“I got this.”
Recently, a medical student was seeing a patient on my schedule who was presenting with anxiety. The student reviewed her chart, knocked on the door, and entered the room with a warm smile. Fifteen minutes later, he was out and presenting her story to me. After glancing down at the chicken scratch on his folded sheet of paper, he looked at me with a confident expression that said it all: “I got this.” There were many patients this student had seen with me that day that had challenged if not confounded him. Unexplained fatigue in one, atypical chest pain in another, brittle diabetes in a third. As a result, we had wide-ranging discussions about how to approach uncertainty in clinical practice—thoughtful questioning, a focused exam, a logical differential diagnosis, and a sensible plan to move forward. But above all, we discussed how good medical practice requires confidence purified by a healthy dose of humility.
Nonetheless, there he sat with a knowing grin on his face.
“I got this.”
And yet, I wasn’t sure that he did.
Somehow, we’ve come to overestimate our judgment, our comprehension of the pathologies of the human mind. Most commonly, maladies of the mind require little in the way of physical exam, labs, or imaging studies. We have at our disposal a range of treatment options ranging from common-sense advice to therapy to prescription medications. With a helping of empathy and a sound follow-up plan, it is tempting to proclaim, “We got this!”
The mind, however, is infinitely more complicated than this. Winston Churchill’s famous description of Russia could even more aptly be used to characterize the human mind—it is “a riddle wrapped in a mystery inside an enigma.” Years ago, in his novel The Terminal Man, Michael Crichton described the ironic paradox of using the human mind to explain the human mind, saying, in effect, that there will always be mysteries unexplained when we study something that we are not superior to.
The human mind can be mercurial, eccentric, and impulsive. Rarely is it cleanly linear or a neat matter of cause-and-effect. For this very reason, the figures in the greatest stories are so damned fascinating. We are all surprised by Mr. Darcy’s hidden grace, disappointed by Henry V’s disavowal of his friend Falstaff, and shocked by Anna Karenina’s last step. And yet the more we consider the human mind, we are not surprised that it is so surprising. In other words, we have come to expect that there is a lot we don’t know. Our lived experience with ourselves and others gives credibility to Jacques Barzun’s observation that once, man was “defined as the rational animal,” until later minds made a vital correction: man is not rational, but “only capable of reason.” We understand that the gap between being rational and being capable of reason is, in fact, a yawning chasm.
Even so, we still get cocky. Somehow, we think we have someone pegged after cursory observation and a few hasty deductions. “Just read their body language,” we tell ourselves. “Watch their expressions. Listen to their tone. Consider their history.” It’s as if a snapshot at a photo booth could tell you the true state of a person’s soul. Time and again, however, our judgment is wrong. Why is this? Just think for a moment: Who do you know better than anyone in the world? Yourself. Every minute of every day, you are with yourself. And if you are like me, you have discovered a thing or two. I know my quirks and charms, predilections and aversions. At times, I can be logical and prudent, wise and objective. But I can also overthink and exaggerate, fall prey to my biases and blind spots. I can be touchy and defensive, proud and stubborn. My feelings can profoundly obscure the facts. In the midst of this wondrous body of glorious inconsistencies, I am faced with a very humbling question: How on earth can I be so sure that I have figured someone else out when I can’t reliably figure myself out?
Indeed, much of what we truly understand about ourselves and others is as if we were seeing “through a glass darkly” when we long to see face-to-face. And Donald Rumsfeld’s adage was right in that the most haunting considerations when seeking truth are not the “known knowns—the things we know we know” or the “known unknowns—the things we know we don’t know,” but the “unknown unknowns—the [things] we don’t know we don’t know.” Now, to be sure, this uncertainty and incompleteness shouldn’t paralyze us from judgment of anything or anyone, but it should lead us to approach discerning the lives of others with charity and humility.
Which leads me to the question of Simone Biles and the parlor game currently afoot over whether she is a hero or a coward for withdrawing from Olympic competition. Let me offer my best clinical answer: I have no idea. I am not her parent, friend, or physician. I don’t know what her past medical history is, nor do I have the long view of her mental health. I have never talked with her, and I am not privy to what is going on inside of her head. All I know is that she is an accomplished athlete who has achieved incontestable greatness, withstood immense pressure in the past, and has likely made one of the most difficult decisions of her life in the last week. No honest, charitable individual could look at Simone Biles, smugly dust their hands, and casually chirp, “I got this.”
What I do know is that Simone Biles is a sister in Christ deserving of our love and mercy, not our judgment. Perhaps, in her prior moments of great strength, she exemplified sound stewardship of God-given talents. But in the last weeks (in what may have been, self-admittedly, moments of troubling weakness) perhaps Simone unwittingly revealed that Christ’s grace is sufficient and that, indeed, his power is made perfect in weakness.
As my medical student unfolded his paper and began confidently offering his judgment of my anxious patient’s condition, his demeanor insisted, “I got this.”
“Maybe,” I answered.
“But, with humility, let’s take another look.”