Could Have, Should Have…

But Didn’t

This will be a somewhat different substack, but there is an important tie-in to Critical Thinking, rest assured.

In my youth, a lifetime ago, I was a competitive fencer.  Or at least I tried.  I wasn’t ranked, but enjoyed myself immensely and fenced against some pretty good competition-the national pentathlon team.  I won some, but mostly lost.  But fencing was a passion of mine.  I enjoyed all three weapons, but epee was my favorite, with saber a close second.

Epee is the descendant of the dueling sword.  It is the heaviest and stiffest of the weapons and has a triangular shaped blade.  The target is the entire body, from the top of the head to the tip of the toes.  But what I liked the most was the absence of priority of attack or sometimes described as right of way.  In foil and saber fencing, it is not enough to score a touch against your opponent.  It has to be under the priority of attack rule, which is only judged by a human.  The touches themselves are scored, nowadays, by an electric scoring system.  The blade contacts a conductive vest (in foil) or jacket (in saber).  It is sent to an electric scoring box that registers valid touches on the target areas.  In foil it is the torso; in saber the body from the waist up. Touches not on target are registered as such.  But it is the priority/right of way thing that was bothersome to me. If it sounds confusing, it is.  Especially when that priority of attack can change several times a second.

In foil and saber, the individual who initiates an attack has the right of way.  The opponent must first parry the attack before they can counter attack.  In epee, only the box counts.  The light goes on if the point hits.  If both fencers hit withing a 25^th of a second of each other, both lights go on and each fencer is awarded a point.    The subjective component, even if subconscious, is avoided.  I liked that.

Each Olympiad, I look forward to seeing the results.  However, this year I was puzzled.  There was no USA men’s epee team!  So, I dug into the reason.

There was an unfortunate incident at the 2023 Pan American games in which one of the USA epee fencers had an unacceptable outburst of anger.  This resulted in a team “Black Card” which nullified their standing and meant the USA could not send a team to the 2024 Paris Olympics.  Yes, you got that right. One individual ruined the Olympic chances of his whole team.

In 1978, when I was in the thick of my own fencing competition, I had this fleeting wish to give up my ophthalmology residency and heavily train for the 1980 Olympics in Moscow.  I was young, and probably naïve, as my chances were really extremely slim.  Thankfully, the more rational side of my brain took over and I didn’t try to follow that dream.

However, many Olympic hopefuls did.  They trained hard and made tremendous sacrifices, only to have Jimmy Carter boycott the participation of the United States in protest for the Soviet invasion of Afghanistan.  Hundreds of athletes and support individuals lost out on their chance to participate in a dream they had for their whole lives. For many, it would be their one and only chance.  And it was lost for a political statement.

The same president who denied those US athletes their chance funded Operation Cyclone that supported the Mujahidin in their insurgent war in Afghanistan against the Soviets.  Two decades later, one of those Mujahidin leaders, Osama bin Laden, repaid the US with the attacks on our embassies in East Africa and the critical 9/11 attacks.

So, how do these two Olympic events relate to Critical Thinking in Healthcare? First, the decisions were wrong on virtually every level. However, more importantly, they are examples of individuals making political and ideological decisions which had a much bigger effect on others than themselves. The decisions were individual, but the consequences corporate.   Lastly, any accountability the individuals faced paled in comparison to the damage they caused. 

All of these factors are the same in reflecting on The Great COVID Disaster and The Great Ethical Collapse.  The decisions were wrong, and  those making the decisions should have known better.   In calculable damage was done, primarily to others.  And the accountability for these actions has been way out of proportion (if levied at all!) for the damage done.  While we can’t right the wrongs, we can certainly at least give some level of deterrence to prevent their repetition. 

But will we???