Chaos* is the science of surprises, of the nonlinear and the unpredictable. It teaches us to expect the unexpected.
My daughter came back to town after finishing midwifery school. She needed a ride downtown to meet a friend for coffee. She came with me first to the five-and-dime, where we bought an electric teakettle to heat up water for the Wound Care nurses, at the Occupy Medical bus. The teakettle was really very pretty: dark red chrome. She helped me carry stuff: my doctor bag, and the teakettle, etc. I introduced her around. We were early: it wasn’t time for me to start seeing patients yet; Dr Peter was on board.
The Butterfly Effect: Small changes in the initial conditions lead to drastic changes in the results.
So we filled up the red teakettle, first asking about the status of the water (potable) and figuring out how the faucet works on the bus (you have to pull a knob). We plugged it in and turned it on, and all the lights went out.
Everybody went, “Woahhh!” and looked at each other. My daughter and I whispered to each other, “Did we do that?” Dr Peter opened the blinds where he was working with his patient, and after a minute, he called out, “Can we get the lights back on?”
I went outside to look for one of the engineers, and Nurse Bill said to me, “You start from the back, I’ll start from the front, and we’ll try to find a fusebox.” When I went back inside, James was already flipping breakers, trying to find one that would work. We unplugged our pretty red teakettle.
Unpredictability: Because we can never know all the initial conditions of a complex system in perfect detail, we cannot hope to predict the ultimate fate of a complex system.
After a while, some of the overhead lights came on, but flickering. Dr. Peter’s lights still weren’t on. People kept calling back and forth, “Is it working now? Now is it working?” “Naw, still out!” “…How about now?”
Chaos explores the transitions between order and disorder, which often occur in surprising ways.
Dr. Peter’s shift was over, and my daughter helped me to quickly wipe down the entire doctor’s area with bleach wipes, like we always do at shift change. Our new Triage EMT, Elliott, asked, “Do you need a medical interpreter for Spanish?” I looked at my daughter, and we both grinned. She’s an activist who just spent the past year and a half learning how to be a midwife, entirely in Spanish. How convenient!
Together we saw a patient with a bad tooth, using a flashlight and the scant daylight through the window blinds half-closed for privacy.
The patient had a friend once who died from an abscessed tooth – most likely septic shock. We were able to discuss this concern in detail, because we happened to have the right interpreter, and happened to ask the right questions, at the right time, on the right day – even though we blew the lights.
Turbulence ensures that two adjacent points in a complex system will eventually end up in very different positions. Mixing is thorough because turbulence occurs at all scales.
My daughter went back outside with the patient, and the antibiotic prescription, and got them signed up for our upcoming Dental Clinic, where hopefully that bad tooth can be permanently fixed.
The lights came on. My daughter went to the coffeeshop. I started seeing patients with complicated issues – a few with simple issues, thank heavens, but as usual, I got behind. More and more behind. There were others with infected teeth, one diagnosed with a skin condition at an urgent-care site but not treated, one with pertussis who’d been prescribed an over-the-counter antihistamine, at another urgent-care site…
Systems often become chaotic when there is feedback present.
…People with digestive or urinary problems, needing a good explanation of what might be going on, to properly manage and treat them. People prescribed $150 brand-name medications they can’t afford, when $4 equivalents are available. People with medical complexities that are like Russian nesting dolls, one ailment enfolding another, with yet another at the root. A medical system so difficult to navigate, that many patients come to us simply to ask directions for it, or to get a translation from ‘Medicalese’ to ‘Plainspeak’.
Running late, just at the time we’d normally close, I got down to my last three charts. But a radio journalist had been waiting for a long time to have a quick word with me. Sometimes, all the work in front of you is time-sensitive! We sat together and spoke for a few minutes. I gave my pitch for volunteers. Doctors! Nurses! Veterinarians! Dentists! Two hours ain’t bad! If you have just two hours a month to give to your community… well, that would be fantastic.
Fractals: Infinitely complex patterns, that are that are self-similar across different scales, are created by repeating a simple process over and over in an ongoing feedback loop. Driven by recursion, fractals are images of dynamic systems.
Everybody’s phone pinged. “Blizzard Warning until 6 pm Monday night.”
Huh?! …It wasn’t just me. Nobody else had had their phone suddenly alert them to an approaching blizzard before, either.
Outside, the wind picked up, and the Intake tent became a very heavy box kite. Volunteers, including the radio interviewer, leaped over to rescue it. I could hear tent poles clanging as I finished seeing patients, long after everyone was ready to hurry home in the dark, through the 50-mph gusts.
It’s a good feeling to tuck everything away at the end of the day, restoring a temporary illusion of order from the day’s chaos – boxes of gloves back in the drawer; dermatology atlas, wilderness-medicine and other textbooks back in the cupboard, sharps box and ear-scope tips put away, homemade public-health flyers and bottles of hand sanitizer stowed – and, of course, the fatal teakettle.
It really is very pretty.
by Dr. Leigh (Leigh Saint-Louis, MD)