I believe everyone holds on to certain metaphorical truths. These are not literal or scientifically validated; in fact, they may be objectively false. Yet, they serve a purpose, offering us a sense of comfort or meaning. For example, the belief that “hard work pays off,” the hope that “good things happen to good people,” or the assurance that “everything happens for a reason.”
Often, these truths aren’t consciously acknowledged; they certainly weren’t for me. But as I stood witness to the slow deaths of innocent young people – victims of senseless violence, like being shot for pocket change or struck by speeding cars during peaceful walks – I felt something deeper inside me unraveling. I couldn’t articulate it at first, but it was the disintegration of my implicitly held metaphorical truths: that the world is fundamentally good, that some form of providence exists, and that life and death, though difficult, are ultimately understandable and meaningful. Holding onto these beliefs, even subconsciously, now felt like cognitive dissonance.
Before starting my surgical rotation, I had already developed a strong interest in the medical humanities. My passion led me to make a presentation at the American Society of Bioethics and Humanities conference last year on the value of creating spaces where students could process and reflect on intense clinical experiences through storytelling, whether written or spoken. At the time, this was an intellectual exercise—a way to advocate for something I believed could help others. I had no idea how personal and urgent this need would soon become.
By the time I arrived at the conference, just after finishing my surgical rotation, I carried with me a profound sense of emptiness — a void where meaning and certainty once resided.
As a medical student accustomed to structured problem-solving—where every case has a clear conclusion, like pancreatitis from alcoholism or cirrhosis from hepatitis—I found myself unable to apply the same framework to the tragedies I had witnessed. What ethical takeaway is there from the murder of a young man for a few dollars? What is the meaning of that? How could I reconcile these experiences with any coherent ethical framework? I felt that I needed answers to these questions.
These unsettling questions were weighing on me when I attended a clinical ethics panel on the last day of the conference. I listened to a philosopher and clinical ethicist, Dr. Virginia Bartlett, discuss her work with narratively complex clinical consultations. She expressed frustration at how often her discipline reduces these difficult narratives to simplistic, digestible conclusions – resulting, as she said, in “the retreat from clinical responsibility into role.”
Dr. Bartlett went on to emphasize an alternative approach – the possibility of letting experiences and personal stories exist in their raw, unedited form without the need for interpretive frameworks or the pressure to extract meaning, any meaning. The result might not bring clarity; it may instead puzzle or confuse. But perhaps there is value in that. Perhaps something true exists in the anarchy of voices found in a clinical context – something that is lost when we attempt to refine or simplify these complex narratives.
The ethicist’s message resonated with me. She hadn’t offered answers to resolve the uneasiness I felt searching for meaning but instead invited me to sit with it—an acknowledgment that ambiguity itself can hold value. In a clinical environment driven by the pursuit of answers, causation, and meaning, what does one do with a question that defies resolution?
Was I naive to believe I could distill significance from my experience in the SICU? Is it possible that some things—like the deaths of young people in the SICU—happen without coherent meaning? Or is it possible that a meaning can be found, but it is different for each person, rooted as it must inevitably be in their own beliefs and experiences?
The experiences in the SICU that I’ve described here were part of my life as a 25-year-old medical student. Is it possible that these experiences were part of the learning process that opened my mind to deeper meanings—the realization that the ideas that I had once held as truth were merely platitudes?
I now see that the role of a medical student isn’t to jump to simplistic conclusions in a reflexive impulse to impose order on disruptive experiences, but to recognize them as a force of intellectual and spiritual growth.
Then in time, with enough experience, the death of metaphorical truths might be followed by the birth of a wiser, more complex, and more nuanced worldview.
Realizing this possibility, I aim to do my best to continue this journey of learning as an open-minded observer of the world around me, and a searcher for deeper truths, including those that dwell within my own mind, heart, and soul.
David Curtis is a third-year medical student at Baylor College of Medicine and a recipient of the Laurence McCullough Travel Award.
Powerfully written!