What is it about our fragility that makes us feel so invincible?
I had a patient a few weeks ago that got me thinking about this. He was a HIV negative man currently having unprotected sex with his HIV positive husband. Before I went into see him I read in his chart that he had been counseled on the importance of using barrier protection and had refused. I was curious as to why. When I got to talking with him he explained to me that he made it through the 80’s – seeing many of his friends and lovers die – without contracting HIV. He stated that he should have gotten it, and since it didn’t happen then he felt that it wouldn’t happen now.
He felt invincible.
There was another patient I spent an absurd about of time with trying to convince him to adhere to his statin therapy. He was post-MI and had several other risk factors that according to our guidelines placed him in the group requiring him to take high intensity statin therapy. When I ran his work through the ASCVD risk calculator it came back with a result of 35% chance he would have a cardiac event in the next 10 years. I showed this to him and he exclaimed “That’s great!”…. It really wasn’t. But to him, a man who had survived a heart attack with very little impact on his daily life, this 2/3 chance of not having an event meant that nothing could touch him.
He felt invincible.
It’s not just patients that have this problem. I see it in myself and my friends.
In medical school, there is a mantra that we follow: “see one, do one, teach one.”
This means that when we are learning procedures we (maybe) get to watch one done and then we are thrown into doing them ourselves. This part of the culture of medical school makes it hard for those who are more cautious to thrive. In my first weeks of clinicals an attending offered for me to give an intra-articular cortisone injection and I jumped right in, and was commended for it. Another time when I hesitated before excising a squamous cell carcinoma from a patients arm, and was chastised for my hesitance. We are encouraged to jump into situations we are in no way confident about or totally prepared for, and those that love trying new things and are comfortable with not being comfortable, do really well.
Now this isn’t supposed to make you not trust your doctors or think that any time a medical student comes at you they are completely unprepared. During all the procedures I have done I always had a resident or attending right next to me with years of clinical experience under their belt ready to step in if I were to fail. Your primary care or specialist has probably been practicing so long that there is very little left in medicine that they are not prepared for (so don’t freak out, they do actually know what they’re doing).
These personality traits that are acquired or maybe (as in my case) are accentuated in medical school spill into all other parts of our lives. While I can think of many times in my life where this applies, one recent experience stands out above them all.
A month ago I did a solo climb of Mt. San Jacinto. To give some background – I am not a mountain climber. Before this I had never even attempted climbing a mountain (although to be fair, this is about the least technical mountain you can climb). When doing the minimal research that I did on hiking in the San Jacinto wilderness, I saw all the warnings about not hiking alone and to have all the proper gear. Did I listen? Absolutely not.
The night before my hike I received a phone call from my parents informing me that one of my friends, Brian, had gone missing. He had gone out on a solo hike the day before and had never returned. He was an experienced hiker who had climbed the mountain he was hiking on several times previously. Yet something had happened. And if an experienced hiker who knew the trail could completely disappear, what business did I have hiking up a mountain that I had never been on without anyone and with very little actual gear?
How little gear you ask? Well here is a list of some of the things I should have had with me, that I didn’t:
-Hiking boots (I wore my trail runners)
-First aid kit
-Enough water (towards the end of my hike I thought I was going to pass out)
-Albuterol inhaler (I have exercise induced asthma)
Somehow in spite of all my unpreparedness and this blatant example right before me of how dangerous the wilderness can be, I still set out bright and early that next morning for my climb. And you know what, it all went perfectly fine.
It all went fine until I came down off the mountain to a text message telling me that they had found my friends body and he hadn’t survived.
I was faced with the absurdity of my arrogance and the realization that this isn’t the first time I’ve knowingly put myself in a ridiculous situation, thinking that it couldn’t possibly happen to me. Is it a result of my youth or is it narcissistic carelessness? Could it be possible that the traits that allow me to thrive in medicine also tempt me to compromise my own health and safety?
Maybe this is why they say doctors make the worst pilots or why I am chronically putting myself in dangerous situations. Do we become too comfortable jumping into the unknown, confident that our general skills and knowledge will save us?
We feel invincible.
Until we don’t. Because we aren’t.