Where Do We Go from Here?

The 21st century has already seen many momentous orbits of the Earth around the Sun, but that the current year — 2020 — will remain a singular year in human history is no longer of any doubt. As of the date of this publication, for over 1.44 million people around the world, 2020 was also their final year of life. Millions more and their families have suffered quietly, from being ill, or being hospitalized, or dealing with disabling and prolonged recovery, or being laid off work, or losing their life savings. The litany of loss is nearly endless.

While for many this year is a low point in suffering, as a maternal-fetal medicine physician I have confronted the joys and sorrows of humanity on a daily basis, on a granular level: one mother and baby at a time, one family at a time. I have been a physician for twenty years now. Twenty orbits of the Earth around the Sun. Time enough to witness a great deal of human joy, courage, strength, and yes, frailty, failure, and suffering. With every patient encounter over these two decades I have been the bearer of news that has carried much import. No conversation has been, or is ever, trivial. On some days I may converse with thirty or more mothers and their families. Some patients have been referred because of a suspected abnormality seen on an ultrasound of their fetus that was performed elsewhere. Some patients have been referred because the patient herself has a serious medical condition, such as lupus or chronic hypertension or diabetes, that poses significant risk to her pregnancy. All need advice. All need guidance. And all need resolution to their anxieties. Often I am able to soothe their worries, but sometimes I am unable to do so. Sometimes, even with the best of my abilities, I am unable to predict an undesired outcome, for we physicians lack technological capabilities to divine all forms of impending despair. Sometimes I actually contribute to a mother’s worries. When I see a fetal abnormality on an ultrasound screen I am inherently aware of the difficult message I will have to convey to a patient. I anticipate the psychic wound I will inflict on her and her family, and I innately know that a profound realization will settle in: the dashed dreams of a life that could have been lived, but because of my words will now no longer be actualized. Alas, as is valid with moving objects in Newtonian space, so too is true with human words and actions: there is always an opposing reaction within the messenger’s psyche. Doctors are not immune from this reality. It’s a lot to bear on one’s own shoulders, the weight of humanity’s trials and tribulations, one individual at a time, one family at a time.

This year has been different for me professionally, of course. From restricting all family members from accompanying patients coming to our office for their fetal ultrasounds and genetic evaluations, to testing all patients for a viral plague at the hospitals where I work, to knowing that I am constantly exposed to the public and could acquire this very same deadly virus — one that randomly slays several percent of the infected — I can recall no other year of medicine in recent history bearing such a bleak semblance. Having fallen victim to COVID-19, some of our patients have required prolonged hospitalizations, some requiring ventilators, some requiring premature cesarean sections, some having been near death. As a middle-aged male diagnosed this very same year with chronic hypertension, and already having asthma, hypercholesterolemia, and a strong family history of cardiovascular disease and diabetes, I have been especially wary of my personal risks.

My wife and I have three children, each of whom we love immensely. Each in his or her own way has been a blessing for us. Our eldest, conceived accidentally fourteen years ago, out

© Can Stock Photo / megaflopp

of profound love, and very much desired, is named for “life” in Greek. Our middle child, who had also been conceived accidentally, a month or so before we were actually planning to conceive her, and thus, very much desired in her own right, is named in Greek for “light.” Our third and final child, willfully conceived, is named for “enlightenment” in Sanskrit. Perhaps one notices a poetic progression to these names that harken back to ancient, great, and noble human civilizations — a progression that each of us hopes to mirror for ourselves within the timespan of our own lives: to marvel at the vibrancy of conscious life; to illuminate our minds and hearts with education, love, and passion; and ultimately, hopefully, to gain a glimmer of wisdom, to glean a sliver of the universe’s deep truths before we disintegrate back into the dust from which we were born.

We have had some of our own sufferings in parenthood. The first child of “Life” had a mild speech deficit that was unknown to us until several years of age. We had a scare, but therapy with a speech pathologist rectified the situation rather quickly. Our scare flew off, like a spirit that no longer had a reason to haunt our child. The second pregnancy that birthed in “Light” began as a twin gestation, but alas, one fetus demised at the end of the first trimester. We wonder about this occurrence even to this day — dashed dreams of how life might have been.

Our third pregnancy of “Enlightenment” has been the biggest challenge of all. He was born with an anomaly that could not have been detected prenatally, but was discovered soon after birth. Our young boy had to undergo surgery at one year of age, which, though relatively minor in a grand sense, was nevertheless palpitation-inducing, especially since it required general anesthesia and since he also suffers from a mildly recessed jaw. A few years ago we also began to notice behavioral difficulties. Though incredibly keen in his interest in nature, science, and history, and reading several grade levels above his own, as well as being quite jovial, being quite loving of those around him, and being fortunate in having numerous friends and being universally liked by his teachers, he was becoming a literal terror at home. Obstinate, defiant, controlling, inappropriately self-centered for his age, and constantly requiring reassurance for all things, we knew he and the rest of us would not survive intact without an urgent restitution of sanity. Raked with our own anxiety about what was happening, we struggled with behavioral therapy for him without much avail. Over the past year we began to notice vocal and motor tics, and my wife astutely suspected what was recently confirmed: Tourette syndrome, likely coupled with obsessive-compulsive disorder (OCD)— and perhaps even exacerbated by aliquots of anxiety and attention deficit hyperactivity disorder (ADHD).

It is finally a relief to have a diagnosis, to know that there is very much a possibility of full recovery, to know that treatment is available. But there are no guarantees, and though many with this condition see a resolution to their tics, they then suffer throughout life with OCD and ADHD. So now we will begin our journey of cognitive behavior therapy, and perhaps medication, for our young man of “Enlightenment” in order that he may one day experience his name in full. The irony has not escaped us that we ourselves will need to strive hard to cultivate our own inner patience, inner mindfulness, and inner serenity to be able to properly guide our son on a path of healing. Action and reaction. And so I ask myself, whose enlightenment will it ultimately end up being? Who perhaps were we really appealing to when we named him so many years ago?

From our human vantage point we are rapidly coming to an ending, and as with all endings, to a new beginning. The Earth has nearly completed its circumnavigation around the Sun as it has done billions of times before. We have collectively breathed in, and we have collectively breathed out. To some it’s a silly game, marking the passage of a year, taking stock of where we have been and making resolutions for where we want to go. One could argue that there is nothing innately special about January 1. From our all too limited human timescale, and setting aside the particularities of Earth’s complex orbital dynamics, every day is, after all, a one year anniversary of essentially being in the very same position around the Sun as we were one year prior — and where we are to be again one year hence. In-

deed, taking that perspective, every moment is an anniversary of sorts, an opportunity for remembrance and reflection.

I have brought up our own family struggles not out of any desire to incite sympathy or pity in the reader, but rather to state that even as a physician’s family we ourselves are prone to the vicissitudes of life. We stand no more above nor any more below anyone else. As the Earth has circled about the Sun from time immemorial, so too has human happiness and suffering cycled over time. I and my family are not privileged in avoiding this universal truth. This same year that we have come to know of the particular ailment afflicting the mind of our son is the very same year our species has been ravaged by a novel coronavirus that will ultimately extinguish millions of lives. This is the very same year when millions have lost their livelihoods due to poor pandemic management, when our government and leaders — at least in the United States where I live — should have known and acted better. This is the very same year that there has been an acceleration in the repercussions of our self-inflicted human-caused climate crisis, where my family’s home was surrounded by wildfires and millions like us in Northern California were exposed to the most toxic air on Earth. This is the very same year that millions around the planet were afflicted with food shortages and faced a risk of mass starvation. This is the very same year that American democracy nearly succumbed to a maelstrom of conspiracies that were concocted within the cauldrons of bubble information universes embedded deeply within the world wide web. And yet civilization has seemingly survived to see the emergence of another year, uncertain as to how badly it has been truly bruised — and whether mortally so. For in 476 CE did the Romans who arose from bed the morning after the deposition of Emperor Romulus Augustulus truly realize that their empire had begun its descent into oblivion?

There has been so much life that has been lived by the universe already. This we know to be true from just our own planet’s history. It is estimated that there are currently one trillion species of life on Earth. One trillion. And yet we know so painfully little about conscious experiences scattered throughout existence in space and time. What perceptions run through the minds of dolphins and whales? Of elephants and wolves? Of owls and eagles? Of domesticated cows and pigs? Of all the other creatures that roam our world even as I write this? And what ran through the minds of ancient life that has come and gone, now evidenced only by the muck of oil, the smearing stain of coal, and the occasional stone of fossils? What runs through the minds of innumerable alien species undoubtedly peppered throughout our universe, but too remote to ever access? It is estimated that 108 billion modern Homo sapiens have lived on Earth since the dawn of our species. A hundred billion human beings. Each who possessed dreams, desires, feelings, pain, sorrow, grief, joy, love — innumerable experiences of life.

Conscious conceptions of our universe, all long-since vaporized, each a part of an organic individual whose matter now circulates through all of us as part of his or her ultimate legacy. Were humanity to burn itself into oblivion we can still take solace in knowing that there is so much of life still left on Earth, and likely in the universe, and that there will continue to be so for aeons of time.

And yet, with such awareness, isn’t it an extreme form of tunnel vision for our species to hold its suffering in one miniscule year above all other suffering its members have had to endure in all the years that have passed? Or for one human family to do so? Or for one human individual to do so? Alas, there is no escape for each of us from this perspective of the one. This is our fundamental dilemma as human beings: that we are able to conceive of multitudes, and yet somehow we have to reconcile this reality with our innate limitations as individuals, as solo travelers in a vast expanse. We are each in some way an isolated eye of illuminated matter trapped briefly in spacetime, a lens of the universe through which it may gaze upon itself in partiality, struggling to visualize itself in unity. So many windows of consciousness gazing upon existence. So many perspectives, so many feelings, and so many attitudes that are so many times colored by discriminating vision, so many times limited by the conceit of a local vantage point, virtually always a sliver of the whole, never truly an apprehension of totality.

And so I come back to myself, the only perspective from which I can write assuredly. So much has been lost this year, and yet there is reason and cause for hope for all of us individually, and for all of us collectively. That language can convey a shared experience of awareness between people is a miracle unto itself. This very language is the crucial engine necessary to help us climb our way out of an existential hole that we have dug for ourselves, one that if we keep digging will lead to civilizational collapse — and perhaps much worse. That I am able to contribute to this language of shared experience, if only for a brief flash of time in a cosmic scale, is a blessing that I choose not to ignore. Rather I choose to fight for life — to persuade, to coax, to enrich my fellow human consciousnesses, if only to set us on a collective path to betterment. And so I will set about to improve my language and my thoughts, and to seek wisdom in the stillness between my thoughts in the coming year. Perhaps that is the best contribution one human being can make towards the improvement of the human condition. And perhaps that is the best resolution one individual — I — can make for a New Year, and for a new circumnavigation of life.

About the Author

Dr. Santosh Pandipati is a board-certified physician in maternal-fetal medicine and obstetrics and gynecology. For the past nine years, he has been working with the Mednax/Obstetrix Medical Group. He has been a Medical Director for Maternal-Fetal Medicine at O’Connor Hospital, and is actively on the medical staffs of several other hospitals in our County. He is currently working on ways to leverage technology to improve prenatal care delivery to pregnant mothers. Dr. Pandipati has a passionate interest in climate change, especially as it affects women’s reproductive health. He has written several popular articles on this subject, and he is an active member of the Committee on Climate Change and Toxic Environmental Exposures for the International Federation of Gynecology and Obstetrics.