The Tragedy of Preconceived Notions
Among the top stories in the New York City area during the past two weeks has been the tragic death of a 12-year-old boy who was sent home from the emergency room with a fever and and rapid heart rate before his blood tests came back revealing a bacterial infection—sepsis—that killed him three days later.
This was all following a cut the boy, Rory Staunton, sustained while diving for a ball when he was playing basketball in his school’s gym. The next day, vomiting, feverish, and with pain in his leg, his pediatrician sent him to the emergency room. The doctors all suspected that Rory was suffering from dehydration. He received fluids, some Tylenol, and was sent home.
Medical records published in The New York Times show that even his vital signs indicated something was terribly wrong with Rory when he was discharged, yet he was discharged anyway.
This story is not all that dissimilar from that of Aimee Copeland, the University of West Georgia psychology student, who contracted necrotizing fasciitis from a cut in her leg while ziplining. While emergency room doctors in the local hospital closed the wound with 22 staples, the bacteria had already gotten into her system. In pain, she came back to see doctors at the hospital for three straight days until finally going into cardiac arrest and requiring a leg amputation.
Since the death of Rory Staunton was reported, medical school classrooms, hospitals, and the internet have been buzzing with discussions of how this could have happened, according to Jim Dwyer, the reporter who broke the story. Dwyer quoted Joshua Needleman, a pediatric pulmonologist, who said:
The big questions are about how to integrate new information that doesn’t fit with the perception you have formed. … How to listen to the patient when they are telling you something that doesn’t fit with your internal narrative of the case. These are the hardest things to do in medicine and yet the most important.
What can we, as existential practitioners, learn from these events? Needleman sums it quite well in his statement above—“How to listen to the patient when they are telling you something that doesn’t fit with your internal narrative”—or, in other words, don’t assume.
In my first training in psychology, I attended a five-week intensive foundation course in order to compensate for having two degrees in completely different fields, as well as to see if a career in psychology was really what I wanted. On the first day, we were given several instructions. One was the somewhat obvious rule to “only speak from the first person.” The second was to never assume or generalize. Each case, each situation, each story was an individual experience, colored by that person’s unique and specific combination of collected experiences. This was our introduction to phenomenological bracketing—Husserl’s epoché.
Bracketing asks us to do the (very difficult and challenging) task of putting aside our assumptions, our beliefs, and our previous knowledge. To view each experience with as fresh an eye as we can.
Most existential practitioners will agree that if a client tells us they are depressed that we need to have them describe for us what that client’s personal, individual experience of depression is. We know depression is not just one thing, but rather a whole constellation of ideas and manifestations.
But what happens when we—in our humanness—occasionally forget to bracket and start viewing a client as “having” a particular diagnosis? And then they tell us something that does not fit into our little picture? Or a client comes to us, viewing him- or herself as the particular diagnosis he or she may have been given? How do we help ourselves or our clients to emerge from the confining label so that we can see the essence of what’s really going on?
The answer goes back to phenomenology—back to bracketing. As soon as we forget that each person is unique in their humanness, as soon as we treat them like an “It,” rather than a “Thou,” we lose the plot.
In an article about the collaborative nature of real group dialogue, Michael Michalko writes:
In order to give fair value to ideas, the group collectively must free themselves of all preconceptions and suspend all assumptions. Suspending assumptions allows you to look at new ideas in an unbiased way. It is undeniable that by the sheer power of his imagination, Einstein suspended all assumptions that other physicists made about the world and completely reoriented reality. Once one makes assumptions that this is the way it is, all creative thought stops.
But allowing each person their own experience—or in medicine, not forcing evidence to fit into the preferred clinical picture—means that each person is allowed to write their own story, not have to fit into someone else’s story about them. Perhaps this kind of bracketing, this kind of allowing space could allow for the creative thinking that might help prevent stories like Rory’s and Aimee’s from ever happening again.
-- Sarah Kass