BY MICHELLE XIN

The following piece was part of the Writing (Clinical) section of The Auricle’s 2021 Writing and Visual Art Competition and is responding to the prompt “The pursuit of knowledge is a quintessential part of medicine, but the benefits and risks sometimes balance treacherously“.

We do not know what we do not know.

Does this unsettle you?

To chase the tails of knowledge, relentlessly.

To walk the roads of answers, endlessly.

To mine the gems of truth, tirelessly.

What do we know when we know?

When we know, a door is closed.

“Unfortunately, the tests did not show what we were hoping for.”

When we know, another door is opened.

“Doctor, how long do I have left?”

We do not know.

Our work is scaffolded by ladders and stairwells – up, up and up. We work to learn more, feel more, understand more, give more. To know more; this forms the foundations of our abilities. Each step is cushioned by knowing, trying to know, or at the very least, the illusion of knowing. We are reassured by answers, by the concrete of our schemas, our evidence-based guidelines, our research. We want to know because it makes sense to know.

We know that once we know, we can synthesise and process and generate. Differentials, management plans, approaches, teaching points. We know this is important. We know that the answers to the questions we pose help us and help them. We know it is harder for us and them when they are unable to answer our questions.

For how important knowing is to us and our profession, it is incredible how fickle it all is. How fallible we are when it comes to knowing. We need to know right. We need to know well. We need to know, without being told what or how to know. We need to know, even when no one does.

Chasing knowledge can be a place of comfort, but only when we want to know, and we are willing to face the consequences that come from doing so. When our landings are blanketed by foresight and the privilege of being the one asking the questions, knowing does not seem so difficult, or surprising, or shocking.

For those at the receiving end of our interrogations, our prods, our palpations, our auscultations – they undergo these without knowing, with compliance, with blind trust. Often without knowing the outcome, emerging uncertain and waiting. They trust us to know, and to know what is best for them.

Sometimes, knowing changes everything. We know what to do. They know what to expect. They know what to do. This pushes us to ask, to seek, to test, to scan, to biopsy, to re-scan, to re-test, to find the answers, without end.

The universe knows better than to give mortals this book of answers; and yet we are tantalised by the possibility of omniscience; by the power that comes with knowing. It is bold of us to assume we know, and that we know best.

Because we do not know what is best. Let alone know what is.

We are grounded by dissonance between the biochemical results and the presentations, the holes in research and the management plans being drafted. We are bound by the preconceived, traditional notions of how things should be, and thinking we know because our predecessors seemed to know, and that is enough, right?

When you next chase the tails of knowledge, have a look at the creature whose tails you are chasing. What would you like to know? Its tails? Or itself? Or the reason for your chase?

When you next walk the roads of answers, ponder where the paths lead, and who forged these beaten tracks before yourself? Where are you headed? Why are you walking? Or running? Or running away?

When you next mine the gems of truth, consider the weight of the tools in your hands, the darkness that surrounds you, and the bright shimmers beneath. What are you looking for? What will these gems become when they are unearthed?

Find comfort in not only knowing, but also the process of doing so, and in understanding how we come to know that we want to know. 

And find solace in not knowing, for we are beautifully human when we have the courage to continue, to strive, to believe, despite not knowing.

“I don’t know.”

“That’s okay. Thank you for your honesty. I can’t expect you to know everything – you’re only human after all!”