“Doctor, can I still get pregnant?” -a seemingly straightforward question, I suppose: quote her some statistics derived from her age, past history and current medical status. But in reality, it’s probably not a single question she’s asking. In many respects, it’s a philosophical question with many facets to consider; it requires a thoughtful reply.
Philosophy, as Michael Blake, a philosopher from the University of Washington once put it, is thinking in slow motion. I like that; it suggests that to answer something, to comprehend the various competing facets of a question, we need to take some time to consider both what is really being asked and whether our answer to it is relevant, sensitive, and in this context at any rate, representative of current thinking.
To make it through even a single day, we all have to make many unexamined assumptions about reality, not to mention about people and their beliefs, hopes and aspirations. Sometimes we assume they share our own opinions, see the world as we do, have the same or similar doubts, exhibit our own biases. But I suspect that this assumption will never properly address the question my patient posed. It may not even come close to answering it.
The question is a tree: it has roots and branches; and rather than existing in isolation, it is probably surrounded by other questions. To understand the tree, you have to understand the forest -or at least look at it in context.
“Can I still get pregnant?” -the very construction of the sentence suggests some of the worries and concerns that she has. It is, on first consideration, merely a question about her ability to conceive and if answered in that framework, is a number. A percentage. It is the product of an algorithm into which you feed her age, past history of pregnancies or diseases, and her current medical status and a type of answer appears. It is a type of answer, because it is really only a statistic -useful for a population of 40 year olds, say, but not necessarily this 40 year old. And what does 20% or even 50% really mean? The question, after all, was “Can I get pregnant?” -not, can a forty-year-old woman get pregnant. Not really; she is asking in effect: “Given what you know of me and my circumstances, my health, my body, do you think I can still get pregnant?” And she is asking for your opinion, not a legally binding statement. She is asking what you think…
And “still get pregnant” is important. In itself it hints at other questions: “At my age, is pregnancy even advisable?”; “What might be the problems I will encounter if I do become pregnant?” And “What would a pregnancy under those circumstances look like for me? And for the baby?”; “Are there disadvantages -long and short-term- that you can foresee, doctor?” Once again, you are being asked for an opinion -perhaps even a personal perspective (with all it’s biases and cultural nuances).
There is an uncertainty built into the very question that demands consideration. Perhaps she is unsure about whether even to consider pregnancy; perhaps it was something someone else had asked her -or even demanded she ask. Maybe she is asking for permission not to become pregnant…
What is inserted into an equation, determines it’s answer; the background of a question, the milieu -the forest in which it lives- should suggest the thrust of the response. There is often no correct solution; in fact that may not even be what is sought. Sometimes a question is more of a search for someone to listen, a hope for acknowledgement, a quest for agreement, than a need for an accurate reply. The skill is in recognizing what is being requested; listening not so much to what is being asked, as to what is meant by the question in the first place.
So the importance is in properly and sensitively analysing the question; recognizing that it is a series of probes for which a thoughtful response is required. It is usually not just a number that is wanted -although that may help to give some perspective to the subsequent analysis- it is a respectful appreciation of the concern and a realistic appraisal of the context. “Can I still become pregnant?” requires not only a judgment -even though that is certainly a part of it- but also an opinion: a thorough appraisal and a considered response; it is not necessarily even final: things evolve -questions as well.
It is thinking -and answering– in slow motion.