The Burden of Knowledge

From a long time ago:

Some college friends of mine just had a baby with some complications- specifically, the kid has a congenital diaphragmatic hernia with subsequent pulmonary hypoplasia- ie his stomach and bowels are in his chest, so his lungs never developed properly.  I found out about this tragedy via the f-book when I noticed that they had posted their child's chest x-ray. Half of the poor kid's thorax was white-out, and my heart sank. I am by no means a pediatrician, but I've had enough training to spot the huge abnormality on the x-ray, to identify the abnormality as a diaphragmatic hernia, and to know how poor the outcomes typically are for diaphragmatic hernias. I've had enough training to know that Zeke, the kid, would need extensive surgery, and with it the substantial risks of infection and hemorrhage in addition to continued respiratory problems.  A glance at one photo and I knew what the outlook was for Zeke. In a word: bleak.

This is the trouble with amassing medical knowledge. Ignorance is bliss, as the adage goes. Prior to medical school, when I heard about someone's dad developing cancer I could sincerely hope and believe that "he'll be the exception to the rule. He'll come out of this ok."  But when you know the diseases and their mortality, when you really know the numbers and the odds it becomes tough to cling to miracles.  Realism sets in. And let me tell you, realism is a harsh bastard.

A perfect example is my friend Suj. When I was a bright-eyed and bushy-tailed second year med student my former housemate was thrown from a motorcycle taxi in Uganda. He wasn't wearing a helmet at the time, so his injuries were severe. When news of Suj's accident reached me and my other housemates, all of whom were ahead of me in school and well into their clinical years already, it was reported to us that Suj's GCS was 5.  FIVE!

The Glasgow Coma Scale (GCS) is a crude tool used to grossly assess brain function. The letters GCS meant nothing to me at the time of Suj's boda boda crash.  I didn't know GCS  from GPS, let alone what a 5 indicated. My housemates, on the other hand, knew full well what a GCS of five looks like.

To paint a picture, five looks a shade of grey away from death. Actually, it's 2 shades away. Literally. A dead person has a GCS of 3. Your regular bloke walking the street (assuming he's not inebriated) gets a GCS of 15, the max score. A GCS of less than 8 typically means a person needs a breathing tube because they're probably unconscious with significant neurologic deficits. My housemates had been in the Neuro ICU. They had taken care of people with scores of 5. They had the image and knew the likely outcome.  I, on the other hand, was ignorant of all of this.


I had left this post as an unfinished draft for well over a year. I returned to it today to finish it. Zeke has since died, and I have never known how to sum up this post in some poignant or hopeful way. Sure, knowledge is a curse. Reality is harsh. People die. Hope is hard. But if hope were easy, it wouldn't be such a special and powerful concept.