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Wrestling with the Infinite and Indefinite in Radiology


What are the best adaptive strategies for mitigating the anxiety of unknowns in one’s work and life?

My favorite thing about this time of year is the combination of warm weather and a maximum amount of daylight in which to enjoy it. Not only can I get outdoors and exercise after work, but there is also ample time to soak in the pool afterwards with the sun decently high in the sky.

Basking in heat and light while physically spent, my mind tends to drift, offering me pleasant bits of nonsense. Occasionally, more substantial insights sneak into the mix. During a session this past week, the terms “infinite” and “indefinite” jostled one another. It occurred to me that a lot of anxiety and general unhappiness result from conflating the two concepts.

Lest it need saying, infinite refers to something that has no limit. Indefinite means something whose limits (or other parameters) are unknown.

Under some circumstances, the distinction is obvious. We won’t know next week’s Powerball jackpot until the day arrives and all ticket purchases have been factored in so for now, it is indefinite. However, nobody thinks the prize will be a bottomless pit of money. The winner will get a very big, but finite, sum.

The waters can get a lot murkier, especially when the stakes are more personal and/or emotionally charged. If I am in a position where every single imaging study that comes from the ER till time X is my burden, and I need to clean it all up before I am done for the day, I might instinctively think of the workload as potentially infinite. Suppose there is a massive pileup on the nearby interstate, or a train derailment, and my facility becomes Trauma City. There might be “no end” to my day.

As anxiety provoking as that might be (especially if I had plans after work), it is not really the case. However big the number might be, there are only so many people who could need medical attention and get sent to my place. There’s only so many of those patients who will be triaged and sent for imaging before time X, and only so many that our imaging units can process before my time is up.

Even if an emergency is declared and I get tapped to stick around for an extra hour or two (in which case presumably other rads will be called in to help), there will eventually be an end to my workload for the day, rendering it finite. It might have been indefinite along the way, even feeling endless/infinite, but no worse than that.

Rads (and other docs) can feel the same way about all sorts of other indefinite but finite stuff. Especially early in a career, one might perceive that there is infinite malpractice liability. Anything allegedly done (or not) can be some ambulance chaser’s excuse to come after a payday. It’s indefinite in that we never know just how many times we will be accused until everything is said and done. However, even in a worst nightmare scenario, there are only so many health-care situations we get involved in, and so many litigious individuals to poke at them.

That anxiety usually wears off over time, but others can move in to take its place. The longer one works in the field, for instance, the more one gets the sense that insurers and government are imposing a never-ending (infinite) series of reimbursement cuts but that is also a finite affair. The absolute most they can do is reduce payments to zero and, realistically, they can’t even do that because we would just stop working for them. Indeed, we would probably knock off as soon as their payments fell below our overhead amount.

It’s not unreasonable for folks to conflate infinity with indefinity (if that’s not a word, I just made it one). This is especially the case for those who do a lot of thinking and planning for a living. We’re accustomed to sizing things up and prognosticating over them. We have got a better handle on things if we can define them, which is precisely not the case with indefinites. If we can’t even concoct a ballpark guesstimate with which to work, we are flying blind.

Put another way, if you tell me that the cost for maintenance or repairs on my home/business is indefinite or unknowable, I am inclined to think of the worst-case scenario and that I won’t be able to cover it. From my perspective, it is just as bad as if it were infinite. It is reminiscent of stuff you might have learned in an old calculus course. The value of the indefinite “approaches infinity.” Our subjective “infinity” is relative to whatever finite resources we have, whether it is our bank balance, the time we have left in our careers or to continue living, etc.

That has a certain pragmatic value to us planners. Once we have done everything we can to remove the “in” from indefinite (by research, asking others who might know more than we do, or racking our brains for data we might have forgotten we already have), temporarily assuming the infinite helps us move on to worst case contingencies: “Okay, let’s say I can’t afford repairs. What am I going to do instead?” “Well, it looks like the 50-car pileup is going to keep me working into the evening. I had better cancel my after-work plans.”

Most of the time, when the indefinites reveal themselves, they are far more manageable. The repair estimate comes in, for instance, or the ER has received whatever trauma patients are going to show up, and it’s known how many of them are in the CT pipeline. Considering the indefinite as an infinite thus serves a second purpose. It helps us “brace for impact” so when we see what we are actually dealing with, it is far less daunting.

Circling back to my original point, these adaptive functions come with a cost: the temporary unhappiness of believing one is grappling with an infinite when, realistically, one is not. It is a matter of individual preference as to whether that cost is worth the gain. One of my yesteryear blogs was about how I consider myself an adaptive “worrier,” so I clearly embrace this approach. However, for folks who struggle with anxiety or believe that ignorance is bliss, my approach might not be ideal.

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