On Evidence and Luck

By Dr. Chris O’Connor, President & Founder of Think Research, and ICU Physician at Trillium Health Partners

I feel lucky. As a critical care physician, I’ve always had a strange relationship with the concept of “luck.” I’m a scientist. I deal in facts and evidence-based best practices. We have protocols, standards, measurements, timelines, diagnosis, prognosis, you get the picture. We act based on the evidence in front of us and our patients would expect nothing less. 

But the night before the Utah Jazz’s Rudy Gobert was confirmed to have COVID-19 — prompting the NBA to suspend its season and setting off the landslide of cancellations and closures that have brought us here — I was on an airplane. Flying home to Toronto from a meeting on a plane with hundreds of other people was the last normal “public outing” for me in a “pre-COVID” world. Reflecting on that now, I feel pretty lucky that my travel didn’t expose me to the virus. 

I’ve been painstakingly, exhaustively careful about how I don and doff my personal protective equipment when I’m on-shift in the ICU. But, I’ll be honest: I still feel pretty lucky I haven’t become ill. 

And, mindful that it’s Doctor’s Day in Canada today, I also feel extremely lucky, especially in the middle of a pandemic, to have such a rewarding career and such incredible, hard-working colleagues.

Here’s what I know — our ICUs in Ontario have not been overwhelmed in the way we had feared. Our supply of PPE seems to be improving. We appear to be coming down off a peak of infections that did not approach the worst-case scenario projections for what could have been. It feels way better. That daily gut-punch of fear when I start a shift is slowly beginning to ease.

Other parts of Canada — New Brunswick, Newfoundland and Labrador, Saskatchewan — have gone days without a new COVID case and are now cautiously lifting some of the restrictions in those provinces. These are optimistic signs.

We also know that our long-term care and retirement homes are facing a mountain of difficulty getting this disease under control. My healthcare colleagues are still very much at risk. If we don’t get this right, we could face another wave of illness that nobody wants to see.

We have to listen to the facts and the expertise of our public health physicians. We need to keep following the rules and hope for some more good luck.

I’m sure you’ve seen the videos circulating of healthcare professionals celebrating the extubation of COVID patients in their hospitals. Many of them have been ventilated for weeks and have come very close to dying. Ask those patients and their families how they feel in that moment of their recovery and I bet “lucky” to be alive would come to mind. We feel it too. These moments are enormously rewarding from our perspective. It’s a fantastic feeling, hence the spontaneous outbursts of dancing that you’ve probably seen on the internet (and, admittedly, some of us are terrible dancers).

As a doctor, my comfort zone will always be in the realm of statistics, vitals, dosages, facts and evidence. That’s medicine. But I know for sure that we can’t control everything that happens inside the hospital or outside of it and I’ll always be open to a little bit of (carefully measured) luck.