Do the Obvious Thing First

People get in a highly perfectionistic way of thinking during medical dilemmas; they think, “I need to do the most excellent thing.” They’re always asking, “What decision would be best?” After all, in a crisis, you want to be dead certain. You have to be sure you’re not making a mistake. Nothing seems good enough in that situation, and so rather than asking “What is something I can do?” you’re always trying to find out the impossible: you’re always trying to do the best thing in the world.

This happens when someone is looking for a new doctor. When they’re in the search, no doctor is good enough, not even the one they last had. All the old doctors, all the doctors in the past, are failures, and all the present candidates are too low quality.

Actually, there are no perfect doctors, and all anyone needs to do in a crisis is to do the thing they believe will be effective. They only have to find something that will help right now, to alleviate the symptoms that are present right now, rather than looking down into the depths of the problem in a single glance. The simplest thing is what you should do now, before riskier decisions come on board.

I don’t just mean right now, right this minute—not everything is the decision of a minute—but also three days from now, or a week from now, after other alternatives and other courses of action have come to mind to be chosen. Right now, this minute, you could text someone who could answer a question you have, or you could write a message to your doctor. Three days from now, when you find that, for example, you’re still coughing nonstop, you could actually try the cough syrup with codeine in it. What I mean is: you can actually do something easy, and it will be enough.

Do the obvious thing first. Take the shortest route. If you don’t, you will find yourself circling back on just one engine.

This is how medical diagnosis is supposed to work, anyway. The doctor rules out the most common, most obvious explanations first. But this principle is sometimes ignored, at great cost, because we are all striving for excellence and comprehensivity in all things, and the shortest route gets overlooked. A man with a cannonball wound goes to the emergency room complaining of pain and the nurse, looking for an invading microbe, asks him if he has recently traveled outside the country.

“Obvious,” as a concept, is linked to “basic.” “Obvious” means “evident” or “apparent” or “apparently apparent,” and doing the apparently apparent thing may mean starting with general basics, starting at the bottom. This is particularly important in medicine because healing follows a ladderlike progression. Some rungs must be tried before others. Step one must come before step two, and step two before step three. This is apparent when pain or histamines get in the way: step one is to create some relief or throw a safety net around the situation so that the patient has the confidence to try anything else. But the healing of the cells itself progresses through natural levels; the biggest blocks must be cleared at each stage, and clearing them is necessary to attain the next level and get anything else to work. A doctor recently told me anemia works this way—hemoglobin carries both oxygen and sugar—and you can’t have any other improvement until you address it. Not any major improvement, anyway. Neil Nathan makes this argument early on in his book: “[chronic] illnesses are caused by years of biochemical and medical dominoes….Unless you know with precision that what you are treating is central for this patient (even if the patient has other, correct diagnoses) you will not make much progress.”(1) He gives an example later on, writing that, for instance, working on a virus when the primary problem is mold “will not move the patient toward health.”

It should be noted that Nathan is not advocating only treating one causal factor at a time; there can be two primary issues (or more, I would assume), like both mercury and mold, and Nathan uses immunological and nervous system supports concurrently with treating the other issues. But, at each stage, there will always be major factors and less important factors, and healing follows a natural progression. Sometimes these basic treatments seem too simple to be worthwhile. In the past year, I kept thinking the solution to my problem was esoteric. I didn’t take the importance of glutathione or exercise completely seriously, and honestly, I had some trouble with both, so I tried everything else. But that glutathione and exercise seem ridiculously simple is a terrible pathology of thinking because they are absolutely vital to healing and repair. Glutathione is a master detoxifier and antioxidant and feeds the gallbladder and liver and heals tissue—it’s a foundational therapy. Exercise, on the other hand, ends the danger response so that mitochondria are turned on to fix damaged cells. So I wonder if the basics, once covered, can ever really be dispensed with.

Another way of thinking about the obvious is to see it as the easy thing. Carrying out the apparently apparent solution may mean not having to do a lot of physical or mental effort. Some, but not a lot. Author Tim Ferriss has written that one of the best problem-solving tactics in situations that come with a lot of overthinking is to ask: “What if this were easy?” For instance, someone in my family was recently considering a stem cell injection (stem cells are often harvested from the membrane of a fetus) for knee pain, and they eventually decided they should try something easier and cheaper first, which led them to microcurrent therapy with a chiropractor and then cold laser treatments. Simply looking up common treatments for knee pain like frequency specific microcurrent is the apparently correct thing to do, the obvious thing, and easy. It’s time-saving to try the easy thing first—because it may work—before you involve an unconsenting placenta.

If someone is choking on a walnut, you would perform the Heimlich, not stand around talking about their high-fat diet. But in a crisis everyone leaps to the most remote, outlandish and difficult solution. They reach for the best, bringing everyone with them. During the pandemic, even my Washington State naturopathic doctor fell into this excellence trap. She told me I needed to fly to New York to see a famous leading specialist in Mast Cell Activation Syndrome (MCAS)—a histamine problem—but I couldn’t fly, because it was a global pandemic. For months, I called all over the country to find a leading specialist we could drive to, with no result. Finally, my doctor asked the colleague of the doctor in New York if that colleague could treat me remotely and, after much deliberation, the colleague of course said no—another long shot that failed when swift, simple action was needed. A year went by in this manner and then, because the situation involved food and had, as a result, become life-threatening, it became necessary to actually do something. At just that point, I found an allergist and immunologist in Salt Lake City who could treat me remotely; not the simplest solution but not quite as complicated either. I will admit that he was trained by the New York doctor, but he told me that whether the problem is MCAS or something different, if you’re having painful reactions, the treatment is the same: an antihistamine, perhaps with a soupçon of mast cell stabilizer.

He eventually saved my life, but before he could do that there was a lot of discussion about what was best to do. I could react to the very medication I needed and so he suggested a “medication challenge” which means trying the medicine in the office: you take something you might react to, and when the nurse comes back in the room she resuscitates you. So we were going to go to Salt Lake and do the challenge in the office with him as soon as possible.

After I finished writing out my packing list, I thought, Wait a minute; there are allergists with offices here in New Mexico. My Utah allergist then called a peer from the University of Michigan who currently practices immunology in Santa Fe, and we did the challenge there. Again, of course, Santa Fe was not the simplest and easiest place to do it, but we had all been caught up in striving for excellence for so long that nothing could stop us. Doing the challenge an hour away in Santa Fe, it turned out, was not necessary, and it prolonged the entire ordeal by a couple months. Also, during the challenge in Santa Fe, I was alone in the room for most of the time, except for the company of Monet in the form of his nympheas, so it was not the armored space I had envisioned at all. An allergist in Albuquerque had told me he would allow the challenge to be done in his office, even though he was short-staffed and recommended using a different antihistamine. I imagine we could have worked with him and persuaded him to let me try the Ketotifen instead: the Santa Fe doctor also maintained a different diagnosis and recommendation than his Utah peer, but he ultimately let me make the call to try the Ketotifen. In the final analysis, the “best” was not really best and we succeeded in stoking the flames of the problem by further delay. Anxiety leads to perfectionism and perfectionism leads to death.

Done is better than perfect. This is not to suggest that quick and easy action should come from ignorance. If I had known what I know now, that all I needed was an antihistamine and mast cell stabilizer at a low dose over time, I would have done the right thing the first time and gone to someone local. The gathering of information is itself a basic step.

If my naturopathic doctor had known this, if she’d had the right information herself, then, armed with new information, she could have called someone nearby. Even my Utah doctor overcomplicated things and avoided the obvious. That’s the trap of excellence: we’re all in it together. None of us will allow mediocrity, and, as a result, this pulls us all down. No choice is actually perfect, and, sometimes, with a doctor’s help, you can adjust the treatment to fit your needs. Do the obvious thing first, even if it seems too easy to be the solution. Alive is better than perfect.

(1) p.12 and p.22 Toxic by Neil Nathan, MD, 2018

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