity of "others" does not seem to be a good match.
To perform well, we still need knowledge, more the better. We still need to memorize colossal amount of facts. But certitude is best left behind. Our treatment decisions are ultimately probabilities that have to dance with the unknowns of a complex human being. Those among us who are exemplary physicians are skilled at ranking facts, humble of the uncertainties that lie ahead, masterful at sensing patient's priorities and fears, motivated by utmost good faith in assuaging suffering. Ultimately, treatment we do is still a best effort. Not a guaranteed intervention. Reality continues to offer disappointments, surprises, gratification. Our personal hubris is clobbered, hopefully, in the process. We learn of a newer reality where our performance and expectations are appraised in relative certainties, relative successes.
We surrender our hubris to the ruthlessness of diseases. And try to cajole, trick, fool the disease wherever we find its weakness. It is not really a heroic job. A rather cunning and tedious one.
COVID-19 pandemic is ravaging the world. As of today, over 200,000 people are recorded deceased from the disease. The actual mortality is likely much higher as not all who died from the disease are tested, particularly in resource-starved countries. Newspapers report heart wrenching stories of lives lost. Young, old. Colleagues working heroically in healthcare settings.
While a pandemic is beyond the scope of my expertise, certain characteristics do not feel far off from what we see in clinical care- just magnified at a staggering scale. At this phase, uncertainty is the emphatic attribute of the disease. And we are best served recognizing this. All the understanding we have of the disease is based on very short-duration information. This disease has not played out in its full extent yet. So we do not even have a tangible data set of disease characteristics. Our interventions are guided by interpretations of these limited information that are likely to evolve continuously as more information is gathered. So the prime question is how best to make decisions when best practices are not known.
This quandary is a familiar sentiment for medical trainees (which we are lifelong to a varying extent) when confronted with a clinical situation where we have no previous experience or knowledge base to tap into. The usual remedy to this predicament is we draw on the wisdom of someone who has dealt with the situation before. Or someone who studies or researches these problems on a daily basis. Sometimes these are known problems to them and a simple resolution occurs with gratifying result. At other times, this is equally perplexing problem but they have broader insights into the overarching patterns and nuances. Their hunches are more likely to be successful than ours. Recognizing and trusting these skilled persons is an art form as well. Better ones among us are better at doing it.
As we look at the global response to pandemics it is not hard to see who are doing better than others. And it is clear where the disease is met with hubris, society has not fared well. Unfortunately, the country I currently live in, my second home, falls into the category where disease was met with an utterly incapable political leadership crippled by cocksure callousness nurtured by sheer stupidity. It is painful to read or watch the news of the political response from the federal level. Conspicuously absent is a notion of grief in this ongoing daily devastation of human lives. Happening in thousands. In this nation, currently, grieving for others is a personal enterprise. It is not happening at a collective level. Shamelessness of political leadership is just stunning.
The devastation that could have been has probably been mollified somewhat by heroic efforts happening at local levels. But there is no doubt that lack of an organized humble leadership at the national level, that could avail the extraordinary expertise of extremely capable people who think about these issues everyday, has cost a lot of lives.
When a ruthless disease demands an agile response, a leadership whose sole qualification is brazen contempt for the lives and dignity of "others" does not seem to be a good match.
