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Showing posts with label cardiovascuar issues. Show all posts
Showing posts with label cardiovascuar issues. Show all posts

Saturday, February 10, 2018

Calculus


[NB: First written in July 2012. I was either in Sienna just recovering from my heart attack, or in Hamburg staying with friends right after that, waiting to be allowed to fly long distance again. This was amongst some (I think) unpublished rambles I found in Evernote while tidying up. . Maybe I used some of it in other posts, but I can't find evidence of that right now (and the swimming pool is beckoning). Some attitudes to life from that time are probably not well placed in a post "#metoo" context. Another one or two old unposteds to come, I hope.]

~~~~~~~~

A man who is good for anything ought not to calculate the chance of living or dying; he ought only to consider whether in doing anything he is doing right or wrong -- acting the part of a good man or of a bad.
Schopenhauer.

~~~~~~~~

I'm not suddenly getting philosophical. I've alway been struggling to understand how a knowledge of philosophy can influence my actions (preferably for the better). It's more than just remembering which philosopher said what (and not a chance of me remembering anything correctly), but it's also the implementation of their philosophy into my life. Perhaps I mean the moral code (whatever that means - and epistemology is also an issue) they offer, suggest or demand. Perhaps I am referring to The Meaning Of Life, or perhaps my reasoning leads to that just because there is no god, and no meaning, and one needn't be polite and scrape the mud off one's shoes before entering another's sanctum.

However, in our second by second existence, life moves too fast. Often it is not until after a situation has passed that I realise an opportunity to make a philosophical decision has passed. Sigh. So rather than being proactive, my philosophical thoughts tend therefore to be post hoc, and I end the day contemplating my failures, and kicking myself for such moral recidivism, after the event. I look back at the muddy footprints and hang my head.

Essentially I see myself as a good man who occasionally plays the bad, and then agonises about it in the pub afterwards. Well sometimes I don't agonise, sometimes I tell everyone how brilliant it was, but that's not the real me. Really.

Writing a blog, a public diary, gives you a chance to examine yourself and your life, to lay it all out in public to incomplete strangers (I feel like I know you, all four of you - hey I do know three of you!), which is what I have been doing in many of my posts, whether you've noticed it or not.

And, now, writing after I've recently had a momentously memorable memento mori moment and was mere millimeters of coronary artery lumen from being no more, well, that is most likely to push a ruminative soul into thinking fuzzily about the otherwise petty matters of life and death, right and wrong, love and sex, and Woody Allen movies in general.

~~~~~~~

Am I lying when I write in my blog? I do try to be honest in essence, even when I am making things up, because it's the general mood underlying the exploits of the composite character that is Bruce that I most wish to convey. The tendency to anger, frustration, and recrimination when you are aware that you (or others, usually the others!) are violating codes that you once held as immutable, but now see as arbitrary. These are out there forever at least until the heat death of the universe, or until something better than the Internet comes along, whichever comes first, so it's too late to go back now.

Not that anyone in the future will give a flying rat's arse. There are already way too many physical books in the universe, let alone all this electronic verbiage. Who would bother? No-one reads the old plays of Voltaire any more, even though these were the basis of his fan base when he was alive (I heard this on podcast - fuck reading them). It cheers me to think this in a way. Because he didn't write Candide until he was 65, and here I am 55 and done fuck all.

~~~~~~~

"The unexamined life is not worth living.”
Socrates

That old chestnut. The Unexamined Life - great name for a blog! Do you think about what you are about to do, what you end up doing, what you have done? More than just wondering what a certain hero might have done in a certain situation - what would Bryan Boytano, Jesus Christ, Tyler Durden, Atticus Finch, Timothy Leary, or Calvin/Hobbes do - are there any hesitation any more, any second thoughts? I wonder about my friends sometimes: Have they just given up on thinking about these issues. Am I Robinson Crusoe here? Was I right in doing that, was the outcome for the best? Primum non nocere? Was anyone watching? Is my reputation (hah!) tarnished? If you answer Yes to any of these questions, Press 1.

I don't necessarily approve of certain behaviours that humans get up to given the chance, though I groan at certain excesses, I don't condemn them out of hand and obviously I don't shy from the milder ones either. I just like to think about them. And sigh. And wonder. And take a Xanax if sleep won't come.

Bad is relative. I'm sorry, but it is.

~~~~~~~~~~~

Utilitarianism used to attract me. Simple rules: maximise pleasure and minimise pain, and not just personally but universally. If it doesn't hurt anyone and you are having a ball, why not? Or it does good and you won't injure yourself, (the other way round) why not? I think that utilitarianism is attractive because of my previous employment as a fetal deformity hunter-killer. Hunger Games with an ultrasound probe. For the best it was, Skywalker. The ostensible justification, to minimise suffering and grief, reduce the overall pain and infirmity in the world. The hidden agenda: save precious resources, defend hospital budgets, doctor's time, preclude those expensive surgeries to keep fixing things. (I am only half serious here.) Protect parents from unnecessary grief and diminished freedom or whatever you want to call looking a disabled child, or at least give parents the information to make an slightly less ill-informed decision.

There are so many "push the old man in front of the train to save five young lives" situations in medical ethics. After a while it gets to you. No, that's wrong. After a while it doesn't get to you any more.

[Don't misunderstand though, I am completely pro-choice and my old job - I still justify it this way - was to provide full and accurate information so that, if necessary, a genuine informed choice could be made.]

~~~~~~

So I am still happy with that part of my history, mostly. But in the rest of my life, now that these justifications are no longer required every evening as I look in the mirror? I am no longer convinced that the narrow moral calculus of Utilitarianism offers the most realistic way to live, despite its persistence into the present time, such with Peter Singer's tit-for-tat stance on how we should live in a practical, real world.

Kant, not that I understand much of this stuff, whoah, nothing really except this: he proposed a matrix of moral action. One was the Categorical Imperative which - I blur like sotong over this - means something like - whatever should be done when a certain situation arises, must be able to become a universal law: it must be done every time, for everyone, everywhere. (Categorical as in "complete" - I categorically deny those allegations.)

But who or what has the power to define what should be done? God? The Bible? Allah, The Q'uran? Calvin & Hobbes? Kant, being a good Christian, said God.

Are there any universal imperatives, however? Thou shalt not kill? -- Except in war, except in prison, except in self-defence. Not universal then.

Thou shalt not wear thy shoes in the house. Thou shalt not get a rub and tug. Thou shalt not take a girl (or whatever) home from the 4FoWs or Nana Plaza. Thou shalt not push in the train queue or overcharge for a taxi ride. Thou shalt not have sex with family members, or animals. Thou shalt maintain marital fidelity.

Believe it not, almost all of the dilemmas mentioned are taboo in one culture, but not in others. For example, the Targaryens marry siblings in order to keep the blood-line of The Dragon pure. Hey.

Kant also makes the point that it is the act itself which is under consideration for being a categorical imperative. The act of pushing of the old man in front of the train, not the resulting saving of other lives. (That would by the hypothetical imperative, I believe.) So killing, while always wrong, is not always wrong.

While I at once preferred Nietzsche's modification of Kant's CI - you should only do what you would do if you had to do it again, that is, if you had to live your life over again to bring you to the exact same point of decision making. Would you do it over and over again in a Groundhog Day scenario? We know what Phil Conner did. He kept modifying his behaviour until he got it right, and eventually managed to shag Rita. If that is what you consider a successful or ethical life, then there you go. (I'm no longer sure this works for me: Andy MacDowell has aged a lot since then. Those teeth, too?)

And if I was a superman, beyond good and evil, and god was dead, then I could easily and consistently commit an act that those who share my cultural capital (all the benefits that my upbringing in my society and culture has given me) would consider to be wrong, because my will dictates it. I want to do it, and I can do it because I am better man than you. Seig Heil! So maybe not taking it that far.

There are then relativities to Kantian categories - they are not universal, or imperative after all. The utilitarian equation is not straight forward arithmetic. The numbers are weighted. What if, instead of pushing an old man in front of a train to save five young people, you have to push a your girlfriend in front of the engine in order to save five Nazis?

I am not satisfied with Nietzsche or any of the rationalists now, because even when I can see in advance the decision points that are going to arise and I know what I should do according to my reasoning, what I would want to do if it came to this again and again, but I can't stop myself from transgressing.

I am merely the mahout of reason on a untrained elephant of will (desire, urge, emotion).

My elephant is bigger and stronger than me. Rationalizing is what most of the time we consider reasoning: Yeh, that's where I wanted to go anyway, because... *see utilitarianism, above. That rider/elephant metaphor is an old one, but recently reinvented in some books I just read; Jonathan Haidt's The Righteous Mind: Why Good People Are Divided by Politics and Religion, and The Happiness Myth. Which is partly where this discussion originates, that and Michael Sandel's Justice: What's The Right Thing To Do. Light reading.

~~~~~~~~~

Why do I (or Bruce) go Orchard Towers or to Soi Cowboy, or to Kings Cross for that matter, when I know I'll feel bad after going there, for a dozen reasons previously described elsewhere in this blog? Why do I throw my conscience out the window when physical gratification is on offer for a price? The answer is, I try not to any more. And I don't mean any less either - OK, yes I do, I mean less. Not everyone is (i.e. me), wants to be (i.e. me), or can be (i.e. me again) in a sexually satisfying relationship. OK, not everyone cheats in one of those unsatisfying relationship but, in unrelated news, not everyone is happy with their lives (and the utilitarians would say get the fuck out of there - or get out of there and fuck). And when the social pressure is somewhat relaxed thanks to certain cultural differences (real or imagined) in certain parts of the world where concepts such as marital fidelity are not so important, or perhaps more correctly, where infidelity not so disastrously unexpected - every HK Chinese wife expects her man to have his little wife in Shenzen, and her job is to look after the kids, not give BJs all the time - and peer pressure (elephants follow each other) is high, the sprit is willing but the flesh is tumescent.

~~~~~~~~

So I am talking about looking at what you do and what you have done, analysing and judging it: is this the way you want to have spent your life? Is this the way you want to be remembered? When you look back, are you proud of everything? Could you survive a parliamentary enquiry?

Is this how I anticipated living when I was back in Australia? Aren't there better things for me to do with the limited time I have? And this limitedness is feeling particularly real - as I was so unpleasantly reminded a few weeks ago at the top of the San Gimignano tower in Tuscany when that elephant seemed to be standing on my chest.

Short answer: I have no idea. I balance pleasure with slightly less pleasure, I balance the exploitation of women with the exploitation inherent in my needing to pay for sexual release (not that the money I pay all goes to the person I just screwed) due to urges I have no control over. I balance my guilt at this with the knowledge that my abstinence is not going to change anything; I balance rampant gadget greed with charity; I balance visiting prostitutes with masturbation. Elsewhere in life I balance little white lies with truth; I balance my privacy and my frequent isolation (work travel or angina attacks in Italy) with friendships and Facebook; I balance my atheism with the belief that people are usually good whether they follow a religion or not; I balance the awareness that I am not perfect with the frequent confirmations I see that there a hell of a lot of people out there doing a hell of a lot worse or more outrageous things than I would ever consider.

~~~~~~~


"It’s only human nature!”
"Nature, Mr Allnut, is what we were put on this earth to rise above!”


~~~~~~~

I thrash it out, but I do not despair that the answers don't come as easily as the questions. I relax. I shrug. I do what I can. I try makes others smile. I try to enjoy myself. I try to explain it to

E@L


Saturday, November 17, 2012

Microemboli

- Taxi rank, it's just on the street out front, says the concierge.

- Ta, brilliant, says E@L and he skips (slowly) down the steps in the chill wind down the easy winding, brick-paved walking steps to the road. There are four taxis. E@L considers jumping into the last one, but hey, don't be a smart-arse prick E@L.

The driver in the front cab, somewhat sullen, says nothing; no 'Good morning,' nothing. He starts the car, puts it into D and starts to pull out.

- H***** hospital, please.

The driver looks at him. His foot lifts sightly off the accelerator. They are already out of the rank's demarcated confines.

- Which H***** hospital?

- The H***** hospital. The Royal? Hang on let me check.

- Which hospital? the driver repeats. There are several.

E@L drags his man-bag onto his lap and pulls out his Tab.

- Yep, the Royal H***** Hospital, he says looking at the email from his colleague.

They are slowly (this is H***** at 8am: there is no other traffic) passing through the first intersection.

The driver points up the road to a squat grey, white, glass, mulit-blocked, multi-temporal building two streets away.

- That's the Royal H***** Hospital, just there. Shit man, you pulled me out of the rank. You could have walked.

- Well, OK, so it's not far. I'll know for tomorrow. You can drive me there. Like, it's you job (E@L mumbles this.)

They are up to the next block, and the driver turns right.

- Shit, man. Which entrance. I'll drop you up here on A***** St.

- I'm meeting someone on the coffee shop on E****** St.

- That's around the corner.

He keeps moving out of the drop-off bay and back to the road, where he immediately turns right, to the road behind the hospital. This side of the hospital is partially obscured by scaffolding. Half the earth seems to be under construction, have you noticed that? The driver drops E@L at a closed sandwich shop on the next corner.

- That's the only cafe on this street. Must be this one, man.

E@L shuffles his wallet out from under his arse. Like everyone else, he only goes for his money at the last possible minute.

- How much?

- Man, I didn't even turn on the fucking meter. (No receipt then?)

- Here's five for your troubles. Buy a pleasant attitude.

~~~~~~~~~~~

E@L meets his colleague, not at the coffee shop on the corner but, on the phone with her for directions until he sees her at the coffee-shop outside the north entrance to the hospital, waves, hangs up - hidden behind the scaffolding.

After introductions and small-talk about the customer's not-all-uncommon-amongst-gastroenterologists obsession with David Foster Wallace, she begins to walk towards the entrance. E@L hesitates, his tummy protesting, and asks:

- Breakfast?

- Haven't you had breakfast yet?

- Well, no (it was included in his hotel room-charge, but, hey, might as well be sociable), I was expecting, you know, as we were meeting in a coffee shop… You've had breakfast?

- I have. But sure, sorry, let's have something.

- Do we have time?

- Plenty of time. (Then why did I get out of bed so fucking early?)

The serving ladies seems your classic looking waitresses, slightly updated; homely apron (the word 'apron', interestingly, or not, has the same root as 'nappy' and 'map', btw - any rectangular piece of material), scarf (not sure how this fits with previous comment) tied back DFW bandana-like, and she is moderately unattractive. Could have been a body-double for the girl in Five Easy Pieces, except shorter by a little, but movies, TV, you really can't be sure, can you?

- How can I help? asks the shorter of the two waitresses.

- Oh, in lots of ways.

They crack-up for some reason. The waitresses can't help laughing, one has her arms on the counter, she lays her head in them. Never heard this one before, obviously. Stressed out; too many serious types this morning?

- What's wrong, asks E@L with a grin.

- Oh, nothing. We have dirty minds that's all.

- That's all? (They're still laughing. These girls go in the front row when E@L next does a show.)

- OK, what do you want to order?

- Ah, you're back. Flat white and some of that toasted banana bread. (Hold the chicken.)

- Thanks, have a seat. I'll bring it to your table. (She wipes away a tear.)

~~~~~~~~

They arrive in the Day Surgery, sign in as visitors, get some Ni-Viz stickers for their shirts and are 20 minutes early. The machine is ready to go, but they need a scope as his bloody thing won't let you do anything unless there is a full scope attached. The machine's probe is part of an endoscope and so it needs to be connected to the large fibre-optic camera - a stylish stack of cream and blue boxes from once respected company that has yet to completely negotiate itself through major legal/corporate issues back in Japan. The scope is still in the disinfectant and will be another 10 minutes.

They have another scope, they'll go get that. E@L fishes into his bag, pushes his hand around. Tries the secret compartment at the back. The secret compartment insode. Nope. He has left the USB thumb-drives (USB sticks, USB drives, what do you call them) back in his hotel.

Microembolism.

Shit.

A small clump of self-adherent RBCs have pulled out of his heart (the disjecta, the jetsam from an atrial thrombus?) or his leg (ditto from a long-haul flight induced soleal sinus DVT?), shot up the carotid, found an impassably small arteriole and knocked a few brain cells into ischaemia this morning: the integrated synaptic song-lines are interrupted and so a memory fades, an essential task is omitted, an anomic aphasia tips on the tongue, a name is list at a crucial career-making/breaking introduction, a forgotten lover's face coming towards you at a party. Hate it when that happens.

- Do I have time to go back to the hotel? (A short walk, two blocks away, don't need a fucking taxi, man.)

- Sure the Doctor is normally not in 'til about 20 to. (Then why did I…)

E@L puts his jacket back on (a jacket and tie, E@L? Unhealthy precedent, that) and finds his way past the anxious patients and the indifferent staff (stranger? shrug) to the lift, thence the street.

It is 8 minutes to the hotel he guesstimates, past interesting old buildings - 1889 built Theatre Royal, "Bare Witness" starts next week, "Crapunzel" still playing. A converted 1880's warehouse, Victorian style (the queen not the rival State up north); red-brick place, the old City Hall, with pale rendered pillars and two incongruous bell/observation-towers, weird, probably the stairwells. But no time/further-interest to look closely and sort this out.

E@L is in his room now, panting. The USB suckers were in his other briefcase. Sigh. He pockets them and heads back. It's an uphill gradient, only 1in 40 or so, but still, he nearly died a few months ago (Death on his holiday) so it's 10 minutes to get back. The scope is by then out of the disinfectant, the machine is on. He loads the presets and fiddles with them, a bit of tweaking.

Three hours later, they are finished all the scans, only one of the three patients nearly died, a good enough morning, and E@L has backed-up the further tweaks to his USB sticks. He has admitted only getting 70 or so pages into "Infinite Jest" but the Doctor has forgiven him, as he at least had completed "Ulysses," which he (the Doctor) agreed was more daunting in reality. "Gravity?" E@L nods. The Doctor nods back, approvingly. "IJ" is more of an endurance test, he said.

E@L's colleague had her copy of "50 Shades" carefully tucked deep in her bag, but she already left, gone back to M*********.

Which triggers the following aside: E@L wonders - Why would you fly down from M********* last night, stay for half an appointment, and fly out at lunch-time leaving The Talent (Phil Connors E@L) who has flown from Singapore - via, A*********, B*******, M******** epspecially to support and train her, and here he is on his own for the most important part of the commsioning/training. He is here merely to support you, beatch, not to do your job himself. Sigh. He shrugs, like Atlas - you're getting obscenely well paid E@L, STFU.

(She's not a beatch, just an over-stretched, under-paid (commission only 4.5%) little Greek girl.)

The doctor has more cases to do, not using the machine, but after lunch. Can E@L come back before they start agina, and do some more training, explaining, uncomplicating? Sure, certainly, that's why they're paying him so obscenely well.

~~~~~~~

A lunch at Cafe Sawak - Malaysian food in H*****! OMG, and they have Kopi! E@L, being shown a seat, asks the girl with the strong mainland accent, if they use the sock! Yes, she answers. He order the kopi, some water and the traditional, homemade laksa. The kopi is of course, densengauno inducing, disappointing: over-milked, too white, only warm. The laksa is OK - not brilliant - however just homesick defusing enough. Chili oil droplets, nonmiscible, on the creamy coconut broth, but not enough tofu, not enough "oysters" i.e. no clams, not really enough laksa kick. But hey, even in Singapore you can get just-as-shit kopi and a-lot-worse-than-this laksa.

- Salamat, shit. I mean telema kasih. Tsche-tsche (谢谢), Mm goi. Khap khun krup. Thanks. Fuck.

Microembolism.

~~~~~~~

The Instruction Manuals are on a DVD - large files packed with Japglish and completely unhelpful explanations ("Spatial Enhance Switch [a button] - This Switch To On and Off Turn Spatial Enhance." Yes, but what the FUCK does Spatial Enhance do?), but the customer wants to read them in hs computer to find out, not about Spatial Enhance (which E@L doesn't understand and therefore has hidden its "switch") but how to turn the system itself on and off, and how to do simple measurements. E@L offers to email some simplified instructional PDFs (2 pages, VERY simplified, we are talking about the limited capabilites of surgeons here) to him.

- Why not send them by Bluetooth?

Doctor fires up his iPhone and tries to pair with E@L's Android tablet. Of course, fucking iPhone, the Bluetooth on Apple devices is fucked proprietary and no files can cross the intangible ether from its OS to a rival OS. (Cue Dr Evil pinky: A BILLION dollars!)

Me, get an iPhone? You've got to be joking.

- Email OK?

E@L's files are in Dropbox and, and, they must be de-clouded before he can trans-etherise them via Gmail. He manages to pull the smaller file down but the larger one (12MB) is taking too long, via 3G, so E@L promises to send it that night. All done, great, shake hands.

- Oh, I have a case tomorrow afternoon. Could you come in about 1:30, 2? Have you read "Every Love Story Is A Ghost Story," yet?

- Sure, sure. (Like who want's to go to MONA, the only reason he agreed to do this diversonary trip to T*********.) Tomorrow. Reading it now, actually.

~~~~~~~~

Back in his hotel room, E@L fires up his MacBook Air (yes he does have some Apple products, reluctantly) and looks in his jacket pocket for the USB drives to back up.

Hmmm. They are conspicously absent. In the pants? Nope? Shit. Man-bag? Nope. Hey, his Tab is not in the man-bag either. Not on the bed, not on the desk. Oh Jesus.

No USB sticks, no Android Tab. They are back in the hospital, the USB still in the machine, the Tab on the back tray.

Microembolism.

Shit. He pulls his jacket back on and heads for the door, steps out quickly in the corridor and as he walks away the door starts closing and he taps his pocket for the door-card. Top pocket, no. Wallet, nnnn…hey! No wallet at all, he lunges back at the door just as it firmly locks with a solid clunk.

Microebolism.

Walking in an anxious pace, in 6 minutes he is the hospital door, he hopes he doesn't send off a real embolus.

He has been thinking of the people who were in the room where he was explaining the system to the doctor. A chubby (fat, but not as fat as him) red/gray-haired nurse from the cleaning room, who waddled and was cheeky. A laconic theatre tech. Tall, in a decorative paper theatre hat somewhat like a DFW bandana, but slack-mouthed, somewhat dopey looking. But these are the smart ones, slow and measured, they know what's really going on, can anticipate. These are the ones you'd want taround if something went wrong, if some surgeon or nurse didn't know how to work one of the ping-machines. The smart, sharp briskly efficient and over-friendly seeing ones are, apart from being as a rule shorter, often as not, try-hard dumb-fucks, and desperately hard to reach a level of competence your big C or G dopey look guy has when he wakes up with a fucked-over hangover, a dozen bongs and a slab of beer downed during a re-run of Apcalypse Now last night. The sort of person who already knows how to drive E@L's machine.

The sort of person who wouldn't steal a guy's Tab.

And they are still there, where he left them.

Sigh.

Shit.

Microembolism.

E@L

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