A Spoonful of Humility Makes the Medicine Go Down
Plus, I got vaccinated and an upcoming event at City of Asylum.
New column in Cancer Nursing Today
About uncertainty in health care and how common it is, even though we clinicians try to pretend it isn’t, creating confusion and consternation among patients.
A Spoonful of humility… (sing along if you’d like)
When I was a kid, my brother, who was just 16 months older than me, had his tonsils removed. After the surgery, he got to eat ice cream for 3 days, which struck me as a good trade-off. When I reached the same age, though, having had roughly the same number of colds and sore throats as my brother, not only were my tonsils not removed, but the very idea of routinely taking out children’s tonsils had become shocking. “Who would do such a thing?” seemed to be the question, ignoring that just a few months before, the answer had been, well…everyone. This change is an example of health care certainty evaporating, leaving confusion in its wake.
I’ve been reflecting on that uncomfortable clinical reality after a recent author event I hosted in Pittsburgh with The New Yorker writer Rachel Aviv. Ms. Aviv’s award-winning book, Strangers to Ourselves: Unsettled Minds and the Stories that Make Us, uses 6 patient stories, including Ms. Aviv’s own, to explore how psychiatric diagnoses and treatments affect individuals. The therapy offered to the patients Ms. Aviv writes about may or may not have helped them, and, in important ways, hurt them. Reflecting on this paradox, Ms. Aviv writes, “There are stories that save us and stories that trap us.” I realized afterward that this description applies to medical and psychiatric treatments.
My conversation with Ms. Aviv and reading her book showed me the problem with believing that our surgeries and drugs are always correct. Since they aren’t, as the examples I’ll discuss in this column show, I propose humility as a necessary clinical accompaniment to uncertainty. With apologies to Mary Poppins, the sugar of humility gives patients an important truth as they swallow their medicine: our treatments are the best available, but they could be rejected in the future and replaced with something better. In some ways, that’s even the hope as health care progresses.
Today was vaccine day
I got my flu and Covid vaccines today and preparatory to receiving these two shots I’ve been thinking back on some of the acrimony over vaccines that people expressed during Covid. Of course there was crazy stuff about the government using vaccines to monitor our movements. (First, who really thinks our government could and/or would do that, but second, Cell phones?!?!? Social Media?!?!?) And there was also the idea that the Covid vaccine made people magnetic. Puh-leeze.
But a phrase that recurred that seems worth commenting on is the idea that people who chose not to get the vaccine were not “afraid” of the virus, unlike we vaccinators. People on Twitter (X) also sarcastically said, “I’m getting my twentieth vaccine,” as if those of us being vaccinated were sheep doing whatever the medical authorities said was best regardless of how nonsensical it seemed to get shot after shot because the CDC said to.
Full disclosure—I’ve never met a vaccine I didn’t like. Before our trip to Africa two summers ago we got loaded up with the polio and hepatitis A and B vaccines, even though we’d all gotten the polio vaccine as children. We had to be vaccinated against Covid to get into Zambia and we would have needed the Yellow Fever vaccine if we had visited different countries in Africa. We also did malaria prophylaxis, which requires taking a daily pill, not getting a shot, but still.
I can’t say I’m not afraid of vaccine-preventable diseases, since they’re scary illnesses, but I can honestly say that getting vaccinated for me isn’t as much about fear as pragmatism. I could skip a vaccine and get really sick with a terrible illness that might kill me or leave me with ill effects for the rest of my life (e.g. Covid, malaria, polio), or not. Or I could get the vaccine and not get sick. Put like that, a one-time shot in the arm seems obviously preferable in terms of a risk benefit calculation.
“Pascal’s wager” is the famous idea from French philosopher Blaise de Pascal that we should all believe in God because the risks of not believing in God if there is a God are so much greater than believing in God if there is no God. Short version: spending eternity in heaven for believers vs. hell for nonbelievers. I have heard this argument described as deeply cynical, and maybe it is, but my argument for vaccines is not dissimilar. Millions of people got the Covid vaccine with very few long term side effects, and millions of people also got Covid and ended up dying or living with disabling sequelae for months, going on years afterwards. That is, not getting vaccinated may lead to no harm, or it may lead to great harm. Getting the vaccine is not 100% protective against harm, but it does pretty well, so why not get the vaccine?
The language of pragmatism is unlikely to sway those opposed to vaccination, but maybe it can lead to replacing the moral valence that now surrounds vaccines with something more morally neutral: doing a risk-benefit analysis. Vaccines have saved millions of lives and are an amazing public health success story. Let’s try to strip the emotional hyperbole away from their use and look at them as life-saving tools, no different from anything else in modern medicine.
City of Asylum Event, November 7 at 7pm
Please join me for this upcoming event in the Healthcare & Humanity Reading Series at Pittsburgh’s City of Asylum. I’ll be moderating a discussion with Greg Marshall, who will discuss his book Leg. This is a live and virtual event.
Coming Out of the Closet(s) with Greg Marshall
From the City of Asylum website:
As our Healthcare and Humanity Reading Series continues, we welcome Greg Marshall to share his debut memoir Leg: The Story of a Limb and the Boy Who Grew from It. Conjure the image of a teenager limping across a high school stage, or in a wheelchair after leg surgeries, pondering why he’s crushing on half of the Utah Jazz. Add to this a mom clacking away at her newspaper column between chemos, a dad with ALS, and a cast of foulmouthed siblings, and you have Greg Marshall’s early years. Years pass and you find Greg happily settled into his life as a gay man only to discover he’s been living in another closet his whole life: he has cerebral palsy. With wit, charm, and intimate honesty, Greg guides us through the particular trials and tribulations of his unique life so far in the extraordinarily funny and insightful triumph that is Leg.
Click the button below to read more and sign up.
I’ve given you a lot to think about. Please leave a comment and share your thoughts—I’m interested. Also, I was just in Miami at a nurses’ convention that SEIU (Service Employees International Union) holds every two years. I met so many great nurses and participated in a march. It felt good.
Hugs to all,
Theresa
❤️🙏
As you said, Theresa, much to digest in your most recent posting. The point about having humility is well taken, as even in this age of evidence-based practice, much of what we offer (with some exception) comes from consensus. And as you point out, that can change over time. The other benefit of humility is it keeps us grounded with patients, especially when we are having difficult treatment conversations; we can be open as to what we do and don't know about what therapies are available.
As to vaccines, I am a fan as well; I struggled when I was practicing to make sure that my patients obtained what they needed, even if that meant having challenging conversations with resistant individuals. Flu vaccine for smokers was the worst, to the point where one patient challenged me to guarantee that he'd have no side effects. I told him that I couldn't do that, as all treatments have a certain amount of risk, but that I would call him at his house this evening to make sure he was OK. He accepted this, took the shot, and later that evening, I called him at home. When he gruffly answered the phone asking who was calling, I replied that it was his doctor, checking to see if he was dead. We both had a laugh over that, and the next time he needed the vaccine, I do recall it was an easier process. One caution: I had to learn how to use humor carefully with patients, remembering that you needed to know your audience, never be condescending or smug, and always operate with gentle kindness.