EBM and CQI Article of the Week 8.3.2020

What’s it like to be a bat?  I might be one of your few acquaintances who knows,..….sort of**.

Thomas Nagel inquired just that in an oft-cited essay (1974).  His point is consciousness is a phantasmagoric experience,…..the one and only thing you and I can be utterly certain of,…..yet a largely inexplicable phenomena despite efforts of scientists and artists.  This frustrates material reductionists and strict objectivists to great end (e.g., Daniel Dennett, Peter Hacker),……of course strict can never be an adjective of objectivist, at least in we humans.

Consciousness is the principal mystery of mankind (I would add quantum mechanics).  Why ‘something and not nothing?’ Gottfried Leibniz wrote long ago. Consciousness is defined by our qualia – those perceptions/sensations/concepts that are not and cannot be shared entirely and accurately with anyone, anytime, anywhere.  Why does one song make me melancholy and you happy?  What exactly is the color red to me and red to you?  How did you intuit that person was upset?  Why did you become an accountant?  What is interesting about your children?

Dr. Nagel wrote clearly – There are elements which if added to one’s experience, make life better.   There are other elements which if added to one’s experience, make life worse.  But what remains when these are set aside is not merely neutral, it is emphatically positive.  The additional positive weight is supplied by experience itself, rather than by any of its consequences.

What’s it like to be a premature infant in a NICU?  Well,…..a lot of interventions/manipulation/pain (see attached from Cong et al).  BTW, the subjects were 28-32 weeks GA,……can you imagine the torment tally in 23-26 week infants?  Bless the hearts of bedside RNs/RTs/therapists/MDs who strive to reduce noxious stimuli.  Less is More.

What’s it like to be SARS-CoV-2 virion in a child with COVID-19?  Well,…..you are present in the youngster’s nasopharynx, shedding yourself just as you do in adults, …..and likely not conscious of such.

** I hang upside down for several minutes a couple times a day. 

Joe Kaempf, MD
Medical Director CQI and Clinical Research
Women and Children's Services
Providence St. Joseph Health
Portland, OR   97225

https://pubmed.ncbi.nlm.nih.gov/28343092/

https://pubmed.ncbi.nlm.nih.gov/32745201/

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