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Recent Newspaper & Online Columns by Kate Scannell MD

In healthy acknowledgment of life's uncertainty


By Dr. Kate Scannell, Syndicated columnist
First Published in Print: November 27, 2011

Like many Americans this past week, my friends and I shared a turkey feast and gave thanks for all that was good in our lives and the world. But this annual ritual is always difficult for me, because I also think about things for which I am not grateful -- the economic and political turmoil in the world, people starving and homeless, my patients who have suffered and died, and ...

Still, I routinely manage to keep my sadness private, off the proverbial table. Pumpkin pie helps. So does a little wine.

While listening to my friends' expressions of gratitude, I am profoundly impressed with the role that happenstance has played in shaping everyone's fortunes (and hardships). Personal intention and deliberate actions have certainly played defining roles, but, to a large extent, our lot in life is the "real" estate of providence and serendipity. Through no free choice or conscious planning, we are born into poverty or wealth, in times and places associated with war or peace, to good or bad parents, and with variable genetic odds of living healthy lives. Our survival and opportunities to flourish in the world largely begin "as luck would have it."

Recognizing luck's uneven hand in determining health and well-being, I am motivated as a doctor to help individual patients gain equal access to opportunity's front door, the one that opens to the so-called American dream. And I am deeply committed to universal health care as the road map we should use to help everybody get there.

It's not always popular to acknowledge the reign of luck and uncertainty over health and modern medicine. We doctors and patients want to believe we are the masters of our personal biology. Disease and aging can be overcome by our spirited and deliberate resourcefulness, fueled by American know-how and can-do-ism.

But here's a doctor's little secret: Despite our strong embrace of the scientific method and our dogged pursuit of evidence-based medical practice, we know that much of what occurs in research or patient care happens beyond our perceived control -- without our conscious intent or deliberate intervention. We generally don't know which patient with a particular disease will respond to a specific therapy. We don't know why many of our treatments work at all. We often stumble upon great medical discoveries that we hadn't been looking for.

In my profession, uncertainty and luck take center stage alongside all the scientific certitude and action calculus within the doctor's playbook. And when all of these operative elements are genuinely and openly acknowledged, it helps to keep us doctors and patients humble and in kinship with one another. It helps to keep us all closer to reality itself -- to the human condition, to what James Agee described as "the cruel radiance of what is." When we doctors and patients mutually understand and accept that while struggling against illness and peril, I am deeply grateful.

Of course, I am also biased about outcomes, wanting to land squarely on the good side of chance and uncertainty. So I am grateful for my patients who got well when all odds and solid medical reasoning defied that. I am thankful for the accidental discovery of my own cancer in the nick of time. I give thanks for the crazy errors that resulted in unintentional discoveries of lifesaving treatments -- like penicillin in a cross-contaminated Petri dish, or cardiac pacemakers through failed audio-recording experiments. I am delighted to read this week about the young girl who was saved en route to the emergency room when her mother's car bounced over a random pothole, dislodging the necklace stuck within her throat.

At dinner last week when it was my turn to toast, I raised my glass and said, "To the luck and uncertainty in our lives. May they be gentle with all of us."
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Kate Scannell is a Bay Area physician. Her most recent book is the novel "Flood Stage."

© Copyright 2011, Kate Scannell