musingsonwomenshealth.com

Reflections on 40 years as a doctor in Women's Health

Alone and palely loitering?


Although it seems a lifetime away, I sometimes try to cast my mind back to the thoughts that used to occupy me when I was young; when the world was still magical, and potentially infinite, things were different -or so they seem to me now, as I peer through the shower of my falling leaves.

I remember then being fascinated by ‘what-ifs’ -or what we would now call ‘thought experiments’. They didn’t require any equipment more elaborate than my own over-active imagination -my own naïve world-view- and for a time I was able to luxuriate in a place I thought of as Keats’ elfin grot: a hollow tree near my house in post-war Burnaby. I was, I suppose, only 4 or 5 years old, but I had asked my father to read to me from a beautifully bound book I’d seen on a shelf in the living room -a book of magic, I was certain. In it, there was a poem by John Keats: La Belle Dame sans Merci. I didn’t understand many of the words, of course, but I was taken by the idea of palely loitering with a wild-eyed faery who was living in a hidden cave somewhere.

The world was alive with enchanted things in those days: unexplained dreams, kind old sorcerers who had my best interests at heart, and faeries whose smile would protect me from the dark. At first, it seemed to me that wishing might be powerful, and that if I squeezed my eyes tightly enough and pretended as hard as I could, I could transform something into whatever I firmly believed I wanted…

Well, that phase didn’t last for long, I remember; despite my fervency, nothing ever changed -not really anyway. But I didn’t give up hope, I merely altered my focus: if something actually did transform I wondered, then what would be the consequences? They were only youthful thought experiments, I suppose, but they served to alert me to the chain of cause and effect -the possible results of an action.

And when you think about it like that, there is something compelling about a thought experiment isn’t there? Brushing aside for a moment, the hubris of believing that the mind could possibly anticipate all of the ramifications of changing something physically outside of its purview, it is cloyingly seductive, if naïve. But, as well as imagining magic kingdoms, children still have to play in the real one: they hypothesize, then experiment to understand the consequences. We lived in both worlds then; I suppose I still do.

As I hurried through the years, the seduction of playing with ideas, and toying with ‘what-ifs’ continued to fascinate me. True, in my career in Medicine I was thoroughly committed to the daily empirical realities which continued to confront me. But that didn’t stop me wondering about ‘what-ifs’: what if there were a better way to put patients more at ease when they visited my office, for example.

I realized that whenever I was a patient visiting my GP, I felt somehow commodified by being asked to wait in a large, impersonal waiting room until the doctor -hopelessly overbooked- could see me. In fact, I was uncomfortably reminded of waiting in a government office for my driving licence renewal, or whatever. You know the drill: you’re asked to tear off one of those numbered slips until it shows up, half an hour later on a screen. Personhood is dissolved; you’re simply a number.

But, what if there were a way to make people -patients- feel they were special? They were already anxious about their conditions, their illnesses, their concerns, and then they were often forced to ruminate about it in what they likely thought of as an auditorium, a holding tank for various different medical and surgical specialties. What if they were simply coming for a prenatal check, and needed to share the waiting area with someone who had a barking cough, or perhaps a malodorous skin condition…?

Well, as a specialist in obstetrics and gynaecology sharing the office with a colleague in the same field, it was perhaps easier for us to soften the waiting area with paintings on the wall, and green leafy plants in corners, toys for the children, and picture books for them to look at, while their mothers browsed through magazines.

And my consulting room was much the same: soft (albeit classical) music, paintings, plants, terra cotta statues, and large window. Also, at least in the early days, there was no computer screen on my desk that separated me from my patient -just a paper in a chart on which the patient could see me writing whenever she answered a question -a direct positive feedback, as she realized she must have said something I thought was important, something that might be useful for her problem.

Of course, that is not much of a ‘thought experiment’, I realize. It certainly doesn’t compare with those of Einstein, or the perhaps Galileo’s idea that heavy objects and lighter objects must fall at the same rate.[i] In these ‘thought experiments’, knowledge seemed to arise from within the mind, rather than from some external source.

Still, to determine whether or not an idea actually ‘works’, eventually requires objective evidence to validate the concept, doesn’t it? So would the idea that suggestion and reassurance might help to alleviate pain, count as a thought experiment, when its premise could only be confirmed by empirical observation? After all it could simply be a placebo effect…

We’re back to the push and shove of empiricism again… the Scientific Method of hypothesize, experiment, and then observe. Are thought experiments merely extrapolations from what we already know -if only through a glass darkly? After all, our minds don’t exist in a vacuum, they work by using things about the world that they’ve managed -however unconsciously- to store away.

But I find myself drawn to a rather unusual thought experiment conceived by the philosopher Bertrand Russell (although, admittedly, about the existence of God) in which he asked us to imagine that there might be a teapot orbiting between Earth and Mars, too small to be seen by our telescopes; his point was that, just because nobody could prove him wrong, did not mean that the teapot actually existed. There is usually no habeas corpus, in thought experiments is there? They are sometimes just clever rewordings of the chicken-or-egg conundrum…

Anyway, I’m probably as tied to empiricism as any physician: I am more comfortable with proven remedies, and yet… And yet, I can still hope there is an elfin grot somewhere out there that we haven’t yet found… can’t I?

[i] https://aeon.co/essays/do-thought-experiments-really-uncover-new-scientific-truths

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