Post Mortem

So you have a patient; you do your workup -- physical exam, draw some blood, maybe scan some x-rays, and you decide upon your diagnosis. Once you've arrived at even a tentative diagnosis, you begin treatment, or do surgery, and usually, since common things occur commonly (and keeping it simple, stupid), playing the odds you are right once again, or even just right enough, to get resolution.

But sometimes Mother Nature leads you down a path, or you lead yourself down the wrong path, and you make a misdiagnosis, and your treatment is wrong, and your patient dies. Or your surgery was right but the sutures slipped off and the patient bleeds out afterwards. Something goes wrong, somewhere along the way. Now you have a former patient, and it becomes the duty of the pathologist to give you some more clues, and perhaps you'll figure out what you did wrong. Because, ultimately, you need to figure this out or you'll get it wrong again, and another patient will die, all because you couldn't admit you were wrong, or couldn't find out what happened.

Pathologists will try to tell you that they ultimately have all the final answers, and most of the time they are very good at finishing up the story. This is not the time to remember the ones who got it wrong, thus preventing forever the truth.

No, pathologists are only human too, and make mistakes; their patients are already dead and cannot complain. So we now have your ex-patient, bound for the necropsy (in veterinary medicine) or the autopsy (in human medicine); each is the same procedure: a post-mortem examination in which the body is carefully examined, opened, and resected to provide gross (i.e., large, not icky) and histologic (or cellular) clues to your fatal error. Or errors.

In clinical and surgical medicine, whether veterinary or human, there is the ordeal known as M&M, the morbidity and mortality rounds. It is a place for peers and superiors to review the case and quiz the doctors, and attempt to use this case as a final teaching moment. There is nothing worse than having your case held up in front of others, for them to see in all its awful glory, just exactly what you did wrong. The pathologic results along with the case history, and any other information deemed important by the senior clinicians is presented. The audience questions the presenters, who might be the actual doctors on the case or they might be innocent pathologists. It is a real life pop-quiz, with the end results already known: patient = dead.

It is also a fire through which you pass, tougher on the other side than when you first began; you are now more capable, wiser in your ways, attentive to your faults, and ready (oh so ready) not to make that mistake again. And you can publicly attest to your shortcomings, because you have done so once, in front of a not-quite-hostile audience, and survived; you are a better person and it gets easier.

Why mention this now?

Because it's too late to jump onto the Race Fail bandwagon -- it would be piling on, and it would not do anything other than start a new flame war -- and others have already spoken eloquently on the subject, far and near. They are right, even when they are angry; it's hard to be polite and pleasant when you're angry. It's also hard to admit wrong when you're angry and defensive, but that's the most important time to do it.

This is now a time for reflection, the post-mortem phase; the time for people to admit their mistakes, one by one, and figure out why they made them in the first place.

As a former pathologist by training, I was once-upon-a-time qualified to have all the final answers, or at least the clues to those.

Clue #1: When it comes to race, and you're white, stop and think before you speak or write.

Clue #2: If you've spoken out, and are getting slammed for your language, the best approach is to apologize. ETA: If you have spoken out about racism (sexism, homophobia, classism, etc.), then you are not the one who needs to apologise. The transgressor is the one who is wrong, and should not -- even if defensive and angry -- be saying anything except "I'm sorry". Being mad about being wrong doesn't mean the other person is wrong too. It doesn't work that way.

Sub 2a: Especially when you're mad and the other people are mad. That's the most important time to start using the "I'm sorry". You don't get to avoid being wrong by being mad, and you don't get to avoid learning the lesson by being mad. (Thanks to daedala and cofax7 for pointing out the unclear language.)

Clue # 3: If your friends are the ones mis-speaking, you do them no service being blindly loyal. Speak the truth to your friends, or if you don't see it, speak not at all.

Clue #4: Any use of the phrase "malicious little cunt" is definitely not acceptable language, even if you strongly believe you are speaking to a troll.

Clue #5: People who disagree with you (or your friends) are not automatically trolls. This becomes a self-fulfilling prophecy, as everyone starts to look like a troll. Then the real trolls attack, and you can't defend yourself because you have no friends left.

In the course of the post-mortem, other clues may surface. Any input from Dr. G will be greatly appreciated.

It's been a long and interesting journey into LJ the past few weeks. At least out here, people won't tolerate racism. I've had to entirely leave the Bar after stumbling across blatant and hateful language from an author in his conference; language in which he did not stop someone else but added his own filth on top. That's a deal-breaker for me.