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Differentials: How Are They Affected by Personal Biases?

Submitted by on April 11, 2017 – 10:26 PM

M9201338-Doctor_reading-SPLThe Hourglass:

Do but consider this small dust,
Here running in the glass
By atoms moved;
Could you believe that this
The body was
Of one that loved?
And in his mistress’ flame, playing like a fly,
Turned to cinders by her eye?
Yes; and in death, as life unblessed,
To have expressed,
Even ashes of lovers find no rest.

-Ben Johnson


Let’s examine this poem from the lens of a forlorn male lover who resents his beloved’s callousness, and how it has left him embittered, defeated. Her mighty flame has charred him metaphorically to ashes which, like the shifting sand in an hourglass, are writhing in pain. Still, he finds no rest — he still yearns for her.


The use of metaphor here enlivens the meaning all the more; almost down to a cliché, an hourglass figure is nearly always indicative of a woman and her expansive contours. What if the hourglass is the cruel diva whose beauty and haughtiness sustains itself on the suffering of the sad beau? It is their dust and cinders that she wants to reduce them to and draw her pride from. Their ashes reside in her.


Now, let’s swivel the tubes of our microscope and consider the specimen before us with another lens — this time, a philosophical one. Suddenly, the poem seems suffused with esoteric implications; this is a poem about life and afterlife and the inherent unrest of Man. An hourglass is an enclosed space with two bulbs, between which the sand or mercury flows repeatedly. It could be symbolic of the continuous cycle of life and death, much akin to Buddhism’s notion of Samsara.


The fact that the poet uses the word ‘dust’ instead of sand or grains (as is normally expected in an hourglass) is also noteworthy. Dust is associated with free landscapes. It can swirl, fly, blow to distant places.


But here, it does not. It is trapped within the hourglass, where there is flow of time and a visible flux of atoms. But no new state is ever attained, no nirvana. This dust is us, hovering between worlds, trying to find meaning and liberation, but failing to do so.


The cardinal and the most uplifting emotion of human life is certainly love. The writer could have used the example of material successes but prefers to choose the image of a mistress and the man’s love for her as the ultimate joie de vivre that we can all intuit. However, does love still offer the ultimate catharsis to the spirit? Is it the final destination? Does it relieve us of the suffering of the Ego?


The mention of a fly reminds one of fireflies, which too we often see as a metaphor in the context of romance and the briefness of life. Man plays like a fly and is ultimately turned to cinders by the beloved’s attentions, her ‘eye’. This is not the typical tragedy of a cold-hearted lady and love-sick sighs, but a very serious engagement with deeper matters of life.


The question is — why this exercise of different viewpoints on a medical blog? It is to illustrate the idea of how an object before us may appear different, simply depending upon how we choose to see it. In this light, this is no longer an impartial, cold-logical examination. The observer interacts with it; his consciousness participates in the process of developing his theories.


The major challenge medicine faces in developing countries like Pakistan does not lie in the development of blockbuster therapies — let that job rest with the first-world crusaders. It is our practice that we can improve, our ethics and decision-making skills that we can build on.


Recently, while shadowing a general physician as an internee, a gaunt middle-aged patient came by. He looked delirious and could hardly stand on his own. His much younger, perky wife chirped concerned complaints about how her darling husband had been vomiting incessantly for the past few months, how terribly it hurt everywhere, especially in the neck, and how drastically his weight had dropped. Upon further inquiry, it was revealed that he worked at a casino, that this was his third wife, and that he often traveled to Thailand and stayed there for months.


Deftly, the tests for CBC, Hepatitis B and C, liver ultrasounds and — yes, and HIV were ordered. I was astonished.


Later, when the patient left, the doctor sighed, ‘God save Pakistan! Casinos and Bangkok spas! Sexual promiscuity on the rise.’ I nodded. It sadly did seem to be the case.


Three days later, the same patient came in, now completely collapsed. The tests were all negative — oh, good heavens! What was the cause? Finally the doctor examined him more thoroughly and called in for a lumbar puncture. It turned out the patient had tuberculous meningitis.


Just like the literature readers of the poem above, we too, as doctors, are readers of the patient who walks into our clinic. Despite all our crisp medical jargon and algorithms for diagnoses, we are after all still members of society, not free from cognitive biases, with our analyses hued by personal beliefs. We scrutinize the specimen before us through our filter systems and our own temperaments. It is hardly ever completely objective, as medicinal journals with standard clinical presentations cleanly appear.


We pick out snippets of information, anchor our internal hypotheses upon them, and set about looking for further clues to validate the initial inkling. And the picture that we form appears very valid indeed! The doctor here was sure to his bones that the patient just fitted the bill of a dandy whom he, outside the clinic in his general social circle, might not have trusted. This attitude was carried into his clinical decision-making.


He sought and found symptoms that confirmed his suspicion. A self-fulfilling prophecy. A very compelling AIDS picture. But then, if his assessment had been purely empirical and his examination exploratory rather than confirmatory for a pre-determined conclusion, he could have as well drawn out a strong meningitis picture and started the treatment right away.


In this case, thankfully, the patient survived. But this is not always so in a society where doctors believe their training ends in knowing simply the threads of this complex, multifaceted conundrum that is the human body. The doctor also needs to identify the threads that regulate his judgment and perceptions, the threads that connect him to society and the erroneous diagnoses he could weave out, if he is not cautious.


Coming up with different explications for a poem is beautiful. They all are convincing and in art, it does indeed equate to diversity. In medicine, however, it could lead to a fatality.



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