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.