Good and Evil: The Changes Inside

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In the George McDonald book The Princess and Curdie one of the main character Curdie, is able to see through the facade of the outer man and tell what kind of animal lies within them simply by shaking their hand and feeling the paw or claw. In the C.S. Lewis book Prince Caspian Lucy exclaims “Wouldn’t it be dreadful if some day in our own world, at home, men started going wild inside, like the animals here, and still looked like men, so that you’d never know which were which?” The stories we celebrate are those of good versus evil. We celebrate our role in the world wars because these are stories of freedom overcoming tyranny, and hate being overcome by love. Movies featuring alien invasions or a robot takeover are easy to watch because the us versus them mentality has clear cut lines. In human conflict, either in war or simply in daily interactions, determining where the line between good and evil is can be less obvious. In many of the military conflicts the United States has engaged in over the past half a century, there was an obvious evil-  a dictator or violent organization on the other side. However it was more difficult to determine if simply being opposed to that dictator denoted being on the good side. In some cases the answer was yes, in other cases it was less clear. In daily life determining who is your partner on the journey and who is an obstacle to be overcome is difficult. In truth people or even groups of people cannot be categorized as just good or evil. Reading Hitler: Ascent 1889-1939 by Volker Ullrich one could not have recognized a youthful Adolf as the monster he would become, least of all himself. Likewise we read about pillars of our community, politicians, religious leaders, shrinks, professors, and CEOs who have an evil side to them amidst all the outward good. One could not say that all the Germans were evil in the rise of the Nazi party as there were those, such as Dietrich Bonhoeffer, who appeared to take the wrong side, even for the most noble reason, such as a plot to overthrow Hitler. The good news is that good and evil exist in everyone, in varying degrees. In The Princess and Curdie the type of animal a person was inside could change for better or worse. The dwarf in Prince Caspian moves from skepticism and selfishness to loyalty and honor. The stories we enjoy have good and evil, certainly, but they also involve a transformation, and awakening. In both of these stories, as well as many others, it is not force of will that changes the character but their friends, their trials and struggles, and beginning to see the good in others. Perhaps the most important question everyday is not “what type of animal am I?” but “to what type of animal am I transforming by my actions today?”

Finding Home In Friends

20170318_170936.jpgOne of the most read novels on medicine is Samuel Shem’s House of God. The reaction of people is most often to either love the fact that it dispels the facade of the all-knowing physicians and ideal medical educations or they hate the book due to the fact that it portrays medical residency as horrific and bleak. What is often missed in the story chronicling the intern year of Dr. Roy Bash is the point. Everyone needs someone. Everyone needs a team. Everyone needs a squad. During the course of the year the interns realize they need one another and they need their leader (the Fat Man).

Often medical students (and pre-medical students) buy into the notion of competition. That those students around them, in the classroom and on the wards, are their competition. In general this could not be farther from the truth. What Roy Bash realizes, and what medical students and residents alike come to realize is that the competition is not peers. Medicine and science contain enough challenges and enough problems by alone; imagined competition has no place. Most of the time medicine and science are enjoyable challenges. However, as with any pursuit, there are moments studying, days in the lab, and interactions with patients that are difficult. At these times it is the students and residents working together that get you through the day.

Recently I was working on a team trying to resuscitate a patient in full-code. Although I’ve seen people coding before, I had never actually played a part of the resuscitation effort. We worked for almost an hour. As I compressed the patient’s chest, a whirl of activity surrounded the patient. As part of any team, communication is key, so the room buzzed with commands, stats, questions, and observations. Alarms were sounding constantly. At some point it became apparent that additional resuscitation efforts will not yield any better response and after asking for any additional suggestions from the team, the time of death was called.  What I did not expect was the silence. After an hour of hustle and activity, an odd hush fell over the room. As we took off our gowns, and gloves, the attending thanked everyone for their efforts. I was covered in sweat and the gown clung to my arms. Gloves and gown both had blood on them. Three minutes after the time of death was announced we were off to see other patients. I strangely felt nothing. The rest of the evening passed and I left the hospital late that night still without processing what had happened.

One of the struggles with pursuing a career as a physician-scientist is, unsurprisingly, that you bounce between medicine and research. The next morning walking into the lab I began to think about the resuscitation the night before. With patients found down out in the field, resuscitation efforts are often not successful. I knew that the team (with some of the best physicians, nurses, and residents) had done everything that could be done. But I still had it stuck in my head. The alarms. The smells. The rhythm of the compressions. The spurts of blood. Arriving in lab it was difficult to concentrate. With the patient dying in the back of my head, did I even care if a protein was being phosphorylated or dephosphorylated by a particular enzyme? It was the conversations and related experiences of other students that helped me process that night and prepare for more medicine, and more research, in the future.

The Tibetan saying goes “ Wherever you have friends, that’s your country. Wherever you receive, love, that’s your home.” It is said that students and residents more or less live in the hospital. It is the kindness, love, and camaraderie of fellow students and interns then, that must make the hospital a home.

Categorizing Millennials

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One of the popular ideas today can be summarized as “Millennials are ruining everything”. The recent closing of J.Crew, the struggles of restaurant chains, and many other market trends have been blamed on millennials. Those who are upset over this trend demonstrate a misunderstanding of the indifference of the market. However the more significant problem associated with this thinking is the categorization and stereotyping of people into broad groups. While the “kids these days” mentality has certainly been around for many generations, selecting out one generation, grouping them into one stereotype, and then heaping the nation’s problems at their feet is disconcerting.

This type of stereotyping and categorization are exactly the types of behavior frowned upon as racist, sexist, elitist, or bigoted if something besides birthday is used to categorize people. Insert a race, sex, gender, or social class in for the word millennial in any of these statements and you will see my point. Absolutely there are differences between generations, but in a similar fashion to any other category, the difference within a generation far outweigh the differences between generations. There are extremely hard working and extremely lazy individuals in every generation. There are extremely moral and extremely immoral individuals in every generation. Knowing the date of someone’s birth does not allow you to say anything about them just as knowing someone’s race or gender doesn’t allow you to say anything. Date of birth is a poor way to categorize and stereotype.

Returning to the issue of blaming shifting millennials spending habits for the closure of J.Crew and other industries. This is backwards. This would be the first time that the inability of a company to adapt to a changing consumer base was let off the hook and instead the tastes of consumers was the problem. To his credit Mickey Drexler admitted that he had been slow to shift with the climate. However both in the J.Crew instance and in many others just within the last year, millennials, not a poor business strategy and inflexible corporate structure, was blamed.

Do people in the millennial generation need to change? Absolutely. Each and every one. But that is because they are human, because they, like every other generation is on a lifelong quest to become something more, something greater. If we are to bin people into categories, let us bin them as humans and again as individuals. Anything more or less is inaccurate and destructive.

On Balance and Efficiency

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My research focuses on the immune system and specifically how inflammatory diseases such as Crohn’s disease, ulcerative colitis, or sepsis can be targeted with specific therapeutics. In contrast to cancer, where the goal is complete eradication of the cancer cells by whatever means necessary, or infectious diseases where complete stasis or death of the offending pathogen is key, therapies involving the innate immune response in inflammatory disease implement a goldilocks principle- too much inflammatory response and an inflammatory disease results, yet a total suppression of inflammatory response also leads to inflammatory disease resulting from an expansion of pathogens against a weakened host immune response. This is intermediate therapeutic zone is much more difficult to design therapies for and determine what the optimal level of response would be. Yet this is how much of life works- at an optimal intermediate between two extremes, with either extreme seen as unhealthy. The ideal would be to have both: an immune response that is robust against pathogens but is self-limiting, in effect not just finding a happy intermediate between the two but strengthening both the aggressive response to invaders as well as the attenuating factors downregulating inflammation.

I have always found the term work-life balance to both mask the real problem as well as cause confusion about what both work and life entail (as an aside Schrodinger’s essay “What is Life” is certainly a worthwhile read). Certainly we need balance in life. Certainly we need to work. And certainly everyone is in favor of life over the alternative. However calculating the minutes spent in an occupation or hours spent at home is surely a poor way to measure either as well. And as great as “Rent” is, love isn’t a terribly concrete way to measure anything. We live in a unique time in human history where our occupations can be our passions and not merely the basis for sustaining life. I enjoy research and medicine, and much of the large quantities of time that I spend working on either could be thought of as a sort of recreation in that it is interesting and non-arduous. However you certainly need time for family and “life” as well. The importance for both work and life is being present in both. What is interesting is that when many people refer to needing down time or “life balance” this is more of a way to say they enjoy time on the couch being entertained as opposed to being intentional about the human interactions between family and friends that we value so much. At work many people avoid thinking about how to push the envelope occupationally and instead escape to pleasant day dreams about their life outside of work. In running there is the idea of junk mileage, that is miles that you run but that don’t necessarily help you become faster or more in shape. Getting rid of “junk” hours both in work and in life is critical. Innumerable “junk” hours can be spent at work without making progress or with family without building relationships or caring for one another.

To find success in work-life balance both work and life must be pursued with intentionality, curiosity, and enthusiasm. Often the balance between work and life is not between work and life, but between efficient use of the time we have and a squandering of that which has been given to us.

On New Transitions

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One of the struggles many new companies have is the transition from a scrappy startup to an established and respected company. This has been notable in the news as Uber has now made repeated attempts to change and establish itself. For companies, this means the transition from impromptu meetings, a general lack of structure, and a pace of work that, while doable for a year or two, is not sustainable for decades. Many people have great ideas in their garage; very few people are able to take their great ideas and organize a sustainable company around those ideas.

Although different than companies, in some ways our lives are very similar. Many people begin with creative ideas and high hopes for changing the world around them. However the transition from idea to instrumentation is the burial ground for many commendable pursuits. The transition from spectator to player is key. Whatever pursuit you are thinking of, whether that be a sport, a hobby, a new invention, a business idea, the beginning of a political career, or any number of things, the first step onto the field is key. Often the thing holding us back from becoming a player is complacency and a fear of a new experience. Often the first step does not have a high opportunity cost. Instead the cost is a bit of comfort to establish a new identity. Growth is embracing the discomfort, digging in for the long haul, and deciding that whatever we are pursuing is ultimately of greater value and worth than the comfort we are leaving behind. 

Changing For A Better Story

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“The man who views the world at 50 the same as he did at 20 has wasted 30 years of his life.”

-Muhammad Ali

Like the proverbial frog slowly brought up to a boil, we are often immune to gradual change. Asked how we are different from yesterday most of us could not see many differences. Even at a week or a month much of who we are may appear the same. Looking back from year to year we can begin to detect the changes. How was I different last year? Five years ago? Ten years ago? As Muhammad Ali notes, the answer must never be “no different”. An essential component to being human is the constant changing of our core selves. The best stories, whether fiction or non-fiction, movie or book, are those in which the characters change, become people their former selves would barely recognize. Take your favorite story, Harry Potter, Lord of the Rings, Star Wars, the Hunger Games, or any other. The most compelling aspect of that story is the dynamic nature of the main character, watching them morph and change as events unfold. Take your own story, your life. How have you changed? How have I changed? Have we changed in a way that makes a great story? Or are we mired in a static bog of routine and comfort? The great news is that the end of our stories has yet to be written and the opportunity for change and growth waits.

A Beginning, A Middle, An End

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A beginning, a middle, an end. These are essential components of nearly all of our experiences. The beginning exciting and invigorating. The middle often repetitive, even monotonous. The end bittersweet and nostalgic. This cycle, these three elements are what imbue every undertaking with meaning and purpose. Whether in education or business, recreation or occupation, at the personal level or at the national level, we function best when these elements are well defined. The repetitive nature many careers take. And the later years of contemplation and reflection before final goodbyes are said. We see this in trips, the excitement while packing and traveling, the rhythm of being away from home, before solemn farewells and departures.  We see this over the course of lifetimes, the learning curve of being a child, a student, and a young member of the workforce. In the movie “In Time” where unending life can be bought for the right price one of the main characters observes that although the body can live forever, the mind cannot. We were made to have a beginning, a middle, and an end.

And there is a blessing in that. We understand poorly the process of aging, why the body breaks down, why even with the optimal lifestyle a hard ceiling to longevity exists. Likely within the next 50 years much of this mystery will be unraveled forcing us to ponder what we might do with an end postponed. Would we use our time differently? Invest in the planet and environment more? Harbor less ill will (grudges accumulated over centuries would certainly be oppressive)? Yet in our current state we must do what we can with the time we have. Making the most of our opportunities and our relationships.

On Being Nothing

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The admission, and also the celebration, at the center of Christianity is that “I am nothing.”  The human bend is to strive to be something, a desperate plea that “I am something, I am someone.” Much of our daily lives is consumed with that pursuit. In career it is to demonstrate you add to the company or team. In society it is to demonstrate your skills are valued and add to others. In relationships it is to know you matter to the other person. Christianity reverses this. It accepts that we are nothing and even at our best fall short of being something or someone. Importantly it accepts that we are in so far over our heads that we need a savior. That our best strivings and a lifetime of good deeds and effort will still see us short of worth. There are two general ways of recognizing a need for a savior- looking inward and looking outward. When we look inward, a realistic self-evaluation (and this is often the most difficult, as Richard Feynman said “The first principle is that you must not fool yourself, and you are the easiest person to fool.”) we see a degree of selfishness, angst, anger, discontentment, insecurity, and loathing requiring us to look away. When we look outward we see the brokenness of the world, both natural and human derived, that destroy our hopes for a better world. Looking both inward and outward the brokenness is apparent. Instead of looking for distraction or a stubborn refusal to admit defeat, the Christian must joyfully embrace this defeat admitting brokenness and a desperate need for a savior. at its essence, being a Christian is a simple progression: (1) making an observation of brokenness both in ourselves and in our world, (2) accepting that at our best we are incapable of being the someone or something we desired, and (3) looking to a savior who can fix the brokenness inside and outside.

Complexity and Gratitude

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The more I understand the human body, all the organs and tissues, all the complex interactions between systems and cells, the more I am amazed not at how terrible disease is (and disease is terrible), but how often things go right in the body. It is amazing how often all the systems come together to allow simple actions like breathing, stretching, walking, and thinking. Take none of this for granted. Every moment, every opportunity should be seized and enjoyed with great gratitude. 

Read, Think, React

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The common trend we see in the online community contains one step: React. More than a handful of times I have seen posts on social media in which the person acknowledges they have not read the item they are critiquing yet immediately following that admission they proceed to provide a uniquely, and by their own admission, unqualified, analysis. Ignorance is a luxury that we as a nation, we as a global civilization, cannot afford. We ourselves cannot be afford to be ignorant, nor can we afford to allows others to continue in ignorance simply because they do not have the means to invest in education. Either the solution to this problem or the cause of the problem will be the internet. The internet provides a solution in that it enables access to a vast amount of information. However, there is virtually no filter on the quality of information online and often the effort to fact check and think critically about the information presented is time consuming and difficult. However this time and effort is what is required to maintain democracy and forward progress. Each person must synthesize their own thoughts from what they have read instead of parroting popular taglines. Contrary to what many political systems attempt to persuade us of, one does not simply decide whether they are on the right or the left. Instead one must think about each important issue and decide on that issue what they believe. Instead of a one movement reaction, we must move intentionally to inform ourselves and formulate our own ideas. This is the cost of democracy. Democracy is not guaranteed and there are certainly a multitude of people waiting to take it away. An educated and informed population refusing to buy into partisan lines must be our defense against this. Read. Think. React.