22 June 2005

What do I know?

Anthony de Mello once said: 'When you come to see you are not as wise today as you thought you were yesterday, you are wiser today,' and 'Wisdom tends to grow in proportion to one's awareness of one's ignorance.'

We physicians pride ourselves with our knowledge. We have conquered anatomy, physiology, biochemistry and all the clinical theory we can possibly learn in five years of medical school. Then we have specialised and again grappled with enormous amounts of scientific facts and applied them to our patients. When our patients ask us questions, we steel our faces and speak with authority. We know. We are all wise.

Even the language we use every day betrays that assumption. The word diagnosis means to know (gnosis) through-and-through (dia). And prognosis is to know in advance! How many professions claim to know even the future! How we pride ourselves with our knowledge.

Ironically, sometimes it is this knowledge that keeps us from truly learning and knowing. When I had finished my exams a year ago, the feeling was quite different. I had just been certified by a conjoint board of experts that my knowledge and skill was befitting that of a specialist. I overflowed with knowleedge, there was nothing I couldn't handle. Only a year but many difficult cases later, I have to admit I know nothing.

What do we really know? The evolution of medical science is testimony to how much we didn't know 10 years ago, and what we think we know now will be laughable in just 5 years. And what do we know of our patients besides the labels we give them? How does the man with cancer feel about his disease? What motivates him to seek treatment? What about death - how will he face it? How do our patients make sense of disease and death, where do they find meaning, how do they carry on? I think I have more to learn from them than I have to offer.

As a physician I have been given the privilege to be in such close contact with the rawest of human experiences - pain, suffering, death. What is the purpose of these? What were they put here to teach? What have I learnt? Are there clues about life and living that I have missed? Perhaps it is in the throes of suffering and inexplicable pain that we can find some answers.

But beyond that, there must be a sense of mystery. For what is science, what is medicine without uncertainty and mystery to keep us plodding and searching? Perhaps when I let go of what I know for a while, I might actually begin to learn...

"What, concretely, is Enlightenment?"
"Seeing Reality as it is," said the Master.
"Doesn't everyone see Reality as it is?"
"Oh, no! Most people see it as they think it is."
"What's the difference?"
"The difference between thinking you are drowning in a stormy sea and knowing you cannot drown because there isn't any water in sight for miles around." - Anthony de Mello

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