Thursday, May 26, 2005


Reasonable and True (birthday blog)

It is much easier to just not think about it. I often wish I could.

Thinking about it entails some attempt to understand it and to make sense out of it and to fit it into some sort of framework. Worse, thinking about it carries some sort of incentive or obligation to do something about it. Worst of all, thinking about it leads to some sort of sense of responsibility for it.

History is humbling. At least any attempt at honest history is so. There is no honest history, so an attempt is the best we can do. But since it is so deflating, perhaps it is the worst we can do.

The history of medicine is particularly damning for me, a physician. A mere century ago the truth was that all illness was caused by an imbalance of the vital humors. Today such beliefs are totally laughable. I know that all my truths of today will be totally discarded in the next century. But they are my truths, scientifically authenticated and verified, today.

Less pragmatic sciences, the "pure sciences" seek deeper truths and are more comfortable about discarding paradigms, for they are always seeking the best way to upset their current beliefs. Thus the history of science is also humorous in the truths that are embraced and then discarded, but less so because that is the game they intend to play.

More orthodox systems deal with the inevitability of change in more interesting ways.

Religion, the bastion of eternal truths, usually denies change. Instead, new truths (where DO they come from if not from Divine Inspiration?) engender new sects or new religions embodying the new REAL truths.

Politics, the bastion of the most ephemeral truths, also denies change. Politicians rewrite the past and rewrite the present: a most convenient way to handle the truth.

Politics and religion also kill off the opposition, thus silencing dissenting truths.

Leaving politics and religion, science and medicine aside, dealing only with day to day truths is still an impossibility. My truth is just not your truth. I do not believe you and you do not believe me. How could I believe you?.... you are WRONG! How could you ever believe ME?... I am SURELY wrong!

So I put aside truth and its physical manifestation -- reality (best definition: "a collective hunch").

What about "reason"? If truth is an illusion or delusion, then how can we be reasonable?

Deductive logic works just fine if we know the truth. True premises lead to true conclusions. The problem is in deriving those premises. Pesky unreliability of "truth"!

Inductive logic, always empirically based, is at best a statistical approximation of reality, at worst, an experiential guessing game.

So I muddle on... doing the best I can with the absolute knowledge that nothing is true or real. Life and death decisions are made on guesses and approximations. In the bigger world, wars are fought based on transiently truthful "facts". Ideologies battle and lives are spent for conflicting truths. In their respective recordings of history, the bearers of truth will tell their opposing tales.

Tuesday, May 03, 2005


Cerberus disguised as St. Peter

This morning a patient described a familiar story. Her child has a minor need for special services from the school system. The social worker of the assessment team has informed her that services cannot be provided because her child's needs are below the cut-off level of severity. The mother's experience is that she is on the outside of the team caring for her child and cannot get in. She advocates for her child and is placed in an adversarial relationship with the team that is to provide the services her child needs.

She cannot get past THE GATEKEEPER.

I do not know when the metaphorical gatekeeper idea arose in our society. About fifteen years ago Managed Care turned the patients' best advocate (and best manager of care) into Cerberus guarding the gates of even mundane and routine care. Increasingly, it seems, those who we most trust to be on our side are actually those who deny us what we need. The restrictions are not for the better good of all, but for the financial protection of some system, be it the insurance company or the Board of Educaton budget.

I guess we get what we ask for. We allowed Managed Care to be the prevalent health care payment model. We vote down adequate school budgets. We ask for Cerberus when we want St. Peter.

Sunday, May 01, 2005


Live like you are dying

There is a popular song currently on the radio about a man who knows he is soon to die and explains how he lived his life once he knew that his time was short. Most of his response is about experiencing life: skydiving, mountain climbing, riding a bucking bull, and taking time to look at an eagle soaring in the sky. The rest is about loving, listening, and giving forgiveness that he had been withholding.

He does not really know EXACTLY when he is going to die, but he knows his time is limited.

Sounds a lot like ALL of us: we do not really know when we will die, but we know our time is limited.

His response makes for a popular song, but it bothers me a bit.

I have no problem with his loving/listening/forgiving. That is the juice of life.

I do have a problem with his adventures and peak experiences. I just do not think that is what life is about. I think those are the diversions from living life fully, not the meat of life.

The song I prefer is about the guy who, upon finding out he was going to die soon, goes back to work the next day and does the best he can do and continues to do that until the day he cannot go to work. If he realizes that the work he is doing is the WRONG work, then he could STOP it and START doing the RIGHT work.

People think I am a workaholic, but they are wrong. I can vacation and relax fully. I can take a diversion from life. But I hope to be Doctor Joe until I can no longer be. And if then I can do another JOB then I hope to do so. And then another until I die.

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