Mindset
4. HOW PHYSICIANS THINK ABOUT EMERGENCIES.
Knock-on Causes: You know what happens next.
First of all, physicians are always dealing with a chain or web of causation. Some are important only for the long run, some may be emergencies. Emergencies take priority.
In emergency medicine, the initial focus is not on the root cause of the patient’s problem, the way climate science prefers to focus on the fossil carbon put into circulation. It is about knock-on problems: immediate life threats, such as internal bleeding and shock.
Our climate problem has secondary knock-on features such as extreme weather, which may threaten civilization on a much faster time scale than does the underlying overheating.
The cartoon chain of causation leading to extreme weather, together with three possible interventions.
The physician’s
mental check list
mental check list
Which parts of the physician’s mental check list would a “climate doctor” want to consider adapting?
Here is a mental checklist showing how the physician usually proceeds, together with my evaluations of the climate equivalents:
Beforehand, sensible anticipations: for winds and heat waves, bury power lines and create battery backup for A/C; rebuilding infrastructure to resist floods; and relocating people out of flood plains and coastlines. Stockpiling—but also economic modeling for emergencies, planning we should have done before the pandemic’s 2020 recession.
A. Protect the patient from the usual causes of terminal downhill slides. This is commonly called “stabilizing the patient.” An example: the public works construction in the 1930s likely prevented civil disorder in the Great Depression. WHC: For both our pandemic and the climate, INADEQUATE.
B. Diagnosis. Recognize what is wrong. For climate, the working diagnosis since 1980 is a global-scale overheating caused by the atmospheric accumulation of CO2, contributed by the annual emissions of fossil fuels. WHC: SUCCESS, but attacking the root cause via emissions reduction is now too slow.
D. Prognosis. To evaluate urgency and motivate action, guess where things are heading. Climate models are good for estimating slow climate change over a century, but they are only beginning to address the dynamic aspects that can create climate flips within a decade.
WHC: PARTIAL SUCCESS.
E. Rule out other problems. Repeatedly search for knock-on climate problems, analogous to shock and internal bleeding, that could provoke a fast track to disaster. There’s a motto in emergency medicine: “Think fast. And then think again.”
WHC: For climate, ONLY BEGINNING.
F. Formulate a plan of action and explain it to get consent. Like most diets, emissions reduction has failed; the annual bump-up in CO2 from emissions is now 50% greater than before 2000. We must now focus on a quick cleanup of the existing CO2 accumulation, similar to using a kidney dialysis machine to quickly clean up an aspirin overdose from the circulating blood.
WHC: For climate, INADEQUATE.
G. Finally, before discharging the patient, try to prevent a recurrence, as in persuading a patient with asthma to stop smoking. Emissions reduction is an exact parallel for climate. But note that addressing the longer term is the last thing to do on the doctor’s mental checklist; most of the list was concerned with keeping the patient alive—to make the long-run relevant.
WHC: LIMITED SUCCESS.
PARTIAL SUCCESS, overall. We have had fifty years of climate education efforts but something is preventing effective climate action even by the knowledgeable—perhaps the stay-in-your-seat spectator mindset for the surreal, where gunshots on stage don’t cause you to hit the floor and phone 911.
Prognosis
Now that extreme weather has replaced fractional-degree overheating as the most relevant threat (it surged when global temperatures remained flat for ten years), we need to reassess the probable course of climate disease if we do not cool ourselves off. There may be a steady progression of damage and disorder, or there may be recovery and relapse. We might want to adapt some medical terminology used for progressive disease to better understand our climate choices.
The time course of disabilities in a multiple sclerosis (MS) patient shows four typical time courses (see figure).
Neurologists, in attempting a prognosis for the patient, take a very detailed medical history in an attempt to identify which path the patient is on, as it matters when considering aggressive treatments with hazards.
I can imagine climate trajectories that resemble all four MS types. I have not heard any discussion of the climate prognosis in such terms. There are certainly "bad years" such as 2018, but what measures should "climate doctors" be using to define stable years?
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The periods in red are when the MS patient has worsening disabilities (e.g., from canes to walkers to wheelchairs); periods in blue feature fairly stable disabilities. For periods in yellow, disabilities seldom get better, only worsen. In 10-20% of MS patients ("primary progressive"), that is true from the beginning of disability symptoms.
Note that this medical connotation of 'stable' merely means not worsening; nothing has been stabilized to resist worsening.
What does not map from medical to climate
There is one big exception in applying medical thinking to the climate prognosis: population thinking and over-the-next-few-generations considerations from preventive medicine do not work when there is only one patient.
We are in the position of the full-time king's physician. There is no "better luck next time." Whole empires have collapsed after the untimely death of an emperor.
Whether we consider the climate patient to be the planet, the biosphere, or civilization itself, there are dire consequences if we fail to become good climate doctors, and soon. Part of Climate's Manhattan Project is to educate a generation of climate doctors from scratch.
This wall cloud lacks only rotation to become a tornado.