Takeaway
In medicine, as in hiking, learning to be comfortable with uncertainty is one of the most important lessons I’ve learned in my medical training.
Lifelong Learning in Clinical Excellence | July 6, 2023 | 3 min read
By Rishab Ramapriyan, medical student, Harvard Medical School
As winter’s icy fingers reached into the heart of New Hampshire, my friends and I embarked on a hike on the Franconia Ridge in White Mountain National Forest. We walked the narrow spine of mountain peaks, shrouded in a thick mist of uncertainty, and flanked by steep and snow-covered sides. As a third-year medical student and an avid hiker, I’ve realized that hiking requires being comfortable with uncertainty, much like caring for patients.
Dr. William Osler wrote, “Medicine is a science of uncertainty and an art of probability.” His statement reminds us that medicine requires a delicate balance of knowledge, preparedness, and instinct—much like the outdoors. The human body and the mountain peaks are both incredible manifestations of nature, humbling and eternally educating.
The first steps onto Franconia Ridge were into the unknown. Just as each step into the wilderness can be obscured by fog and fierce winds, determining the next best step regarding a patient’s diagnosis and treatment can be equally elusive. Each path demands respect, careful planning, and a genuine openness to the unexpected.
I’m reminded of a patient, Ms. K, an older woman whom I cared for on the wards recently. Ms. K, a woman of remarkable strength, arrived at our hospital facing many challenging medical conditions. She had a diabetic foot wound, a cruel manifestation of her poorly controlled diabetes, which was complicated further by peripheral artery disease, restricting the vital blood flow to her extremities. The decision was made for a toe amputation. However, this path was not as clear as we had hoped; her condition swiftly and unexpectedly deteriorated into sepsis, causing prolonged delirium. The fog of uncertainty enveloped all of us, as we were forced to consider other sources of infection, scrambling to regain the upper hand against the invading pathogens, much like a group of hikers suddenly engulfed in a thick fog on an unknown ridge, trying to find their bearings. We had to be open to other possibilities, such as the delirium being a result of the antibiotic’s toxicity on the brain.
Just as a hiker wouldn’t venture into the wilderness without their compass, map, and basic knowledge of survival, medical professionals rely on experience, training, and intuition to navigate daily challenges. Like the undulating paths that wind through the wilderness, the course of a disease is rarely a straight line. It bends, forks, and sometimes disappears altogether, forcing us to blaze our own trail.
Both situations require us to be prepared for the unexpected, to be humble in the face of the unknown, and to continue learning from each new experience. Nature and medicine are fundamentally exercises in the science of uncertainty and art of probability— challenging, yet beautiful.
On other hikes, I’ve had to make the humbling decision to cut the hike short, prioritizing safety over the preset goal. Such was the case last May, when I had to abort a much-anticipated hike after failing to pack appropriate ice traction equipment, mistakenly thinking that there was no chance of encountering a largely ice-laden trail, which makes every step a possibility for injury. It was surely a lesson for this Californian who assumed that the winter was long gone in May.
Similarly, in medicine, a chosen treatment path might need to be reevaluated based on a patient’s changing health situation. Learning to let go of the initial plan, whether on an icy trail or in a hospital room, taught me the importance of flexibility in the face of unpredictability.
Navigating through the complications with Ms. K mirrored this lesson. Her deteriorating condition called for a shift in our approach—a larger amputation. Though the decision to amputate her entire foot was distressing, it became evident that it was necessary to ensure her health, just as changing our hiking plan was critical for our safety. Ms. K had to lose an entire foot to continue her life’s journey.
The beauty and complexity of life unfold through steps navigated on mountain ridges and hospital wards. The trails of the White Mountain and the struggles of Ms. K taught me that we may not always know what lies ahead, but our ability to adapt and learn with each step ensures our journey continues.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.