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.

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.  

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.

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.