Monday, April 05, 2010

You can't handle the truth!

"You can't handle the truth!" So screamed Col. Nathan R. Jessep (played by Jack Nicholson) in the Rob Reiner film "A Few Good Men." He then launches into a tirade against Lieutenant Kafee (played by Tom Cruise)

"Son, we live in a world that has walls and those walls have to be guarded by men with guns. Whose gonna do it? You? You, Lt. Weinburg? I have a greater responsibility than you could possibly fathom. You weep for Santiago and you curse the marines. You have that luxury. You have the luxury of not knowing what I know. That Santiago's death, while tragic, probably saved lives. And my existence, while grotesque and incomprehensible to you, saves lives. You don't want the truth because, deep down in places you don't talk about at parties, you want me on that wall; you need me on that wall. We use words like honor, code, loyalty. We use these words as the backbone of a life spent defending something. You use them as a punchline. I have neither the time nor the inclination to explain myself to a man who rises and sleeps under the blanket of the very freedom that I provide and then questions the manner in which I provide it. I would rather you just said thank you and went on your way. Otherwise, I suggest you pick up a weapon, and stand a post. Either way, I don't give a damn what you think you are entitled to."

Jessep has a different system of priorities to Kafee; a different version of the truth. One of the discoveries of the post-modernists is that truth is relative. Perhaps they overemphasize this aspect, but it is an insight of some validity. Many witnesses may view a car crash from a different direction and each see something or at least emphasize something that the others have missed. But the bottom line is that the car has crashed. In the Hitchcock film, "The Birds" a dropped cigarette sparks a major explosion at a gas station. We know that the real problem is that the birds have gone haywire, but someone, concentrating on that detail, might use the scene as a case against smoking, or even against fossil fuels.

One of our problems is that we never see the complete picture. Scientists tell us that even by observing an event, we influence it. Sometimes I fantasize, when my soccer team loses and I was not there to observe it, that had I been there I might have made a difference. Perhaps a smart remark would have been taken up by the crowd. It might have raised the mood, which could have inspired the team to greater effort so that another goal would have been scored and the match saved. Fantasy, indeed, but might it not be true?

When Pilate asked, "What is Truth?" he was being a cynic. He'd seen so much that he did not believe in absolute truth. Modern man might say, "It may be true for you, but it's not true for me." as if there were a multitude of truths. Yet the car still crashed, the gas station exploded, Santiago was murdered. However, we 'see' the sequence of events we cannot uncrash the car, unexplode the gas station, bring Santiago back to life.

When I was a young doctor I worked for a surgeon who used to counsel his cancer patients thus, "My dear, you have a small growth, but you mustn't worry. I am going to cut it out and cure you." The word 'cancer' was never mentioned. It was referred to as a 'neoplasm' or a 'mitotic lesion'. It was terribly paternalistic and resulted in surgeons being regarded as gods. Things are very different now. It is expected that patients should be given every detail of their diagnosis (except in Japan where cancer is still never mentioned).

I wonder if this is a good thing. Truth about the future is nearly always contingent truth. If this happens then that will happen. It is also frequently speculative truth with a varying degree of uncertainty. Given what we know, this is likely to happen, but there is a one in ... 10, 100, 1000, ... chance that it won't.

Moreover, patients don't hear what is said. The mention of the word 'cancer' still screens out x number of subsequent sentences. Patients asked to recall what was said to them after the word cancer, usually give a garbled version of the subsequent conversation. It was my practice when breaking bad news to send the patient to an experienced senior nurse who had sat in on the conversation, so that she could rehearse what had been communicated to the patient.

I have heard patients complain, "Why won't the doctors tell me what is wrong with me?" when I know for certain that they have been told several times. I can only conclude, that they haven't been told what they wanted to hear.

I have been through this experience from the other side of the desk. I have become adroit at putting both the best and the worst face on the news that I receive. I am well capable of thinking up the most dismal prognosis for myself following a twinge in my tummy, yet at the same time of thinking up a totally benign explanation for the most worrying of X-ray findings. I shouldn't think that I am very different from most patients - I may have more information, but I am subject to the same emotions.

"You can't handle the truth!" No I can't. But then I don't know what the truth is.

When I tell a patient that his immunoglobulin genes are unmutated I can add that the median survival for such patients is 8 years. But that still means that 50% of patients that I studied lived longer than 8 years. I could tell him that the longest survivor that I saw lived for 12 years, but my study didn't look at huge numbers of such patients, there may well be many others who have survived for longer that I didn't see. And the patients I saw date from the early nineties and treatments have moved on from there. In any case in eight years time CLL might be a totally curable disease.

One thing I am sure about. All of us are going to die, unless the Lord returns first, whether we are nine or ninety. Should we metamorphose into Methuselah - he died aged 969, drowned it is said in the Universal Flood - our end is nigh.

But of this I am also certain. Jesus Christ died to save sinners and rose from the dead to demonstrate that the sacrifice was sufficient. He ascended into heaven and sits at the right hand of God the Father and one day He will return to judge the living and the dead. The only escape from judgement is to put your trust in Him who saves to the uttermost.

Francis Schaeffer called that 'True Truth'.

12 comments:

Anonymous said...

Dear Dr. Terry,
Your commentary could not be more timely as I prepare for my appointment with my oncologist next week. I feel I have little information one year out from diagnosis, yet I have been given the general outline of things. I think I want the details, but something in me hesitates. Thank you for your reminder about statistical interpretations, and I enjoyed your observation about the narratives we create when given plain facts, which in and of themselves may portend neither good nor bad. I would have to agree, that in the end, we created beings walk in faith.

I wish you Easter blessings.

Anonymous said...

Dear Terry
I am a doctor like you. I understand you deeply.
I know nothing will take "the fabulous sensation of helping others" away from us BUT I tell you, Terry,to be a physician and get sick is not the nicest thing in this life....but let's move on...let's seek for better places...
Thank you.

Anonymous said...

It's hard to say how long a unmutated CLL patient will live. I've lived for 11 1/2 years as a ZAP-70 positive, unmutated patient.
I guess I'm closing in on your record.

Sadly, there is no way CLL will be cured (outside of a bone marrow transplant) in eight years. Twenty years is more likely, and that is optimistic.

Dr. Keating famously swore there would be a cure for CLL before he retired. I think that comes under the heading of 'unknown unknowables'. When he said that, he obviously wasn't prepared for the subsequent research and trials that showed that even FCR isn't a cure.

Watson said...

Nice bomb there at the end. After all you just said, how can you claim Jesus Christ is truth? It's all relative, is it not? The Muslims or Hebrews never saw a divine prophet in him, so with that relative proof, how can you claim truth?

Terry Hamblin said...

I've studied the historical records. I believe that they are true. After all this time no new documents are likely to be forthcoming.

I have experientially lived on the assumption that they are true and not found them wanting.

No other world view is so internally consistent.

Mark said...

Well stated! I especially appreciated "the bomb" at the end. Jesus is the Way, the Truth and the Life!

Anonymous said...

there's a difference between a truth and a fact. that the car crashed is a fact. truth is a concept. you can have your truth and i can have mine and never the two need meet - or will ever see the light of day. conceptual truth remains within our skulls. but not facts. the facts are non negotiable, they are physics and are the same for us all.

Terry Hamblin said...

Historical facts are facts even though they can't be observed with the same precision as gravity. We accept the evidence of many witneses for all sorts of historical facts, like the assasination of the Archduke Ferdinand - both because of the mant witnesses and because of teh consequences. Similarly the resurrection of Jesus was attested by many witnesses - over 500 at one time many of whom were still alive at the time of reporting - and because of the consequences which are still visible 2000 years later.

Anonymous said...

Greetings Terry

now regarding those facts :-)

if the testimonies and recordings of the many have no emotional agenda driving them then there is a much greater chance that the events will not be as distorted (allowing for differences in perceptive ability) and one can more readily accept that it did 'actually' happen as a fact.

if and when you do have your hands on such an un affected fact (such as; according to our knowledge of genetics testing 'so far' the person has CLL) then a belief (as in a vervent wish that something be so - or not) will be superfluous.

but, if the testimonies of the many were recorded when driven by an emotion such as (example only) an instinctual survival passion fueling a belief that the sixth sense - the brain's seemingly transparent/invisible ability to be conscious of its own thoughts and from this has concluded that its sense of self awareness must therefore be in essence an immortal metaphysical being dwelling 'within' an 'outer' body (whew :-) then there is a much greater chance that that a fact could be distorted.

now, if it is not possible to experience or observe a fact with one's own senses, or the repetition of one such as (example only) the resurrection of a body that has been deceased for a # of days, then one owes it to the intelligent brain to activate 'all' its mental faculties and certify the facts of the matter before accepting it as a gospel truth.

but there is a glitch in mind that one's own unbiased examination of a fervently recorded event,that one may have wholeheartedly accepted as fact. it may not be possible IF one's own instinctual passions have the same agenda as those that saw or documented the original testimonies. in that case one may have to wait until another fact becomes apparent or is experienced before one will have sufficiently encouragement to re-examine the facts of any matter, especially those that have a great impact on one's life.

so what do you think has to become apparent before the youth of the taliban will be able to see a need to re-examine their emotionally distorted beliefs?

Anonymous said...

correction, last paragraph should read:

but theres a glitch. it may not be possible to conduct an unbiased examination of a wholeheartedly accepted fervently recorded event if one's own instinctual passions have the same agenda as those that saw or documented the original facts. in that case one may have to wait until another fact becomes apparent or is experienced before one will have sufficiently encouragement to re-examine the facts of any matter, especially those that have a great impact on one's life.

and i may have doubled the whole post. if so my apologies for the shambles.

Terry Hamblin said...

The story of Thomas illustrates how reluctant were the disciples to believe that Jesus had risen. This was not some mass hysteria or wish fulfillment. Examine the documents. The earlest written documents date from less than 15 years after the event when many of teh actual witnesses were still alive and could be directly questioned. The authorities could easily have disproved the claim by producing the body. Those who made the claim would not relent under torture and threat of death. It was not a single occasion; there were many witnesses. The consequences of this event were greater than Julius Caesar crossing the Channel or the Turks being defeated at the Gates of Vienna. To doubt that the event occurred takes more faith than to believe it.

Belief in an historical fact is of quite a different order than the brain washing of Taliban youth by the elders of the tribe. Nobody brain washed me. I came on this historical fact by studying the documents from a position of thinking it was all rather unlikely on scientific grounds.

Anonymous said...

Hi Terry :-)

you have piqued my curiosity so i did a little research on the resurrection.

one site:

http://www.infidels.org/library/modern/richard_carrier/improbable/resurrection.html

..which i have yet to cross reference extensively, indicates that it would not have been hard in those days to convince people that a resurrection was possible it was, apparently, a widely held belief that many heroic personages had risen from their graves, usually 3 days later and around the 25th of March, and eventually ascending to heaven. one of the earliest on record (tablets) is of a goddess around 1500BC.

not sure yet what to make of this. am looking into the Thomas documents next. thanks.

one thing that concerned me was discovering the degree of conflicting testimonies of the event in the bible, in fact many events during that time. i was particularly concerned how quickly Peter lied at the crucifixion saying something like "I know this man not". which made me wonder; did they - when realizing their days were numbered anyway so it was hopeless to deny having preached this new religion - did they throw caution to the wind for a place in history and lie some more?