Sunday, January 30, 2011

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.


Saturday, January 29, 2011

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!




Wednesday, January 26, 2011

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...


Monday, January 24, 2011

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.  


Saturday, January 22, 2011

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.



Friday, January 21, 2011

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.




Thursday, January 20, 2011

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.


Wednesday, January 19, 2011

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.



Tuesday, January 18, 2011

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.




Monday, January 17, 2011

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.

Saturday, January 15, 2011

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.

Friday, January 14, 2011

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.

Thursday, January 13, 2011

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.

Tuesday, January 11, 2011

Babies and suicide

Probably an unfair title.  There isn't much literature on babies committing suicide oddly enough.  What I mean by it is I never understood the concept of suicide until I had my child.  Strange to think the concept of mortal self limitation should arise out of my blonde haired, blue-eyed bundle of joy but it did.

I always thought that if I hit rock bottom somehow (whatever rock bottom is) then, in the very least, I'd be the world's greatest stuntman or the best war photographer of the century or the first man to eat 10 gallons of cookie dough a day.  Rock bottom would, in a sense, be freeing (another topic altogether already well put together by Chuck Paluhanakanaksanahun [possibly misspelled] of Fight Club fame).  If I truly examine this, then freedom to me was no longer caring about my mortality.  My life and death was the meaningful base from which all sprung.

With the advent of my daughter, that base changed.  She added a dimension that trumped my mortality.  Her physical safety; her emotional and intellectual growth; her potential role in society; my future enjoyment in watching her grow up; her present and future dependence on me; and much, much more all represent a richer, more immediately present meaning to my existence.  In other words, although the I've always enjoyed my life and am quite fond of who I am (contrary to the self-reflective brow-beating I give myself in this blog - you hurt the ones you love), the fall to rock bottom was not truly a long one.  I was standing on the 3rd floor veranda of a beautiful summer home in San Sebastian.  With my daughter, I am standing on top of 100 Burj Khalifas ).  I'm so tall now, everything I used to know and care about is microscopic.  I understand suicide now because I could not tolerate any other view than the one my daughter gives me.  My life became richer but more fragile with the birth of my daughter.

Camus said that the one philosophical question worth asking was why not commit suicide.  It is a brilliant question that, if you truly think about it, is a difficult one to answer (the question of course being the unanswerable "what's the meaning of life?").  I say flip it on it's head: why commit suicide?  What could you have in your life that truly means more than your life?  What would die over?  (Napoleon suggested that he can make a man die over a piece of ribbon.)

Philosophy and the Meaning of Life: [http://plato.stanford.edu/entries/life-meaning/]

Monday, January 10, 2011

The mini-van and the death of self

My wife won't let me buy a mini-van. I want one because it's spacious; it has little TVs that silence two-year olds; it can go the 80 miles an hour that I don't go beyond anyway; it allows for easy clean-up of the ill-defined baby particles that seem to make their way onto the floor and seats; and it has floor stow away things that serve no real purpose but are cool anyway.

But it's a no go. It's a no go because it marks the death of what we could be. Our future rock star selves. The one's that put the baby to bed at 7, arrive by plane to the Baja coast by 11, drink shots dripped through each other's ass cracks, and be home in time to film our American Idol audition songs before our baby wakes up. A mini-van marks the death of a dream. We are our parents. We are the middle class.

I am the worst perpetrator of this fallacy of identity. I am a writer even though my books and plays and whatevers haven't been written yet. I am a jujitsu master that can defend my family with Jason Bourne-like skill even though I haven't really committed to practicing the art. And I am a great husband and father because of these things I'm going to do, not the things that I am doing.

This is a big problem; a big, under-recognized problem. It is not the dreaming that's an issue. I believe possibility to be a great source of inspiration and productivity. It is the narrative we build - that thing we create to bridge the pinpoints of our lives into a false fluidity - that is the problem. Somehow with our perceived future weaves its way into our present and, in some ways, dominates it. We begin to think we are what we want to be.

Sartre stated that we are what we are not and not what we are. Utterly confusing but expected from a man who thought he was being chased by gigantic lobsters through his amphetamine haze. Confusing but insightful. We are what we are not: we are our projects, our expectations, our goals. We are not what we are: we are not our present selves but instead what we are working towards. To some extent this is healthy. If we cannot own our future selves in some way now, what would be the point of working towards anything? Sartre was a perfect example of how this can be healthy: he was striving towards something but actively doing something about it now. He was a philosopher and writer so he wrote everyday (enough for 20 pages a day for his entire lifetime). He was active. He lived his future in his present.

I don't think most of us are like him. We get lost in what we are not. I explain why I'm a writer instead of writing. I explain to my wife why I'm a good husband instead of doing what it takes to be one. I abstract myself from my present.

I'll be coming back to this idea of the present a lot. Although impossible to pinpoint, this now, this present, this whatever the fuck this is that we're truly living in is the only thing that's real. The past is misconceived, misconstrued, and misinterpreted. The future is undefined, unpredictable, and unsustainable. The present defines us. The rest is false narrative.

But fuck the mini-van. I'm getting a Porsche. It fits my Hunter S Thompson meets Bruce Lee persona better anyway.

Sartre: www.sartre.org/
Stow-Aways (love 'em): www.helium.com/items/785698-pros-and-cons-of-stow-n-go-seats-in-minivans

Saturday, January 8, 2011

Patience

How the fuck does one learn patience? (I'm actually not that angry about it. I just like the way the f-bomb implies that I'm impatient about learning to be patient. I love using the word "fuck". It's the Swiss army knife of words: it's a noun, verb, adverb, adjective, preposition, conjunction, everything. In fact, if my entire blog was made up of the word "fuck", it would probably be grammatically correct.). But I digress...

I am not patient. I wish to hell I was. My interaction with our intersubjective world would go a whole lot smoother. (That line reminds me of Matthew McConaughey in Dazed and Confused when, confronted with a freshman not bearing weed, he states "you'd be a whole lot cooler if you did...") When I expect something, time expands. Seconds are minutes. I am patient in relation to my new perspective of time, but certainly not to everyone else's.

At first glance, impatience seems to expose a love for the present. I have no interest in future gratification. The present is king. On further inspection, however, it is the opposite. When I can't wait for something, I am focussing my attention on the future. I am not or have not what I want. The present is in fact distasteful. This also works for those things that we don't look forward to. I'm in Mexico right now and have zero interest in going home tomorrow. The possibility of a future event (there's that damn probability crap getting in the way, affecting my actions despite it not being a real entity) alters my respect for and attention to the present.

Time and the present have obvious and enormous implications in death and disease. Both are inevitable and, as Ernest Becker suggests in his book Denial of Death, the knowledge of this possibility (the probability being 100% on a long enough timeline) constantly affects our self consciousness. The inevitability of my death - which, I would argue, I have infinite patience for (against?) in that I hope to forever avoid it - alters my respect for the present.

Back to the question, though, how the fuck does one learn patience? Seriously. I'm asking you. I have no idea. In fact, I don't have the patience for this fuc...


Thursday, January 6, 2011

Probability

I'm having trouble with probability. It seems simple enough: you have a fifty percent chance of getting heads with the flip of a coin. There is a 25% chance of flipping heads twice and so forth. Where I get stuck is that although there is a 25% chance of flipping heads twice, if I flip heads once, on the next flip there's 50% chance of flipping heads on this go around. Mathematically it makes sense and is almost childish in it's simplicity. But the point of probability is not only mathematical prediction, but a way to describe and understand our environment. Unfortunately it goes against the value I place on it. Past probability has no impact in present probability. Although I can predict a 25% chance of heads twice, it has no bearing on the moment of action.

How does this affect me? Let's say that there is a 25% chance of your head exploding if you drink a pint of Jaeger mixed with espresso and hot sauce. This is based on observations of things that occur in the past. Based on this percentage I think, well shit, there's 3/4 of a chance my head won't explode so pour me a drink! Although rationally I know that this bit of "science" carries no protection, irrationally I don't act this way. I use percentages as a protective guide as if these past events shape the present.

The thing that really gets me is what are my chances? My father had a heart attack at 38 and died of heart disease at 57. I eat differently, don't smoke, minimize time on my ass but I have a high stress job. If 5% of people in my situation have an MI, does that mean I have a 5% chance? Or do I have an X% chance that in the grand scheme of things only carries meaning as a single mathematical point in thousands observed from afar?





Wednesday, January 5, 2011

Faith

My wife and I had a discussion yesterday about religion and faith. We live in an area where the dominant religion has an enormous impact on the government (of course, that area of religious dominance is a mere subset of a larger area of religious dominance, i.e. the U.S.). We have our grievances with this particular religion because it's dogma infringes on our lives and beliefs. Unfortunately, our irritation extends beyond the boundaries of this religion's politics into it's philosophies. In other words, because some religious asshole shits on my parade, I hate the religion.

But my system, whatever that may be, is not perfect either. And if I hope to achieve what Tyler Durden would call the "instant of perfection", I need to consider the value of other people's ...well... values.

As I said before, I am burdened by mortality. Not to jump ahead and ruin the ending, but I think it unlikely that I'll ever find an answer to my burden (hopefully just some relief). Because of the weight of this burden, I wish (if i am truly areligious, to whom or what do I wish to? So many contradictions...) I had faith. True faith provides an answer by not giving one. It says it's there but you just can't "see" it. Just trust whoever or whatever it is you have faith in. Pulling it out of the dogmatic, politicalized, business entities that we deem religions, it is quite beautiful. We are perceptually imperfect beings. We can't know everything. If there is something we need desperately (i.e. meaning, order, purpose), maybe it does exist. And if it doesn't and we have to make it up, why not create it in the hands of an extraterrestrial? Who cares where it comes from, as long as it does it's job. I wish to whatever god I believe in (we all believe in gods - the providers of truth - whether they be in the form of a white male, a multi-limbed elephant, or the scientific method), that I had faith. It would give me a reason for my mortality and lessen it's burden.

I think Kierkegaard explained faith beautifully. He dismissed the dogma and piety surrounding his beloved Christianity and boiled religion down to faith: subjective faith that can't be understood by anyone other than the practitioner him/herself. In essence, the god is you. Quite beautiful and empowering.

Tuesday, January 4, 2011

In the beginning...

I'm scared shitless of death and disease. I say this as a practicing physician. Mortality is a bug up my ass that won't go away. Why am I so afraid? There are probably a million reasons but one stands out, mainly because it is an intriguing sob story that may lure you in if only out of pity.

My parents divorced when I was five. I am an only child so it had to be my fault. I must have done something heinously wrong to drive the wedge between my parents. I didn't know what that thing was, so everything I did or felt was subject to scrutiny. If I was to prevent them from the obvious next step - divorcing me - I had to change. Whatever concerns or emotions I had needed to be kept in check.

The problem was that I was a stressed out 5 year old who was sad as hell. I don't have the emotional maturity now at 35 to make sense out of my feelings. How could I possibly do so as a 5 year old? But as far as I could tell, I was being blamed for my emotions so I must have control of them. I didn't feel like I did, but I must given the catastrophic consequences (I was a bit dramatic as a kid) my emotions elicited. Although I was confused about my ability to control the health of my emotions, I was astute enough to realize that I definitely did not have control over the health of my body. When I got sick, I got sick. There was nothing I could do about it. So instead of being sad, I became sick. My body became my emotional dumping ground. Aches and pains in lieu of tears, fear of death in lieu of fear of abandonment.

Like all healthy American males, I chose not to address this quirk in my being and chose instead to pretend it did not exist. So it grew like the nasty emotional fungus it was into a near hypochondria. (Although an anesthesiologist and not a psychiatrist, I know enough about psychiatric diseases to hide behind technical definitions: I don't meet all the criteria to be considered a true hypochondriac. Of course, tell this to my pediatrician wife who will follow with eye rolling acrobatics.)

Today I have an enjoyable yet stressful job that resides in an enjoyable yet stressful life. Stress is an emotion we all have difficulty dealing with, both psychologically and physically. So, as you can imagine, when the pressure builds in my head, I displace it on my body. When I'm stressed, your disease becomes my disease. Whatever medical or surgical dilemma my patients face, I worry about having the same. And unfortunately, I take these "diseases" home with me.

It is time for me to face mortality; to understand it as much and to fear it as little as one can. It is time to be what I truly believe a doctor should be: a guide, leading patients through the seemingly conflicting meanings in objective disease and subjective illness. I have been doing my patients a disservice by not coming to terms with my own being and the inevitability of its demise.

So here it is. My journey to understanding my mortality. I'm not a religious man although I appreciate the philosophical aspects (not the dogmatic!) inherent in the major religions I have encountered (all seem to have as their goal a loss of self, the pinnacle in coming to terms with mortality). Nor am I a traditional scientist. I believe science to be a habit like religion with as much dogma and politics. I will primarily look to philosophy, the tradition that asks the same questions as religion, but uses the techniques of science. (It, of course, has its own bullshit too but I enjoy it's brand of bullshit.) But, in the end, what the hell do I know (that's the point isn't it?). I'll just figure it out along the way.