Madness and chaos. That was what disease seemed to me, a medical student struggling for the first time with life and death in the hospital wards. Kind and generous patients suffered from horrific fates while the malingering and malicious fed off of the system's generosity without punishment. The hospital was a new and disorienting place in which the old rules, the old Reasons no longer seemed to apply. Who lived and who died was less a function of morality as it was of biological processes, lab tests, missing information, and elements of luck. In a world where so much was at stake, only the new reasons, the Evidence of hard data and tight correlations mattered. Even basic assumptions about standards of care were challenged and occasionally overthrown by the latest and greatest studies, and many reasonable, long-standing associations between health and disease disintegrated under closer scrutiny.
My own shift in perspective was subtle at first. I wasn't able to articulate my discomfort in the new environment until one of my friends began using "evidence based arguments" for everything. He would launch into political discussions with others and pepper them with the question, "Where's your reference? Show me the study." It was an irritating thing to do in the context of otherwise casual conversation, but the inflammatory nature came from the realization that most of what we say on a daily basis is complete bullshit and superstition. We speculate and make conclusions based on very little evidence because that is how we must deal with the complexities of daily life; we ignore and deny how uneducated and sporadic our decisions are because we would otherwise lose the confidence to act and survive from one moment to the next.
Something in me hardened. My faith in God, the Ultimate Reason, which had once been so strong, began to settle for lesser things. God may count the hairs on your head, but that number will be exactly zero once your chemotherapy is started. You can pray for a miracle, but if we don't amputate that leg tomorrow you might lose your life. Praying is good, but praying 20 hours outside in the snow is not; please restart your bipolar medications or we won't let you out of here.
And so prayer, something I once loved to do, became more an act of desperation and superstition than one of faith. To some degree it was because I didn't know what to pray for, but really it was because I was tired of being disappointed.
Curiously enough, I began knocking on wood and crossing my fingers. I started avoiding words like "quiet" and "slow". At first I thought it strange that sensations of powerlessness and futility would inspire superstition and stifle prayer, but then I realized I was tired of bullshitting and really just wanted to admit that I didn't know I didn't know I didn't know.
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