Monthly Archives: February 2018

It’s Complicated. That Cannot Stop Us.

I am a medical doctor. I was trained to look at a whole person, to evaluate and assess every human system – renal, cardiac, digestive, circulatory, hormonal, neurological, psychiatric, social, immunologic, and many others – and to keep my eyes and brain open to systems I might not think of at first. I was trained to think clinically, empathetically, and ethically. I was trained to advocate for my patients, to serve in their best interests at all times. I was trained that “hoof beats mean horses,” but to look for the zebras. I was trained to ameliorate symptoms while working to correct underlying disease and to look for ways to prevent disease from occurring in the first place. I was trained to recognize that causes of illness are multiple – that there is an interplay of genetics and environment, of biology and social factors, of pathogens and immune responses. I was trained to attack each of the underlying causes while looking at the whole person and keep his/her overall well-being in mind at all times. I have been trained to look for cause and effect, to understand human processes from the molecular to the sociological, to weigh risks versus benefits, to use scientific knowledge combined with psychological understanding and empathy to work to relieve suffering, and to work to provide the conditions that will be most conducive to health. It’s complicated as hell.

I am a parent. I was trained to distinguish my children’s hungry cries from their “I’m in pain” cries from their tired cries and many others – and to keep my eyes, ears, hands, and brain open to cry causes I might not think of at first. As my children grew, I was trained to listen not only to their cries and their words but also to what they did not say. I was trained to control my emotional thinking and combine it with my rational thinking while at all times keeping my children’s long-term well-being in mind. I was trained to recognize that there is an interplay of genetics and environment, of personality and friends, of strengths and stress. I was trained to combine my scientist’s mind with my mama bear instinct with my understanding of risks and benefits to work to provide the environment that would be most conducive to my children’s healthy, adjusted progression to adulthood. It’s complicated as hell.

I am a human. I have been trained to look at society globally and locally. I have been trained to rejoice in the goodness of humanity and to balk at the evil. I have been trained to recognize the interplay of psychology, sociology, religion, economics, philosophy, politics, technology, and more in how they promote good and how they promote evil. I have been trained to consider the risks and benefits of the manipulation and modification of all of the above. It’s complicated as hell.

I watched the footage two days ago of the high school in Florida with a lump in my throat, a rock in my stomach, and tears in my eyes. I watched and listened to the video taken by a hiding student and heard the gunfire that went on and on and on and on and on and on and on while children screamed. I now read the words and hear the voices and watch the faces of those grieving, of those lamenting, of those judging, of those blaming, of those who are sure they have the answers even though those with completely opposite views also are sure they have the answers. I listen to people discounting the arguments they don’t believe and discounting the people who hold the differing views. I look at this shooting and the ones that came before and the ones that will come after as an interplay of psychopathology, of sociology, of religion, of philosophy, of history, of politics, of ethics, of ineffective laws, of imperfect systems, and more. There are risks and benefits to the ways in which we address different aspects of all of the above. It’s complicated as hell.

I listen to very smart people for whom I have the utmost respect espouse combinations of diametrically opposed and surprisingly in-synch opinions. But during the discussions, the subject of which is so emotionally charged, the defensiveness kicks in, the self-righteousness kicks in, the name-calling kicks in, and these very smart people’s thoughts are almost immediately drowned out by the sounds of heels digging in and minds shutting down to ideas not already firmly entrenched in those minds. Unless the discussion is taking place in a venue only open to one opinion – then the discussion is infinitely more amicable but really not productive, since you cannot understand something and figure out how to deal with it if you only consider it from one vantage point. It’s complicated as hell.

What seems logical and obvious, what is taken as truth, is not infrequently wrong. This is nowhere more demonstrable than in the field of medicine. As medicine has evolved, we have looked at the theories, the treatments, the outcomes, and we have refined our methods continually. We delve into the basic sciences – the biology, the pathology, the physiology, and we figure out what the cause of an illness is and how to cure it and prevent it. We run trials. And we are frequently wrong. And when we are wrong, which we discover because we look at outcomes, we change what we do. We have come so very far by doing this. And we have done this not by dividing up into our own little labs or offices, but by listening to what the other smart minds have found. We don’t approach a patient with cancer just from a surgical angle, nor just from a chemotherapeutic angle, nor just from a radiotherapy or immunotherapy angle. We look at the disease from all the sides we can think of, we talk to one another, and we listen when someone thinks of another angle we hadn’t thought of before. And we think about the potential risks and benefits of each approach – there is nothing in medicine (including the option of doing nothing) that is without risk. It’s complicated as hell.

We need to hear the thoughts of people who approach the problem of gun violence from different angles. We need to look at the numbers. We need to verify the numbers. We need to evaluate risks and benefits to every approach. We need the minds of people who look at the problem differently than we do – we need a holistic approach to an enormous problem that is complicated as hell.

NRA members are as equally horrified as Moms Demand Action members by what happened two days ago. Republicans and Democrats feel equally as sick to their stomachs. And as long as no one trusts “the other side,” we will continue not to evolve, not to refine, not to fix this horror. I am currently gathering a select group to set a course of action. It will include Democrats, Republicans, centrists, NRA members, Moms Demand Action members, gun owners, gun haters, gun tolerators, people with backgrounds in mental health, people with backgrounds in education, people with backgrounds in the military, people with backgrounds in law enforcement, Christians, Jews, Muslims, people of other religions, atheists, agnostics, Blacks, Caucasians, people of other races, people from urban, suburban, and rural areas, and other areas of representation. We will develop a core set of goals and a core set of questions that need to be answered, numbers that need to be found. We will consider physical safety, civil liberties, societal factors, public health factors, racial factors, religious factors, physiologic factors, psychological factors, ethics, politics, and whatever else we come up with. It’s complicated as hell.

We will listen. We will discuss and argue with respect. We will find research that is objective and unbiased, and where that doesn’t yet exist we will outline the next steps for creating it. We will do this because there is no other choice. And it’s complicated as hell.