Sunday, June 23, 2013

What Will Happen? Dealing With the Challenge of Uncertainty.

Three lives abruptly altered in a matter of minutes. For Henry, a hard working 65 year old engineer, it was a walk in downtown Ann Arbor that turned into a stroke taking half his mobility with it. Would he be able to build again? For 88 year old Angi, it was a doctor’s office visit that turned into a swirling sensation that led her to the brink of death two hours later. How long would her daughter get to be with her mother? For Alexi, it was the morning of his son’s wedding when he lost consciousness following a stroke, only found because he was late for the wedding. He doesn’t speak English. In fact, he can’t say anything right now. Will he speak in any language again?

Uncertainty. It’s an uncomfortable state. Medicine attempts to decrease uncertainty with percentages, trends, labels and precedents. But ultimately, nobody really knows what will happen. This week has been paradoxical in that the sickest and the oldest patients have actually turned out to fare better than those seemingly less afflicted. Again, uncertainty. So I have wondered this week, what is the healthiest approach to uncertainty? Is it to battle it with information, data and analysis? Should we constantly try to decrease uncertainty? I saw several strained expressions of family members this week eager for the doctors to answer what they should expect. Will Henry work again? Will Angi leave the hospital? Will Alexi speak? It would seem that the humane thing to do is to eliminate uncertainty, but that is often not possible. Then what? Platitudes? Well meaning but ultimately hackneyed sentiments like “Hang in there”? What is the best response to uncertainty?

I think uncertainty, though uncomfortable, can achieve something worthwhile. It can put our focus squarely on the present. We may not know where we’re headed exactly but the right now can be attended to. Angi’s daughter wanted to know if her 88 year old mother would make it. She listened stoically as the doctors explained what they were up against. I was impressed with her resolve given the intense, high stakes setting of the emergency room and the grim details of her mother’s condition. All of a sudden, her mother reached out her hand shakily, unsure of where her daughter was. Her daughter rose to grasp it and held it against her face. A few seconds later, tears streamed down her face and onto her mother’s hands. It was the expression of someone who did not know how much time she had left with the person who brought her into this world. By this point, the docs and residents were busy working on the next steps in her care as was appropriate. I felt I had to go to her. I approached  Angi’s daughter, laid my hand on her shoulder and just looked at her. I wanted her to know that she did not have to be strong at that moment. That it was OK to simply respond with whatever she felt. She looked at me appreciatively. I still have so much to learn in medicine that it’s kind of ridiculous. But I hope I will always recognize when such gestures are needed. If uncertainty is to be confronted, it should never be confronted alone.

A few days later,  my team and I were walking past Angi’s room. We all had a double take as we saw her sitting in a chair chatting with her daughter, both beaming. The story could have had such a different ending. We still don’t know where Henry and Alexi’s stories will lead, but uncertainty also means possibility. And so, who knows?

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