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?

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.

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

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.