White vans, white coats, and the human desire for meaning

Imaan Javeed is a medical student at the University of Toronto

 

On Monday, April 23, while driving on Yonge Street near Finch Avenue in Toronto, it's alleged that Alek Minassian whipped the steering wheel of his rented white Ryder van sideways and killed ten innocent, unsuspecting people; physically injured sixteen more; and emotionally scarred hundreds of others. At the time of my writing, a clear motive for these actions has yet to be publicized. Minassian is alive and certainly under investigation, as much as he may have desired otherwise, but there still isn't much we know about the lead-up to the event.

Indeed, much to the dismay of some members of the media, the 'default' assumption quickly turned out to be untrue — there was not a single known link to "jihadist" terrorist groups or foreign radicalization to be found. Reporters continued digging, and found a strange, young, white, tech-savvy misanthrope and alleged sufferer of mental illness with a potentially difficult upbringing, a very brief stint in the army, and an extremely poor choice of role models. They found glorification of and identification with the alt-right-linked misogynist subculture known as "incels" — but no confessed links between this movement and the attack.

In the hours and days that followed, the information well began to dry. No manifesto, no messages to friends, no recent troubling interactions. Even release of the notably (but, for Toronto, appropriately) cosmopolitan victims' identities was not enough to fill the vacuum. Headlines cryptically tried to link the killer's actions to incel ideology, quickly turning a niche internet portmanteau into a city-wide household point of discussion. Eight women and two men. 8-2. Not the most satisfying ratio, but as people we cling to what we know.

Whether or not incel leanings may have led to the attack, what fascinates me is the human desire to search for ways to fill in blanks and try to make sense out of the senseless. We are wired to hunt for meaning; to search out and appreciate patterns, signs, and symbols. Day and night. Seasonal and harvest cycles. Cultural, religious, social, and political rituals. Dubstep. We are creatures of ritual, pattern, and habit. We are naturally inclined to stereotype, to observe for gestalt, and to witness our reality as narratives.

When we are presented with an empty space — whether the space exists within us, outside of us, or somewhere in between — we are naturally inclined to try and fill it in. Calm, cool reporting of an event that resists jumping to conclusions is admirable, but also makes us paradoxically uneasy. Upon reflection, I believe this truly speaks to the idea that the media’s central role in society is, or perhaps always was, the peddling of narratives for mass consumption.

As physicians, we also find ourselves to be storytellers tasked with somehow braiding the loose threads of findings into diagnostic ropes for our patients to grasp. But we, too, are often tripped up when the question of "why" arises.

The reasons are not always clear. Sure, the sports injury may have been what tore the ligament, or the rogue virus could have caused the cold. However, though we can sometimes explain pathophysiology and etiology until we run out of breath, we will never be able to provide satisfactory answers when delivering some news or when faced with certain questions.

Certainly, since that fateful April day, each of the victims' loved ones has contemplated the questions: Why them? Why then?

No healthcare provider will be able to answer these questions. No one can tell a patient diagnosed with lung cancer why their uncle — who smoked daily since he was 12 years old — died without illness, while they ended up sick despite diligently avoiding even second-hand smoke. No doctor can turn back the clock and tell a 50-year-old patient with certainty that their condition’s course would have been different if they had led a different lifestyle in their twenties. As much as we may sometimes desire it to be, a stethoscope is not a crystal ball.

Anxious parents of a child with a rare genetic disease will often silently wonder the un-answerable on the car ride home: Why them? Was it something they ate? Something they did? Were they — the parents — somehow the choreographers of their chromosomes' unique and peculiar dance routines?

The answers are not easy ones. The idea of things being due to random chance — a game of numbers and statistics — may placate some, but it does not bring much ease to the rest. The vacuum of the inexplicable, the unfair, and the seemingly nonsensical is an anxious place where science, logic, and mathematics hold little value. Emotion, resilience, reflection, and faith are the masters of this dark domain.

Sometimes there is simply no way to inject method into the madness.

However, simply brushing off or pushing aside these unsettling feelings does not bring us any closer to reconciling with the void. As patients, physicians, and citizens of this world, we must learn to cope in healthy ways with the idea of uncertainty being the only certainty in our lives. Emptiness can be filled in countless ways — but not all of them are healthy for us as individuals or for society as a whole. Recognizing the vacuum is often the first step towards ensuring it is tended to in healthy ways: with love, care, and compassion.

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