A Physician’s Descent into the Abyss

BetterPathology.com, October 4, 2021

Next to my wife and family, medicine is my life.  I go to work in a hospital almost every day, and while I’m there, I’m focused on the patients whose blood, fluids or tissues come to my attention.  I give them the very best I can, not perfectly, but humanly.  Many patients aren’t aware that pathologists exist, but if you’ve ever been on a Hero’s Journey involving cancer, you know who I am.  I was there at your jumping off point.  I’m the one who signed your biopsy report, giving you the information needed to face the monsters of your quest.  I’ve never personally experienced cancer, although both my wife and I have fathers who did, but I see cancer up close daily, and I frequently encounter those on the cancer journey.  

Here’s a short summary of the Hero’s Journey.  A hero candidate is called out of ordinary, mundane life to go on a quest. The candidate initially resists but is eventually drawn to the edge of the abyss and outfitted for the journey.  Descending into the darkness, the hero enters a fantastic, dream-like world where rules of ordinary life don’t apply.  Think Star Wars, Alice in Wonderland, or Odysseus in Hades.  Real dangers are encountered, and sadly, not all heroes survive.  But those that do come back to the ordinary world changed, and they share their wisdom with the generations.  Joseph Campbell’s masterful articulations of the Hero’s Journey demonstrate that this formula transcends cultures and epochs.  Cancer survivors know what I’m talking about because they’ve been on a Hero’s Journey.

Although I don’t feel much like a hero, COVID has sent me tumbling out of my ordinary world into an abyss.  My pre-pandemic world was based on trust.  Physicians are taught to think for themselves, but to doubt themselves at the same time.  More than anything else, our education and training teach us that we just don’t know enough.  There’s always someone smarter or intellectually more energetic, someone who dives deeper or stretches broader than we can ever hope to do.  Yet there’s something about this humiliating self-awareness that gives us the tools we need to help those in the ordinary world with their ordinary health problems.  We frequently consult trusted references, colleagues, and experts, and as we do, it slowly begins to make sense.  Experience gives us confidence, and that confidence is transferred to our patients.  Physicians become the handles patients hold onto when the earth drops beneath their lives.

The pandemic has changed all that.  Physicians feel compelled to take sides.  You either stand with most of your colleagues and friends, medical associations, and trusted institutions like the FDA and CDC, or you stand with what has made sense to you throughout your career.  The pandemic has made this an either-or proposition.  Like 1984, it’s a battle between your thoughts and the thought police; you either participate in the Two Minutes Hate enthusiastically, or you risk vaporization.

My trust in the CDC began to wane in May when, in contradiction to my education and training, the agency insisted on vaccination of COVID survivors.  My trust was further depleted when I realized testing would not be used to guide vaccination decisions despite years of established pre-pandemic practice.  Now, there is contradictory information published on CDC and FDA websites, and disregard for approval and authorization processes.  Yet even the act of pointing out these discrepancies separates you from the herd like a calf in a cutting horse competition.

I have decided to stand for truth with the confidence instilled by my education, training, and experience, no matter what. There’s a lot in that “no matter what”—isolation, ridicule, coercion.  But if you don’t have your thoughts, you don’t have your humanity.  Humans are not required to believe alike, but they are required to believe.  I am determined to crawl out of the abyss, humanity intact, back into the ordinary world, dragging as much trust with me as I can carry.

Maybe some of my colleagues will identify with what I’m saying.