Before the pandemic hit, the habit of subconsciously using “If __, then ___” conditions to understand my life was very much built into me. As everything around me started closing and changing, I was forced to confront a lot of the “If __, then __” statements that were no longer possible. “If I move to NYC for medical school, I’ll enjoy going out to all of the different restaurants and shows in the city.” “If I do the in-person research project my PI and I proposed over the summer, I will have a great start to my research career in medical school.” “If I try my best in medical school, I’ll be able to match at my dream residency program.”
As the pandemic raged on, I received the advice to frame things in “even if” statements instead of “if then” ones. Given that many of my “If __, then __” statements seemed less possible during the pandemic, I decided to start compromising, which involved many “Even ifs.” First, with respect to medical training as a preclinical student: “Even if we don’t learn the abdominal exam in person, we will have plenty of opportunities to practice during clerkships.” “Even if I can’t do the summer research project I had originally planned because of COVID, I can do a virtual research project within the same department and still learn a lot about clinical research.” Then, to more ‘big picture’ aspects of my life: “Even if I don’t match at my top choice residency program, I will be doing a specialty that I love.”
And finally, I began applying my COVID-19 coping mechanism to clinical practice. As I went through clerkships, I realized that rather than just as a tool to preserve my mental health, “even if” was a much more accurate way of looking at clinical practice than “if then.” Statements like “If we get this lumbar puncture, then we’ll figure out what is causing the patient’s new-onset neurologic deficits” and “If we give this ulcerative colitis patient IV solumedrol, then they will recover from their flare” were tenuous at best.
Instead, senior clinicians thought in “even ifs.” “Even if the LP results don’t explain the patient’s neurologic symptoms, we can move on to other options like nerve conduction testing.” “Even if the IV solumedrol doesn’t help, we could try infliximab.” I realized that although the multiple choice questions students spend hours practicing are in the format “if you see the following clinical scenario, then you should __,” medicine itself is very much a field of “even if’s” in practice. Clinical practice is a matter of differential diagnoses and contingency plans, and it rewards people who let go of the “if__, then __” mindset.
Furthermore, “even if” presents a much more compassionate way to frame things to patients. “Even if GI can’t get the 50 polyps out of your colon during colonoscopy, we are still here for you and still have surgical options to offer” is much kinder than “If GI can’t get the 50 polyps out during colonoscopy, then we will have to take your colon out surgically.” Framing options to patients with “even if” restores hope and relieves some of the tension associated with the calculated extremes often ending our “if then” statements.
Some may feel that “even if” statements represent too much of a constant compromise. But I would argue that the uncertainty reflected in these statements does not make one any weaker or less likely to achieve goals. Instead, knowing that there is not a single end-all be-all option allows one to focus without the paralyzing pressure of “if ___, then___.” The transformative experience of training during the COVID-19 pandemic has taught me that “even if” is key to navigating personal and professional life.