Moral Dilemmas and The Mind (the part that's in the brain)

Moral Dilemmas. The fun stuff of life right.

Like if you're working really hard on a project intended to serve the greater community and you wanted to keep it on the LD, and have it be wonderfully "grassroots"-y and possess a certain lovely anonymity -the stuff of that ideal of civil society. And it's all going well, and you find yourself often just you and God (or the Universe, or whatever you believe in that's bigger than yourself) because your conviction drives you to get the job done and help people, even if you sometimes feel that you're 'going it alone' when it comes to organizing and planning and setting the wheels in motion. And you spend hours upon hours and it's a wonderful labour of love and you're getting satisfaction just by doing it really -it doesn't matter if people know it's you or it's not you or it's the wind. You feel happy about it.

But then you hear through the grapevine that someone has decided to play politics with your brainchild. They poach it and claim it as their own and announce it suchly to the world. It's as though these people sit around waiting for people who actually care to do something, just so that they can snap it up like vultures. It's a filthy business. Setting the record straight though, also a yucky business. But we feel compelled to because suddenly you feel violated to your core, insulted, undermined -the spirit and integrity of what the project was meant to be, a beacon of youthful goodwill in a still, stale fog of inaction and apathy, has been dimmed. And it feels deeply moral because if you don't stand up for yourself and what things were meant to be, and what they really represent and that the whole darn thing was born out of love and not out of guilt or a feeling of mere obligation, then they will walk all over you and abuse you for life. And it's not just me, it's not about me at all. But the reality that the youth are capable of getting shit done by themselves without the interference of old bureaucrats -and the youth as a whole should get credit for that. Because then other youth can be inspired to do the same -that youth and youth alone can make a difference, that they are a force with which to reckon, that they are unstoppable, and that they can change the world and make it right.

But the whole point was not to be political remember? So what does one do? Fight for which cause -the object of the action in the first place, or the philosophical, existential cause of the actors and the group of people they represent, and what that means for future change, expanding the base of individuals who feel that it is within their power to act? And is it possible to do both?

It's not just this -it has been a week of moral dilemmas. I've been interviewing various people for the article I'm working on for my community project on health care rights, specifically dealing with the 3-month Delai de Carence that mainly affects new immigrants in Quebec. See, I have mainly often thought that to really change the world, you gotta do it from the 'inside'. But it's hard to really know. Because when you're on the inside trying to make change, you inevitably have to compromise your ideals, and is it really okay to do this just in the name of expediency? I don't know. And a lot of people get sucked in and sell out even though they originally thought they were going in as a 'mole'. It's tricky -really a moral pretzel. I don't know. And when you interview politicians who obviously have little moral conscience, you wonder how they raised their children. Because how can you tell your son or daughter to lead an ethical, moral life, to maintain consistency between thought and action in the name of what's right and just and good and principled when you're off lying, cheating, manipulating and misconstruing in your everyday professional life, for power and profit and that's it. It is not okay. And it's even less okay if you took an oath to do no harm and to serve your fellow human being. It is not okay.

And what about all those people who say the reason that Canada's health care system is failing is because it is a public system and that privatization would solve all the problems? Don't they have any conscience at all about the lot of the poor and disenfranchised? Do they not feel like they are cheating their own minds by this reductionist argument? It is not about throwing money at a weak system. Yes, money is necessary, but not as much as people think. This is what I learned more about today from Michael Rachlis, one of Canada's leading health policy analysts, who came to give a couple of talks here. And it's not about needing to quadruple the number of doctors working in the system even though we should at least try to hold on to the doctors that we train in this country. How about giving them a reason to stay? Innovations in that area called 'Advanced Access' are what's going to save this system. It costs less money in the long run and not trillions even in the short run. It will make the system more efficient, it will make patients happier and healthier, it will decrease mortality and morbidity within the hospitals, it will strengthen the sense of community and common goals of various professionals involved in health care (doctors, nurses, pharmacists, social workers, psychologists, nutritionists, etc...) and it will rejuvinate and remotivate tired, disenchanted doctors. The research has already been done. It has been implemented with positive results in a few little towns. It's here now. And yet all those lobbyists for private health care turn a blind eye, all those false 'grassroots' pharmaceutical-sponsored "researchers", they're convincing people that privatization is the only way. It is not the only way. And it is not okay.

Neuro is Amazing.
In other news, we have finished the blood, muscles and bones unit and we're now doing neuro. Coolest so far, especially in anatomy (I held a real human brain! and it sooooo cool!). Also we had the most famous neuropsychologist in the world lecture us over the last couple of days. Dr. Brenda Milner (http://www.mcgill.ca/about/history/pioneers/milner/) -probably the most impressive professor I have ever had, more so because she is so unassuming and down to earth and is so old but still on the cutting edge of research. She comes from that whole generation of passionate scientists who did much of their groundbreaking work in the 1950s-1970s -and really had the 'big picture', that fiery approach where anything is possible in such a real way... like I've never met a scientist of a later generation with that same openness, who brings that higher philosophical, existential passion to scientific endeavour. Like Woody Hastings. Milner is to cognitive neuroscience like what Hastings is to chronobiology. And her lecture was so very engaging -she is still so passionate -and the tales of her experiments and their conclusions were peppered with anecdotes of what it was like to work with Dr. Wilder Penfield (often called the 'father' of neurobiology) at McGill. Anyway, she was very inspiring and has received all the honour that she deserves in Canada, in the U.S. and in the world. Pretty awesome.

Like a Peacock. Pan's Peacock?

We often perceive waiting as disempowering. Or maybe I should get off my royal soliloquey here. Until today I always felt that having to wait for anything was disempowering. Because if you're waiting, that's pretty much all you can do -wait. And wait. And wait some more. You cannot be proactive, you cannot take any action, you cannot take control... but you're left waiting.

And so in the social game of life and in evolutionary selection, we also often find ourselves waiting, waiting like good, well-socialized creatures. And then if you're me, one day, you decide that this is ridiculous -I ain't waitin' for nothin'. But when you look around for that bull that you've decided to very cliche-ly "grab by the horns", there is no bull. Lots of its excrement, but no actual bull. And then a wave of lava-hot fire sweeps over you and you're seething. Because who was it who got to decide these things anyway and why the bleep didn't anyone ever consult you about it? Like we can control nearly everything else about our lives -our performance, the extent to which we decide to give back to serve humanity, the way we express ourselves creatively (notice how very noble all of these endeavours are!) -and moreover, things always seem objectively better when we do control them. So in fact, things that we can't or don't control can't actually be that great.

And just to prove our point here with a concrete metaphor: we can't control public transportation (which is why it drives me up the wall most of the time!) and so what happens when that thing we can't control breaks down, or doesn't show up or the dumb new-turnstyle machines reject our fully-paid fare swipes? Nothing. And the nothing is inefficient, makes us miss the next connection, and just gets totally under our skin. It's the inaction, the nothing, that is the royal viral impotency that infects all these things over which we have no control. And ought we not to protest against such a thing? Should I not be redeemed for my precious time wasted? Should there not be some kind of cosmic justice here?

But how does one protest nothing? Especially when trying to do anything only makes more nothing? Which then only results in increased outrage for oneself (positive feedback... except it's not 'positive' at all)?

My sister has been taking a psych class lately and she shared the following insight: Across the animal kingdom, mostly, it's like how it goes for peacocks. The male bird struts about in all his Nature-given splendor, fanning out his tail of brilliantly coloured plumes, striving to impress the female... a 'vain chase' indeed. The female waits. She waits for the male to come strutting by. But here's the thing -she waits, but she also chooses. She gets to decide whether or not said male is good enough. So her waiting is in fact empowered (that is, if we set aside the fact that peacocks most likely do not have a consciousness or mind to feel either empowered or disempowered).

How do we translate this into our everyday human experience of how we feel about waiting, about all those things we can't control (but if we did, the world would be SUCH a better place, guaranteed!) -whether it's the bus, or the lack of available computers at the library, or the wheeze that follows the best workout of our life, or the inaction of others (whether that inaction is the teetering we see in politics, in business or in relationships). If everything can be related back to sex, then it follows that the peacock analogy should apply to all these other situations. The thing is, I'm still not convinced that not being able to control things can be empowering. Unless maybe if you have faith. But faith is like Peter Pan's shadow. It should stick once it's there, but sometimes it doesn't really, and then suddenly we wake up and find ourselves looking for it in a dresser drawer.

P.S. I know. I failed at not "we"ifying the whole darn thing. Well, I also "you"ifyed it and "one"ified it. Anyway, the point is, one cannot discuss these difficult matters of our common experience in the first person, singular.

Med World: On the Myths of "Memorizing"

I had an epiphany today as I walked down Peel in the sharp, mauling cold after class, under a deceitful sun: we intellectual snobs need to stop hating on "memorization". How often since I started medical school have I heard my peers (and frankly, my own disdainful voice) ragging on the drag, monotony and general lowliness of all the "memorizing" we have to do? We do it most of all in anatomy, in biochem, histology... actually pretty much every 'level' requires a degree of it. Here's the thing though: that we know anything at all is thanks to "memorizing", and memorizing is essential to our everyday social interactions. We memorize each other's names, how to get from place to place, any prayers that we might say on a regular basis, words that we read and then decide to use later... we are memorizing all the time. We would be ignorant to relegate memorizing to the no-personality, robotic-like side of science, technology and medicine. And for all the advocaters of "applied knowledge", what on earth are you applying if nothing's in there as an initial 'baseline'?

I think this gets to the heart of the issue really. There's the first baseline (ABCs, 123s), but then there's always a new, higher 'baseline' for the next level up. Like nobody questions the fact that one has to memorize the alphabet and numbers, so that we can make words and sentences, do arithmatic, read, write and engage in more complex mathematical and financial endeavours. And don't give me the "it's the concept" not just the "thing" -the "thing" and the "concept" are so intertwined. By memorizing the representation, we can focus our energies on what it means. If we had to think about each letter every time we spoke, read or wrote a word, or even think about each word for every sentence, there would be no Descent of Man, Principia, Mathnawi, or Jane Eyre. No epic symphonies or ballads to pass on to future generations. No string theory. And no sophisticated (or unsophisticated) medicine.

We scoff at those intense, book-worming, memorizing-types in our classes. But who ever frowned down upon the child who was just learning how to read? I remember being applauded for many a slow, laborious pronounciation of syllables as I learned to read such ridiculous, 'useless' phrases as "The king decided to eat steak for supper every Tuesday". I learned to quickly recognize (and isn't a lot of memorization about recognition, identification in some kind of automatic way?) each of those words, so that I can now read the menu at The Keg, analyse historical writings about the kings of the Ottoman Empire, and organize my life in Google Calendar.

And you don't have to pin it down to reading, the same goes for learning about some foreign delicacy and how it's prepared, or the random trivia we store in our brains, which we then randomly pawn off onto some unsuspecting victim or another (this is really the perfectest of examples in terms of quanitfying what we memorize, and proof that it is memorized knowledge that we pass on in 'units' of trivia). Those sports stats, the ability to quote the famous and infamous, knowing which Broadway musical ran for 15 years at the New Amsterdam Theatre in New York (which may or may not be a trick question), knowing the periodic table, rocking back and forth reciting religious texts, rattling off every psychoactive drug that can be used to treat depression, schizophrenia and bipolar disorder... it's all memorizing. And (brace yourself) -all of it is useful because all of it makes us more socially fit, whether we can bond better with each other over the random things we know (the extent to which 'trivia' may also communicate about our interests), whether we can make a million dollars because of it, whether we can at least seem more 'well-read' or 'hip', whether it makes us more competent in our professions... there is a point, and that point is mainly that we gain social currency. Memorizing gives us street cred in life, for whatever different streets we have to walk.

I think a lot of people get confused and try to separate "real" learning and "memorizing". They seem to think that if you memorize something, then you don't really know why it is the way it is. But true memorization is a kind of total memorization -you memorize what, you memorize why, you memorize how. And sure, you will use various devices to better memorize all of it -and so you'll make those "more intellectual connections" in order to better memorize, just like how we use mnemonics to memorize the order of the planets or the points of a compass rose. If I memorize the anatomy of my arm, or all the hemoglobinopathies (including their genetic basis, clinical manifestation, diagnostic tests and treatment), then I am so much better equipped to take any of it "a step further" later on. And memorizing and understanding / gaining insight are not mutually exclusive -they can be mutually reinforcing. It's also worthwhile to recognize the fact that we can't understand everything, and there are a lot of things that we cannot understand right away (but that if we can commit to memory, we may understand better at a later point in time). And as a doctor, I will have to know things, so many things, and I may not be able to philosophically, existentially, thoroughly understand it all from A-Z, but I still have to know what is known.

Memorizing is to commit to memory, and we can only remember what has been committed to memory. As a clinician, this means that the more I remember, the more I can apply to help my future patients, in which case memorizing is, in fact, a very noble endeavour.

Also, I am loving hematology so far.