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Stomaching uncertainty

<h5>Tulips in the hospital room, picked the day before.</h5>
<h6>Courtesy of Emily Miller</h6>
Tulips in the hospital room, picked the day before.
Courtesy of Emily Miller

If there is one place you do not want to be famous, it is the hospital. Unfortunately, that was the position I found myself in last April when an ulcer ruptured my stomach. Over the past year, I have been called “an enigma,” “a mystery,” and “a surprising case.” No one had ever heard of a 27-year-old woman’s (with few prior symptoms) stomach spontaneously exploding. 

I was a favorite at rounds. “Why did this happen?” I asked countless times. The modal answer, “We don’t know. Sometimes these things just happen.” As a graduate student in Population Studies spending my days trying to uncover the why, I was unimpressed.

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Upon my release, everything I believed about myself was challenged. Two weeks prior, I had run the Essex Cherry Blossom 10K. I thought I was healthy and strong — now I could barely open the doors in Forbes or hoist myself into my lofted bed. I thought I was a cheerful person — now I cried in the aisles of Wegmans and in the bathrooms of bars in Atlantic City during my “vax-cation” — a day-trip to get vaccinated. I thought I was a hard worker and enjoyed my job — for weeks I could not read a journal article, or listen to a friend’s thesis defense, or write a paragraph, or even use ggplot without being completely exhausted. 

One question dominated my thoughts, “When will I be back to being myself?”

My recovery was framed to me as such: My ability to return to my normal self was a function of time (6 weeks, at most 6 months) and a binary variable — whether or not I followed directions. Linearity is baked in the world around us: If we do X, Y will happen. If I work hard in high school, I can go to Princeton. If I work hard at Princeton, I can get a good job. I can have a good life. If I work enough hours on my research, I will get published in a top journal and I will be on my way to tenure track. If the population is highly vaccinated, we can stop wearing masks. We can return to the way things were. The “Five Stages of Grief” implies a stepwise function.

I have spent an above average amount of time thinking about and believing in linearity, control, normality — they are all fundamental concepts to social science. The linearity assumption, so ingrained in statistics, is frequently glossed over. But here’s the thing, linearity is often a mediocre assumption. We know this, but often it is the best we can do. 

Causality is notoriously difficult to establish, even in medicine. The world is wracked with uncertainty, deviations from predictions, and events that experts do not see coming. Average experiences are not universal. Random bad things happen all the time. You can be young, double vaccinated and boosted and still be hospitalized due to COVID-19. You can follow best environmental practices and have your home or town destroyed in a natural disaster. The normal curve exists in the aggregate — the median age of a perforated ulcer is 72 — but there are always individuals at the tails. Being an outlier is not as fun as Malcom Gladwell led me to believe.

It is one thing to intellectually understand academic concepts — it is another to live them. For the last two years, we have all been living in a world wracked with non-linearity, uncertainty, grief, and trauma. It is overwhelming. I imagine many of us have asked ourselves when we will be back to “normal.” I coped with the chaos of 2020 by compartmentalizing the macro (what was going on in the world) from the micro (what was going in my life). I took comfort in my good fortune that I could control my immediate surroundings. This is a privilege. For many, the macro and micro are inseparable. And, this strategy is tenuous.

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Follow-up after follow-up visits, new prescriptions, procedures, supplements, and diets yielded little improvement. Most days, I experienced some sort of pain ranging from mild discomfort to pain so great that I am bed-ridden. I was unable to predict what the next day would bring. After the prescribed 6 months, it was clear that despite doing everything “right” my recovery was not following the functional form. So, I shifted my expectations — to be more patient, to accept that there are limits to what I can control, and to focus on the present. These strategies are key to recovery for other ailments — the Serenity Prayer is a staple at Alcoholics Anonymous.

My embrace of nonlinearity and the unknown, has been, well, nonlinear. At first, I found embracing uncertainty to be deeply unsettling and frustrating. It ran counter to my belief that we should not accept the status quo. We should strive to improve systems and decrease the odds of bad outcomes. I wanted to do, to plan, to solve. But, improvement and progress are not binary variables between perfection and abdication — they are continuous with many fluctuations. 

Over time, I found accepting some degree of randomness to be freeing. I thought back to my first-year statistics class. We discussed that linearity being imperfect is a good thing. Otherwise, life would be pre-determined and unsurprising. Getting back to normal might not even be a good goal. It implies stagnation.

Timeframe is another important academic and now personal concept. When we start and when we follow up with communities, countries, and ourselves can profoundly shape our findings and the stories we tell. Take for example, the Moving to Opportunity experiment and Gautreaux Program about neighborhood effects and child outcomes. These programs moved people out of disadvantaged neighborhoods and into more affluent ones. Short term evaluations were mediocre. Longer term results are more promising. 

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We are living in a world where death and destruction dominate the news. But, zooming out, humans around the world have been living longer and healthier than ever before. In an attempt to control what I can, I took up weight lifting last summer. I yearned for linear progression. There are weeks I don’t progress or I even regress. But, I am demonstrably stronger than August. Life is long. History is longer.

In a favorite Star Trek episode, “A Measure of a Man,” Captain Picard says to Data, It is possible to commit no mistakes and still lose. That is not a weakness. That is life.” 

Sometimes there is no satisfying answer to the question, “Why?” Setbacks happen. Code and experiments break, tests are failed, new variants emerge, war and conflict break out. Things go wrong. They stay wrong for longer than we want. But, things go right too. We learn new things, discover new hobbies, improve technology, and develop vaccines. The paradoxical feelings of liberation and apprehension for accepting uncertainty are captured in the closing number of Avenue Q “For Now.” The disillusioned Princeton, sings “And we'll accept the things we cannot avoid, for now...”

Today, I cannot avoid the 13 pill bottles littering my dining room table. But, this April, I presented at the conference that I missed last year. My tears have slowed down even if they haven’t stopped. I will not know what caused my perforated ulcer. That is alright. I can remain an enigma. I have done my best with what I can. For now, I can just be.

Emily Miller is a fourth year PhD candidate in Population Studies and Social Policy and a RGS at Forbes. She is originally from Palisade, Colorado.

Self essays at The Prospect give our writers and guest contributors the opportunity to share their perspectives. This essay reflects the views and lived experiences of the author. If you would like to submit a Self essay, contact us at prospect@dailyprincetonian.com.

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