War and Peace

In my work as a pediatrician, every once in a while I am privileged to be asked to see a child of a military or law enforcement officer. Even if sometimes they do not identify themselves as such, there is often a moment when their professional identity becomes apparent. It usually goes like this:

They tell me why they brought their child. I ask questions to clarify. I do an exam, possibly follow up with tests, possibly not. Then I start telling them what I suspect is going on. There is a pause as it dawns on them that what I do is similar to identifying a suspect in an investigation, or enemy intentions in intelligence assessment. Then there is a change in the tone of the conversation: it becomes a council of colleagues. That is the moment we both realize that we are in the same business.

I said this before and I will say this again: Mother Nature is not our friend She is not our enemy, either, more like a disinterested observer in the competition between us and her other children — a group that includes both the Angus cow and the Anopheles mosquito. Being that I am basically on the human side, I have no problems with either carpaccio or carbenicillin.

Pediatrics, military and law enforcement are united, forst and foremost, by justified paranoia. In ten thousand children with fever, one will turn out to have meningitis. Of a million people who got parking tickets in 1977, one was Son of Sam. And of a dozen counter-attacks in the winter of 1944, one turned into the Battle of the Bulge. The ability to stay alert and ready for trouble through weeks or months of false alarms is what I call justified paranoia.

We are united in staying away from the magic bullet. Spies and informants may lie; aerial photographs, Xrays, and physical evidence may be misleading; big guns and antibiotics may fail. Cops and soldiers look at you funny when you say, this ONE test tells me WITH ABSOLUTE CERTAINTY that this is the diagnosis. If you tell them that these three or four or five things point in the direction of one of these two or three diagnoses, and this is what you need to do to be safest in all likely events, they look at you — well, they look at you like you are their colleague.

We are united in contempt for wishful thinking. Unilateral disarmament is positive assistance to the side that ignores pacifists; naturopathic medicine is positive assistance to diseases with naturally high mortality. Nature, like anarchy, is on the side of survival of the fittest. Survival of the beloved is as unnatural as one can imagine. This is where we come in.

And, having faced friendly fire and adverse events, we understand the difference between the best possible decision under the circumstances, and post-factum omniscience.

Where we part company is the question of personal risk. Not needing Kevlar apparel, my safety in in being behind those who do, and to them this post is dedicated.


2 thoughts on “War and Peace

  1. Pingback: Pediatric Center News » Blog Archive » Flu vaccine availability update

  2. Pingback: Pediatric Center News » Blog Archive » Swine Flu 4.5: Told You So!

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