Read this article before my spoilers.
What a stunning op-ed in NYTimes by a medical resident at Stanford University. He certainly provides some cool insight into how statistics can be so cold and humans always gravitate towards instincts. As a person who has inside knowledge of the system, the detailed data, the perspective from both the physician and patient standpoint, it still was pretty difficult for him.
So many lovely lines in the article (italics by me):
“But this scan was different: It was my own.”
There’s always this eerie feeling when for once it’s about yourself.
“I learned a few basic rules. Be honest about the prognosis but always leave some room for hope. ”
does it really work…
“We never cite detailed statistics, and usually advise against Googling survival numbers, assuming the average patient doesn’t possess a nuanced understanding of statistics.”
then what do we do when this patient understands it, completely, or so he thinks.
“I still dissuaded them from looking up the statistics, saying five-year survival curves are at least five years out of date.”
indeed, most of our knowledge is out of date and incomplete. what then do we have to work on
“Mostly, I felt that impulse: Keep a measure of hope.”
“Physicians think a lot about these curves, their shape, and what they mean.”
think a lot, then?
“It’s impossible, irresponsible even, to be more precise than you can be accurate.”
still no answer
“One would think, then, that when my oncologist sat by my bedside to meet me, I would not immediately demand information on survival statistics. But now that I had traversed the line from doctor to patient, I had the same yearning for the numbers all patients ask for.”
“Now, instead of wondering why some patients persist in asking statistics questions, I began to wonder why physicians obfuscate when they have so much knowledge and experience.”
all those data and studies, and still largely helpless. do some questions not have answers, or are we far from it
” But then again, most of those patients were older and heavy smokers. Where was the study of nonsmoking 36-year-old neurosurgeons? ”
“Initially I wondered if all the stories referred to the same person, connected through the proverbial six degrees.”
“In a way, though, the certainty of death was easier than this uncertain life. Didn’t those in purgatory prefer to go to hell, and just be done with it?”
“The path forward would seem obvious, if only I knew how many months or years I had left. Tell me three months, I’d just spend time with family. Tell me one year, I’d have a plan (write that book). Give me 10 years, I’d get back to treating diseases. The pedestrian truth that you live one day at a time didn’t help: What was I supposed to do with that day? My oncologist would say only: “I can’t tell you a time. You’ve got to find what matters most to you.””
like questions without answers, lotteries without results, dice that never stop, stories without conclusions, they all haunt us, irk us, leave us with an unsatisfied feeling that is hard to shake off.
“Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew it acutely.”
“What patients seek is not scientific knowledge doctors hide, but existential authenticity each must find on her own. Getting too deep into statistics is like trying to quench a thirst with salty water. The angst of facing mortality has no remedy in probability.”
“I remember the moment when my overwhelming uneasiness yielded. Seven words from Samuel Beckett, a writer I’ve not even read that well, learned long ago as an undergraduate, began to repeat in my head, and the seemingly impassable sea of uncertainty parted: “I can’t go on. I’ll go on.” I took a step forward, repeating the phrase over and over: “I can’t go on. I’ll go on.” And then, at some point, I was through.”