From “Omens,” which was published in the Spring/Summer 2023 issue of the Virginia Quarterly Review.

Very early on in medical school, my classmates and I wrote answers to four questions about our health beliefs—things we “just knew” about our own health, superstitions, things that weren’t based in scientific fact. This was intended to enhance our ability to connect with patients who, for various reasons, might have convictions that contravened the Western medical canon we were starting to learn. I struggled with the assignment, which seemed loaded, like it wanted us to admit something embarrassing about our premedical knowledge, something we could all laugh at together once we were in the club. I found that I didn’t really have anything I could categorize as a superstition. I believed that medicine worked, and that even if it wasn’t perfect it was probably the best way forward for a sick person.

And yet, in medical school, I got to peek behind the curtain and see, not that the emperor had no clothes, but that the ones he wore changed constantly, and that we sometimes didn’t even know where he got them, and that how he felt about them could matter as much as whether they existed or not. I learned that we don’t really know how acetaminophen works to reduce pain, though it is one of the most common medications used today. I learned that placebos can work even when people know they aren’t real. In this golden age of “evidence-based medicine,” or “personalized medicine,” when we harness the power of science to decode the secrets of our DNA, outcomes are not as reliably predictable as we would like. People get sick. Some people get better, some don’t. More often than not we don’t know why.

I got very touchy during residency about using the word “quiet” when I was on call. If, during sign-out, someone even hinted at wishing me well, I would admonish them not to use the q-word. I wasn’t embarrassed by my superstition—I came by it honestly. The nights I particularly needed a silent pager seemed to be the busiest nights I had. Once, during my third year, my co-residents tried to convince me to eat dinner with them at a restaurant half a block from the hospital. The list of patients under my care was short, there was nobody waiting to be seen in the emergency room; everyone was “tucked in.” I hemmed and hawed and said I would think about it, and the moment I had made up my mind to go, the code bell rang and I sprinted upstairs to find a patient, seven days out from his operation and by all accounts healing well, exsanguinating from an artery that had suddenly burst in his neck. After that, I refused to leave the hospital during a call night for any reason. I was convinced that if I so much as thought about stepping outside, someone would die.

This kind of superstition among supposedly scientifically minded medical personnel is common enough to have been repeatedly investigated. Over the past twenty years, physicians have published studies in reputable journals examining whether patients born under Leo skies have worse outcomes; whether brain aneurysms are more likely to rupture during a new moon (yes!); whether certain physicians are “black clouds,” objectively busier than their counterparts (possibly); whether surgery on Friday the thirteenth or during particular phases of the moon is associated with a greater likelihood of postoperative complications (not true following tonsillectomy, thyroid surgery, elective spine surgery, cataract surgery—all independently conducted studies). There have been multiple randomized controlled trials assessing whether saying the word “quiet” aloud leads to busier shifts in the microbiology lab or the emergency department.

Some of the studies are tongue-in-cheek; some seem determined to exorcise any vestige of superstition from the medical field, a quest that has been ongoing since at least the nineteenth century (“some good physicians . . . need a thorough shaking up before they will let go old notions and adapt their surgery to the present day,” wrote a contributor to the Journal of the American Medical Association in 1884). The latter often adopt a scolding, humorless tone toward those who could possibly believe such things.

There are hints of uncertainty, even in the studies that purport to conclusively put a false belief to rest. One suggested that patients with strongly held beliefs about the lunar cycle should be taken seriously, even allowed to reschedule their surgeries for a more auspicious phase of the moon, so long as rescheduling “doesn’t constrict evidence based treatment regimens.” One of the numerous black-cloud studies noted that the residents who reported black clouds felt busier than their white-cloud counterparts. A trial about the effect of the q-word noted that some people felt as though their nights were worse if someone had uttered the word, even if, by the numbers, they weren’t. The authors of these studies used their pesky findings to argue that physicians ought to rid themselves of the black-cloud and q-word mythologies once and for all, because they have destructive potential even though they’ve been proven, scientifically, to be false. And maybe that’s true—maybe ridding the term black cloud of any significance would help overworked clinicians feel less busy. The phrase that comes to my mind, though, is self-fufilling prophecy.

In medical school I believed that surgery was a refreshingly concrete enterprise. That it was pure cause and effect. You have a lump in your neck that you can feel; I remove that lump and now it’s in my hand, out of your body, and you can’t feel it anymore. But once I started practicing, I witnessed experienced surgeons decades into legendary careers—surgeons I would trust to operate on my loved ones—make mistakes during supposedly routine cases, and be illogically anxious about their work, and insist on doing things a certain way with no scientific basis for it.

“I stopped taking pictures of my free flaps,” one head-and-neck surgeon told me, describing a particularly finicky type of reconstructive surgery that involves sewing arteries together with suture thinner than a human hair. “I’m convinced if I revel in how nice it looks, the flap will surely die later,” she explained. “Pride goeth before a fall,” a thyroid surgeon in Atlanta wrote to me, “so I practice humility before the Gods of Surgery, the Gods of Airway, and the Gods of Bleeding. They hate arrogance in the OR and will punish you.” Practicing surgeons were quick to own up to lucky totems: Wonder Woman scrub caps, special necklaces or earrings, auspicious colors, particular types of music. Some refuse to wear red on labor and delivery days, or orange anytime, or listen to Pearl Jam (“it kills free flaps”).

Superstition is built into medicine’s foundations: Though there are twenty-six operating rooms in the main hospital where I work, there is no OR 13.

Seeing the world as an ultimately scientific and logical place based on rules that can be explained, and making weighty decisions in that world, is a struggle for me. It’s difficult to treat a patient with any degree of uncertainty, difficult to admit what I don’t know, when, for the majority of my professional training, I’ve been conditioned to think that I do know—or should know. Some things are unknowable because there isn’t enough of an impetus to study them. Other things we don’t know yet. My crisis isn’t existential, it’s epistemological. How do we know what we know? How do we know for certain that we know anything at all?

Humans are meaning-seekers: We ascribe narratives to the world around us. When things are too big, we seek meaning; when we have no control, we seek meaning. We confabulate, we invent. In that context, perhaps surgical superstitions represent a learned humility, born of experiencing the unexpected over and over again, watching the randomness of the universe unfold in a body on an operating table. “I think whatever you need to do to convince yourself that you have the skills to handle what comes that day is worth it,” said another head-and-neck surgeon. “Sports research says athletes with a lucky charm perform better because they believe in themselves more. So maybe that’s it for us, too.”