Isolation (Part 12)

Posted by Jeremy Windsor on Apr 18, 2020

Last week Piotr Szawarski, Consultant Intensivist and DiMM holder, shared his thoughts on the current pandemic. Struck down with COVID-19 he's back again with more...

"Instead of a planned tropical holiday away from the NHS we are stuck at home. Not only that, both me and my better half are suffering the onslaught of a viral attack on our bodies. COVID-19 is ruthless, unpleasant and vile. We are hanging in there. The belay is strong. Love, friendship and professional support. The daily statistics of deaths add to the anxiety. Our kids are great and in spite of their young age behave in a very mature way. It helps. 

A few months ago I bought a special National Geographic Issue - Atlas of the Ancient World. I am making the older one, Alicja, read it on a daily basis going through different civilisations she has encountered either through school or on her travels. On the subject of ancient Greece there is a short piece on Alexander the Great and his untimely death aged 32. It says there that Alexander the Great died of fever … or poison. Those are two very different causes of death! One is natural and the other is not. Are there 2 potential versions of the truth? Which one should we pick? What is the truth anyway? 

A lot of criticism surrounding the current pandemic has focused upon a lack of transparency. First, there was the attempt at suppressing the facts by the Chinese. More recently we heard about NHS workers being gagged over their claims over insufficient personal protective equipment. Then there was uncertainty about the actual number of the infected people and the lack of testing. Is transparency synonymous with the truth? Or perhaps truth is expressed through the daily statistics? We know those are inaccurate, but its what the media and government say - so at least it's the "official” truth. Are "facts” - synonymous with the "truth”? The former president of the United States of America, Barack Obama, knew a thing or two about dealing with the "truth”. In his book Audacity of Hope he wrote,

"Today’s politician understands this. He may not lie, but he understands that there is no great reward in store for those who speak the truth, particularly when the truth may be complicated. The truth may cause consternation; the truth will be attacked; the media won’t have the patience to sort out all the facts and so the public may not know the difference between truth and falsehood”

The conclusion must be - we don’t know the truth. We are given a version of the events by the media, which may sound more or less credible and may be based on more or less sound set of data. We are given some, but perhaps not all the facts. We don’t know. And the truth? That’s a tall order! "Facts are of no interest to me” wrote Tiziano Terzani an Italian reporter, writer and a thinker (and a sort of a hero of mine). The truth is more than mere facts. As doctors we know the distinction well.

Often we'll announce to a patient a presence of an abnormality on an chest x-ray. It is there, it is a fact. We can stop there. Aristotle, who was Alexander the Great’s mentor, might have asserted that what we say or believe is true, if it corresponds to the way things actually are - the facts. But without being a philosopher and making life more complicated than it should be, we know that "abnormality on the chest x-ray” is an unsatisfactory "truth”. It is not unlike the updates from the BBC telling us that COVID-19 infection has caused 2352 deaths in the UK and there 29474 positive patients out of 152979 tested (01.04.2020). On the surface, those are solid facts - just like an abnormal x-ray. The question is the interpretation of those facts in the light of other facts that are known to the authorities in case of COVID-19 and to the doctor in case of the x-ray. There is a big difference between saying either your chest x-ray is showing an abnormality, it looks like a patch of pneumonia, we will fix you with some antibiotics, or your chest x-ray is showing an abnormality, it looks suspicious for cancer, should we have a chat about what happens next? The discussion then moves beyond mere truth or facts. It is a question of candour which allows for expression of uncertainty and a degree of interpretation. It allows meaning to be attached to the bare facts. It allows for honesty, about the uncertainty surrounding the facts, and this is the only way to build trust. 

Candour can feel uncomfortable for both a doctor and a politician. But those on the receiving end appreciate it. They appreciate honesty. They appreciate the humility linked to a phrase “I don’t know”. With the current coronavirus pandemic the facts are almost overwhelming. The danger of hiding behind the facts without candidly trying to interpret them (however worrying the projections might be) is that we fail to grasp the truth. We may feel betrayed and the society’s fragile trust will be broken. And who knows whether it is fever or poison that will be the cause of death in the end…?"

Thanks Piotr - Get well soon!

Part 13 of "Isolation" can be found here.

Please get in touch if you'd like to take part in other "Isolation" posts! 

Stay safe.

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