Tuesday, August 9, 2011

e Pluribus Unum (From the many One)

      Once I was a student of medicine. That was such a long time ago. It was filled with anticipation. Lots of stuff happening. There were things to learn; knots to tie, dressings to change and patients to please. I cannot forget of course the books. Oh yes the books. And there were many. And I loved them. They were big, no maybe the word huge would qualify them better. They were filled with diagrams and photos but mostly words. Some of the more strange sounding words that seemed to filter into my ears and stay, did so without much ado. It was like I was born to know them. The words were definite. They spoke of finality. They spoke about facts. They spoke about the known truth. They spoke about the human body as it existed then. 

What a wonderful love affair this was. From the embryo to this vast adulthood landscape, it was a journey of immense understanding worth undertaking! From a tiny germ cell to the trillions of cells joined up in perfect union and harmony to format us all. “E Unum Pluribus” would describe that better. Anyway life was great as the pages of the books got dog-eared and dirty and my mind filled up gradually with this and that.

And then came the internship, residency and fellowship years and the tomes disappeared while the thin weekly journals took over. The facts became thinly disguised, like the shifting desert sands; the landscape changed every time you looked at it.  This too was gratifying in its own right. Plumb with the nuance of progress was the slight itch and restlessness of understanding. I wanted to gain an advantage over disease. And how best to do it would be to cull through the thin journals and use that information to gather experience in real life, essentially to see if the data that I was reading fit the scales in real life. 

There were disappointments along the way but mostly the illustrated events seem to have a fairly robust tit-for-tat relationship. Life was fine now that the bandage dressing and suturing was a thing of the past and I could delegate that to the younger crowd, which kept filtering in.  And they in turn happily jumped at the opportunity. It is a strange case of leadership quality that is so pervasive in medicine that most fail to see it. Essentially you learn a process and then you teach it to the one willing to learn next to you. The process never stops. The teaching continued through part of academic life and through it though lesser and lesser time was spent in caring for patients

So life transformed once again into clinical practice. But here is where it got interesting. The diseases started to morph into the ugly and the strange and the bizarre. The pathologies became grotesque. The manifestations did not seem like the cookie-cutter factoids that I was used to, secluded behind the great halls of learning. Now the disparities in the kind of patients that were showing up at the doorsteps were strangely unique and not the ones that I had cared for in my past. The paradigm did not fit with my former mental landscape. It was back to the books again. This time however the journals were thicker and many, many more then what I had skimmed and read before. Each and every one of them appeared to have landmark studies. The data in these journals was chock full of graphs, numbers and details. Everything I read made some sense. Yet the very next month another study would refute the data from the previous one that had been rendered a gospel a month before. My natural cranial suture lines hurt from the exploding controversies within. This went on for a while, until one day, I decided it was time to look at the wonders of statistics.

That is when I learned the subtle nature of the world of probabilities. I discovered that everything could be an inference based on a simulated process derived from a part of the whole. Or to put it simply, one could use small numbers and through the “gizmatological” use of number crunching come up, expressing the premise one set out to prove. So everyone can prove their own premise by mathematical means and thus give credence to their study. Oh these became heady times. The splitting headaches, the conundrum of contrarian viewpoints seemed charged with deception yet imbued with legitimacy. “Oh what a web we weave in an effort to deceive,” is all I could think. And yet there were kernels of truth too in there. Now this became a time where, I had to do my own work to extrapolate real information. No more could I depend on the authors. And just when I was about to get comfortable with this thought, a rash of very bright and driven individuals decided to up the ante to gain fame and become the "Best of the Best." They decided to create data from “thin-air” and publish it. It all appeared legitimate. It appeared fool-proof and as all such behavior is wont to come to light, this did. Authors, found fabricating in an effort to “publish,” perished by their own sword. Legitimacy once again became an issue.

Back to the drawing board once again, I went. The once bright portrait of reality now faded appears smudged, in need of restoration. The art of the craft has yielded to the temptation. It is time for some of the journals to fold and the readers to realize that quality is definitely better than quantity. Instead of publishing every nuance and hiccup of the wayward cell, the basic framework needs to be understood. 

With the Social Media in full bloom there are many “doctor” experts touting scientific data that they don’t even comprehend much less understand. Maybe we should arm ourselves with enough knowledge to be able to decipher between those that know and those that pretend to know.

So here I am, back with the books and the journals trying to find the wonder and delight of the yesteryear. Some days it is there for the taking and other days it is wanting. Interesting as all things in life are; the pathology of disease starts in one cell or multiples of a single cell. 

And here in lies the “e Pluribus Unum,” from many, one; that the behavior of the many can be learned from the behavior of a single entity. 

The peaks of knowledge stand out from the valleys of ignorance. We need to see them both at a single glance. I am, become, the student of medicine again. The wonderful journey begins anew.

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