Reflection 10: Diagnosis

October 21, 2008

 (Copyright © 2008)

In the mid-1960s, I was in the hospital undergoing a week of diagnostic tests. It was a teaching hospital maintained by a distinguished university. Every day my doctor led students like so many white-clad ducklings to the door of my room, where they ogled me in my bed, and murmured faint quacking sounds out in the hall where I couldn’t hear what they said. I remember my insides being insulted in the most intimate fashion as if I wasn’t conscious or even there. But I was there and remember the week as painful, harrowing, and humiliating. It’s hard being reduced to an experimental subject on a par with a slab of raw pork. Barium enema, upper and lower GI series, Sigmoidoscopy—I remember them to this day.

Worst of all was the consultation at the end of my stay. I reported as instructed to the Great Doctor’s office, a huge, bare room with an ornate desk in the middle facing the door. The room was dark, the only light coming from a green-shaded lamp on the desk, reflecting from my medical folder onto the heavy mass of my benefactor’s jowls from below. “I thought you had cystic fibrosis,” he said, “but you don’t.” Long pause. “What do I have?” “I don’t know, I have done everything I can for you.” I saw immediately it was my fault. I had made him seem unknowing and foolish in front of his ducklings. That was the end of that.


Thirty-five years later I found out I had celiac disease, and had had it my entire life. That’s what the Great Doctor might have found if it hadn’t been masked by presumed symptoms of cystic fibrosis. It was all out in the open; he just didn’t see it. Just as I didn’t see the mustard jar when it was right in front of me on the refrigerator shelf (see Reflection 3: Mea Culpa). Instead of mapping my symptoms onto his superior understanding, the Great Doctor had struggled to map his suppositions onto my innards. They didn’t jibe, so the case was closed. Except it wasn’t a case, it was my life, and I went confusedly onward as I had been going up till then, no wiser than before.


Consciousness gives us a chance to put our judgments out there in the world. And even more importantly, to evaluate how effective our actions are in accomplishing what we set out to do. It persists in a looping continuum, changing with the feedback we get. That way our true situation grows clearer over time. Our judgment improves, our actions become more appropriate to our circumstances as we come to understand them. Or it can if we let it by taking full responsibility for our awareness as a fallible guess or estimation. Which sometimes, as the Great Doctor illustrates, we don’t like to do.


Men don’t like to ask directions of strangers because it seemingly lowers their status. They like to be right all along. Consciousness is anything but rational. It has much to do with my place—my standing—in my social situation. That can have serious consequences in clouding our vision. Professionals don’t like to admit it when they are wrong. They often press on when they might well rethink what they are doing. Carry on Pretending, the Brits might call it, if they made consciousness into a movie. As they could do in producing a documentary about the causes of the current credit crunch, or conduct of the Iraq war. Men bring such things about because they, like my doctor, aren’t paying attention to, or even looking for, feedback. They continue to roll right up to the crash.


Women, unlike my doctor, tend to care more about social situations, and about maintaining them in good order. They thrive on feedback (sometimes called gossip), and tuning their judgment to the facts as they come in. They care primarily for and about people more than they care about reputations or status. That’s a gross generalization, but my life experience tells me there’s something to it.


As I have said before in this blog, we find what we expect to find. And if we don’t, then we can take that as an opportunity for redefining our search. Consciousness is a rough estimation that can grow sharper through trial and error. In fact, in my case, that’s the only way I have learned anything in my life. By falling on my face, picking myself up, and wondering where I stepped wrong. Then taking care to avoid such missteps in the future.


We are all diagnosticians, trying to figure what has gone wrong and how we can fix it. Consciousness has a lot of play in it, room for error. Our merit and survival depend largely on expecting that error, and being prepared to do something about it when it crosses the threshold of awareness.




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