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.

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.