THE GIFT OF NOTHING

You are not a doctor, they told us on the first day of medical school. So don’t go around acting like one.

Then they told us the story of two young people at a carnival. The girl fainted. The medical student, feeling compelled to act, stepped forward. He mistook her for a cardiac arrest. It was in the days before modern techniques of resuscitation, and with his pocket knife he opened her chest. The patient, a healthy teenager, did not survive.

Authority is dangerous. Coupled with ignorance, it can be lethal. Nor is the problem confined to the occasional medical student. On the Autobahn near Würzburg, Germany, I pulled over to help a Middle Eastern man, sitting with his son beside his overturned Mercedes. The son had a broken arm. I’m a doctor, I said. Thank you, said the man. Would you look at my son’s arm?

I was out of my element, an army doctor who ran a dispensary for soldiers and who remembered little about roadside medicine. I recall debating whether to stop in the first place, uncertain what might be required. It made me nervous and cloudy.

Maybe it’s not broken, I said, only glancing at it, choosing foolish optimism rather than confessing I wasn’t sure what to do, missing the boat rather than declining to act or comment. I think it’s broken, the father said. And there was a long silence in which the man and his son were more at ease than I was.

I should have left well enough alone, but I broke the silence: Maybe I could examine your son’s arm again.

The father winced as my thumb flipped the floating radius. Like the medical student, I was acting without reason. Maybe it’s not broken, I said and left. Only miles down the road did I realize I had not even offered to make a splint.

Ignorance dominates. Wisdom is slow in coming. I’d been sucked into the vortex of apprehension and was paralyzed. It would have been simple to break out of it if I’d just confessed that I didn’t know what I was doing.

Action has the appearance of competence. Physicians trained at intervention may lack the courage to do nothing. Yet “nothing” would have saved the young woman and avoided unnecessary pain for the boy at the roadside.

Hippocrates knew about that. Primum non nocere, he said. The first rule of medicine, do no harm.

The more I know, the more I feel my ignorance. And the more I want to make peace with that. So I practice doing nothing a lot these days. I’m getting better at it. I told one of my patients I saw it as my job to build a wall between her and her surgeons. A brick wall. After six abdominal surgeries, the devil we know is better than the one behind the next surgery.

I admire decisive action. It can be lifesaving. But I respect inaction in some ways even more. It takes a different kind of courage to withstand the pressure to do something and abide by your limits. So I’m thinking of hanging a sign where I can see it every day. “Okay, so you’re a doctor,” it might say. “Just don’t go around acting like one.”