Month: May 2019

The human soul is often kept confined and imprisoned by society and its rigid structure. However, it continually yearns to be let free and is always on the search for new ways to express itself, whether through music, through visual art, through film, through science, through poetry, or through any other means. I find it essential to express oneself in a variety of ways and to dabble here and there in as many differing crafts as humanly possible. Why not, I ask, try something new each time, only to discover a newfound passion for that particular subject. Most individuals have heard of the quote that someone can be a “Jack of all trades, but master of none.” This often taken negatively in context, however, it excludes the entirety of the couplet, “Jack of all trades, master of none; though oftentimes better than the master of one.”

However, I often engage with myself in silent conversation about the things that I enjoy doing. I think of all of the amazing projects that are possible and get inspired by things I see online. Despite this, something that I have only now realized is that very few of these ideas, if any, will ever come to fruition. Leonardo Da Vinci’s fatal flaw was alas, his extremely broad interests. He was so often compelled by new subjects, that he usually failed to finish what he started. As a result, he completed only about six works in 17 years, including “The Last Supper,” and he left dozens of paintings and projects unfinished. He spent most of his time studying science, either by going out into nature and observing things or by locking himself away in his workshop cutting up bodies or pondering universal truths. This is a problem that plagues many people in the modern age, including myself. I admit that I have fallen over many times in my quest for achievement, but I believe that the strides I have taken overcome these setbacks and make them look inconceivably small. No man can ever succeed without failures, as these failures are what define success: the more failures you have, the more the success feels better.

Society both craves instant gratification, and antagonizes melancholy. Consequently, laziness and procrastination are abundant, like an eerily quiet disease that disguises itself with symptoms of happiness and joy. Thus how wise it is, to be the destroyer of such a disease. Unfortunately, in modern society, the purveyor of the disease is, none other than the media. I was recently rereading Fahrenheit 451, and noticed that Bradbury also states that “Not everyone is born free and equal, as the Constitution says, but everyone is made equal.” There are clearly multiple analogies with modern society. However, the conflict is that the media is not purely a bad thing. In fact, books are essential to Montag, the main character, because they give to him the truth in its bare form, emanating the history which happened so long ago, not what the propaganda the government or other institution wants. Expressive, unadulterated media is an essential component of a free society. Media today, however, is a means of further tightening the grip of the powerful on society. Without reading a real history book, not a simplified digest of information that the government provides. Yet in society, do these truths really matter? The cognition of these facts have no importance to a great society, as the average man simply does not care. Bradbury famously said, “‘The zipper displaces the button and a man lacks just that much time to think while dressing at dawn, a philosophical hour, and thus a melancholy hour…. Bigger the population, the more minorities. Don’t step on the toes of the dog lovers, the cat lovers, doctors, lawyers, merchants, [etc.] … There was no dictum [to stop writing], no declaration, no censorship, to start with, no! Technology, mass exploitation, and minority pressure carried the trick, thank God. Today, thanks to them, you can stay happy all the time, you are allowed to read comics, the good old confessions, or trade journals.’ … ‘With school turning out more runners, jumpers, racers, tinkerers, grabbers, snatchers, fliers, and swimmers, instead of examiners, critics, knowers, and imaginative creators, the word ‘intellectual,’ of course, became the swear word it deserved to be…. [By limiting books,] Each man the image of every other; then all are happy, for there are no mountains to make them cower, to judge themselves against…. People want to be happy, isn’t that right? Haven’t you heard it all your life? I want to be happy, people say. Well, aren’t they? Don’t we keep them moving, don’t we give them fun? That’s all we live for, isn’t it? For pleasure, for titillation? And you must admit our culture provides plenty of these.’” This specific passage so enthralled me because it nearly perfectly aligns with our society and culture here in America today. The fact that Bradbury wrote this sixty-three years ago (in 1953 when Fahrenheit 451 was published) highlights his genius. The book is an incredible piece, and is eerily accurate with its predictions of what modern society would look like.

What greater pain is there but for the wonderous thoughts that so wander about to flutter into oblivion the very moment they are conjured?

Our greatest gift is our sauntering imaginations, and for such a beautiful thing to go to waste is a distressing notion, in my mind and in other minds alike. To spew thoughts onto the page without regard to the meaning, but as a stream of consciousness, is an incredible freedom not often appreciated enough.

A creative is able to conjure up fictional worlds in such a manner that they often become tangible, alive even, within the mind of the beholder. However, because the memory of the human mind is feeble, the incredible fantasies vanish into thin air just as quickly as they arise.

Writing is the only solution therefore, as we have yet to discover a device that can record thoughts directly in some way that is understandable to mere mortals. The chief complaint regarding writing, is the sheer difficulty of simply beginning. After all, to move such a heavy mass as the imagination requires significant energy and effort.

I used to be in the same boat. A significant amount of time has passed since the beginning of my own journey through my conscience, though now more remains to be explored than when I first made headway. With each passing moment, I am more satisfied by the new questions that arise from the old. This is the great joy in life: learning more and more about the universe, yet realizing how much more there is to know. With every question that is answered, there are easily ten more that arise.

Therefore knowledge is not a linear progression, but rather, exponential. As more is discovered and as more is understood, the imagination is let loose on a larger field and is free to wander through an ever growing universe. The mind can saunter along at its own leisure, finding new paths and reminiscing on old memories. Please, for the love of all humanity, set your life free and explore every inch of your own mind. What happens is relief from having to remember all of the great thoughts that you once had.

Note: This article was originally published as part of the Q3 2019 issue of the WFCC Newsletter and is reproduced here with permission. See original: http://www.sahilnawab.com/wfcc/q3_2019.pdf

Dealing with stress is an integral part of the modern human experience. We all struggle with health-related issues, financial difficulties, family disagreements, and many others. There are a number of negative effects associated with high levels of stress, from headaches and depression to even physical health issues and increased recovery times. Therefore, it is crucial to have healthy and productive coping mechanisms to manage our stress.

In a brilliant TED Ed video, Massimo Pigliucci discusses the Stoic philosophy and its origins in the teachings of Zeno of Cyprus when he became shipwrecked off the coast of Athens and lost all of his wealth and possessions.

While today the term stoic has developed its own meaning as an adjective to describe someone who endures difficulties while remaining calm and collected or someone who rarely shows emotion in the face of adversity. However, the original philosophy goes much deeper, and is in fact much more applicable in our daily lives to help recognize and handle stress.

“While we may not always have control over the events affecting us, we can have control over how we approach things.”

This statement concisely summarizes the Stoic philosophy. But while this captures the essence of Stoicism, how can we actually apply it to our lives?

Pigliucci describes the four core tenets of Stoicism that we can follow:

• Practical wisdom — the ability to navigate complex situations in a logical, informed, and calm manner;
• Temperance — the exercise of self-restraint and moderation in all aspects of life;
• Justice — treating others with fairness even when they have done wrong; and
• Courage — not just in extraordinary circumstances, but in facing daily challenges with clarity and integrity.

Often people conflate Stoicism with having a nonchalant attitude towards life. However, that’s an incorrect characterization. Stoicism is not about discounting or not caring about issues, but rather it is about understanding that these issues should not cause unhealthy levels of stress. Rather, we should focus our efforts on matters which we can actually address.

In fact, a nonchalant attitude can be quite counterproductive. Stress is an effective motivator for action. Modern psychologists describe this through the stress-productivity curve, or more formally known as the Yerkes-Dodson Law.

Fig. 1 – Stress vs. performance curve, adapted from the Yerkes-Dodson Law (Image: Heath, 2019) (PS. I first saw an image like this in a class presentation HU3900_D2019, but since have not been able to find the original source. I searched for a similar image, and found this here: https://slideplayer.com/slide/16338179/)

Perhaps this response arises from evolutionary pressure. Stress may have been an action-motivator to our evolutionary ancestors. During primitive life, actions were likely conducted over much larger timescales, especially given the exponential increase in pace in our modern lives. Consequently, stress arising from situations such as limited food availability or lack of social contact, may have pushed early humans to act, potentially providing an evolutionary advantage to a stress response.

Therefore, in a well-managed manner, stress provides an excellent way to push ourselves to do better — just the right amount can make us more productive and compel ourselves to address the challenges that we face.

First, know and recognize stressors before they become stressful. If you can recognize that certain matters are out of your control, you can begin to address those that are /in/ your control. That is the first step in being able to act calmly to actually address those factors and reduce the stress.

By incorporating elements of Stoicism into your own personal philosophy, you can become self aware and more conscious of how external events affect your emotions and mental state. It then becomes much easier to deal with those changes and develop healthier stress coping mechanisms. Let me end with an interesting thought to ponder: “Suffering stems not from the events in our lives, but from our judgements about them.” — Epictetus

Dossier

“The Philosophy of Stoicism,” by Massimo Pigliucci, June 19, 2017. https://ed.ted.com/lessons/the-philosophy-of-stoicism-massimo-pigliucci. This is an animated video lesson explaining the history and general philosophy of Stoicism in an entertaining story format.

“Are You Too Stressed to Be Productive? Or Not Stressed Enough?” By Francesca Gino, April 14, 2016. https://hbr.org/2016/04/are-you-too-stressed-to-be-productive-or-not-stressed-enough. This is an article from the Harvard Business Review that provides some practical advice to improve your performance from related stress.

As much as medicine desires to be a purely objective science, it is still mired in ethical controversy as a consequence of its human element. Often, medical decisions are not always made through logical reasoning, but rather include social, emotional, and economical components, among others. However, what ties together these alternate components is the rhetorical discourse between the patient and physician, patient and family, and more generally, the patient and society at large.

In order to effectively work within this rhetorical environment, physicians should realize that medicine inherently lies at the intersection of art and science. In some ways, it is the perfect blend of creativity, technique, empathy, emotion, technology, and evidence-driven science. However, medicine remains first and foremost an applied science, and therefore it must contend with the divergent goals of not only serving the needs of the patient but also furthering the scientific study of the human body. Whether or not medicine is able to reconcile these discordant ambitions is a complex issue. However, the conflict is particularly evident in end of life care. Medicine has continuously struggled to answer the question: at what point do physicians, or the patients for that matter, decide that enough is enough? When is intensive medical care considered to too costly (both in terms of the wellbeing of the patient, as well as more recently the monetary expense)? This questions is often posed to patients and physicians alike during difficult times, for example, when patients are facing a terminal illness, or are unresponsive and on the brink of death. What role does medicine play, or rather what role should it play when there is nothing more that can be done? What role should medicine play when what can be done in fact causes more harm?

The answer to this question has changed drastically within the last two decades during which the pace of advancement has exponentially increased. Some might even argue that medicine has advanced past the point of “naturality,” or in other words, to the point of being able to artificially support life for longer than considered natural. At the same time, the majority of Americans have expressed the desire for a peaceful death, free of pain and unnecessary intensive care. As the aggregation of discourses surrounding this topic has evolved, public policy has adapted to reflect that desire, with the establishment of advanced directives and the “Do Not Resuscitate” order. Although beneficial in reducing unwanted intensive care, this idea has had its share of controversy, particularly when a patient reverses their decision when faced with death and decides that they do, in fact, wish to be resuscitated at the last minute.

As a result, effective communication of the patient’s end-of-life desires are critical. This communication issue is exacerbated when the patient is not able to express their wishes directly, and this has real life ramifications. Emergency physicians were confronted with a difficult dilemma when an unresponsive and deteriorating 70 year old male patient was brought to the emergency department. He had a tattoo on his chest with the words “Do Not Resuscitate” in bold lettering, followed by a signature, as shown in Figure 1. This situation, although ostensibly a medical ethics issue, is in fact inherently rhetorical in nature.

Fig. 1 – Photograph of patient’s “Do Not Resuscitate” tattoo on the chest (Image: Holt, NEJM)

The attending physicians struggled to make a decision in discerning whether or not the tattoo was an accurate representation of the patient’s wishes and whether or not it was legally valid without the presence of an official state-sponsored document. Eventually the physicians decided to not honor the tattoo, “invoking the principle of not choosing an irreversible path when faced with uncertainty” (Holt, 2017). This is the aggregation of discourses at act; the medical field has decided that life saving interventions is the default mode of action. In essence, the discourses contend that life is too precious to lose, almost regardless of cost, even if the cost is to the patients themselves. The question becomes, does the tattoo represent the true desires of the patient, or is it a regrettable attempt at morbid humor? If the patient were conscious, would he request doctors to ignore the tattoo?

Rhetorically, tattoos hold little significance in comparison to other forms of communication. However, this begs the question, why would doctors choose to ignore the tattoo? Why is the tattoo considered an inadequate form of communication? The general negative stigma surrounding tattoos is likely a significant contributor. Some tattoos serve as permanent reminders of a regrettable decisions while a person was intoxicated. The possibility that the patient did not intend the tattoo to be taken seriously forced the physicians to err on the side of caution. Despite this, the attending physicians remarked that “this decision left us conflicted owing to the patient’s extraordinary effort to make his presumed advance directive known” (Holt, 2017). This conflict led to the physicians requesting an ethics consultation.

Following careful review the ethics committee advised the physicians to honor the wishes of the patient’s tattoo. They argued that “it was most reasonable to infer that the tattoo expressed an authentic preference, that what might be seen as caution could also be seen as standing on ceremony, and that the law is sometimes not nimble enough to support patient-centered care and respect for patients’ best interests” (Holt, 2017). The process of obtaining a D.N.R. order can be challenging and time-consuming, and therefore patients may eventually choose to take matters into their own hands.

Despite being given exactly the same data, i.e. a terminally ill and deteriorating patient with a “Do Not Resuscitate” tattoo, the physicians and ethics committee made differing claims. This is attributed to the different warrants used to justify the claims. Specifically, the physicians used their professional “gaze” in order to establish a warrant that they have a responsibility in prolonging life to the best of their ability, as well as the discourses within the physician community as justification. However, the warrant of the ethicists relies much more strongly upon the relatively new idea of patient-centered care with respect to end-of-life directives and the notion that medical intervention may not necessarily be in the best interest of the patient. Importantly, a warrant common to both the physicians and the ethicists is that the tattoo may not reflect the current desires of the patient, given its permanency in contrast with the much more malleable nature of human ideology.

Would the ethicists have made the same decision, however, had the patient not been in deteriorating condition? Would they have instead waited until the patient became conscious, albeit potentially in significant pain, to confirm their desires? This alludes to the fact that rhetoric is highly contextual; that is, contextual clues can often change the meaning and seriousness of the message. Just as human perception forces a reality to be constructed spontaneously “on the fly,” the rhetorical situation is itself built on that perception and is therefore processual as well. At each situation, the rhetorical perception is reconstructed based on the aggregation of discourses that existed prior, and most importantly, those discourses are constantly added to and modified as the environment changes. Thus the discourses are alway in flux, slowly adapting alongside society.

Currently, when an unresponsive patient presents with a life threatening illness, the general presumption—that is, the current aggregation of discourses in the medical field—is to care for the patient and prevent death to the best of medical practitioner’s ability. This is an aggregation of discourses that has roots in society’s fear of death. However, this discourse is slowly changing in response to the acute realization that death, and specifically a pain-free death, is not always unwelcome.

Of note is that, subsequent to the decision by the ethical committee, the social work department was able to identify the patient and obtain the patient’s official Florida DNR order, “which was consistent with the tattoo” (Holt, 2017). The patient continued to deteriorate and eventually passed away without further advanced airway management. The attending physicians note that they “were relieved to find his written DNR request, especially because a review of the literature identified an earlier case report of a person whose DNR tattoo did not reflect his current wishes” (Holt, 2017). This earlier case provides an antithesis to the argument that the tattoo accurately reflected the patient’s desire that his end-of-life wishes be conveyed appropriately and taken seriously.

A few years earlier, a 59 year old man with diabetes presented to the hospital with a “D.N.R.” tattoo on his chest, shown in Figure 2. However, this patient explained that though he did not want prolonged attempts at life saving care, “he indicated that he would want resuscitative efforts in the event of cardiac or respiratory arrest” (Cooper, 2012). The patient later explained to physicians that he had lost a bet and consequently had to tattoo “D.N.R” on his chest. “He stated that he did not think anyone would take his tattoo seriously and declined tattoo removal” (Cooper 2012).

Fig. 2 – Photograph of patient’s tattoo that was regretted (Image: Cooper, JGIM)

In context of these situations, the rhetorical implications of a “Do Not Resuscitate” tattoo have serious consequences for patients and their families, as well as for the field of medicine as a whole. However, in each case, a rhetorical analysis is completed based on the aggregation of discourses at the time, which is continually being modified and updated to reflect a changing society, and its changing values.

References

Bever L. A man collapsed with ‘Do Not Resuscitate’ tattooed on his chest. Doctors didn’t know what to do. Washington Post. December 1, 2017. https://www.washingtonpost.com/news/to-your-health/wp/2017/12/01/a-man-collapsed-with-do-not-resuscitate-tattooed-on-his-chest-doctors-didnt-know-what-to-do/. Accessed February 2, 2018.

Cooper L, Aronowitz P. DNR Tattoos: A Cautionary Tale. Journal of General Internal Medicine. 2012; 27(10):1383-1383. doi:10.1007/s11606-012-2059-8.

Fortin J. His Tattoo Said ‘Do Not Resuscitate.’ Doctors Wanted Another Opinion. New York Times. December 4, 2017. https://www.nytimes.com/2017/12/04/us/do-not-resuscitate-tattoo.html. Accessed February 2, 2018.

Holt GE, Sarmento B, Kett D, Goodman KW. An Unconscious Patient with a DNR Tattoo. New England Journal of Medicine. 2017; 377(22):2192-2193. doi:10.1056/nejmc1713344.

Khullar D. We’re Bad at Death. Can We Talk? New York Times. May 10, 2017. https://www.nytimes.com/2017/05/10/upshot/were-bad-at-death-first-we-need-a-good-talk.html. Accessed February 2, 2018.

Despite all of the writing classes I have taken, I don’t really consider myself particularly adept at writing compelling prose. In fact, I think my writing skills have deteriorated over the years. When I look back at my work from high school and even pre-high school years, I am often surprised by it’s quality and then think to myself, “Did I really write that?”

Maybe one contributing factor is that I decided to pursue a scientific discipline. In science writing, we are constantly extolled of the virtues of direct and concise writing, and from this I think my writing has become quite dry and literal — not at all enjoyable to read, but very clear. There are certainly advantages to this style, but I think it’s valuable to explore different avenues of creative expression, including narrative prose and even screenwriting.

As I’ve been thinking this through in detail, I realized that this shift is not uncommon, and is especially evident when observing people’s speech. Eventually as we mature, we develop a certain linguistic style. As our mastery of language comes more easily, we develop heuristics that we can rely on when we want to convey as specific message. We begin stringing together these building blocks rather than synthesizing new ways of communication entirely from scratch. The end result is that we keep using similar language and similar style.

Heuristic: a technique used to arrive at a practical solution without directly solving the problem itself

That over reliance on these heuristics is, I think, a major contributing factor to the reduction in creativity that I struggle with.

Looking back at my old writing, what sticks out the most is the vocabulary. In middle school, we’re still learning how to express ourselves through writing. We don’t yet have a grasp on the intricacies of life, and we’re constantly trying to prove ourselves. For that reason, we’re constantly experimenting with language and how we use words to express ideas — often incorrectly in my case 🙂 Yet experimentation is what fosters creativity. Maybe we no longer experiment for fear that we may be wrong or appear foolish.

There’s nothing wrong with having a consistent style. But for me, being cognizant of the heuristics that I rely on pushes me to experiment a bit more and if in that process I can be more interesting, then I don’t mind being foolish! At the end of the day, I hope that this allows to think introspectively about our writing. I think that when we examine our own linguistic biases, we tend to better understand the limitations of writing and communication.