Editor—Like Cuddihy,1 I have a life threatening illness. What I find interesting is how I can spend most of my time not thinking about my prognosis. Is this denial or wisdom? Calling it denial makes my relative comfort into a pathological mental mechanism. Perhaps I should not complain about it. Most of us prefer ignorance about how our sausage was made. I like to think that I'm learning that the future and the past actually don't exist except as they affect the present; that I won't live six months or 20 years but only today, and every today.
This does not make me avoid reasonable planning about the future and pleasurable and informative recollections of the past, because such activities are part of the present. When we go through training we do so because of our expectations about what we will do with it, yet the training itself, especially in retrospect, is as important and fulfilling as the future career.
Does my medical knowledge help or hinder? I am a psychiatrist, not a cardiologist, and have had to learn much cardiology to understand my illness (myocardial infarction, coronary artery bypass, ventricular tachycardia) and its treatment (many pills and an indwelling cardioconverter). But I find myself uninterested in the technical details, and I don't rummage through the literature to read about the risk:benefit ratios of various treatments and my estimated life span. Again: denial or wise acceptance of the inevitable?
I've learnt during my long years of psychiatric practice to have less concern about untangling the web of causality of symptoms and blind spots and more concern with marshalling intact skills. Do I encourage ignorance? At best we understand very little anyhow. I consider most important what we do with our limited knowledge.
References
- 1.Cuddihy T. Uncertainty—from different perspectives. BMJ. 2001;323:460. . (25 August.) [Google Scholar]