What was the patient’s pulse?

RESIDENT: Patient is a 62y M who presented with shortness of breath, cough, and fever, diagnosed with pneumonia by chest X-ray in the emergency room, and is now, hospital day two, in the intensive care unit on broad-spectrum IV antibiotics for sepsis secondary to pneumonia.  Earlier this morning, patient is dong well; overnight, no events.  Vital signs are stable.  On physical exam…

ATTENDING: What were the vital signs?



In clinical medicine, there are a set of vital signs, including temperature, pulse, blood pressure, and respiratory rate, that help a clinician to assess the patient.  If the respiratory rate is high, perhaps the asthma exacerbation isn’t getting better; if the pulse is low, perhaps there is an arrhythmia.


The problem with these measurements are that they are a point in time, a static reading of otherwise dynamic process.  In the above scenario, unless the vital signs were abnormal, there isn’t much utility in saying that “at 7:38am this morning, for one second, the patient’s pulse was 83.”  It could have changed after walking away.


The purpose of measurement is to more and more precisely describe reality.  We are still affected by the enlightenment’s static and reductionist worldview; with the accompanied coarseness of mind came a loss of understanding the complexity of existence.  With a mechanistic vision of the universe, perceiving the subtleties of change gradually faded from scientific inquiry – reality was forced into boxes and integers and human definitions.  Instead of seeing change in all things, the idea of staticism was introduced.  Yet, reality begs to differ.  When a patient’s pulse is “unchanged” at 75 from one minute to another, it is not a default static state; rather, an extremely complex set of physiobiochemicalneuroendocrine interactions are working to maintain the pulse at that rate.  The only thing not changing is the number on the monitor and the frequency of the beeping sound; only our measurement is the same number from second to second.  But all things change – it is a law of reality.  Movement is an essence of existence.  And even stillness is not lack of change, but rather a state of dynamic equilibrium.


Clearly, in order to describe reality more precisely, we need more profound conceptions of measurement, and not simply more measures (as is the response of medicine, for example).  Throughout the history of medicine, blood pressure has been one attempt at this.  Hundreds of years ago, pressure was measured as a single number – the pulse pressure.  This was originally done with inserting a tube into a cut artery; as this proved too dangerous, non-invasive methods were used.  Yet, it was still a single number, “pressure”.  It was only just around 100 years ago that the concept of systolic and diastolic pressure was introduced, the one we currently use.  The value of the maximum and minimum pressure exerted on the artery walls at any given heart beat is vastly more informative that a single number representing arterial pressure.   Why is it more informative?  Because it’s one step closer towards a more adequate reading of reality.


The measurement of blood pressure as a spectrum is a step towards reflecting the underlying truth of reality that all things are on a continuum.  Perhaps pulse can be reported as “between 65 and 72 overnight” or “between 45 and 110, with an average of 82 overnight” (which are two different clinical pictures).


The work of the Bahá’ís and their friends in community-building at the grassroots is based upon a progressively more precise reading of reality.  And reality is a dynamic continuum.  The mode of functioning, at the same time, of this community-building work is systematic – which involves quantitative (and qualitative) measurement.  The Baha’i community has been learning about placing its descriptions of reality on a ever-more-rich continuum.  This helps avoid two pitfalls – both manifestations of the same underlying tendency to reduce reality – which have plagued society for years: collapsing all individuals into one middle group (such as in the case with school systems) or collapsing all individuals into one of two bi-polar groups (such as in the case with political systems).  The reality, instead, is that there is a continuum.


Take the example of a group of junior youth engaged with the junior youth spiritual empowerment programme.  One can describe them by saying, “The group has around 12 junior youth, and the group has completed one of the texts so far, and 7 of them were at the first service project”.  One can also – more precisely – describe the group by saying: “The group has 22 junior youth that are associated with the group – 6 form the core and have completed every lesson, 9 come sometimes and have done more than half the lessons, and another 7 have come at least once or twice and the animator and junior youth are in contact with them.  7 were at the first service project, yet another 4 were at the planning meeting, and 2 lent supplies; a participation total of 13.”  What a more befitting way to describe the reality!  These activities are living and moving and changing – they are dynamic.  The pulse pressure is not a static 12, but a dynamic 22 over 6…



As we sharpen our perception, we will learn to recognize and measure social and spiritual dynamism in both movement and stillness in order to build vibrant community life.