Despite reading numerous books tailored to the non-physicist, my rudimentary understanding of quantum physics suggests that quantum particles exist in multiple synchronous states and numerous synchronous positions. They are only truly defined upon the observation of that particle. Its nature fluctuates between particles and waves. Schrodinger and his famous thought experiment of the alive/not alive or dead/not dead cat, depending on one’s Weltanschauung, has popularized his observations.

While recently reading a review article in JAMA about colorectal cancer, I was struck by my reaction to the data presented. Death rates were stratified by various treatments’ algorithms, something we as physicians frequently encounter.

Whether the daily COVID “death toll” numbers numb or amplifies our ability to incorporate the reality of death and the frailty of life entirely is up to debate.

For the first time as a colorectal surgeon, what struck me is the association of the death data as a printed number to memories of excruciating images of death from malignant bowel obstruction or of cachectic deterioration. I fully realized that I, too, am living in several states at the same time.

It is that same juxtaposition of states that we learn as compartmentalization, perhaps from anatomic dissection in the first year of medical school. We now are told who the cadaver was before they became a cadaver, exchanging a virtual smell of perfume this once elegant woman probably wore while alive for formaldehyde, in their current form.

We are conditioned, early on, to live in multiple states to function as healers and scientists. As a surgeon, we shepherd our patients into the operation room, and then after putting square drapes on them, we make our incision without second thoughts.

The time from the completion of an examination to the rendering of a diagnosis or plan seems to be infinitesimally short to the physician but to be infinitesimally long to the patient. Perhaps Einstein’s theory of general relativity and concept of time dilation might have something to say about that. Two states of time coexist, both encompassing the same number of seconds.

We now have “compassion fatigue,” the euphemism for “burnout, “the former term acceptable, the latter not so.

A major cause, according to people who study this, is what feels to be a “black hole” of the electronic health records with its voracious appetite for information, whether relevant or not for patient care. The ever-present documentation requirements are exhausting both in their input and the interpretation of “too much information,” a casualty of the cut-and-paste world. Wading through repetitive information could surely be minimized by some technical wizardry to delete redundant data. We exist between the states of a meticulous physician and profound frustration.

Thanks to the forward-thinking leadership of some hospital systems, our internal state is being calibrated by “wellness” experts who use tools like mindfulness to adjust how we observe ourselves and subsequently react.

In the observation, they say, is the changing. Following the Biblical playbook, we first accept dominion over our internal state and then we name it. We need to lasso the tsunami of emotion we are told, and call it something, then go about controlling or changing it.

Existing in our mind is one thing; existing in the real world is another. We live in a world of hypervigilance. Many observers note what our “true” state is, whether that reflects our intent.

The cameras in the operating rooms, the willingness of people to “write you up” for the most minor of perceived insult or infraction, the political correctness which differs by geography and institutions, a negative patient review, ad nauseum all document the observation of our state at an observed time 0, a time generally not of our choosing.

Admittedly, I have taken some poetic liberty and admit that quantum states exist only for the smallest particles and not physicians.
Nevertheless, there are some truly relevant similarities between us and a photon.

The first remedy is to accept that observation will define us. For internal observations, we can read death data with both compassion and its use in making clinical decisions with no one the wiser.

As the pendulum of our thoughts swings back and forth, we will be both compassionate and scientific at different times and in different proportions.

The observation by the other is more problematic. As the heightened anxiety and cortisol levels will increase memory encoding, the patient may very well remember and amplify any less than perfect interaction they perceive. The trick I would imagine would be a reduction of their stress level. Easier said than done.

Removing the white coat, not having the entire discussion and history in a sterile examination room but in an office and minimizing the gap from exam to the discussion by the “everything’s good” or “I’ll explain everything to you” when bad news is on the horizon will go far in dropping the patient’s stress level.

There is always a brief conversation to be had prior to the start of the consultation, given the knowledge gleaned by the patient’s vocation, ethnic background, referring physician, etc. That may or may not be realistically possible depending on how much time the administrators allot an appointment.

The wellness folks insist that we have self-compassion, the self-forgiveness for past transgressions or for aberrant thoughts. The minute-to-minute scrutiny of our colleagues, patients and family may not be so generous.

Existing in a quantum minefield will fuel paranoia. Must we always be on our A-game to avoid someone’s negative observation?

Over the past 30 years, I have noticed my peers walking on more eggshells as compared to the younger generation who have been brought up in this “observed” culture. Newly minted physicians tend to interact less with staff at the hospitals for fear of saying the wrong thing, pimp medical students less for fear of a call by the program director and overall keep their head down.

They have been inculcated in an atmosphere of sensitivity that, for older surgeons, was always a given but never, as now, articulated and documented, often without the opportunity to rebut.

Courses in the dos and don’ts are now mandatory for hospital appointments. The operating room culture as a place for sexist jokes and lack of respect for ancillary staff is gone. In the past, we could be observed and despairingly thought of by the observer, but there were usually few consequences.

The effects of the COVID pandemic are being written in real-time. We have seen increases in depression, anxiety, suicides, substance abuse and all other forms of psychological maladies in physicians. Most physicians by now will be vaccinated. Whether the collective sigh will normalize emotional states or leave many with an expected post-traumatic stress syndrome is yet to be seen.

As Polonius said to his son Laertes, the oft-quoted line: “To thine own self be true.” Withdrawing to our true selves will diminish the mean deviation of our multiple states. Curtailing the extremes of these states will force observers to have any negative observations based more on the actual merit of those actions and less on prejudice or the occasional aberration.

It is unlikely that the observers will be more forgiving. The pleas of physicians on national television to wear masks and forgo Thanksgiving travel as ICUs were being overloaded, and warnings of dying from COVID were left unheeded by most. I suspect this lingering disappointment, compounded by emotional exhaustion, will temper our quantum fluctuations and may reflect a more genuine variety of ourselves. I think that the relative isolation all have faced allowed us to consolidate our psyche about a truer, more accurate version of ourselves. Or maybe we are too tired to be someone we really are not.

Lester Gottesman is a colorectal surgeon.

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