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.

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.

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.)

Chuck: [http://chuckpalahniuk.net/]

Burj Khalifa: [http://en.wikipedia.org/wiki/Burj_Khalifa]

Camus: [http://www.tameri.com/csw/exist/camus.shtm]

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

Napoleon Quotes: [http://www.military-quotes.com/Napoleon.htm]

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...

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?

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.

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.