Shitter Ontology

I would like to provide you with a little insight into my inner dialogue.  I was taking a crap at the local massage... place? ...institute? ("Massage parlor" makes it seem like I entered and exited with dark sunglasses and a hat covering all hints at my identity.)  On the wall in front of me was a picture of a cat in Japan.  I thought to myself, what's it like being a cat in Japan?  My inner asshole responded with:

"What the hell do you mean?  A cat is a cat!  It shits, fucks and eats."

"What I mean is, the basics have to be different, right?  It's in Japan.  There has to be unique feline cultural differences."

"It just means it shits, fucks, and eats in Japan."

"But the resources must be different.  What if it gets injured?  Would it be treated differently than here for better or worse?"

"If a cat gets injured, it shits, fucks, and eats with a limp."

What I believe my underlying existentialist dick wad was telling me is the level of consciousness I assume a cat has is inadequate for a personal narrative.  Its identity is biological: an entity that fills this space and requires these resources (food, sex, territory, affection, etc.).  The cat is not burdened by hope or aspiration or expectation.  A broken leg doesn't represent lost days at work, inability to ski or surf, or an opportunity to learn guitar.  To a cat, broken leg means "I feel pain as I do these chores of daily living."  The pain, and more importantly the dysfunction, is now.  It is not a representation.  It exists.

I want to be a cat.  Don't get me wrong, I adore my consciousness, as well as my sub- and unconsciousness.  They provide a great deal of entertainment and distraction.  The near random meanings they apply to the non-existent directions my life can motivate me.  My consciousness, and more importantly my self-consciousness, allows me to expand.  It makes me ten to the tenth.  

The problem is that in the end, we're all going to die.  And sometime in the middle we are all going to suffer.  That suffering is bad enough in itself.  It doesn't need to expand.  I don't want the burden of the implications of my suffering to push the actual pain beyond its borders.  I just want to shit, fuck, and eat with a limp.

Forgiveness

I apologize for my absence.  I've been vacating, both literally (vacation) and figuratively (coughing and spitting and aching and snotting and hiding and complaining).  But I'm back for what it's worth.

My wife and I were talking about forgiveness yesterday.  I, of course, charmed her with the knowledge I derived from Matt Damon movies.  In discussing the impetus for pardoning those responsible for South African apartheid, Mr. Freeman informed Mr. Damon (and thus me) that forgiveness is the ultimate weapon (it may have been Nelson Mandela who said this but I'm not splitting hairs).  My initial thought on this statement was that it is a bunch of bullshit.  If one is wronged in a life altering way (i.e. as a victim of racial segregation and the violent consequences that follow) the proper response is a beat down of the perpetrators, both literally (i.e...well...a beat down) and figuratively (i.e. policies and procedures that ensure a loss of personal freedom and integrity. As an aside the word "justice" is a derivation of revenge not equality.).  

This is of course not a sound ethical response.  It does however, feel good.  Why does it feel good?  Because it helps relieve the tension created by the impenetrable anger that betrayal creates.  If I am wronged in someway, the effect it has on my life is magnified: the drop of objective alteration ripples into a riptide of subjective anger and resentment.  My life becomes plagued by a need for vengeance.  The problem is, the relief of a beat down doesn't last.  It's like drinking away your sorrows: you will sober up.  The anger will return.

Morgan was telling us that the true power is to let it go.  To forgive.  Forgiveness isn't necessarily hugs and kisses and servitude.  The forgiver tells the forgivees that they don't have control.  What they say or do has no effect.  When I forgive you, it says that I am independent of you; your actions have no meaning in my life.  For human beings whose lives and self-worth a wrapped up in meaning, forgiveness can be an attack.  Forgiveness can be a beat down.

I have a shitty theme song.

I listen to music as I run.  It turns my head right side in.  It percolates meaning through the bland rhythm of my Nike's.

I listen to King's of Leon and the Raconteurs and in my head I am covered in mud sliding and dancing between other sliders and dancers on the grassy knolls of Grant Park during Lollapalooza.  Or I listen to Binary Star, K'naan, and Mos Def and I'm throwing beats down with Jay-Z at the MTV after after after party while Beyonce stares at my ass.  Or I take up arms with Rage Against the Machine and One Day as a Lion and plant elbows and fists on The Man as he tries to bring this brother down.  Or I construct the ultimate drama with the tragedies of Zoe Keating filled with love, tears, crisis, and happy endings smothered by unhappy endings.  

So stuck in my head, I don't realize how long I run.  I look up and find I'm home.  The music stops and the earphones come off.   My true theme song, the one that stacks the grand scales of my intoxicating life, should soon blare down from the heavens, engulfing everyone in the magnificent show that is me.

And then I realize, no one but me is listening.  I open the door, walk upstairs, take a shower, drink some water, eat some dinner, and watch some TV.  The music never starts.  At least until my next run...

My imperceptible bond to a jolly old fat man

I love David Hume for multiple reasons: he was a genius, he was perfectly round (not that I promote obesity and its enormously deleterious effects on our health care system, but it kind of worked for a short, 18th century, ultra-sociable philosopher), he loved backgammon and beer, and he quit philosophy because he was "too old and too rich."  The thing I love most about him, however, is his understanding of cause and effect.  Essentially his thought was cause and effect did not exist (anyone that is a Hume scholar will shit their pants and throw their computer across the room at my bastardization of one of the greatest Scottish minds - a mind only one step behind that of Mark Harris.  To them I say 'shut the hell up, it's my blog.').  Cause and effect is a temporal ordering of a timeless set of events.  It is us manufacturing order and meaning.  We create the "necessary connection."

Consider a billiard ball hitting another.  The second bounces of a in predictable, linear manner.  My daughter has never seen a game of pool.  To her, the white ball hitting the black ball and the black bouncing off is an isolated event.  The single case yields no connection.  It is simply an event.  It is over time, seeing numerous balls hitting other balls (yes I chuckled a little) that one develops a connection.  In other words, we create the connection and then define it.  Potential energy becomes kinetic energy following the repulsion of electromagnetic forces inherent in the balls (I laughed again).  

What are these other than words to define the unknown?  What is energy?  Force?  Power?  What is honor?  Freedom?  Justice?  What is love?  These are varying definitions of the space between cause and effect.  They are our way of placing order on the world, a world that without our order driven consciousness would simply exist.  Not change, not progress, just simply exist.  

We live in that space between cause and effect.  And it is that space that we as a medical field need to look to truly treat our patients.  Smoking causes cancer causes death.  My patient doesn't derive meaning from smoking, cancer, death.  S/he derives it in between.  As a physician I create a cause (surgical excision) to alter what I suspect would otherwise be the effect (cancer elimination instead of growth).  I define that space between smoking, cancer, death through science.  But my patient may define it through art, religion, social bonds, etc.  The point is, it's the same space no matter how we define it.  We can't forget that the meaning is arbitrary and subjective whether by scientific experiment or spiritual intuition.

Living in minutia, but dreaming in the abstract

I was thinking about what it takes to be a soldier.  To kill.  A universal morality is topic for another day (another lifetime?) but, for sake of argument, we can say that in Western society, an anti-killing morality has persisted to the point of genetic modification: killing another human being has a negative visceral feel to it.  I would like to think that I can defy the moral load on my genetics and kill in certain situations that clearly call for it.  If someone threatened my family, I KNOW that I could ravage them without thinking.  That knowledge is so lucid that in a Nietzschean eternity, I would see it as one of the few definitive points in my life.  A singular hinge of truth.

I would know all this objectively.  But would I truly feel it?  Would I be able to dismiss the fact that I killed?  I live in the minutia of my life: breakfast, work, play, dinner, sleep.  This is me.  I am these actions.  But my mind is an abstraction.  It lives in concepts and phrases.  It is global and not particular.  What happens when the minutia is in conflict with the abstraction?

It is easier with solid objects: my daughter and my wife.  A threat to them is a threat to a tangible thing.  But concepts of freedom, honor, justice are not.  They are murky abstractions of what we think we value on a day to day basis.  Shooting someone in the face is palpable; weighing the loss or gain of freedom is not.  

Let me make something clear: I am in no way judging the actions of our soldiers over the last few days.  Let me rephrase that: I do judge them but in a positive and grateful way.  I believe they did a remarkable service for those who suffered and need closure.  What I am talking about is how it may affect them; what it means to be a soldier.  Maybe being a soldier is not about the act of killing.  Maybe it is about being able to grasp the intangible in a way that the untrained cannot.  To essentially live in the dream of freedom, honor, glory, justice.  This is in no way a criticism.  In fact, it is a representation of my jealousy.  We need meaning.  These abstractions are the heart of meaning.  Living in them in them and by them seems to me to be a dream come true.  

Why should I give a shit about eternity?, Part 3: Why I give a shit about eternity

I was thinking about suicide bombers the other day because that's what I do: I think about the moral psychology of fundamental terrorists while on the shitter.  There is the expectation of 42 virgins in heaven (of course, at 3 virgins a day, that exact scenario would only work for 14 days; then what're you gonna do for eternity minus 14 days?), but the real value is an abstracted personal concept: honor, glory, whatever.  These intangibles are immortal.  The suicide bomber lives on eternally through these abstract ideals.  (Unfortunately it breaks down when one realizes that the immortal abstractions require mortal beings to carry them; the sun will eventually burn out, ya know...)

I think glory, honor, celebrity, freedom, pride, etc. is a bunch of bullshit.  It is the quasi-religious currency used for mass manipulation.  Your concept of personal glory dies with you.  The fundamental terrorist's ameliorated personal identity stuffed silly with honor incinerates itself when the bomb explodes.     

But I can't pretend that eternity doesn't matter to me.  Consciously or unconsciously, my baby girl represents a future beyond my future.  She carries my intangible currency: my semi-immortal genetic makeup.  Subjectively, eternity matters; objectively, it means nothing.  Eternity may mean dick, but the concept means everything.  The fact that eternity is somehow an innate part of my emotional existence, drives my actions now.  My irrational belief in a perpetual future shapes my present.  That's why I give a shit about eternity: because as a human being, I contradict myself and make no fucking sense.

Just in case...

I fucking hate "just in case."  The phrase implies a certain laissez-faire attitude, yet you are actively probing the unlikely (i.e. shitting on the concept of come what may).  "Just in case" gives primacy to impossibility.  It teases fear out of complacency.  "Just in case" is the seat of a hypochondriac's psychosis: it is unlikely that you have the rare sub-saharan plague that is butchering small puppy liver's throughout midwestern China, but let's check you JUST IN CASE!  Better run just in case I decide to shove my fist up your ass for freaking me out.

I wrote this piece just in case someone is reading my blog.

A selfless rhythm

I remember there were times during football games in high school where I seemed to function independent of conscious thought.  My body was in rhythm with it's environment and acted without restraint.  I had the the perfect economy of motion.  I was invincible.  (You may cite my several concussions as a counterargument to my claims of invincibility, but my response would be that I have no recollection of these purported concussive events.  No really, I don't remember them at all.)

Oddly enough, I was reminded of this economy of motion at the VA hospital the other day.  To briefly acquaint you with the Vets, they are a wonderful group of guys (mainly guys anyway) who performed a remarkable service for the rest of us and are now suffering the mental and physical consequences of their efforts.  Diabetes, heart disease, obesity, hypertension, depression and numerous other ailments run rampant throughout the system.  Despite the seriousness of their disease states, the Vets are oddly robust.  They seem able to survive an acute decompensation of their physical status much better than most of the rest of us could. And when I ask a Vet what type of medical problems he has, the majority of the time he will respond with "none".  True, certain diseases in this group are so common they almost seem like they are not diseases at all (if everyone had diabetes, would we have a name for it?), but they appear truly unaware that anything could be wrong.  Or maybe they are ware but just don't care, brushing me off with "do what ya gotta do doc."

It makes me wonder if they have a certain economy of motion to their lives.  Having experienced an intensity that is not replicable, life now simply comes to them.  They move through it with a rhythm that lacks self-awareness.  Life comes and goes and they accept and release it.  The question that follows is, does this lack of self-consciousness effort strengthen an individual?  Is a lack of a self-concept and thus a fear of loss of that self, the key to prolonging life?

Why should I give a shit about eternity? Part II: The passion of Buddha

So I shouldn't give a shit about eternity.  But, of course I do.  It makes me wonder if I have been giving religion an unnecessarily bad rap.  Religion's purpose is to provide purpose.  It hides the existential emptiness inherent to self-consciousness under a pillow of soft, warm bullshit.  The bullshit bothers me. It enrages me.  It blinds me to the actual value:  the ritual.  Through ritual, religion provides purpose by eliminating purpose.  The genius of Hemingway, Picasso, Matisse, Neruda was not the actuality of their creations, but the ability to commit to their ritual and give it direction.  One cannot expect everyone to possess this genius.  It may come as shock, but I am not a genius.  I can't commit to my passion.  Hell, I don't even know what my passion is.  Maybe I need a helping hand, someone to provide me with self-effacing ritual.  Maybe if I had a passion for Christ or Mohammed or Buddha, I would have eternity.  Not the 40 virgins in heaven type of eternity, but the eternity I could hold in my hand now like Matisse did his paintbrush.  Maybe religion was meant to give us passion and ritual and not dogma.  Maybe religion was meant to make us all forget about ourselves. 

And maybe we should think about this next time we use religion to create counterfeit pedestals from which to judge the "non-believers" and thus individuate ourselves that much more.

Why should I give a shit about eternity?

I've totally figured out immortality and I'm going to share it with you.

You're welcome America.

John Logan pointed it out in his new-ish play "Red" about Rothko and some random guy who bitch at each other about the nature of art, change, and death (excellent play).  In it the random guy talks about Matisse and how fierce the colors of his later paintings were despite the fact that he knew he was dying.  And when he was to ill to paint, he took some scissors and made collages.  He made collages until he died.  That is immortality.

It certainly would be wonderful if this blog were dipped in titanium and bolted to the White House steps for eternity.  But why should I give a shit about eternity?  I'll be dead.  I won't care who reads the immortalized yet under-recognized genius of this blog.  Nor will I care about the millions of lives this blog will save through it's brilliant insight into the human condition.  Again: I'll be dead.

At this moment, Matisse doesn't care about his paintings nor his fame.  Matisse's a sense of immortality came from passion and the consequent loss of self.  Painting wasn't about creating a personal image.  It wasn't about demarcating a past or impregnating a future.  It was about a ritual.  The dipping of a brush into paint, into canvas, into self.  The ritual eliminated self-consciousness.  Death, illness, body, identity were meaningless.  And when the ritual became impossible, he developed a new one.  Death meant nothing.  That is immortality: not that something is left behind, but that you don't care if it is or not.  Immortality is now.

Should I Jump?, or Rocks Sure Have It Good

Like I said the other day, I'm constantly hunting for methods to create purpose (i.e. meaning) in my life.  Methods to the madness.  Better yet, methods to the meaninglessness.    I firmly believe that I create the meaning in my life.  But creation is irrational and exploratory not logical and systematic.  In other words, I don't know what I'm thinking when I create meaning.  I kind of dick around until something fits (what a fantastically inappropriate way of saying that; so inappropriate, I can't bring myself to delete it).

So I get frustrated.  Nothing except my daughter adequately fits a satisfactory sense of purpose in my life.  Much comes close, but there is always some microscopic failure that I cannot articulate.  I try and fail.  I try.  And fail.  However, no matter how many times I fail, I can't stop.  I require meaning like I require air.

There is a sadistic piece of me, albeit barely perceptible, that unconsciously fantasizes about the demise of meaning in my life.  It's like the itch you get in your feet when standing on a ledge: what if I jumped?  What would really happen?  The irrational (stronger) part of my brain insists on the existence of meaning.  The logical (weaker) part of my brain knows meaning is just a conglomerate of distinct fragments of bullshit glued together on a background of nothingness in my brain. My life will eventually end in meaninglessness.  Any thoughts of immortality are a joke.  (What do you think about your great grandparents?  Probably don't make a meaningful impact on your daily life.)  So why struggle with it so much now?  Why cling to the impossible?

I do not want to lose that which is meaningful in my life (see Babies and Suicide).  I wonder if there is something in between?  An intensity of being.  An existence with an imperceptible self.  A purposeless now.  I wonder if there is a way to be a rock.

I've got a lot of shit

It's true.  I've got a lot of shit.  I've got a lot of shit because I have big plans.  Big plans I tell you!!  

I'm going to be a martial arts master.  I've got the belt, the gloves, the tape, the bag, the pads, and the timer.  I'm going to be a philosopher.  I've got Nietzsche, Sartre, Camus, Heidegger, Aristotle, and Plato.  I'm going to look like Hugh Jackman in Wolverine.  I've got random shit for pull-ups, push-ups, swimming, running, biking, kayaking, surfing, and SCUBA diving.  And I've got a full length mirror.  I'm going to be a writer.  I've got plays, screenplays, novels, short stories, children's  and how-to's stacked shoulder high.  I'm going to be a musician.  I've got a bass guitar.  (I know that is a little weak, but in my defense, it's an expensive bass guitar.)  I'm even going to be a better clinician.  I've got books on neuro, cardio, trauma, pharm, GI, babies, vaginas, exams, machines, and books on books I can't live without.

Alright!  So I'm ready to fulfill my big plans: the writing, philosophizing, rock-star anesthesiologist who can beat your ass if you weren't so paralyzed by the sight of his monster pecs.  

I'm ready....but I'm pretty sure there is a new book on the minute pharmacologic digitization of cerebral membrane proteins in the perioperative period.  Can't be an anesthesiologist without it.  Of course, there is also the handheld Swedish sure-grip ab builder and a 2-week camp on the Tao of fucking some fools up.  Can't forget the neon green dive computer for existential treasure hunters (the treasure, in the end, is meaningless) nor the guitar hero heavy bag that you pound to the beats of Jay-Z.

I'm piling shit upon shit in preparation for my future self.  I'm building an anti-existentialist bomb shelter: when meaningless overtakes us,  I've got enough crap to pretend I have purpose for years.

But what about right now?  What am I doing this second?  I'm writing.  I am a "writer" because I am writing, not because the Art of Dramatic Writing or the Marshal Plan are collecting dust on my shelf.

So as of yesterday, I don't have as much shit.  The local charity does.  And hopefully I'm not just making room for different shit.  Hopefully I'll start looking at who I am and what I'm doing instead who I could be and what I'll do.

I am synonymous

It is clear that we require meaning. Our lives need significance, import, substance, usefulness, value, essence, and consequence.  We need powerpoint and bar graphs and collectibles and little paper awards signifying our significance.  Because in the end, if there is no point, then what the fuck is the point?

We make this meaning up as we go along (existence before essence).  I decide that what I say or do or think has value.  Or I decide that some god gives it value.  This means I also decide when it is meaningless.  When it is futile, pointless, empty, hollow, purposeless, insignificant, and incomprehensible.

Or maybe I decide that it just is.  That what I say or do or think is just what I say or do or think.  It exists as it is.  

But I can't just 'be', can I?  I have to abide, continue, endure, happen, last, prevail, and survive.  I cannot be, I can only become.  Inactivity and complacency are existential impossibilities.  

So I ask myself, what the fuck am I talking about anyway?  What does it all mean?

Death panels for pundits, mortality navigators for the rest of us.

Death and disease are commonplace for most physicians.  The tubes and wires and beeps and machines are familiar to us.  We know their function and, more importantly, we know their meaning.  We speak in statistics and are comfortable making life and death decisions based on "chance".

As non-pysicians, you are not comfortable with any of it.  Tubes and wires and beeps and machines are added complexities to an already too deep unknown, mortality.  You don't know their function nor their meaning (even if you do, you really don't just like I "know" the function of a carburetor but have never had my hands on one).  They are symbols to you.  A ventilator means life when death is eminent.  The identity of your love one merges with this symbol of life-sustaining medicine.  This places you are in an inadequate position to make death decisions: the medicine is no longer external but instead an intimate part of who your loved one now is.  But we make you do it anyway.  We make you decide on chance.  And, consciously or unconsciously, a piece of us resents you when you make the "wrong" decision.

We also make the wrong decisions.  Sometimes from the perspective of hardened practitioners who seen innumerable loved ones die and expect to see innumerable more.  Sometimes it's from the perspective of scared individuals who see their own mortality in you or your loved one.  And sometimes it's from the perspective of people hopped up on adrenaline and unskilled in the art of inaction, like a soldier in the heat of battle incapable of lowering his weapon. 

The point is, individuals - patients and physicians alike - are not equipped to decide on death.  You can't do it when a piece of you dies with your loved one.  We can't do it when a piece of us dies with them either.  Nor can we when that piece of us stops dying with them.

Decisions of futility need to be made at a policy level.  We need to take it out of the hands of the individual.  We need to free up the family to be the family and not the caretaker/decision-maker.  And we need to free up the physician to be the physician and not the perceived hand of God.  I don't suggest we make a death policy on all illnesses, only the most extreme, the ones where mortality is all but given and futility is obvious.  The institution of medicine needs to start navigating patients and family through the maze of morbidity and mortality and not simply construct definitions which they are expected to piece together themselves.

What a gene wants, what a gene needs...

Cause and effect drives Western thought.  We look at things as a linear progression: A to B to C to D ad infinitum.  I am a direct result of physical forces that drove unicellular organisms to share responsibilities for survival a trillion or so years ago.  It is mechanical and objective.  I see what you see.  So what do we see?

There is a "force" that we seem to see when describing/understanding cause and effect: desire.  A gene "wants" to survive.  It wants immortality.  But really, a gene doesn't want shit.  A rock doesn't want to fall; ice doesn't want to expand; a tree doesn't want to grow.  A worm doesn't want to eat shit and, I'd even argue that a dog doesn't want to crap or fuck.  These things just do.  They just exist.

This puts us in a chicken or egg situation.  Do I act because of desire, or describe the already initiated act by desire?  There is some scientific evidence that it is the latter.  Our actions (at least a subset of actions studied) are initiated a fraction of a second prior to our conscious decision to perform them.  Whether this is true or not doesn't really matter.  It doesn't matter because I don't know where my desires are initiated anyway.  Why do I like the color blue?  Why do I love my wife and child?  Why do I brush my teeth?  To maintain their health.  Why do I want to maintain their health?  Cosmetic, practical, and customary reasons.  Why do I care about these things?  The pre-pubescent eternal questioning can go on forever.  (It's pre-pubescent because after puberty you only have one question: how do I get laid?)  At certain point, it just is.  I just like the color blue.  I just love my wife and child.  

Babies and Heroin

The long-awaited follow-up to "Babies and Suicide."  My baby-less friend and I had an interesting conversation regarding the irrationality of loving ones baby.  We "justify" our love for our babies on multiple levels: genetic progression and molecular immortality; provision of personal meaning and purpose; communal growth and sustainment; societal expectations; and so-fucking-cute-ness.  But the reality is, it is inexplicable.  It is irrational, incomprehensible, and indeterminable.  In other words it simply exists.  It is what it is and I can't rationalize it.  

Having a baby is a drug.  It stimulates some neuron in some minimally used portion of our brain that causes us to act like rats and push the reward button incessantly and at whatever cost.  Babies are heroin.  Just like no one can rationalize the heroin experience or why one would sacrifice everything for it, I can't rationalize my love for my baby or why I would sacrifice everything for her.  You don't know until you try.  The first one's free.  (That's actually not true.  My financial advisor told me to plan on saving $300K for college in 2027.  Not a good marketing scheme for the baby pushers.)

Procreation, individual genetic progression, and social evolution seem about as basic as things come.  The cause, effect, and meaning seem clear.  But they are not.  Again, I don't know why I love my child, I just do.  I can come up with a million reasons that seem rational, but none are perfect.  I rely on the poets and playwrights to explain it adequately.  If the supposed base of our entire being - procreation - is inexplicable without obvious causes and effects except those that describe the entity but not make its being apparent (i.e. I can give you a million reasons why I love my child but none are absolutely true; each is a brushstroke on Van Gogh's Starry Night, but I want the whole picture!), what else that seems obviously explicable is just the opposite?  

Masturbation and time travel, or How can I possibly regret anything?

I have my childish fantasies.  One that crops up consistently is the back-in-time-change-things-for-the-better one where I find a wormhole at the bottom of my Corona that allows me to walk a bridge to my past.  Usually that bridge is to my college years.  I don't regret my college years at all.  I had a GREAT time.  The greatness, however, was transient.  I could have done things differently to allow for a longer, more steady influx of greatness.  The things that get me going now (knowledge acquisition and interpretation and Coronas) are not what got me going then (except the Coronas).  But since my daughter's birth, I always find a glitch in that fantasy.  I can't possibly go back in time because I didn't count how many times I masturbated.

Yes, time travel is an impossibility for me because of masturbation.

My daughter is by far and away the greatest thing that has ever happened to me.  I would not do anything to risk not having her.  I don't just want a daughter, I want my daughter.  What if I went back in time and masturbated one more or one less time?  Prospects of my daughter would go down the drain (literally).

I enjoy where I am.  I enjoy my life.  I have very few complaints and, in the end, feel very lucky to be me.  So how many other things in my life are so exquisitely dependent on little, seemingly meaningless aspects of my past?  How can I have regrets when I am happy to be where and who I am?

Complexity as a disease

I was thinking about chaos today.  Chaos theory, complexity theory, emergence theory, all that shit amounts to patterns within chaos (at least it does to those of us with brains incapable of accurate mathematics).  Things as we see them are not the sum of their parts.  I am not the sum of atoms and electrons and molecules and proteins and cells and organs and whatever.  I as an entity emerge from those things.

Complex entities have two important properties.  First, they are robust: they can handle a lot of shit (like the crazed, Kali wielding Scotsman of "Cats in a Sack") without apparent dysfunction.  The second property is called the tipping point: the complex system that hides the dysfunction from our eyes/ears/nose/throat/touch becomes saturated.  The dysfunction then becomes immediately apparent.

The key is things as we see them.  There is a lot of ego tied up in concepts of chaos.  I can't comprehend it, so it must be chaotic.  This of course is not the case.  The pattern is there from the beginning.  Our inability to perceive it is a function of our dysfunction: we lack the capability.  Chaos is inherent in us.  It is not external.  

The opposite is true as well.  Coherence is internal.  Patterns don't exist outside our consciousness.  Chaos and coherence are labels like dog, cat, human.  This makes it interesting.  Coherence is in our heads, but lack of coherence is a defect in our heads; it is a limit to our perception and understanding. Following this logic (if you can call it that), we can't figure out our own heads.  My mind labels certain systems as a pattern.  I "can't" label certain systems as a pattern, not because I can't "see" it, but because I can't create it.  This makes us entirely responsible for the coherence of our environment.  I am the master of my own chaos or the lack there of.  

Disease is chaos.  It has a million little pieces that, when confronting it personally and directly, are impossible to grasp.  As physicians, we eliminate the chaos by creating patterns: congestive heart failure, diabetes, arthritis, cancer.  These are all labels and patterns.  And they are created in our minds as physicians.  But the pattern you create as the patient may differ.  Regardless, I direct you through my system of patterns, my coherence.  I make it so you are no longer the master of your own chaos.  

Proposition 69: A Ban on Traditional Marriage

Here's my foray into politics: I would like to propose a ban on traditional marriage. I am worried that my next door neighbor's traditional marriage may negatively impact my daughter.  

What is it about traditional marriage that I find so dangerous?  It's not the white-washed, Zoloft-induced, fake-ass wifie's smile that hides all but the eyes which overlook the workaholic, nanny-fucking father; the Xanax-curbed, coke-bingeing, straight A daughter; and the pseudo-sexual, near suicidal, will never be Jesus son.  (I actually made that all up.  I really like my neighbors.  But I don't think I'd like them as much as I would enjoy the middle-aged Jersey-Shoreness that the neighbors I just made up would provide.  I'd save a lot on cable.)   What I find so dangerous in traditional marriage is the concept of marriage itself.  It becomes it's own entity.  An entity with defined parameters that require "work".  To be married means something (whatever that something is) whether you fit that meaning or not.  

Marriage should be seen as what it is: a personal and legal symbol.  Legally, it's easy: we're recognized by the state because we signed love-papers and therefore receive benefits.  Personally, it is not so easy.  The symbol needs to be individually and co-operatively designed, defined, refined, aligned, combined, and intertwined.  It is a beautiful and unmanageable product of the love between two people.  I was committed to my wife long before we had a paper-signing party (i.e. wedding day).  Getting married had two purposes: the legal recognition and the opportunity to bring everyone we loved together in the same room to celebrate us.

One could argue that we have a traditional marriage.  I am technically a man and my wife is technically a woman.  But on closer inspection, I'd say she has significant manliness and I have significant gay-li-ness.  In fact, the only differences between me and my gay friends are that I'm not sexually attracted to men and I dress poorly.  Otherwise I love the theater; have no problems talking about my feelings; tend towards the dramatic; and listen to Justin Timberlake, Rihanna, and Fergie (my gay friends would be appalled by the Fergie comment).  As for my wife, the only differences between her and a bulldog are that she sometimes wears lipstick; she's hot; she's intelligent; she's bipedal; she cleans up her own shit; she has normal human hygiene...I'll stop there.  It appears that unlike Sarah Palin, my wife differs significantly from a bulldog in all ways except her tenacity.  My point, however, is she's definitely an alpha male except without the maleness.  So how traditional is our marriage?  

To tell you the truth, I'm sick of people telling me what marriage should or should not be.  Whether you are talking about same-sex, different-sex, mutli-sex, or whatever-sex marriage, you are making a comment on my marriage too.  You suggest that the nature and purpose of my marriage is fulfilled because I have a penis and my partner has a vagina. You cannot reduce my love for my wife to easy fitting appendages.  In fact, if I were gay, I wouldn't want the love I have for my partner to be so narrowly defined as it seems to be when "married" (although I would get married - and divorced like 60% of "traditional" marriages - just to tell the man to fuck himself).  In fact, if I were not gay, I wouldn't want the love I have for my partner to be so narrowly defined as it seems to be when "married" (although I did get married for whatever ill-defined reason; therefore EVERYONE should be able to get married for whatever ill-defined reason even if it's just to tell the man to fuck himself).

So please, vote for Proposition 69 to ban traditional marriage.  From now on, marriage is what you and your partner make it.  Fuck everyone else.

Taking my father for granted on Superbowl Sunday

My dad died in 1997. He loved football. Morning until night every Sunday. I wondered if he'd be watching the Packers beat the Steelers today if he were alive. Of course he would. And I would have flown out to watch it with him like I'd do every year if he were alive. Then I thought, no I wouldn't. If he were alive I'd see him once a year and talk to him once or twice a month. If my dad were alive, I'd take him entirely for granted.

I wish I could fly out to watch the Superbowl with my dad. I wish I did when I had the chance.

Anxiety is easier

I sleep fine.  It takes maybe ten or so minutes for me to fall asleep and I stay that way without effort.  My life, my imaginations, my cares are a comfort at bedtime.  They remind me I'm alive and that I'm going somewhere.

My wife can't sleep.  She hasn't been able to for decades.  Her mind comes alive at bed.  What's next?  What's now?  What has been?  How can you possibly sleep when there is so much?  So she paces; she cleans; she reads; she jots it all down.

My daughter is two years old and sleeps like a baby (coincidence?).  How will she sleep when she gets older?  Like her hibernating father or her persevering (to continue a course of action even in the face of difficulty) mother?  When I asked myself this question, the answer arrived instantly: her mother.  Anxiety is easier.  

I have no follow-up to this.  I am astounded and appalled but I am certain it is the truth.  Anxiety is easier for me as well.  I just have a talent for sleep.  I worry about a lot that my wife doesn't and vice versa.  To stop worrying is too stressful.  I don't know why this is the case. 

Fuck, I'm not going to sleep tonight.

Fame monster

I had an interesting conversation with my wife regarding my writing. First, though, I have to show you how it started off. The following occurred after my wife couldn't wait 1.5 minutes for a movie preview:

Husband:  I need to send you to patience school with our daughter.
Wife:  I need to send you to how not to be a dick school.

Husband:  I wouldn't be such a dick if you weren't so impatient.

Wife:  I wouldn't be so impatient if you weren't such a dick.

Oh the joys of marriage.

The discussion about my writing revolved around this need for external recognition I seem to have.  I rarely write for myself.  It lacks satisfaction for me.  When we explored it further, I realized it wasn't so much personal recognition.  I would love to write a popular novel or play or movie (or blog!) under a pseudonym.  I wouldn't need the fame.  My ideas seem to need the fame though.  The unanswered question at the end of our discussion was, "why?"

It's obviously not personal fame.  And it's not an unrealistic belief that my ideas can change the world.  I think that it's a couple things.  First, it is solidarity.  If you're reading my writing, we are sharing an experience.  I am not alone (and neither are you).  It's also a solidarity in thought.  If you're reading this or my book or play or whatever, I presume you share the same idea (I don't mean agree with the idea, I simply mean that the idea means something to you whether negatively or positively).  

Secondly, it's an exploration.  My ideas are extremely important to me.  The reality of it is, however, these ideas are not clear to me.  I don't really know what I'm talking about until I'm halfway done writing it.  Even then it is very much in the abstract until someone else interprets it.  In essence, I understand my ideas and thus my mind through external interpretation.

I share this world with you, both in body and mind.  The body part is easy to understand, the mind not so much.  Writing helps me understand this.

If a tree falls in the woods and no one is there to hear it, does it make a sound?  If I write a blog and no one is there to read it, do I make sense?  

My future with Justin Timberlake

I'm a 36 year old anesthesiologist with a daughter, a wife, and a mortgage.  In high school, I prepared for college.  In college I prepared for med school, then residency, then fellowship, then the real world.  Now I'm here.

So what now?

There's nothing to strive towards other than the goals I set for myself.  I must admit, however, I am neither menacing nor a particularly good task master.  Why the hell should I listen to me?  Certainly I could write a novel, master Jujitsu, trek the Sahara, publish scientific and philosophical articles, climb mount whatever is the tallest.  Or I can veg out on the couch and watch Jersey Shore.  Who's going to stop me?  Me?  I weigh all of 145 pounds.  I could kick my ass!

I do have plans, however.  I want to be a writer.  Novels, plays, screenplays, and apparently blogs.  But let me tell you how I envision this goal: dancing with my wife to Justin Timberlake's SexyBack at an after-Oscar party sipping Cristal until 4 a.m.  (Realistically it would be a Corona and we'd be back by 11 using the babysitter as an excuse while hiding our obvious exhaustion from staying up past 10.)  That's my writing goal.

What I'm hoping to find out from you is that this is a normal goal for a 36 year old anesthesiologist with a daughter, a wife, and a mortgage.

Right?...
Hello?...
Bueller?...

Pity party for my inner hypochondriac

As with all psychopathologies, it is best to place the blame on one's parents.  My father had significant cardiac disease with a heart attack at 38 and 40 and sudden cardiac death at 57.  Since I became a physician, I retrospectively diagnosed him with obstructive sleep apnea, peripheral vascular disease, and metabolic syndrome.  He wasn't on a statin or an aspirin, and he was on an anti-arrythmic that causes sudden death.  In other words, there are six things off the top of my head that could have been done.  (I could have done?  Guilt is our most constant companion.)  Moreover, he ate like shit, smoked, drank too much, and barely got off the couch.  (As an aside, this isn't to berate my dad.  He was a remarkeable man.  He was the most insightful and intelligent person I have ever met and treated me with the utmost love and respect.  He just didn't treat himself with love and respect.)  His disease, although mixed with genetics and bad luck, was mainly due to a lack of action: not taking the proper meds; not exercising; not eating well; not receiving the proper diagnosis; not getting surgery; etc.

So I take action.  I eat (sorta) well; I exercise; and I take a statin and aspirin.  The problem I have is my near obsession with action.  My hypochondria clusters (and they do come in clusters depending on what is occurring in other aspects of my life) are less about the disease process and more about what I have to do about it.  Go to the doctor; make sure s/he does the correct tests; wait it out; not wait it out.  The possibilities are endless.  I start to malfunction because I am convinced there is something that I am not doing.  I often think that it would be easier to live during a time when there was very little we could do with illness (assuming that there was minimal diagnosing; it's worse to have a disease with a name but no treatment).

The problem is, when you look closely at it, there is no "correct" thing to do.  It's all probability.  I am not trying to imply that there is no such thing as preventative medicine.  My grandma lived to 88 as a lifetime smoker, but for everyone like her, I can find 100 smokers that died of a heart attack, emphysema, stroke, or cancer.  Taking control of my eating and exercise simply gives me the illusion that I have control over the possibility of future heart disease.  It certainly puts the odds in my favor, but it is not control.  I have no control over any future disease state.  This is truly an existential dilemma: I have control over what I do now (i.e. not smoke or eat like shit) but have no control over the future (i.e. heart disease or lack of it) despite the fact that I put an enormous amount of thought and meaning into it.

When faced with our mortality, it again comes down to the ability to surrender to the present.  I (we?) need to reposition the meaning and magnitude of our existence within that existence and not in what may be.

My brain saving me from my mind.

While I was watching Closer with my wife, we hated it. Almost walked out. Immediately after we saw it, we couldn't articulate what we thought about it. Forty-eight hours later, we realized we had discussed it almost non-stop. In other words we loved it!

I've had the same experience with a number of movies (most recently Black Swan - Notes of an Anesthesioboist: Black Swan; holy shit it's a good movie!). I realize now, that I've had this experience with a number other things too. Hearing that my wife was pregnant with our daughter was objectively thrilling. But subjectively, it was too much to process. I knew that somewhere I was ecstatic. But where that was, I couldn't tell you. It was too big. My brain shut itself down on the topic as if defending itself from implosion.

It makes me think of our immune systems. Absolutely necessary for survival (who knows how much feces can be found on my keyboard right now despite my religious handwashing; think about that next time you hand a fesces-ridden dollar bill to the guy at Starbucks). It is necessary because it destroys and kills. Unfortunately, it also destroys and kills us. The more we study it, the more we realize how much our immune systems and associated inflammation are responsible for common disease states. (Coronary artery disease has been linked to air pollution through inflammation; statins and aspirin prevent heart attacks mainly because of their anti-inflammatory properties). So our body regulates it as best it can.

Richness of experience (both positive and negative), in my opinion, is the key to fulfillment. We are naturally dramatic beings who love happiness and tragedy equally (not necessarily our own tragedies however). But maybe richness of experience has limits to its safety. Maybe our brains need to keep our minds in check to prevent richness overload. Maybe some of the psychopathologies have their origin in an over-rich experience.

Or maybe I'm just an unfeelingly sociopath.

Economy of motion

I love that phrase: economy of motion. I first heard in my Jeet Kun Do class (so enamored was I of the phrase that I thought I'd ponder that for the next 6 months instead of return to the class). Jeet Kun Do is the martial arts system developed by Bruce Lee. Economy of motion is defined as (as always, thank you Wikipedia):

1. Efficiency: an attack which reaches its target in the least amount of time with maximum force.
2. Directness: doing what comes naturally in a disciplined way.
3. Simplicity: thinking in an uncomplicated manner

The second two are what fascinates me the most: doing what comes naturally and thinking in an uncomplicated manner. When I first started my anesthesia residency, I was sure I made a horrible mistake. I watched every number and squiggly line and listened to every beep and buzz with such intensity (lives were on the line!...sort of) that it was if I was pausing the screensaver in brain so as to burn the picture forever in my memory. And, although I was competent, my procedures were riddled with a second to second critique of the prior steps and intense analysis of the future steps. I was an alien in the OR. Nothing was natural; nothing was uncomplicated.  Everything was extraordinarily stressful.

Now I don't think at all. I can discuss the case or chart or whatever without thinking about the beeps and whistles. But if the heart rate changes by 3 beats per minute, everything else gets shut out and I return to the same intensity I had as a resident. When I perform procedures now, it's like dialing a number: don't ask me what the number is because I don't consciously know it; I can just dial it. I can just place the line or intubate.


I learned the complexities and theories behind anesthesia in residency. But what I really learned was to breathe it. To be it. Performing anesthesia is natural; it is uncomplicated. I do it without thinking.

Economy of motion is action without self-consciousness.

Loss of economy of writing: I thought I'd start linking to blog entries that have helped me better understand the medium. This is blog that I find quite entertaining. The reason I'm linking to this entry is that, based on his first couple paragraphs, Suldog developed a level of self-consciousness not there before getting the blog nod...  Suldog: Hello, New Followers! Here's Where You Begin To Realize I'm A Lazy Slug!

Jesus saves snowboarding from cancer

If you've ever snowboarded, you've probably experienced the skill bolus you seem to get the second and third days.  I went from a red ass and frozen legs from falling on the bunny hill the first day to a red ass and frozen legs from taking jumps on the intermediate runs the third day. Granted my athletic abilities are near perfect (I like to put lies in my entries to throw your scent off and maintain my anonymity), but I suspect it is a similar occurrence for most everyone. I don't think my technical skills improved that much over a course of two days, however. What I think happened is I gained confidence. Instead of a tendency to lean back so I could force a fall if I started going too fast, I started leaning in and accepting the speed. I was less afraid because I was more familiar with what to expect. I was less self-conscious.  I wasn't thinking about what I needed to do to protect myself and was, therefore, not analyzing my every move.

I don't believe that a cross, a buddha, an ohm, or a naked lady tattoo confer actual physical protection.  I do, however, believe that they provide an alternative to self-consciousness provided that the user places significance on the object.  It will protect me so I don't need to protect myself.  I can concentrate on the task at hand and not on myself.  I would argue that, even though I am placing my security in the hands of something that truly only exists in my head, this puts me at less risk.  Often the true danger is in one's head.

Such a symbol can help the ill as well.  I've already hinted at this with my Surrender entry: the physician becomes the symbol.  Disease is a scientific description; illness is what the patient experiences.  Finding one's "new" identity lies in between.  (Imagine the identity crisis one undergoes when s/he feels fine but is diagnosed with a disease with a treatment that causes the patient to feel horrible.  To justify the acquisition of illness by the treatment, one has to redefine oneself, often as "sick".)  I can think of no other time in a person's life that they are more self-conscious than when one loses his/her identity.  As physicians, we need to consider this as part of our patient's illness: an acute sense of self-consciousness.  Symbols may be the treatment for this.  Of course, 9/10 symbols actually get in the way of what I feel is the proper course of treatment.  But a blog for another time...

Thank god I'm an atheist II: Why I'm not an atheist.

Long list of "sorry"s to my friends who are atheists.  I can't define myself as an atheist.  Here's why:

(Caveat:  My arguments breakdown if you define gods as the quasi-religious political dogmas used to control the masses.  If this is God, then I am an atheist.)

The first and more simple of the two reasons is that I do not wish to define myself as anything.  I'm not an atheist, a Christian, a taoist, an existentialist, a feminist, or an anesthesiologist (I practice anesthesia).  I wish that I had a true passion about something (the devotion yoga for you Hindu enthusiasts) that would allow me to more or less pin my existence on, but I can't.  My personal identity is extraordinarily elusive as it is.  I can summarize my motives or "projects" as Sartre would have, but I can't summarize me; or at least I don't want to because summarizing sets you up for dismissal.  "Oh, he's an atheist.  I can't get through to him."  I certainly think that the standard definition of atheism carries a lot that appeals to me.  Feminism carries an enormous amount that appeals to me (standard definition is important; consider the definition of Islam or Muslim by a fundamentalist versus that of the other 99%) .  But I have to admit, as much as I like her, Simone de Beauvoir, a highly regarded existential feminist (she'd hate that I called her either), says a lot of weird shit.  Am I a feminist of the weird shit too?  I would even argue that I shouldn't say I'm not something.  I'm not a Christian but there are many non-dogmatic points that appeal to me.  (Isn't the initial concept a response to sin in Judiasm?  Wasn't the idea attributed to Jesus that we should forgive all "sin" and thus essentially eliminate the concept entirely?)  Buddhism, Taoism, Hinduism, Islam all have appeal to me.  (Did you know that the original texts for Islam were a response to a lack of women's rights?  They urged that women be allowed to have rights to property and inheritance.  Those wild and crazy fundamentalist muslim feminists!)

Definitions are battleground delineations.  They absolutely have their place.  I am not a feminist, but I certainly believe in a large portion of what they symbolize.  When laid out on the line, I would call myself a feminist to show what I believe I'm not and to set my limits on what I can tolerate.  (Goddamn right that my daughter will have the same opportunities that I have/had.)  But, this blog is not a battleground.  Nor is my head.  So I'm not an atheist here or when when I'm alone on the shitter.  When I'm at my Scottish super-atheist friend's house, I barely resemble an atheist; when I'm at my highly religious father-in-law's house, I'm a militant atheist.

The other reason is more difficult to explain.  Most definitions of God invoke an image of a
supreme humanoid being that warrants worship.  By those definitions I am an atheist (the theory or belief that God does not exist).  But others suggest something ill-defined: the supreme or ultimate reality; an idol to be worshipped (to treat with reverence and adoration); the source of moral authority.  Given these definitions, I can't say I don't believe in "god".

Let's pause for a minute, however.  Outside the sphere of human consciousness, I am an absolute nihilist.  There is no morality, knowledge, being, truth.  These things are all human interpretation, perception, and construct.  If there is no one to touch something, there is no substance.  But this is not where we live.  My world is a conscious world so the fake truths it defines are true for me.  I believe there is a common point to reality and morality (see Common Morality; also a blog for another day).  I believe there is an ultimate irreducibility to our world.  And, even if there is not, I believe there is an irreducibility to our capacity for understanding which therefore becomes the de facto ultimate reality.  And I worship: I worship the idol of science.  I perform rituals on a daily basis (consider the known effectiveness of all we do in the OR; we know nothing as fact, we only know probability so we have our quarks and rituals to pretend to have some control over the uncontrollable).  I treat science with a reverence deserving of a deity.  

Thank God I'm an atheist

Could it be that your atheism is so dogmatic it might as well be a religion?

Eff that shise man

I find myself saying "eff" and "shise" around my friends now. The habit of not swearing around my daughter has infected my non-daughter life. I notice that my ability to express myself is severely limited. (Let's face it, there are cases where only the word "fuck" can truly convey the logic and reason of your argument.)

I said "shise" today in front of my daughter who immediately said "shise, shise, shise, shise!!!". I thought to myself, success!! I expressed myself without dragging my daughter down into the depths of the culturally unacceptable. Call it a win.

Or is it? Barring some intervention from a god I don't believe exists, language is a human construct. We set the meaning of our words. So if "shise" means "shit" to me and my daughter learns it is used when brown stuff comes from our butts or when daddy stubs his toe, what does it matter that I replaced the t with an se? (Oh the irony: I just told her she can't eat cookie crumbs off the coffee shop floor and she yelled "crap"!)  If the meaning is what counts, shise is as good as shit.
I would argue that the same applies to morality. We set the meaning of our morals.  The subtle redefining of the meaning of death in abortion, suicide, death penalty, war, etc. is shise.  Eff that shise man.

The meaning of life redux

I've been listening to The Meaning of Life from the Teaching Company (I have listened to and forgotten hours of academic material through them). Something Professor Garfield mentioned hit a cord with me. He said that Nietzsche's vision of meaning in life is turning one's life into art. In other words, letting aesthetics guide your motivations and you will find meaning.

This strikes a cord with me for the reason I mentioned yesterday: there is an irrational, incalculable, illogical, intangeable aspect to our perception and understanding. Our sixth sense is an ill-defined "art". What Nietzsche is telling us is that there is no rational explanation for meaning. It can not be sculpted with language or calculated with numbers. It is that whatever that we see when we are not trying to see.

How does this relate to medicine? Who gives a shit.

Apparently I do. What it means to medicine is that our goals may need some tweeking. Instead of the objective criteria of absence of disease, we may need to consider the irrational criteria of meaning. In other words, our patients are expressions of our art. Success is ill defined and irrational. It may not be represented by a lab test.

Echos from my heart (yeah I vomited in my mouth a little too)

Part of my job is to read echocardiograms: ultrasound images of the moving heart.  The machine sends out sound waves which bounce off an object (red blood cell, cardiac cell, polish sausage if you're Chris Farley) and returns.  The machine measures how long it takes for the return trip and calculates the position of the object.  It then marks it with a dot on a screen.  Movement is simulated by the temporal coordination of flashing dots (in other words the movement is in my head and not on the screen).

What my patients see are flashing dots with a fuzzy 2D animation of something.  The most adroit may even see some semblance of a heart.  What my residents see are isolated images of various aspects of a poorly defined organ.  What I see is a detailed map of the heart laid out in 3D outlining subtle normalities and abnormalities.  I tell my residents that it isn't really something I can teach.  You see enough and you just kind of get it.  Like an autostereogram in which you are looking at a bunch of wavy lines then, magically, a boob pops out (you're probably wondering where I found my autostereograms and what exactly the "auto" part stands for).  Or like the dirty, smelly guys with the shitty lives because they saw no "honor" in living life as a lie in the Matrix (I would have taken the blue pill) who could see Keanu's crappy acting and clumsy karate on a screen that the rest of us only saw 1s and 0s.

The point is there is something intangible - even unintelligible - to our perception.  Take a book for example.  A series of dots make up what you perceive as a letter that, when strung together with other dot-laden letters, forms a word then a sentence, a paragraph, a chapter, and a book.  But it is all a series of dots whether its this bullshit blog or the bible.  Perception is interpretation; the two are inextricably linked.  The fallout of this is objectivity is impossible (at least how we commonly define it).  Our knowledge is based on error prone perception (sorry Plato, but I fall on the "nuture" side of nature vs. nuture when it comes to knowledge; action is a different story entirely).  The scientific method is empirical at it's heart.  So the "medical method" is as well and therefore must be equally as subjective.  (Shit, thanks to Einstein we can't even agree on time and space!)  When I take care of you as your physician, your disease and its treatment do not live in an objective world.  I can't tell you is true.  I can only tell you what fits our shared subjectivity.

Pattern recognition and an identity crisis

What the fuck am I? (Too many "fuck"s in this blog? It just works so well at getting readers...) You'll definitely notice an identity crisis weaving it's way through these entries. I guess it's not so much a crisis as I am content with not ever finding out who or what I am. I do believe, however, that the search is a necessary and vital process. In other words, my identity - my life for that matter - is boiled down to a fruitless search. In order to prevent utter personal chaos, the process then has to be the goal. And since meaning is a human construct (yes, I will be serving drinks and similar bits of bullshit wisdom in hell) and a rite of consciousness (more nails in the a-religious coffin), brain-chaos-containment is meaning.  So, Aristotelian logic leads us directly to the idea that I have discovered the meaning of life: process not achievement. The world is now saved. You're welcome America (standard hilarious Will Ferrell).

But back to question at hand: what the fuck am I?  Phenomenology has us bracket our perceptual habits and start fresh (more on phenomenology when I know what the hell I'm talking about).  So starting fresh: I am atoms.  I am carbon; I am oxygen; I am hydrogen; and I am sprinkles of other molecular crap.  The table my computer sits on (I won't discuss the computer itself because I don't pretend to understand whatever magic the Warlock Jobs used to create it) is also made of similar, if not identicle, molecular crap.  So what am I in relation to it?  I am exactly that: a relationship.  When I see myself in the mirror, I am looking at the same particles as I see in a cat, or a table, or tree.  I am different because of the relationship of those particles.  I am a pattern, not a substance.

What does this mean?  I am a construct of my mind.  My brain interprets the relationships and creates me or the table or the tree.  I don't exist as I think I exist outside of my head.  So what the fuck am I?  I am whatever my mind wants me to be.

Does anyone know how to fly this thing?

Flying freaks me out. Never used to but, since the advent of my daughter, the almost nonexistent risk is magnified. Am I really going to risk not being able to see my daughter grow up so I can rock out with Soungarden at Lollapalooza (top five shows of all time by the way)? The answer is of course yes because I know I am an irrational jackass. My friend is more of an irrational jackass than I am. She is remarkably courageous in my opinion because she flies despite her fear (courage is not a lack of fear but what you do with that fear).  We shared a flight from LA one time.  We started out in a torrential rain and she asked one of the stewardesses if it was safe to fly.  The stewardess said yes and that they too had an interest in living and would therefore not taking on any unnecessary risks.  

This is a very important concept.  The pilot and staff on the plane assume the same risk as the passengers: we all go down together.  It is not as obvious in medicine that we share the same risks as our patients.  I would argue, however, that this is absolutely the case.  There are questionable statistics on the limited life spans of physicians.  I can't honestly say what's right.  But it is clear we have stressful jobs and the burnout rate is astronomical (think about how this affects patients).  I can say from experience that if you do poorly under my care I am affected whether its my fault or not.  There are anesthetics that have changed my life, for both better and worse.  In addition to the baseline empathy we non-psychopaths share with other humans, we are tied to our jobs (and thus you as the patient) through the exceptional amount of time, effort, and sacrifice we put in.  My identity is inextricably linked to my profession (think about how you answer the question 'who are you'; I'm a father then a husband then an anesthesiologist then some other shit I can't remember, but I only mention the anesthesiologist part).  Consider also the patient who comes in who is nearly identicle to me except with a life threatening disease.  I am unconsciously tied to his outcome if only to protect my fragile concept of my own mortality (if it can happen to you, it can happen to me).

When you come under my care, we take the journey together.  We share risks. My say is equal to your say.  We forge a path together, neither of us directing the other.  I have the most knowledge of the controls so I'll be flying the plane.  I won't, however, drop you off in Minnesota when you're expecting Kansas City.  I'll do my best to avoid the uncomfortable bumps that are familiar to me but terrifying to you.  And I hope that you respect me and my stake in this journey enough not to force me to land in a pile of shit.

Identify with your disease

My guaranteed to read lead in is this: Fuck.

The origin of this lies in the fact that my "Patience" entry is the highest rated.  I am certain that it isn't the quality of the writing but the fact that the word "fuck" reveals itself in the first sentence and has two encores in the first paragraph.  Everybody loves the unnecessarily inappropriate.  I'd love to hear the top ten words that would get you reading (ear muffs everybody: fuck, shit, balls, cock; are you listening Google?).

Now that you've gotten this far, on to identity.  I don't know who the hell or what the hell I am so this will be an oft-treaded topic on this blog. I don't think I'll ever really know who this person who fakes my narrative truly is (there is so much redundancy and feedback in that sentence - I, I, my - I'm getting nauseous; I truly am a strange loop).  I refuse to read The Ugly Duckling to my daughter because I don't want to give her the false impression that we ever figure out who we are.    Maybe that's Buddha and Sartre's point anyway: defining yourself is succumbing to entropy (energy not available for useful work).  If I am what I am, the process is complete.  I am not available for useful work (i.e. the process of becoming).  I am a pinpoint.  I am stagnant.

But that is a topic for another day.  What concerns me here is identity and disease (there is a great book called Human Identity and Bioethics if you’re interested).  My god is the physical process.  I wouldn’t say physics per se because physics is a construct for understanding.  I simply mean that everything as we understand it is an infinitely dissectible set of processes: the unicellular organism driven by physical forces shares work with other organisms forming multicellular organisms that become increasingly more outwardly complex, but still driven by the same basic forces.  We are simple patterns of cause and effect (I don’t actually believe in cause and effect to be honest - blow your mind on this: Backward Causation).  Consciousness, free will, morality, spirituality are all versions of an uninterpretable chaos of physical processes.  I am that zygote in my mom’s uterus (just opened up a shit-can for the pro-lifers).

This means that we could not be anyone or anything other than our diseases.  Whatever the arbitrary classification of disease that my body will eventually degenerate into, that is me.  It is part of the process that is me.  If I were to define myself by the personality that emerges from the chemicals in my brain, I would have to define myself by the disease that shares the same chemicals, cells, and physical causation.  It is the ultimate Catch-22: you couldn’t live without the disease that’ll kill you.

Surrender

I have a friend in the hospital. He is also a physician. When he first arrived, there was significant concern that his symptoms indicated something monstrous (although it continues to be frightening, it is not as bad as they thought). He knew to be scared when he heard the overhead page calling the emergency team to treat his suspected condition. The physician overseeing his care saw his fear and placed a hand on his shoulder. She then said that they will take good care of him. This, he told me, meant the world to him.

As a physician, he knew that to navigate disease is daunting even by experts. Despite the constant push for data and protocol, the art of medicine - action guided by the inarticulable and seemingly imperceptible - is very much alive and well. (The first thing you learn as a physician is "sick" or "not sick" with just a look.) He knew that she had little power to direct his future, but still her words put him at ease.

It is difficult to accept when things are out of your control despite the fact that most everything is. His doctor knew this, so she took control for him. She made it so he did not have to act. He simply had to be (is this true authenticity?). I think, in the end, that is our primary jobs as physicians: to provide opportunities for surrender.

The doctor is ill at ease

When it comes to my mortality, I always think there is something to be done. Go to my doctor, get a test, take a pill.   I mistakenly believe that I have full power over the molecular direction of my body.

Here's what I do with your disease: I take objective measure of it; I evaluate what I may have control over and seize it; and I recognize what I have no control over and surrender to it. This is not to say I don't do everything in my power to help and protect you. What it means is I understand what power I have. I understand when I can't (and shouldn't) intervene.  I am a better doctor because I understand my limitations and the limitations of medical science. I suspect I'd be a "better" person (by better I mean more psychologically at ease) if I took the same approach to my family and myself. My control over my body is limited and there is not way around that.

My forefathers want me to gave grenade launchers

If I took the proper explosive training and the boy scout's national grenade launching skill/obstacle course, why can't I have one? It's never been the grenade launcher's fault in the various domestic grenade launching attacks. It's the person behind the grenade launcher, not the launcher itself that is at fault.

My right to a grenade launcher is firmly grounded in the second amendment: "A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed." Just because our forefathers wrote this several hundred years ago when they were planning on fighting the most powerful military power in the world without an organized militia of their own; desperate to recruit as many people as possible; during a period with a very small population density; living with minimal protective services such as the police; and with wild animals (as well as "wild" natives) constantly knocking at their doors, doesn't mean that it is not applicable today. Don't you watch TV? Global warming, fundamentalist terrorism, toxic pollution, economic collapse, Mayan calendars, Glenn Beck all are indicators of the coming Armageddon. Don't you listen to Palin? We need to "reload" not "retreat". We need to prepare. We need grenade launchers and Barrett M107 Heavy Caliber Anti-Materiel / Anti-Personnel Sniper Rifles and Colt Commando (XM177E2) Submachine Guns.