Heroes Not Zombies

One day a patient came to see me and I asked how things were. She replied, “not so good, my husband has been diagnosed with cancer and he’s been told he’s got six months to live.”

“Oh dear, how do you feel about that?” I asked.

“I’m angry”

Not a response I expected but I was interested to understand. “Why are you angry?”

“Well, how come he gets to know how long he’s got and I don’t get to know how long I’ve got?!”

This led to a discussion about certainty. I’ve never been a fan of doctors telling patients they have x months or years to live. Many people take it as a death sentence and either go downhill turning it into a self fulfilling prophecy or they reject it and soldier on.

The point is we can’t be that certain. The further ahead we look the less certain we can be. You see that every day with the weather forecast. But even over a short period of time we can’t be 100% certain. Thanks to diversity, chance and constant change, we cannot be certain.

But we crave certainty. We want to know for sure that we’re making a good choice. We would like to be sure we have at least another x years to live. (We would like to know the value of x!)

We want the pilot to be certain he’s pressed the right buttons, made the necessary pre flight checks. We want the surgeon to be certain they are about to make an incision exactly where it should be made. And so on…..

But, on the other hand, those who are utterly convinced of the rightness of their own views can be scary and dangerous people. From religious fundamentalists to despots like Hitler, Stalin, Mao or Pol Pot. To narcissistic politicians who refuse to tolerate any opinion different from their own (don’t we have way more of those than are good for us in the world just now?)

Or how about the “new atheists” who are so certain of their own position that they mock and dismiss anyone who has any faith? Or the so called “sceptics” who are so sure of their own “evidence” that they campaign to prevent others making different health choices?

When I was taught how to make a good diagnosis, I was taught to draw up a short list of possibilities….a “differential diagnosis” then to act according to the most likely one whilst remaining constantly alert, observing, examining, testing as time past, ready to drop the chosen diagnosis if the facts no longer fitted.

Maybe what we need is enough certainty to make choices and to live the life we want to live, but to hold those certainties loosely….ready to change and adapt as we encounter the ever evolving reality of daily life?