บทถอดความฉบับเต็มของ Gut Strings

uncertainty that even some of the best doctors in the 72 00:05:01,350 --> 00:05:11,835 world couldn't dispel for him, but before he could even get to 73 00:05:11,835 --> 00:05:12,585 that decision... 74 00:05:12,765 --> 00:05:16,935 Loren Ludwig: I started to try to reach somebody that could 75 00:05:16,935 --> 00:05:19,035 explain to me what the situation was. 76 00:05:19,035 --> 00:05:21,525 Simon Adler: ...well, he had to navigate the American medical 77 00:05:21,525 --> 00:05:21,975 system. 78 00:05:21,975 --> 00:05:24,585 Loren Ludwig: And I mean, you know how hard it is to reach a 79 00:05:24,585 --> 00:05:27,105 doctor under under the best of circumstances. 80 00:05:27,600 --> 00:05:29,040 Simon Adler: When he tried to get in touch with the guy who 81 00:05:29,040 --> 00:05:31,650 did the colonoscopy, he discovered that that guy had 82 00:05:31,650 --> 00:05:33,270 like disappeared 83 00:05:33,270 --> 00:05:36,540 Loren Ludwig: Yeah, I was never able to get in touch with him, 84 00:05:36,540 --> 00:05:41,640 and my primary care doctor, she was unreachable, and so I went 85 00:05:41,640 --> 00:05:47,280 through these weeks of not-not being able to answer what seemed 86 00:05:47,280 --> 00:05:49,530 to me to be some straightforward questions... 87 00:05:49,530 --> 00:05:52,455 Simon Adler: ...like how serious is this? What are the survival 88 00:05:52,455 --> 00:05:53,025 rates? 89 00:05:53,025 --> 00:05:55,755 Loren Ludwig: What is even this thing? How do I even say this 90 00:05:55,755 --> 00:05:58,365 word so that I can have a conversation with somebody about 91 00:05:58,365 --> 00:06:03,195 it? I was-I was so confused about so many things, like not 92 00:06:03,195 --> 00:06:06,675 just seeing that I was confused and that I didn't even quite 93 00:06:06,675 --> 00:06:10,545 understand what I was confused about. I'm calling different 94 00:06:10,545 --> 00:06:13,425 people. I'm just trying to talk to people. Like somebody must 95 00:06:13,425 --> 00:06:14,910 have the knowledge I need. 96 00:06:14,930 --> 00:06:17,060 Simon Adler: And when he eventually did find that person, 97 00:06:17,240 --> 00:06:25,010 well, unfortunately, it only made the uncertainty worse. The 98 00:06:25,010 --> 00:06:28,550 doctor explained to him that yes, they'd found a small amount 99 00:06:28,550 --> 00:06:32,420 of cancer in his colon, and it was possible that that cancer 100 00:06:32,420 --> 00:06:37,985 had made it to his lymph nodes. In which case, he was in serious 101 00:06:37,985 --> 00:06:43,115 trouble. However, it was also possible that the cancer had not 102 00:06:43,115 --> 00:06:46,415 reached his lymph nodes, that they had cut all of it out 103 00:06:46,415 --> 00:06:49,895 during the colonoscopy, and that he was currently cancer-free and 104 00:06:49,895 --> 00:06:54,245 totally fine. But which of those two is true... 105 00:06:54,245 --> 00:06:57,755 Loren Ludwig: ...was simply not knowable without taking out a

106 00:06:57,755 --> 00:07:02,630 foot and a half of my colon to see whether there's cancer in 107 00:07:02,630 --> 00:07:03,290 the lymph nodes. 108 00:07:03,470 --> 00:07:05,570 Simon Adler: And so, is that the big decision point here? It's 109 00:07:05,570 --> 00:07:09,560 like, do I get this thing cut out? Do I have them take out how 110 00:07:09,560 --> 00:07:10,400 how much of it was it? 111 00:07:10,400 --> 00:07:13,340 Loren Ludwig: Yeah, like a kind of a foot and a half. So it came 112 00:07:13,340 --> 00:07:19,220 down to this question of, like, okay, there's some number that 113 00:07:19,220 --> 00:07:23,735 we can assign to the likelihood that the cancer has made it into 114 00:07:23,735 --> 00:07:26,075 the lymph nodes, and there's some... 115 00:07:26,075 --> 00:07:26,705 Simon Adler: Probability. 116 00:07:26,660 --> 00:07:29,630 Loren Ludwig: ...some probability, exactly, but 117 00:07:29,630 --> 00:07:33,140 everybody's got different ideas of the numbers. So I'm getting 118 00:07:33,140 --> 00:07:36,350 ten percent, fifteen percent, five percent, forty percent. 119 00:07:36,350 --> 00:07:38,270 Simon Adler: On top of that, they're hitting him with how 120 00:07:38,270 --> 00:07:41,330 long he'll likely live if it's reached the lymph nodes. 121 00:07:41,330 --> 00:07:43,580 Loren Ludwig: Numbers like less than two years, less than a 122 00:07:43,580 --> 00:07:44,750 year, five years. 123 00:07:44,750 --> 00:07:45,770 Simon Adler: And on top of that... 124 00:07:45,780 --> 00:07:48,000 Loren Ludwig: When I would talk to clinicians about this 125 00:07:48,000 --> 00:07:51,360 surgery, the thing they wanted to talk about first was the 126 00:07:51,360 --> 00:07:55,110 risks, and they were like, "doing the surgery has some 127 00:07:55,110 --> 00:08:00,090 risks associated with it." And so how do I, how do I make a 128 00:08:00,090 --> 00:08:02,910 decision? Like, I don't have an equation for that. 129 00:08:02,930 --> 00:08:05,960 Simon Adler: Right, it sounds like in an attempt to penetrate 130 00:08:05,960 --> 00:08:12,350 the uncertainty, they went to math, and not straightforward 131 00:08:12,350 --> 00:08:16,010 math, but relational probabilities. 132 00:08:16,210 --> 00:08:20,140 Simon Adler: ...that now you need to have a math PhD. Are you 133 00:08:16,229 --> 00:08:16,739 Loren Ludwig: Right, yeah. 134 00:08:20,140 --> 00:08:21,130 a math guy? Like? 135 00:08:21,130 --> 00:08:23,260 Loren Ludwig: No, no, no, assuredly not. 136 00:08:23,000 --> 00:08:26,270 Loren Ludwig: And and um, I'm not. I'll never be an expert in 137 00:08:23,260 --> 00:08:23,350 Simon Adler: Okay. 138 00:08:26,270 --> 00:08:33,650 that stuff. And so, this was one of those things of like, just 139 00:08:33,650 --> 00:08:37,790 how do I make a decision so that I'll continue to be alive? 140 00:08:37,790 --> 00:08:41,240 Sounds dramatic to say it, but the the stakes were pretty clear 141 00:08:41,240 --> 00:08:44,780 in terms of figuring that out as a kind of life or death 142 00:08:44,780 --> 00:08:47,915 question. And again, I don't want to be overly dramatic, but 143 00:08:47,915 --> 00:08:51,335 that's what it felt like. It felt like there's-I need to I 144 00:08:51,335 --> 00:08:55,085 need to know the answer to this, and the experience of not 145 00:08:53,855 --> 00:09:57,980 Gail Geller: thing before before I retire, the one thing I wanted 146 00:08:55,085 --> 00:08:57,725 knowing the answer and not knowing how to think about what 147 00:08:57,725 --> 00:09:01,625 the answer might be, plus not trusting or having confidence 148 00:09:01,625 --> 00:09:07,205 that that the the medical establishment was like taking 149 00:09:07,205 --> 00:09:10,025 care of it and asking the right questions and coordinating with 150 00:09:10,025 --> 00:09:15,500 each other was a-was a uniquely terrible experience. 151 00:09:57,980 --> 00:10:02,240 to do is just have a course for medical students, called like I 152 00:10:02,240 --> 00:10:06,080 don't know 101." You know, just like practice saying those 153 00:10:06,200 --> 00:10:07,070 words. I don't know. 154 00:10:08,180 --> 00:10:09,650 Simon Adler: So this is Gail. 155 00:10:09,780 --> 00:10:13,290 Gail Geller: Gail Geller. I have been on the faculty at Johns 156 00:10:13,320 --> 00:10:17,700 Hopkins for 35 years in the School of Medicine and the 157 00:10:17,700 --> 00:10:18,960 Berman Institute of Bioethics. 158 00:10:19,000 --> 00:10:21,700 Simon Adler: She has spent her career studying uncertainty, and 159 00:10:21,700 --> 00:10:25,090 she says that the various forms of it that Loren faced with his 160 00:10:25,090 --> 00:10:28,660 diagnosis, about what his doctors were thinking, about how 161 00:10:28,660 --> 00:10:33,310 he was even feeling, well, those have just become hallmarks of 162 00:10:33,310 --> 00:10:34,270 medicine today. 163 00:10:34,270 --> 00:10:37,660 Gail Geller: In medical practice, in medical education, 164 00:10:37,660 --> 00:10:38,170 yes. 165 00:10:38,230 --> 00:10:41,710 Simon Adler: Well, and so to ask perhaps a stupid question, like, 166 00:10:42,280 --> 00:10:44,845 what actually is uncertainty? 167 00:10:44,845 --> 00:10:47,155 Gail Geller: Well, at the risk of, I mean, I don't want to 168 00:10:47,155 --> 00:10:50,305 sound too academic about this, but... 169 00:10:50,305 --> 00:10:52,135 Simon Adler: I'll reel you back in if it gets too academic. 170 00:10:52,165 --> 00:10:57,265 Gail Geller: Well, no, I mean, so, so there's this idea that 171 00:10:57,265 --> 00:11:04,915 uncertainty is an umbrella term for risk and ambiguity. 172 00:11:05,070 --> 00:11:05,190 Simon Adler: Okay. 173 00:11:05,610 --> 00:11:07,680 Gail Geller: So when you're talking about risk, you're 174 00:11:07,710 --> 00:11:10,710 talking about situations where the probabilities are known, 175 00:11:11,400 --> 00:11:16,050 whereas you know ambiguity arises in situations where the 176

00:11:16,200 --> 00:11:17,820 probabilities are unknown. 177 00:11:18,300 --> 00:11:21,930 Simon Adler: So this is the known unknowns, unknown 178 00:11:21,960 --> 00:11:24,870 unknowns. Is that Rumsfeld? Was that Donald Rumsfeld's thing? 179 00:11:24,930 --> 00:11:25,050 Gail Geller: Yeah, yeah. 180 00:11:25,050 --> 00:11:25,290 Simon Adler: Okay. 181 00:11:25,380 --> 00:11:29,190 Gail Geller: So those are two very, very distinct forms of 182 00:11:29,190 --> 00:11:29,820 uncertainty. 183 00:11:29,880 --> 00:11:32,370 Simon Adler: Neither of which, she says, really used to be all 184 00:11:32,370 --> 00:11:33,570 that present in medicine. 185 00:11:33,570 --> 00:11:36,600 Gail Geller: In the early days when you know basically all we 186 00:11:36,600 --> 00:11:40,920 had was antibiotics for infection, the doctor was the 187 00:11:40,920 --> 00:11:46,485 expert, and that doctor, mostly men, but he or once in a blue 188 00:11:46,485 --> 00:11:50,205 moon, she would know what was needed to be known. 189 00:11:50,420 --> 00:11:52,880 Simon Adler: We knew less. Things were simpler, and so, in 190 00:11:52,880 --> 00:11:57,980 a sense, there was just less uncertainty. But then, that 191 00:11:57,980 --> 00:11:59,930 really changed with one moment. 192 00:11:59,930 --> 00:12:01,430 Gail Geller: I think yes. 193 00:12:01,430 --> 00:12:01,790 Simon Adler: Okay. 194 00:12:01,790 --> 00:12:04,190 Gail Geller: I'm not sure whether I'm identifying that 195 00:12:04,190 --> 00:12:07,700 because it happens to coincide so beautifully with my career. 196 00:12:07,700 --> 00:12:09,050 Which I mean, you know... 197 00:12:09,050 --> 00:12:11,270 Simon Adler: Every philosopher believes that they're the last 198 00:12:11,270 --> 00:12:14,270 philosopher. They are at the end of the Hegelian arc, so it's 199 00:12:14,315 --> 00:12:17,315 fine. You're-you're amongst a great tradition of people here. 200 00:12:17,315 --> 00:12:19,925 Gail Geller: So I would say the Human Genome Project. 201 00:12:19,925 --> 00:12:21,875 Archive: We are here to celebrate the completion of the 202 00:12:21,875 --> 00:12:25,925 first survey of the entire human genome. 203 00:12:25,925 --> 00:12:26,405 Simon Adler: Okay. 204 00:12:26,405 --> 00:12:29,975 Gail Geller: 1990 is when the Human Genome Project was 205 00:12:29,975 --> 00:12:30,815 started... 206 00:12:30,815 --> 00:12:35,465 Simon Adler: This massive effort to map every A, C, T, or G of 207 00:12:35,465 --> 00:12:37,055 our genetic code. 208 00:12:37,040 --> 00:12:39,905 Gail Geller: ...and the people who were working in genetics 209 00:12:37,810 --> 00:12:44,500 Archive: It will revolutionize the diagnosis, prevention, and 210 00:12:39,905 --> 00:12:41,465 were so confident. 211 00:12:44,500 --> 00:12:46,990 treatment of most, if not all, human diseases. 212 00:12:46,990 --> 00:12:50,440 Gail Geller: ...that genetics was going to be the answer to 213 00:12:50,440 --> 00:12:51,250 everything...

214 00:12:51,310 --> 00:12:53,770 Archive: Alzheimer's, Parkinson's, diabetes, and 215 00:12:53,770 --> 00:12:54,520 cancer. 216 00:12:54,520 --> 00:12:59,350 Gail Geller: ...all the unknown questions we've had, and it's 217 00:12:59,350 --> 00:13:06,325 answered some questions, but has raised so many more. 218 00:13:06,325 --> 00:13:08,455 Simon Adler: Like, take for example, she says before the 219 00:13:08,455 --> 00:13:09,685 Human Genome Project... 220 00:13:09,745 --> 00:13:12,745 Gail Geller: ...you were either well or you were sick. 221 00:13:12,745 --> 00:13:16,105 Simon Adler: You were presenting with the problem or you weren't. 222 00:13:16,105 --> 00:13:16,615 Gail Geller: Yeah. 223 00:13:16,615 --> 00:13:19,345 Simon Adler: Whereas after, there was this third totally new 224 00:13:19,345 --> 00:13:20,305 category: 225 00:13:20,305 --> 00:13:24,505 Gail Geller: the at-risk patient that's neither sick nor well, 226 00:13:24,580 --> 00:13:30,130 but may be sick or living with a risk factor and may not ever 227 00:13:30,130 --> 00:13:32,050 develop that condition... 228 00:13:32,050 --> 00:13:34,720 Simon Adler: ...putting both patients and doctors in a really 229 00:13:34,720 --> 00:13:35,470 difficult spot... 230 00:13:35,500 --> 00:13:38,770 Gail Geller: ...because doctors have this massive amount of 231 00:13:38,770 --> 00:13:42,250 information they have to understand themselves, 232 00:13:42,250 --> 00:13:45,820 communicate to their patients at the same time that the patients 233 00:13:45,820 --> 00:13:51,595 are coming in with, you know, demanding more information about 234 00:13:51,595 --> 00:13:56,425 their risk, and so you know, medical school has to evolve. 235 00:13:56,425 --> 00:13:59,365 You know, medical school has to become more and more about 236 00:13:59,365 --> 00:14:05,545 teaching you a way of thinking and how to find the information 237 00:14:05,545 --> 00:14:10,705 that you need, not this sort of we have all the information and 238 00:14:10,900 --> 00:14:12,220 you just need to memorize it. 239 00:14:13,200 --> 00:14:15,390 Simon Adler: But if uncertainty in medicine can be seen as a 240 00:14:15,390 --> 00:14:23,700 problem, she says, it can also be seen weirdly as progress. 241 00:14:23,700 --> 00:14:27,270 Look at Loren's situation, she says, yes, it was full of 242 00:14:27,270 --> 00:14:31,560 uncertainty, and yes, it was miserable. But the very presence 243 00:14:31,560 --> 00:14:34,980 of that uncertainty was a consequence of our 244 00:14:35,025 --> 00:14:39,315 ever-expanding knowledge. Like he could only be uncertain about 245 00:14:39,315 --> 00:14:42,525 what he should do because we knew that he should get screened 246 00:14:42,525 --> 00:14:47,295 at 45, and because we know how to biopsy polyps, and because we 247 00:14:47,295 --> 00:14:50,355 know how to remove 18 inches of your colon without automatically 248 00:14:50,355 --> 00:14:54,615 killing you, and in that way,

she says, the uncertainty he 249 00:14:54,615 --> 00:15:00,510 faced, as painful as it was, it is a feature of the system we've 250 00:15:00,510 --> 00:15:03,330 built, not a bug. 251 00:15:06,030 --> 00:15:08,370 Gail Geller: Absolutely, absolutely. 252 00:15:09,000 --> 00:15:10,830 Simon Adler: I love this argument you've laid out that 253 00:15:10,830 --> 00:15:16,200 there was this explosive growth in knowledge that led to truly 254 00:15:16,200 --> 00:15:19,860 more uncertainty when it came to medical diagnoses: if only 255 00:15:19,860 --> 00:15:23,490 because we knew more, there were now more questions to ask. And, 256 00:15:23,490 --> 00:15:26,430 you are advocating for a different approach inside the 257 00:15:26,430 --> 00:15:29,340 medical system that could alleviate some of the tension 258 00:15:29,340 --> 00:15:33,015 that that uncertainty has caused, but what we haven't 259 00:15:33,015 --> 00:15:37,155 discussed yet is the sort of larger medical infrastructure, 260 00:15:37,155 --> 00:15:41,475 the demands on doctors to see patients in 15 minutes, and how 261 00:15:41,475 --> 00:15:47,025 do you fit these ideas of yours into that without demanding the 262 00:15:47,025 --> 00:15:49,725 whole thing be rebuilt from the bottom up? 263 00:15:49,725 --> 00:15:52,245 Gail Geller: Yeah, I've thought a lot about this... 264 00:15:52,245 --> 00:15:53,415 Simon Adler: I'm sure you have. 265 00:15:53,415 --> 00:15:55,785 Gail Geller: ...because it you know that question's been asked 266 00:15:55,815 --> 00:15:57,330 a lot, and... 267 00:15:57,330 --> 00:15:58,530 Simon Adler: You're telling me I'm not original? 268 00:15:58,480 --> 00:16:02,485 Gail Geller: No, no, no. You have been amazingly original. 269 00:16:02,574 --> 00:16:08,270 You know, I sort of cringe when I hear the excuse, and you know, 270 00:16:08,359 --> 00:16:13,788 because because I've heard it my entire career, you know that 271 00:16:13,877 --> 00:16:19,306 that we don't have time, and I don't mean to be unempathic. I 272 00:16:19,395 --> 00:16:25,002 think doctors are overwhelmed, overworked, all of that, but but 273 00:16:25,091 --> 00:16:30,164 I don't- I think we have to support them in understanding 274 00:16:30,253 --> 00:16:35,950 that it doesn't it doesn't have to take a lot of time. It has to 275 00:16:36,039 --> 00:16:41,557 take a lot of letting go. There was a dean, I believe it was a 276 00:16:41,646 --> 00:16:46,541 dean of- at Harvard, who gave a lecture at some medical 277 00:16:46,630 --> 00:16:51,970 education conference, and he said, "you know, I do, I do the 278 00:16:52,059 --> 00:16:57,666 orientation for students every year." And he said, "I start the 279 00:16:57,755 --> 00:17:02,917 orientation with, you know, welcome to medical school. I'm 280 00:17:03,006 --> 00:17:08,435 here to tell you that 50% of what you're about to learn isn't 281 00:17:08,524 --> 00:17:14,043 true, and furthermore, I can't tell you what 50%

that is." You 282 00:17:14,132 --> 00:17:19,383 know the the simple- it's not simple actually, it's kind of 283 00:17:19,472 --> 00:17:25,168 profound in a way, to start the whole process with the idea that 284 00:17:25,257 --> 00:17:30,775 we are in this great exploration together. And-and frankly, to 285 00:17:30,864 --> 00:17:35,848 me, that's the kind of ideal doctor. It's the doctor who 286 00:17:35,937 --> 00:17:40,921 says, "yes, we will learn as much as we can about what's 287 00:17:41,010 --> 00:17:46,261 knowable. We'll get to the answer if the answer is knowable 288 00:17:46,350 --> 00:17:50,000 today, and we'll play with all the rest." 289 00:17:50,050 --> 00:17:52,150 Simon Adler: Were there pieces of music you were working on as 290 00:17:52,300 --> 00:17:53,680 this uncertainty was swirling? 291 00:17:54,690 --> 00:17:56,220 Loren Ludwig: You know, I haven't- I haven't... 292 00:17:56,280 --> 00:17:57,690 Simon Adler: Again, Lauren Ludvig. 293 00:17:57,720 --> 00:17:59,760 Loren Ludwig: ...there's-there's one song actually that I was 294 00:17:59,760 --> 00:18:03,600 playing a lot at that point that takes me to that place. 295 00:18:03,600 --> 00:18:04,380 Simon Adler: Can I hear you playing? 296 00:18:04,410 --> 00:18:06,420 Loren Ludwig: Yeah, yeah. That's-that's this great this 297 00:18:06,420 --> 00:18:10,050 great tune called Bonaparte Crossing the Rhine of all 298 00:18:10,170 --> 00:18:42,345 things. Yeah, that that that was a that was a thing... was kind 299 00:18:42,345 --> 00:18:45,270 of sitting there and playing that tune and letting my mind 300 00:18:45,270 --> 00:18:48,690 wander and you know- 301 00:18:48,760 --> 00:18:50,140 Simon Adler: Where would your mind wander as you were 302 00:18:50,200 --> 00:18:50,890 practicing that? 303 00:18:52,000 --> 00:18:56,050 Loren Ludwig: Well, you know, I was trying to make this decision 304 00:18:56,050 --> 00:19:02,680 about this surgical intervention, and because I 305 00:19:02,680 --> 00:19:05,260 didn't have the information, and I didn't know how to think about 306 00:19:05,260 --> 00:19:07,450 it, and I didn't know what I didn't know, and all of that, 307 00:19:07,450 --> 00:19:13,360 there was just a lot of ruminating on it. Kind of what 308 00:19:13,360 --> 00:19:18,685 you know, sort of sometimes maybe not in a great way of just 309 00:19:18,685 --> 00:19:21,715 kind of cycling. And when you have a tune like that, kind of 310 00:19:21,715 --> 00:19:24,415 going underneath, and you're yeah, you discover oh, I've just 311 00:19:24,415 --> 00:19:27,085 been playing this thing again and again for ten minutes, and 312 00:19:27,085 --> 00:19:32,125 and I've been thinking about all these things, you know. 313 00:19:32,125 --> 00:19:35,005 Simon Adler: What was the what was the decision point? Was 314 00:19:35,005 --> 00:19:38,005 there a moment? 315 00:19:39,140 --> 00:19:43,670 Loren Ludwig: What I eventually came away with was that the idea

316 00:19:43,670 --> 00:19:49,430 of discovering that the cancer had made it into my lymph nodes, 317 00:19:49,430 --> 00:19:54,380 and I had chosen to not do the procedure, that would be a very 318 00:19:54,380 --> 00:19:58,880 difficult conversation to have with myself. So, I eventually 319 00:19:58,880 --> 00:20:03,905 got there. And the surgery was fine. The several days in 320 00:20:03,905 --> 00:20:07,535 recovery didn't go well for a number of frustrating reasons 321 00:20:07,535 --> 00:20:10,115 that are kind of along the lines of I'm going to say like the 322 00:20:10,115 --> 00:20:13,115 institution not quite having their act together in the places 323 00:20:13,115 --> 00:20:16,025 that they needed to at that moment, and that was hard and 324 00:20:16,025 --> 00:20:21,965 frustrating and sucked actually. But also I'm still alive. They 325 00:20:21,965 --> 00:20:24,365 didn't find any cancer in the lymph nodes. I feel like I 326 00:20:24,365 --> 00:20:27,410 can't. I-I really have nothing to complain about here. 327 00:20:27,930 --> 00:20:30,240 Simon Adler: What we're two years out from this? May? We're 328 00:20:30,240 --> 00:20:31,470 coming up on two years. 329 00:20:31,530 --> 00:20:31,800 Loren Ludwig: Yeah, yeah. 330 00:20:32,010 --> 00:20:34,560 Simon Adler: You're still here, and you're cancer free. 331 00:20:34,560 --> 00:20:36,480 Loren Ludwig: Cancer free, so far as I know. Knock on wood. 332 00:20:36,510 --> 00:20:36,810 Simon Adler: Okay. 333 00:20:36,900 --> 00:20:36,990 Loren Ludwig: Yeah. 334 00:20:38,220 --> 00:20:40,890 Simon Adler: I'm very happy to hear that. 335 00:20:40,890 --> 00:20:41,490 Loren Ludwig: Thank you. 336 00:20:41,490 --> 00:20:44,310 Simon Adler: But two years out, I guess, what it- what meaning 337 00:20:44,310 --> 00:20:46,950 do you pull from all of this? 338 00:20:46,930 --> 00:20:50,620 Loren Ludwig: I think if I hadn't been so distracted trying 339 00:20:50,620 --> 00:20:56,500 to dispel the uncertainty, like if I'd known in advance that 340 00:20:56,500 --> 00:20:59,110 it's the uncert- it turtles all the way down, it's uncertainty 341 00:20:59,110 --> 00:21:01,810 all the way down. There's not really you don't really hit a 342 00:21:01,810 --> 00:21:06,310 bottom there, both like institutionally and in relation 343 00:21:06,310 --> 00:21:09,895 to a particular patient, and in relation to cancer and prognoses 344 00:21:09,895 --> 00:21:14,785 more more generally, that I might have maybe next time when 345 00:21:14,785 --> 00:21:17,605 I'm dealing with something like this, I won't be so distracted 346 00:21:17,605 --> 00:21:19,825 by the uncertainty part of it, and somehow feeling like if I 347 00:21:19,825 --> 00:21:23,035 just cure the uncertainty, then I can somehow make myself 348 00:21:23,035 --> 00:21:25,585 healthy again. It's like no, no. There's going to be a ton of 349 00:21:25,585 --> 00:21:28,645 uncertainty. You're not going to know it. You're not- you're just 350 00:21:28,645 --> 00:21:31,405 that- that is the cloud. That's-that-that is what's hard 351 00:21:31,405 --> 00:21:45,850 about the whole thing, you know? I basically look at this whole 352 00:21:45,850 --> 00:21:48,700 thing not as like, oh, I could have known, but I just somehow 353 00:21:48,700 --> 00:21:54,250 couldn't access the information. I look at it as like the 354 00:21:54,250 --> 00:21:59,725 uncertainty isn't that dispellable in a lot of cases, 355 00:21:59,725 --> 00:22:05,245 and in fact, you still have to make decisions and feel things, 356 00:22:05,245 --> 00:22:08,875 and don't get distracted by trying to get yourself certainty 357 00:22:08,875 --> 00:22:18,055 because it's not actually going to be available. 358 00:22:45,045 --> 00:22:46,995 Lauren Arora Hutchinson: Gut Strings is an original 359 00:22:46,995 --> 00:22:50,415 production by the Dracopoulos-Bloomberg iDeas Lab 360 00:22:50,415 --> 00:22:55,035 at the Johns Hopkins Berman Institute of Bioethics. This 361 00:22:55,035 --> 00:22:59,385 production is inspired by Professor Gail Geller's 35 years 362 00:22:59,385 --> 00:23:06,000 of social and ethical research on medical uncertainty. Special 363 00:23:06,000 --> 00:23:08,850 thanks to Loren Ludwig for sharing his personal 364 00:23:08,850 --> 00:23:14,010 experiences. This was written and produced by Simon Adler. 365 00:23:14,010 --> 00:23:19,500 Viola de Gamba musical performance by Loren Ludwig. Our 366 00:23:19,500 --> 00:23:23,430 executive producers are Lauren Aurora Hutchinson and Tony 367 00:23:23,430 --> 00:23:29,760 Phillips. Sound engineering by Alexander Overington. Production 368 00:23:29,760 --> 00:23:35,025 assistance from Brian Ricker. Our administrative coordinator 369 00:23:35,025 --> 00:23:40,425 is Leah Lord. This production was funded by Johns Hopkins 370 00:23:40,425 --> 00:23:44,505 Program in Arts, Humanities, and Health, which is led by Gail 371 00:23:44,505 --> 00:23:50,055 Geller, Kamna Balhara, and Loren Ludwig.