Thursday, April 30, 2009

Pet Peeve

It really annoys me when I'm walking down the street and some random guy (always non-Jewish) walking the other way will say "Shalom!" to me and then continue on their way. They don't mean it maliciously as far as I can tell, but it's offensive in the same way as walking up to a Native American and saying "How!" would be.

Wearing a yarmulkah doesn't make me an effing mascot, jerks.

Monday, April 27, 2009

Picture God?

In response to Daas Hedyot's recent post, where he asks "What persona was your god?," he gave me pause to recall how I conceived of God as a child, and this is what I pictured:

I can't remember a time when I ever considered God to be any kind of person. Even as a child if I tried to picture God, I thought of a black misty cloud against a dark backdrop or of my standing before a focused yet endless expanse of white presence. God was the moral imperative that without words communicated approval or disappointment for my behavior.

In retrospect, I guess I had a different kind of picture than most people. This may be instructive.

Sunday, April 19, 2009

Nihil and Void

Sigh. Alright, we're here again pondering the meaning of life. I halfway hate myself when I think about these issues because I sound irritatingly like some angsty teenager, but in reality people don't typically figure it out to any real satisfaction, they just ignore it by embracing one distraction after another. Perhaps that's easier to do as an adult when there are more practical concerns (whether necessary or artificial) which can serve as distractions. But in any event this issue should bother people right down to their very being, whether they go to highschool or can drink alcohol legally.

Of course nobody really knows the answer but there are a two basic approaches: one, that there is no point and the only "goal" is to make yourself as fulfilling a life experience as you can - however you define that for yourself. Or two, there is a point and the ideal is to match your goals to be in proper accordance with that point - however you understand the point to be.

Obviously you can see the basic self-centered vs externally centered foci between the approaches. There's a value judgement there that makes (at least) me feel that selfish concerns should not be the ends of one's existence, but that hardly serves as a point of fact to base a conclusion on. I go back and forth on this issue - often several times a day. That is, when I'm not distracted. When I'm feeling idealistic and moralistic I find myself leaning towards there being a reason for existence - where what we do matters, where our choices and the effects of our choices matter beyond how they make us feel. In those times I feel encouraged to pursue an active course of bettering the world, fighting for causes, conscientiously intervening in things gone wrong.

But then there are other times when I think that everything I know and everyone who knows me will be gone and lost and long forgotten by some not-too-distant future time. So I feel fatalistic and disinclined to make an effort to change anything at all. Kohelet. Humanity is filled with the wretched, the poor, the liars, the hypocrites; persecuters and the persecuted - all destined to die after a few short years, why work yourself up about it? This has been the staus quo for virtually all of human history and there is little sign of it changing. I'm constantly amazed at how far we've gone and how we've survived so long when there is so many WRONGS in how people do things. Our public institutions reek of intrigue and scandals. Our private lives fill the newspapers with crime and senselessness. Civilization itself may just be a bubble waiting to burst. Is anything worth fighting for?

In the end I make the conscious decision to live as though there is a point. But in my heart the battle wages and I fear that the other side - the void of fatalism and selfish nihilism - may take the field.

Sunday, April 05, 2009

A Haiku: Palliative Care

Palliative Care
Not meant to cure what ails you
Hope you feel better

Friday, April 03, 2009


So I'm in the middle of a two-week stint of Geriatrics right now. The topics of the day invariably surround the most depressing parts of medical practice. We have the incurable chronic conditions, the terminally ill, the demented, the depressed, the disabled and the debilitated. How many times have I heard the term "health care proxy" this week? I can't even guess. Palliative care; "sedation therapy."

Which is more depressing - nursing homes or hospices? At nursing homes the residents are generally demented and seem to exist in a sad world of juice boxes, patronizing nursing staff and the pervasive smell of urine. A second childhood? Perhaps. More akin to a gentle warehouse where they wait for...y'know. At the hospice the patients are generally making the good faith effort to gradually complete their wretched existence which at the end revolves around their particular personal horror. Yet their families want them to die "with dignity." Ha. Dying with dignity is among the most mythic of all ideas. There is no dignity in death, folks. None at all.

Are these the successes or the failures of modern medicine? Thanks to modern medicine we've destroyed the previous strongholds of the Angel of Death. Infectious disease, once the major killer of humanity, has now largely fallen thanks to germ theory and antibiotics. Women dying in childbirth is today only a remnant of the merciless killer of a bygone era. What we are left with are the chronic conditions like heart disease, COPD, and cancer. We are so good at keeping people alive longer that more of them successfully make it to a state of debilitation and dementia. On the one hand, of course it is better that people live longer (and presumably better) lives today - but on the other hand, they weren't storehousing people in nursing homes and hospices in the past. Of course we are glad when a person survives an ordeal that would have easily taken them in a previous century, but we then all too likely send them on their way to a possibly worse ordeal before they take their final leave. Better? Depressing. The Angel of Death is less brazen today, but he makes up for it by being more sinister.

There is no mystery for why this is so. Evolution via natural selection is a great problem solver but it applies its solutions jealously only towards the primary goals of survival and procreation. The human body is incredibly complex and works amazingly well - but only for the first few decades of life. Y'know, the decades where the procreation and raising of young takes place. After the children are grown the elder generation no longer serves a much adaptive role. They are expendable. Natural selection stops working its problem solving magic on the likes of grandparents and soon enough the human body breaks apart on predictable fault lines. If the human body is like an automobile - modern medicine has largely cured the likes of a head-on collision, but after driving hundreds of thousands of miles even the best designed car will be totaled by an accumulation of wear and tear.

Ideally the purpose of medicine is to cure disease - not to let disease win. Yet palliative care is about letting the disease takes its natural course while treating the symptoms. Perhaps we need to recognize our limits since medicine today is still remarkably primitive in many ways, but palliation is still the real booby prize of medicine. The patients suffer less but they still die. There are no victories, only slightly less bitter defeats.