Category: Personal (Page 1 of 3)

A Life Well Spent – Part 2: Do Good, Create Something, Have Fun

September 18, 2025 / Ryan / 0 Comments

This is the second part in a series of philosophical posts that I started in early 2021, and which I have added to in fits and starts over the last few years.

In Part 1, I started with questioning my inability to fully believe all the feel-good advice about setting aside achievement and “enjoying the moment.” That quickly led down an existential rabbit hole, through some definitions of terms, to the Big Question of “How do I spend my life well?”

After thinking about this a lot (after all, this series of posts has, somehow, taken me several years to write), I find that my answer really boils down to three key points:

Do good
Create something
Have fun

Let’s take a look at each of these in turn.

Do Good

If the first aspect of a life “well spent” is that we should “do good,” the immediate follow up question is: how much is good enough? Is my life wasted unless I do as much good as possible? Is it morally acceptable to do less? As the lyric from Hamilton goes:

“And when my time is up / Have I done enough?”

I am very privileged, which means I have a lot that I could give up. If I donated all of my life savings, it could save or change many lives. Is it morally acceptable to keep that for myself? I am still relatively young and relatively healthy, so if I gave up on studying Mars and dedicated my life to service I could likewise have a big positive impact. Is it ethically acceptable to use my skills on something that does not directly address any of the many problems the world is facing?

Heck, maybe I should run for office so that I can be in a position to enact better policies that would help tons of people. So what if I would hate it, if I could have a big positive impact, then I should do it right? (To be clear, I should not run for office. US politics is not the best place for an introverted atheist scientist.)

Should I give up everything I possibly can to maximize how much I help others? The world might indeed benefit if more of us did that, but it’s a false choice. The only choices are not: (1) Give up literally everything to make the world a better place, but live a miserable life, or (2) Give up nothing and live a comfortable but selfish life. As with everything, the goal is balance. How do we maximize both our positive impact on the world and our enjoyment of life? The optimal solution will be different for different people, but all or nothing thinking is a trap.

(As an aside, because these posts took me a long time to write, I learned long after I had written this part but before I had finished, that the philosophy term for someone who maximizes the happiness that they generate in the world at the expense of their own happiness is a “happiness pump” and it is one of the primary critiques of a purely utilitarian philosophy. There’s a whole episode of The Good Place about this.)

(And another aside: whether we are talking about giving up money, or changing behaviors, it is important to acknowledge the staggering inequality of the world. I can make some difference by donating and recycling and the like, but a billionaire or a corporation could give up proportionally far less and have a far greater positive impact.)

Kieran Setiya discusses this same question – “How do I know if I have done enough?” – in Life is Hard:

…though we know that we have limits, we don’t know where those limits are. The result is that, when I ask myself whether I am doing enough to meet my responsibility for justice, it would be an awfully neat coincidence if the answer were yes. What are the odds that I’ve hit the mark precisely, the most I can expect of myself? Close to zero, I would think. The result is that I am virtually certain that I am falling short. Perhaps it’s obvious that I am. But the same reasoning applies to almost anyone, even those who do much more, people whose lives are devoted to social change. They can’t be sure they’ve done enough. In conditions of profound injustice, we are compelled to doubt that we are living well.

There’s instruction and reassurance to be found in this. We shouldn’t feel too bad that we feel bad: our guilt is not a mistake. More important, we shouldn’t let it put us off, condemning our own efforts as too small. They may be small—but it’s perverse to deal with that by throwing up our hands and doing less. There is value in a single step toward justice, and one step leads to another.

[…]

You may not do enough, but the difference you make when you save a life is the same whether you save one of two or one of two million. A protest may not change the world, but it adds its fraction to the odds of change. It’s wrong to disregard the increments.

It’s easy to tell stories about heroic individuals, and it’s good to take inspiration from those who go above and beyond and do great works, but we don’t all need to be heroes. More to the point, we can’t. As I discussed in my second “Finding Balance” post, we are taught by our very individualistic culture that problems are always solved by heroes: remarkable people who, through sheer force of will, single-handedly change the world. The thing is, most of the problems in the world cannot (and never have been) solved by one person, no matter how passionate or brilliant, no matter how much they sacrifice. If there is a boulder blocking your path, you can recklessly dash yourself against it and have no effect other than hurting yourself. That doesn’t mean don’t try to make things better, it means we need to prioritize sustainable, collective efforts rather than martyring ourselves to a cause in an attempt to single-handedly fix the world.

My conclusion on this question is that the goal is not to do the most good we can at the expense of everything else. The goal is to do good when we can, and avoid bad when we can. Yes, push the limits of what we’re comfortable sacrificing (whether it’s time, effort, money, etc.) but it is ethically acceptable to not be a “happiness pump.” We cannot reasonably expect ourselves or others to be purely dedicated to improving the world every moment of every day. It is ok to do things that make us feel happy and fulfilled, not just things that have a measurable positive impact. Ideally, we can find ways to both have a positive impact and feel happy and fulfilled while doing so. Which leads to…

Create Something

The second aspect of my definition of a life “well spent” is to create something. To quote Hamilton again:

God help and forgive me, I wanna build something that’s gonna outlive me.

I talked about this already in my second Finding Balance post and probably in other places too: as someone who doesn’t believe in an afterlife, I want to put something of myself into the world so that when I am gone, some part of me remains. Is this a self-centered, ego-driven impulse? Absolutely. But it’s there, and I don’t think I’m unusual in feeling this way. There is a reason that one of the most famous stories ever told focuses on the choice between living a long, ordinary, but forgettable life or dying young but living forever in legend. The appeal of being remembered is so strong that dying young to achieve it has been a compelling choice for thousands of years:

“My mother Thetis tells me that there are two ways in which I may meet my end. If I stay here and fight, I shall not return alive but my name will live forever: whereas if I go home my name will die, but it will be long ere death shall take me.” – Achilles, The Iliad

The Achilles dilemma is not the whole picture though. While there is certainly some amount of ego in the desire to “make a mark,” there is also more to it than just being remembered. It doesn’t have to be about being remembered at all. It can also manifest as contributing to something bigger than yourself, or taking actions that will have effects long after you are gone, even if those actions are known only to yourself.

Writing, raising a loving child, painting, planting a tree, teaching, building. These all are ways to satisfy this aspect of a life well-spent. This quote from Fahrenheit 451 sums it up well:

“Everyone must leave something behind when he dies, my grandfather said. A child or a book or a painting or a house or a wall built or a pair of shoes made. Or a garden planted. Something your hand touched some way so your soul has somewhere to go when you die, and when people look at that tree or that flower you planted, you’re there. It doesn’t matter what you do, he said, so long as you change something from the way it was before you touched it into something that’s like you after you take your hands away.” – Ray Bradbury, Fahrenheit 451

While it would be nice to be remembered, that’s not really something I can control. What I can control is whether and what I create. I want to put something of myself out into the world in a way that satisfies me and hopefully connects with others. This will manifest in many different ways, it doesn’t have to be (and probably shouldn’t) be just one big project. Writing is certainly one aspect of this, but so is my scientific work, and so is raising my kids, and many other things as well.

Writing this section has been kind of tricky because this inevitably blends with the other two aspects: Do Good and Have Fun. When we do good, the impact of that action may “ripple” out into the future, having unexpected and unknown effects. Knowing that our good actions propagate is satisfying in much the same way that creating something is, and sometimes Doing Good and Creating Something can go hand in hand.

But, importantly, Create Something does not have to be explicitly tied up with Doing Good. It often goes the other way and blends with Have Fun. We’re allowed to put a part of ourselves out into the world, even if it doesn’t seem like it benefits anyone. It is ok to create just for the sake of creating something. It doesn’t have to be done to achieve some noble goal. Creation is worthwhile in and of itself because it allows us to share — even in some small, inadequate way — the richness of thoughts and feelings and experiences inside our head with someone else.

Of course at its best, Create Something blends with both Do Good and Have Fun and binds the three together. By creating something, we can enjoy ourselves and (deliberately or not) have a positive effect on the world. Maybe that effect is to tell a story that lets someone escape when they have a bad day, maybe our art inspires others to imagine a world better than this one and work to make that world a reality, maybe it shows someone that someone else out there is going through the same things they are. Maybe by creating something we “just” make ourselves happier and more fulfilled. That’s still a win.

“What an astonishing thing a book is. It’s a flat object made from a tree with flexible parts on which are imprinted lots of funny dark squiggles. But one glance at it and you’re inside the mind of another person, maybe somebody dead for thousands of years. Across the millennia, an author is speaking clearly and silently inside your head, directly to you. Writing is perhaps the greatest of human inventions, binding together people who never knew each other, citizens of distant epochs. Books break the shackles of time. A book is proof that humans are capable of working magic.” – Carl Sagan

“You think your pain and your heartbreak are unprecedented in the history of the world, but then you read. It was books that taught me that the things that tormented me most were the very things that connected me with all the people who were alive, who had ever been alive.” – James Baldwin

(Don’t just scroll past this video, at least save it to watch later. It’s a really great reflection on creativity.)

Have Fun

“Name one hero who was happy.” – Achilles, Song of Achilles

The third facet of my definition of a life well-spent is to just enjoy life when you can. Life is tragically short, often painful or unpleasant, and ends in sadness and death. The curse of being human is that the same big brains that let us do all sorts of wonderful things also make us aware of future tragedy.

Eleanor: All humans are aware of death. So we’re all a little bit sad… all the time. That’s just the deal.

Michael: Sounds like a crappy deal.

Eleanor: Well, yeah. It is. But we don’t get offered any other ones.

– The Good Place

Sibling Dex, to Mosscap the robot: “Your kind, you chose death. You didn’t have to. You could live forever. But you chose this. You chose to be impermanent. People didn’t, and we spend our whole lives trying to come to grips with that.”

– A Psalm for the Wild Built

As I get older, and especially over the last few years as cruelty and pain and suffering in the world have become increasingly impossible to ignore, I have come to appreciate more and more the value of escapism, mindless entertainment, and generally anything that makes people happy. Good food, engrossing stories, games, music, art, watching sunsets, traveling the world, anything that is done for no other purpose than to enjoy it: embrace those things. People talk about “guilty pleasures.” Never feel guilty for finding joy in something. Life is hard enough without punishing ourselves for the things we enjoy.

The closest I have found to escaping the existential dread that is part of being human is to do things that absorb you in the moment and sweep you up in a “flow” state. Things that are so engaging that you can, at least for a little while, shut up the doom-and-gloom voice of the prefrontal cortex and enjoy the present moment.

One of the most reliable ways to end up in a flow state that I have found is to Create Something. Painting, writing, building something, whatever your preferred creative outlet, as long as it can engage your mind fully, it is fun and rewarding.

The other sure-fire way to enter a flow state is through entertainment. In particular, the kind that is often seen as a distraction or self-indulgent escapism. Video games, “guilty pleasure” novels, silly TV shows, sports, movies, etc.

Yeah, life is short and you’re spending some of that precious time watching reruns of that sitcom instead of solving world hunger or whatever. But you know what? You’re not a happiness pump, you’re a human being and you are allowed to relax sometimes.

Kieran Setiya agrees:

How can we listen to music, or work on the more speculative questions of philosophy and science, while the planet burns? But while political action is urgent, it’s not the only thing that matters. In fact, it couldn’t be. If the best we could do was to minimize injustice and human suffering, so that life was not positively bad, there would be no point in living life at all. If human life is not a mistake, there must be things that matter not because they solve a problem or address a need that we would rather do without but because they make life positively good. They would have what I’ve called “existential value.” Art, pure science, theoretical philosophy: they have value of this kind. But so do mundane activities like telling funny stories, amateur painting, swimming or sailing, carpentry or cooking, playing games with family and friends—what the philosopher Zena Hitz has called “the little human things.” It’s not just that we need them in order to recharge so that we can get back to work, but that they are the point of being alive. A future without art or science or philosophy, or the little human things, would be utterly bleak. Since they will not survive unless we nurture them, that is our responsibility, too.

Or, to put it more concisely:

To be alive: not just the carcass

But the spark.

That’s crudely put, but…

If we’re not supposed to dance,

Why all this music?

– “To Be Alive” by Gregory Orr from Concerning the Book That Is the Body Of the Beloved (Copper Canyon Press, 2005)

A Life Well Spent – Part 1: Worth and Meaning

June 28, 2025 / Ryan / 1 Comment

It is hard to believe but I started writing this series of posts in early 2021! It is now, inexplicably, mid-2025. I have of course not been working on these non-stop, but I return to them now and then to edit and add and tinker. I am not sure I have really figured any of this stuff out – I’m not sure anyone ever fully does, but I decided it’s time to wrap these up and share them.

It’s a new year, and despite all of the craziness of 2020, I find myself in a remarkably similar mental place to where I was last year at about this time. Maybe part of growing older is that year-to-year life is more or less the same, and so my thoughts are basically the same too. I’m stuck in the same ruts, struggling with the same issues, setting the same goals every year. I’m not sure how old I have to be for my regular everyday existential crises to earn the title of “midlife crisis,” but I feel like I’m getting close.

In 2019 I wrote a pair of lengthy philosophical blog posts as I tried to work through some mental health and existential questions. As a recap, in the first post I talked about how the book Feeling Good had helped me recognize that a lot of my mental health struggles could be traced back to a need for approval and an addiction to achievement, which was getting frustrated since I’ve hit the major milestones in my career and life and am now looking ahead to basically more of the same.

In the second post, I talked about insights from some essays by Ursula LeGuin that helped me make an interesting connection between achievement addiction, the myth of the “hero” and the desire for immortality via fame/achievement, misogyny, and taoism. And I concluded that a lot of what I was struggling with was trying to shift away from the “yang”/heroic obsession that our culture prioritizes to something more balanced, more focused on the present than on future goals.

I am pretty proud of those posts. They were difficult to write, but they helped me clarify my thoughts, and they seemed to resonate with many others. They also fit with a growing movement among people of my generation, especially during the pandemic, to challenge the conventional narrative linking self-esteem to productivity. I’m seeing a lot more discussion on social media of self care, more openness about mental health, and an emphasis on simplifying life and living in the moment.

An example is this great article. The whole thing is worth reading, but the key quote is:

“Here’s a secret I tell to my students. I’m going to tell it to you. You aren’t a tool. You are an end in yourself. Meeting your personal goal, whatever that might be, won’t give you one iota more worth than you already have. The purpose you hope to serve will hopefully fulfill you, but has no effect on your worth.

Human worth is contingent upon nothing, and your dreams are separate entities from you.” – Eric Dovigi

Reading those words makes me feel like I can breathe easier for just a moment. Likewise, going back and reading my writing on related topics makes me feel better, at least briefly.

The problem is that the relief doesn’t last. There’s something about these feel-good ideas that I can’t quite fully believe. It has been nagging at me, and rather than letting it rattle around in my head any longer, I want to pin it down and take a close look at it. So here we go:

What if all of this philosophizing is just an elaborate way to make excuses for not achieving my goals? What if I’m just seeking out affirming messages wherever I can find them to justify the lazier course of action because that’s easier? What if this is what the process of giving up and settling for mediocrity looks like?

Ouch. With thoughts like that, no wonder I’m sometimes anxious or depressed. These thoughts sound harsh, especially writing them down like this rather than letting them remain semi-abstract in my mind. But unpleasant things can still be true, and I think there is something significant buried in these thoughts that I need to explore.

Why is there this part of me that is so fixated on achieving goals? Why does it sometimes seem like I get more stressed out when I try to follow advice telling me not to work so much, and less stressed when I manage to actually do the work? (But at the same time, trying to be productive all the time is exhausting and burns me out.) Why does being kind to myself and living in the moment and forgiving myself if I am not spending every waking moment on something “productive” feel like giving up or failure?

As the main character in the book A Prayer for the Crown-Shy says:

“How am I supposed to tell people they’re good enough as they are when I don’t think I am?”

At some point, I became obsessed with the idea of “making the most” of my life, of “spending my life well.” There is this piece of me that is afraid of looking back at my life from my deathbed and being disappointed with what I have accomplished. In the book A Psalm for the Wild-Built (to which A Prayer for the Crown-Shy, quoted above, is the sequel), the main character perfectly articulates this idea:

“All I have is right now, and at some point, I’ll just end, and I can’t predict when that will be, and—and if I don’t use this time for something, if I don’t make the absolute most of it, then I’ll have wasted something precious.”

In a culture that values measurable achievement and exceptionalism, I am scared of being just ordinary and forgotten after I am gone. I talked about this before: the appeal of the heroic myth is that it offers a sort of immortality. If you can be a “hero” in the sense of achieving something that leaves a mark on the world, then even after you’re dead, there is something of you left.

And yet, how does that fit with what I’ve written before about the inherent value of human life? If it is true that human life has intrinsic, non-quantifiable worth that we do not need to prove through our actions, then can it also be true that those who achieve more have “better spent” their life than those who achieve little? If it is possible to “better spend” one’s life, then does that mean that those who achieve a lot in life have more worth than those who do not? Written that way it sounds pretty bad. Do I… believe that?

Part of the problem, as always when grappling with big abstract questions like this, is with definitions. Language is an imprecise tool at the best of times, and especially for conveying the ideas involved here. There are a couple of similar but distinct concepts getting blurred together. What does it mean to “achieve” something? What do we mean when we say that a life has “meaning” or “worth” or “value”? As pedantic as it may feel, it’s worth pausing for a moment to pin down some definitions of these terms. Not just the dictionary definition, but what do I actually mean when I use them?

Value/worth

When I say that all humans have intrinsic value or worth, what I really mean is that I choose to believe that there are basic human rights that everyone deserves. Everyone should have food, shelter, health, education, love, happiness, fulfillment. By “worth” I mean that everyone is “worthy” of these things automatically. As the excerpt from the article above says, “Human worth is contingent upon nothing.” Our achievements or our benefit to society or fame or fortune or race or religion or anything else have no bearing on whether we deserve these basic things.

This is a definition that I take as an axiom, upon which a lot of my other thinking is based. I have no evidence to support the claim that all humans have intrinsic worth and therefore have certain rights. I want to believe it, so I do. That’s an uncomfortable statement for a scientist to make. But like so much of society, human rights only really exist to the extent that enough of us agree that they exist. I choose to believe that they do because I do not want to live in a world where they do not. (This is discussed quite a bit in the book Sapiens: that human rights, along with other seemingly fundamental ideas like religion, money, and society itself, do not “really” exist, but agreeing amongst ourselves that they do is beneficial in various ways. The author argues that this ability to create and believe in and organize around these abstract concepts is the hallmark achievement of humanity.)

Good

What does it mean for something to be “good”? I try to stick with a relatively simple definition: something is good if it makes the world a better place. In other words, does it reduce the overall amount of suffering? Does it make life more pleasant, more tolerable, more meaningful? Of course the simple definition is anything but. It is easy to fall into the utilitarian trap of trying to quantify goodness and end up paralyzed trying to figure out how to weigh the pros and cons of every action, and its second- and third- and umpteenth-order effects. There is, improbably, a whole TV show about the folly of trying to tally up goodness in this way. In the end, I think you just have to not overthink it. Just do what you reasonably can to help everyone to have the basic rights listed above. Do what — as far as you can tell — is the right thing. Make life better when you can.

Achievement

Achievement is just accomplishing a task that you set out to do, so achieving something is not in and of itself good. An achievement is only as “good” as its outcome. If you set out to do something bad and succeed, you have achieved your goal but it was not a good way to use your time.

However, there is another dimension to achievement, and that is: how fulfilling was what you did? Maybe you set a goal and achieved it, and it was pretty neutral in terms of whether it was “good” or not for the broader world, but you’re proud of what you accomplished. In other words, it was meaningful to you. I would argue that that was a good use of your time. As the quote from the article above says, achieving your goals does not alter your worth, but hopefully it fulfills you and is meaningful to you. Which leads us to “meaning.”

Meaning

I am not religious. The idea of an afterlife is wishful thinking that people cling to because the alternative is facing the fact that someday we all cease to exist and all of the richness of our internal lives will be lost without a trace. I’m also a scientist, an astronomer posing as a planetary geologist, trained to think in terms of extremely long time scales and vast distances. Humans have existed for a blink of an eye in the history of the universe. We are less than microscopic when compared to the vastness between galaxies. On the scale of the universe we are inconsequential.

With that perspective, it’s easy to jump to nihilism. Everything is meaningless. We live short, pointless lives and then we die and the universe goes on as if we never existed and eventually the universe itself will succumb to entropy and there will be nothing. So what’s the point in caring about anything? It sounds pretty grim, but it can actually be kind of liberating. If nothing matters, why not just chill out, stop writing long blog posts agonizing over existential questions with no good answers, stop worrying about your legacy, and just enjoy your stupid insignificant life while it lasts?

“Dancing through life (down at the Ozdust)
If only because dust is what we come to
Nothing matters but knowing nothing matters
It’s just life
It’s just life
So keep dancing through”

– Dancing Through Life, from the musical Wicked

This is essentially the answer put forward in A Psalm for the Wild-Built. In the book (bear with me here if you’re not a sci-fi person) robots have become sentient and have gone off to live life in the wilderness separate from humanity. The main character of the book, Dex, is having an existential crisis and wanders off into the wilderness too, where they meet a robot named Mosscap who helps them work through these existential questions. The robot’s answer is a sort of positive, comforting spin on nihilism. I’m going to put several quotes from the book here in a row. They’re all in the same section of the book and go together. (They’re also sort of the climax of the book, so if you don’t want it spoiled, scroll past…):

“You [humans] were proud of us [the robots] for transcending our purpose, and proud of yourselves for honoring our individuality. So, why, then, do you insist on having a purpose for yourself, one which you are desperate to find and miserable without? If you understand that robots’ lack of purpose—our refusal of your purpose—is the crowning mark of our intellectual maturity, why do you put so much energy in seeking the opposite?”

“You’re an animal, Sibling Dex. You are not separate or other. You’re an animal. And animals have no purpose. Nothing has a purpose. The world simply is.”

“You keep asking why your work is not enough, and I don’t know how to answer that, because it is enough to exist in the world and marvel at it. You don’t need to justify that, or earn it. You are allowed to just live. That is all most animals do.”

“It doesn’t bother you?” Dex said. “The thought that your life might mean nothing in the end?” “That’s true for all life I’ve observed. Why would it bother me?” Mosscap’s eyes glowed brightly. “Do you not find consciousness alone to be the most exhilarating thing? Here we are, in this incomprehensibly large universe, on this one tiny moon around this one incidental planet, and in all the time this entire scenario has existed, every component has been recycled over and over and over again into infinitely incredible configurations, and sometimes, those configurations are special enough to be able to see the world around them. You and I—we’re just atoms that arranged themselves the right way, and we can understand that about ourselves. Is that not amazing?”

Or, put slightly differently by Ursula LeGuin in The Lathe of Heaven:

“Things don’t have purposes, as if the universe were a machine, where every part has a useful function. What’s the function of a galaxy? I don’t know if our life has a purpose and I don’t see that it matters. What does matter is that we’re a part. Like a thread in a cloth or a grass-blade in a field. It is and we are. What we do is like wind blowing on the grass.”

The attitude is actually very comforting and appealing to me, but as I have written before ultimately I can’t help thinking it’s a bit of a cop-out. It’s true that our lives are short and our significance to the universe is nil, but guess what? The universe doesn’t get to decide what matters. We do. Meaning is a human construct, and therefore it gets defined on our terms.

In the book Life is Hard, philosopher Kieran Setiya talks about this:

while we cannot prove that there is value in the world—at least, not to the nihilist’s satisfaction—that doesn’t mean it isn’t true.

He then quotes polymath Frank Ramsey:

“I don’t feel the least humble before the vastness of the heavens. The stars may be large but they cannot think or love; and these are qualities that impress me far more than size does.”

Just throwing our hands up and saying “nothing matters because the universe doesn’t care about us” is a way to avoid the responsibility and vulnerability that comes with choosing for yourself what matters, and then living your life accordingly. In a way, religion takes a different path to end up with the same result. Nihilism and religion are both ways to shift that responsibility elsewhere. Either nothing matters in the big uncaring universe, or someone over-interprets an excerpt from an old book written by ancient superstitious weirdos and tells you what matters. The important thing is that you’ve found a way to not have to choose for yourself.

If I’m not going to choose nihilism or religion, then I need to figure out my own definition for meaning. So what is it? I think Sartre gets it right:

Life has no meaning a priori…It is up to you to give it a meaning, and value is nothing but the meaning that you choose.

Meaning is whatever we choose it to be. This definition is frustratingly imprecise, and as intimidating as the blank page before you set down the first word of a novel. Meaning is whatever inspires us with purpose, excites our imagination, whatever satisfies and fulfills us. As Victor Frankl says in Man’s Search for Meaning:

“What man actually needs is not a tensionless state but rather the striving and struggling for some goal worthy of him. What he needs is not the discharge of tension at all costs, but the call of a potential meaning waiting to be fulfilled by him.”

This, I think, gets at the heart of why I have a hard time with advice to just relax and be mindful and in the moment and stop measuring myself based on my achievements. I feel a constant conflict between the desire to take a break and relax, and the desire to achieve something meaningful to me. The key is to balance those urges. I often forget the key point that my previous posts were not about switching from one way of thinking to another, they were entitled “finding balance.” I find myself trying to overcompensate for a life spent on the achievement-oriented side of things and feel like I need to swing the pendulum all the way to the other side and focus only on living in the moment and the day to day “un-heroic” parts of life. But that’s not balanced either, and it stresses me out in its own way. I need both sides to feel fulfilled. The tension between them is not going to go away and that’s ok.

So, if I am seeking actual balance, rather than seeking to swing the pendulum from a pure achievement focus to purely living in the present, what does that look like? How do I really “make the most” out of life? I think about this a lot, but what does it actually mean? I’ll look at that in Part 2.

The Gallbladder Saga: Part 2

June 6, 2024 / Ryan / 1 Comment

I survived surgery! I’m now about a month out from surgery so as promised in my previous post, here’s a second post to share the lead-up to and recovery period after gallbladder surgery! Again this will include a lot of detail to hopefully help others who are going through this, but also to share my experience with anyone who knows me and is curious.

Warning: This post will be more gross that the last one, and will include pictures of surgical incisions, my giant gallstone, and discussion of gross medical stuff including poop. Read at your own risk!

The Gastroenterologist

I didn’t actually get to speak with a gastroenterologist doctor until 4 days before the surgery. Last fall, after my ultrasound, my GP referred me to the gastroenterology office, and I met with the Physician’s Assistant (PA) there. She is the one who recommended a HIDA scan and upper GI x-ray series. After the HIDA scan, I reported back that it triggered a gallbladder attack that evening, and based on that and the discomfort I felt she referred me to surgery.

Meanwhile, I had to go back and forth with the gastroenterology office about the upper GI x-ray because they kept asking me why I hadn’t done it yet and I kept telling them that they were referring me to a place that doesn’t have the equipment to do that imaging. I finally had the imaging done in January, and I had to share the radiologist’s report back to gastroenterology myself because apparently doctor’s offices just are incapable of communicating with each other. The imaging was negative, but I asked to do a follow up with someone from gastroenterology anyway because I had some lingering questions that I wanted to ask prior to surgery.

Twice they scheduled me to meet with someone, only to realize that the person didn’t take my insurance, so they had to push back the appointment. Finally they tried to schedule me out into June and I told them, no, my surgery is May 10 and I want to speak to someone before that. (Remember, this is the office that referred me to surgery, they should have known that I had surgery scheduled, but apparently the surgeon’s office didn’t tell them) They finally squeezed me in with the actual doctor on May 6. I feel that it is worth mentioning that when I showed up on the 6th for my appointment, they still didn’t know why I was there. The nurse asked me “So, you’re here for GERD?” (Gastroesophageal reflux disease – which is my official diagnosis for my reflux issues). I had to remind them that, no, I am here to talk about gallbladder surgery which I am having in 4 days, because your office recommended it.

At this point, I was pretty much sure of surgery: my gallbladder had been acting up over the last month much more than usual, which was actually reassuring about the right course of action, and I had read the research that said large stones come with an increased cancer risk. But I had a bunch of questions about the specifics of my symptoms, and I was also just looking for some reassurance. I’ll go through the questions that I asked and his answers (feel free to skip ahead to where I talk about surgery if you don’t want to read all of this):

Why are my attacks so intermittent?

He said that larger stones often have very intermittent symptoms – sometimes they shift and block things, other times they don’t. Whereas small stones can actually get stuck in the duct, so that you get immediate and extreme pain.

For a long time I mistook my rare attacks for bad gas because they do come with gas. Why would a gallbladder attack be associated with gas?

Basically he said you get gas when undigested stuff gets farther down your digestive tract where bacteria can break it down. So whether it’s fiber, or lactose (if you’re lactose intolerant), or fat if your gallbladder is not releasing bile properly, that can be a source of gas.

A few years ago I changed my diet to have more fiber and it seemed to reduce the frequency of attacks. Likewise I’ve notice that when I’m on vacation and eating out all the time and having a lot of fatty food but also walking around a lot, I usually don’t have attacks. Could gut motility be related to gallbladder attacks?

He was pretty skeptical of this, and suggested that it pointed to a possible overlap between gallbladder issues and IBS issues. He also said that having symptoms 3+ hours after eating sounds a lot more like IBS than gallbladder.

For what it’s worth, I think he’s wrong on this. I think there is a difference between “textbook” gallbladder attacks caused by small stones blocking the bile duct and large-stone gallbladder attacks that are more of a cramping or spasm due to the gallbladder having to work too hard to release bile around a big fat stone. This isn’t just a hunch, the HIDA scan showed pretty clearly that my attacks are a delayed gallbladder reaction. I had only mild discomfort when they injected the CCK during the scan, but that evening I had an attack because my gallbladder was fatigued and started spasming.

What should the HIDA scan feel like for someone without gallbladder issues?

He said that for people with normally functioning gallbladders, there should be little to no discomfort, so the fact that during the scan I was saying that “maybe” I was feeling something similar to my attacks, that suggests there’s an issue. When I asked why I would have an attack later that night though, he literally said “That one, I think I’m gonna have to take a pass.” But again, I personally think it’s the distinction between textbook gallbladder attacks and large-stone or hyperactivity attacks.

My HIDA scan showed an EF of 79%, could that be thrown off by having a large stone taking up a lot of volume in the gallbladder?

He seemed skeptical of this idea but I’m not sure I explained it very well. Basically, my thought was that if I have a big golf ball taking up half the volume of my gallbladder, then if my gallbladder ejects a large fraction of its available volume, maybe that is equivalent in terms of bile released to a gallbladder without stones ejecting a smaller fraction. And likely having to work a lot harder to do so. That might be an explanation for why I have digestive symptoms of having too little bile but a high EF.

He also briefly mentioned the relatively new diagnosis of “hyperkinetic” gallbladder, which is generally considered to be EF of 80% or higher, so I would be right on the borderline. He said that there isn’t a lot of data about that yet, but bottom line you can have issues if you’re releasing too much or too little bile.

My suspicion is that my gallbladder was sort of “acting” hyperkinetic because the large stone made it have to work too hard to release enough bile.

I read that something like 10% of people have “post-cholecystectomy syndrome” with long-term digestive problems.

He said that 10% sounds like a “fantastically high” number, and that likely what happens is that in the medical literature, there is a bias toward over-reporting because it’s better to report something that is unrelated than to not report something that is related. In other words, false positives are better than false negatives. So he said that it’s more rare than the literature would suggest.

But he also said that diarrhea after fatty meals is not uncommon, especially in the first couple of months, and that some people if they continue to have issues take medication pre-emptively if they know they are going to have a fatty meal, similar to how someone who is lactose intolerant might take a pill if they know their upcoming meal will have lactose in it.

I have a family history of Crohns/Ulcerative Colitis, and I’ve read that having the gallbladder out can increase risk for intestinal cancers, should I be scheduling a colonoscopy sooner than usual?

His answer on this was kind of unclear, he basically said that if he had seen me earlier, he would have ordered an endoscopy and colonoscopy before going forward with surgery, just to have a full picture of what is going on in my upper and lower GI. But then he also said that I can probably wait until age 45 before doing a colonoscopy. So I’ll probably bring this up with my GP when I go back to him for a regular checkup and see if I should get checked sooner.

All in all, although I got some answers to my questions, I was disappointed with this visit with the gastroenterologist. I was hoping for more reassurance about surgery, but instead got a noncommittal “yeah, you should probably do the surgery, but don’t be surprised if it doesn’t fix everything”. I also didn’t love the apparent tendency to diagnose everything as IBS when the HIDA results indicated pretty clearly that it was my gallbladder even if the reaction was delayed from what it is “supposed to” be. I really did not appreciate the statements about “well, if I had seen you sooner, I would have ordered XYZ additional tests before going forward with surgery.” As if I had not been seen by his own physician’s assistant 6 months ago, as if this last minute appointment was my fault and not the fault of his office’s scheduling incompetence.

Anyway, let’s get on with the surgery.

Surgery Prep

In the lead up to surgery, the main things that needed to be done were a pre-op phone call, some blood work, and washing with special soap. The pre-op phone call was simple enough, they just asked me about medical history and what medications I was taking, and gave instructions about what I could eat when. I had just received a pre-surgery info packet in the mail when they called, and there were some differences in instructions. An important one was that the packet said no food or drink after midnight, but the nurse on the phone said that clear liquids were fine up until a couple hours before check in. This meant I could have some apple juice the morning of the surgery to keep my blood sugar up.

The pre-op bloodwork was super easy, just walked into the lab, they took one vial of blood (thankfully, I got a skilled tech and barely even felt the needle), and they handed over the packet with pre-op instructions and the special soap.

The soap was pretty weird. You have to use it the night before surgery and the morning of surgery. Each time, you’re supposed to thoroughly wash yourself with regular soap, then turn off the water and wash with the special hospital soap that feels and smells like a combination of hand soap and hand sanitizer. Then wash yourself again with it without rinsing! Then finally rinse. The idea is to super thoroughly disinfect your skin to reduce the chances of infection. I doubt I’ve ever been cleaner than the morning of my surgery!

Surgery: Pre-Op

My surgery was scheduled for 12:30pm, so I had a relaxed start to the day. We got the kids off to school, went for a walk, then I did my shower with super-soap and changed into my comfy day-of-surgery clothes. I got some supplies set up for my recovery “nest” by the couch in the den, picked out some possible low-fat meals to eat during recovery, and then it was time to go.

At the hospital, we checked in and I was given a tracking beacon (which I handed off to the pre-op nurse) which would automatically update my status, so my wife could tell where I was in the process just by looking at screens posted around the hospital, so for example if she wanted she could go get lunch in the cafeteria and tell when I got out of surgery. Pretty cool, though we didn’t need it too much.

The nurse led us back to the pre-op area where I had to change into the very stylish hospital gown, socks, and hairnet. They even had a pre-heated blanket to get under!

They did the usual height, weight, blood pressure stuff, and got me set up with an IV. My veins are easy to see under my skin, so you would think I would be easy for stuff like blood draws and IVs, but I think I am often dehydrated, and my veins tend to slip away from the needle so I’ve had issues in the past. Unfortunately, the restrictions on eating and drinking before surgery didn’t help with this, and my main nurse was unable to get a good vein despite some painful digging around. She ended up calling over a different nurse armed with an ultrasound machine. Even with the ultrasound they had to poke around a bit, but finally they got the IV placed and secured. In retrospect, I should have hydrated a lot more while I was allowed to before surgery to help with placing the IV.

The lull while we waited for the ultrasound to show up was the perfect opportunity to ask the question that was most on my mind during pre-op: Can I please keep my giant gallstone? (And could they please take some pictures of my gross gallbladder after removal?) The nurse asked around and told us that likely they would have to send everything to pathology and then I could pick it up from pathology in a couple of days.

Then there was a bunch of paperwork to sign to show that I was who I said I was, that I understood what surgery I was there for, the associated risks, etc. The anesthesiologist came by and I talked to him for a bit about potential nausea, and he gave me some medication ahead of time and adjusted the IV medication to hopefully prevent nausea afterward (I was worried about throwing up with fresh incisions in my abdomen). He said that nausea from anesthesia tends to correlate with how prone to motion sickness you are. I am not very prone to motion sickness, and I ended up having basically no nausea after my surgery or from my pain meds so this seems to be anecdotally true.

Then the surgeon came by and did a quick rundown of what the surgery involves, where the incisions will be, and what to expect for recovery. He asked if I had any questions and I felt like I should have some, but didn’t so he went off to get ready.

There was a lot of waiting around. My surgery was slightly delayed because the previous surgery took a little longer than planned, but even if we had been on time, there’s a good amount of down time. I was worried that I was going to be super-anxious on the day of surgery but I was actually not too bad. Because I am a huge dork, I kept thinking of this line from Lord of the Rings:

“Things are now in motion that cannot be undone.” – Gandalf

Essentially, all of the decision making and researching and worrying was done, so on the day of surgery it was just my job to show up and go with the flow.

I have had a very similar feeling before when a major milestone or event is coming, and at a certain point you just have to kind of surrender to the passage of time and accept that it’s going to happen. I got this for major deadlines and milestones in school (such as qualifying exams, PhD defense, etc), and I still get it sometimes for work deadlines. At the end it’s just a sort of relief: “well, this thing is going to happen and then it will be over.”

The main thing I felt while sitting around waiting on the day of surgery was not so much anxiety but a surreal feeling. It’s just really hard to mentally accept that in an hour, someone is going to cut holes in your abdomen and remove an organ and then supposedly you’re just going to go home and be fine in a week. This was part of the reason I asked them to not only let me keep the stone, but take a picture of my gallbladder once it was out. Just a little additional piece of evidence to say “yes, that is a thing that actually happened, they really did cut that thing out of me.”

Surgery

Finally the time came for surgery. They wheeled my bed out of the pre-op area, let me hug my wife goodbye, and then wheeled me down the hall to the Operating Room. Along the way, they kept me talking, making small talk about being a scientist and that maybe one of the nurses had seen my public talks in years past. Pretty obviously doing their best to keep me distracted. As we chatted, one of the nurses pushed some medication into my IV which made me extremely sleepy in a matter of a minute or so.

I only saw the operating room briefly. My main impression was that there was a ton of equipment in there, including giant TV monitors showing test patterns. I was too out of it to really understand at the time, but in retrospect those must have been the screens they used to view the video feed from the laparoscopic camera. I also was struck by how many people were involved in the surgical team. I am not sure what I expected, but there’s really a whole team involved, it’s not just one surgeon and one nurse.

They wheeled my pre-op bed up right next to the surgical table, and I had to shuffle myself over onto the table. At that point I was already quite out of it. I remember being surprised at how irresistibly heavy my eyelids were, and trying my hardest to open my eyes and just being unable to do so. They told me they were giving me some oxygen with a mask and I remember thinking “this mask is on crooked” and that’s all.

Post-Op

Next thing I knew, I was back in the pre-op area, waking up from what felt like a very deep sleep. My wife was there, as was a nurse or two. My memories of the immediate post-op period are very hazy, but pretty soon after I woke up I know my wife was excitedly telling me that she had my stone! No delay for pathology, they popped the big gross stone in a sample jar and gave it to her! There were also some pictures of my gallbladder in my body, after removal, and after the stone was removed, all taken with the laparoscopic camera. They also said that I apparently had a few more smaller stones that were hidden by the big one on the ultrasound (this was apparently not accurate, no other stones were listed on the pathology report when I got it at my follow up appointment).

Ok, are you ready for gross pictures?

Last chance to turn back!

Top Left: Gallbladder in place in my body, with cameo appearance by my liver on the left plus some fat and other stuff.
Top Right and Bottom Left: Gallbladder after removal, you can see the stone is lodged in the neck.
Bottom Right: Stone removed from the gallbladder.

My post-op pathology report said that my gallbladder showed signs of “chronic and acute inflammation” but thankfully no indication of “neoplasms” (i.e. cancerous growths).

The stone in all its disgusting glory. It was initially pretty uniformly dark, but has gradually gotten more of a mottled appearance.

My incisions, the day after surgery. The bandaid is covering a second hole like the one farther to my right, plus a tiny pinprick hole. It’s just there because there was some leakage around the glue – I didn’t come home from the hospital with the bandaid. Apparently the big incision under my sternum was a bit larger than typical because of the large stone. I am amazed by how little pain or bruising I have had. (the orange tint to my skin above the top incision is from the pre-surgery scrub they use to disinfect before starting)

There was not much to post-op. Nurses came by and gave us instructions about recovery, what to do and not to do. (Do not: overdose on painkillers, lift heavy objects; Do: walk as much as you’re able, stay hydrated, eat bland food at first) My incisions were all glued shut, so there was essentially no wound care to worry about. They basically said just don’t soak in the tub (showers ok) and let them come loose naturally in a couple of weeks. (I am now 1 month post op and the final bits of glue just came off this week)

I had read about people in recovery having to stay until they showed that they could walk, or until they urinated, but I don’t remember any such tests. They basically gave us our instructions, had me change back into my clothes, and sent us home. I was wheeled out to the curb in a wheelchair and then climbed into the car and we went home.

Recovery: Pain

I remember very little of the rest of that day. I think basically I took pain meds and slept.

I was and am surprised by how little my incisions hurt. The most incision pain was from the large one under my sternum where they took the gallbladder out, and the general path from there to where the gallbladder was. Presumably that’s where the most internal bruising and damage occurred. All the rest of my incisions have been pretty darn near painless.

More painful than any of the incisions was the gas pain. I had read about this beforehand, but it’s very strange. Basically, when they do laparoscopic surgery, they need to be able to see what they’re doing inside your body, so they kind of inflate you with carbon dioxide. At the end of surgery, they expel as much of this as possible, but there’s often a bit left. This left over CO2 can irritate the phrenic nerve, which is the nerve that controls your diaphragm. This nerve connects to the spinal cord up in your neck, and so when it gets irritated by gas, even though the gas is in your abdomen, the pain can manifest in the right shoulder. For me it was behind the right collarbone and for the first couple of days it was a pretty persistent and unpleasant ache.

Right shoulder pain after surgery is because the nerve that connects your spine to the diaphragm also extends into the right shoulder. This entire gallbladder experience has been one big argument against intelligent design.

Even though I knew it wasn’t actually something wrong with my shoulder, I kept rubbing it as if it were a tense muscle or a cramp that might go away. I had heard that walking helped with gas pain so I took a very slow and uncomfortable walk around the neighborhood but it didn’t seem to help all that much. Maybe it actually did help the gas dissipate, but at the time it felt like it just made the pain worse because I had to breathe harder.

I found that I was most comfortable sitting in a recliner with a bed pillow across my abdomen and an electric heating pad around my shoulders. Sometimes, I would put an ice pack under the pillow on my abdomen to keep swelling down.

Between the gas pain and the pain from the big incision, I had trouble taking a deep breath for the first couple of days but once the gas dissipated and I had healed a bit I felt much better. If I hadn’t gotten sick I would have been feeling pretty good by day 3 or 4.

Strep Throat? Really?!

That’s right, about three days into my recovery, I came down with strep throat. At first I was afraid I was getting a cough, which would have been very painful for my incisions. But instead, it developed into the worst case of strep throat I’ve ever had. Very quickly, my tonsils were far more painful than anything relating to my surgery. Like being stabbed in the throat every time I swallowed even saliva or water. At the peak, I woke up in the night in significant pain and with a fever. I was quite grateful that I had pain medication from the surgery, which I took at night to help fall asleep with the strep throat. My 4 year old also came down with strep at the same time, which for him manifested as a sore throat and vomiting. My poor wife was stuck taking care of a vomiting child and a useless sick adult. She is the best.

I don’t know if the strep is something my kid brought home from preschool and it just wiped me out because I was already weak from surgery, or if it’s something that I caught at the hospital and brought home. In any case, another lesson learned is to wash hands super well after being at the hospital because you really don’t need to get sick while recovering.

When I went to the doctor for the strep, they warned me that the test can take a long time to show a positive result, like 20 minutes. 5 minutes later the doctor came in and said “yeah, your test is already clearly positive. The nurses are very impressed.” The bright side of having strep is that it responds pretty quickly once you get medication. It still took nearly a week to feel all the way better as my throat healed but the worst of it was over in a couple days once I had some antibiotics.

Recovery: Sleep

Back to surgery recovery. I was really worried that sleeping on my back instead of my side would be really difficult but I didn’t actually have much trouble. I held a second normal bed pillow across my abdomen and rested my hands on top and was able to sleep decently. I was generally just very tired, usually going to bed early and waking up early, and taking naps in the afternoon. I sometimes napped back in my bed, but also often dozed off while reclining on the couch. Between the surgery and the sickness, my body was just wiped out.

Recovery: Food and Digestion

TMI warning: This section is going to talk about poop. It’s kind of an unavoidable topic when it comes to gallbladder issues and surgery.

One of the main things I have been worried about with this surgery has been whether I would be trading being able to eat anything I want with only rare (once or twice a year) pain, for a lifetime of low-fat food and chronic diarrhea. At about two weeks post-op I was feeling pretty good and thought I could basically go back to normal, but unfortunately I’ve gotten worse since then.

In terms of food, I tried to take it very slow, starting off with things like white rice, plain bread with honey (no butter), low-fat soups, applesauce, bananas, etc. I also stayed hydrated with a lot of gatorade and water. Slowly, I graduated up to small servings of low fat meals like chicken breast, tuna, etc. My appetite was pretty low for a while after surgery, which I think is normal. Being unable to swallow anything without pain due to strep kind of messed up my progress and I was living off soft stuff like broth, soups, applesauce, and yogurt for a while, but once that cleared up, I started slowly adding fat back in and for a little while was fully back to normal.

I was given stool softeners to take to counteract the constipating effects of anesthesia and narcotics, and they told me to start taking them immediately the day of surgery. It took a few days for my digestive system to “wake up” and once it did I did have diarrhea and soft stools for maybe a week. Then as I shifted my diet back to normal, I was back to normal for about a week and was optimistic that I had avoided the chronic diarrhea that I had heard about.

Unfortunately that brief period of feeling normal was temporary. I now always have loose stools and gas and have to go to the bathroom urgently within 30-60 minutes of eating. The most confusing thing is that I also get the urge to go sometimes when I don’t actually have to. Apparently all of this is due to the effects of the constant trickle of bile into my intestines. Bile acts to stimulate the gut to contract and also causes fluids to be released into the intestine – the result is a laxative effect.

I’m still experimenting with diet to see if I can make things better, but so far it’s very hard to figure out. All the advice out there says to stick with low fat, but if there’s too much bile, it seems like I would want to eat some fat to “use it up”. There is also advice that you should eat more frequent, smaller meals, so I am going to be trying that out in the coming days. Basically a Hobbit system: Breakfast, second breakfast, afternoon tea, dinner, supper, etc.

Conclusion

All in all, the surgery and recovery were much easier than I anticipated. I am really amazed at how well the incisions have healed. One of the holes is taking a little longer because there is a bit of the internal stitches sticking out, but it’s not painful, just a little itchy. My abdominal muscles are almost entirely back to normal, though I have been trying to be careful. Lately I have been having some more aches and pains in the gallbladder area, so I’m not sure if that is still some healing going on or if it is due to the digestive issues.

A couple weeks ago I was very optimistic about the digestive recovery, but now I am less so. The thing I was most worried about with this surgery was that I would go from being able to eat anything with only rare symptoms to having constant diarrhea and having to stick to low-fat foods. So far it is looking like the latter is exactly what is happening, which is very disappointing. I’ve heard that this is pretty normal for the first couple of months so for now it’s just a matter of experimenting with diet and hoping that things improve.

The Gallbladder Saga: Part 1

April 23, 2024 / Ryan / 3 Comments

On May 10, 2024, I am having surgery to remove my gallbladder.

It has been a long road of figuring out symptoms, trying to rule out other causes, learning, and indecision. Writing this all out is a way for me to process everything, to tell friends and family what’s going on, and hopefully provide useful information for others out there who may be in a similar situation. This is going to be long, but hopefully interesting and useful to someone.

I am NOT an expert, I’m just a scientist with gallbladder issues who has read way too much about this stuff to satisfy my own anxiety/curiosity. Please talk to a doctor if you are having similar problems.

Before we get any farther: heads up that this post will include frank discussion of digestive symptoms, medical conditions, and generally gross body stuff that some may consider to be Too Much Information. I’ll try to keep it relatively tame, but if you don’t want to read about this sort of thing, stop now!

History and Symptoms

I would start at the beginning, but it’s unclear when exactly that was. For many years I have occasionally suffered from very painful digestive symptoms. The first of these “attacks” that I remember occurred on November 6, 2012. I recall the exact date because it was election day. I was driving back to Arizona from California where I had been doing operations for the Curiosity Mars rover. It’s a long drive, so I spent the day sedentary in the car and eating fast food. That evening at home, as election results were coming, I was lying on the floor suffering from what I thought was a painful bout of gas.

Over the years this would happen occasionally with varying severity, and each time I just figured it was bad gas. I usually could (and did, and do!) eat whatever fatty food I wanted, but sometimes when I ate a large/heavy meal, especially if that meal also included a few alcoholic drinks, and especially if I was mostly inactive that day, I would end up triggering what I now know was a form of gallbladder attack.

Part of why it took so long to figure out what was happening is that my pain is usually not easy to localize. Often gallbladder attacks are described as a sharp stabbing pain in the upper right abdomen right where the gallbladder is. For me, it starts with “epigastric” cramping across the front of my abdomen, under the ribcage. As the intensity ramps up, the pain spreads to the upper middle of my back, like the muscles between my shoulder blades are extremely tense but no amount of stretching or rubbing can relax them. Often, it’s the inexplicable upper back tenseness that really clues me in that an attack is coming. There’s an irresistible urge to move, walk, stretch, anything to find a comfortable position, but there is no comfortable position. At the peak of an attack, I’m rolling on the floor, sweating, shaking, and generally miserable. During my worst attacks, my hands and arms went all tingly. The only things that slightly help are walking and a hot shower or bath. And to further confuse things, the attacks don’t just feel like gas, they are accompanied by gas and bloating. They tend to occur in the evening and last most of the night (one memorable attack had me awake and wandering the neighborhood moaning in pain like some deranged zombie all night on Christmas eve), subsiding in the morning. After an attack, it tends to take a day or so for my digestion to normalize. It’s almost like whatever happens completely shuts down my digestive tract and it needs time to reset and start working again.

A few years ago the symptoms were happening often enough that I changed my diet, cutting out all alcohol for several months, and switching from bagels and cream cheese to raisin bran for breakfast. This seemed to help, and even now that I do drink alcohol again, I usually only have problems once or twice a year.

In the last couple of years, I’ve also started to have symptoms of reflux. Often not traditional heartburn, but when my stomach is full and I do something like a plank or bend over or exert myself I can feel my stomach contents “overflow” and start moving up my esophagus. Rarely, after a really big meal, I’ll sometimes wake up at night on the verge of vomiting, but without nausea. Just… overflowing. (I know, it’s weird and gross) For a long time I’ve also often had to clear my throat a lot after eating (my dad does this too, so it’s likely some combination of our particular biology and learned behavior). Recently I’ve noticed that I need to do it more and that I’m increasingly prone to losing my voice if I talk a lot. Altogether, my reflux symptoms are most consistent with something called “silent reflux” or laryngopharyngeal reflux (LPR).

It’s unclear if this reflux stuff is related to my gallbladder issues or not but I’m quite curious to see if it changes after surgery.

Doctors and Tests

For a long time, I didn’t really go to the doctor, ever. I was young and healthy and didn’t see the need. But I’m almost 40 now, so last year I finally set up an appointment to establish care with a general practitioner. At the appointment, as I discussed my health history with my doctor, I mentioned these rare but severe bouts of pain. I said that I was pretty sure they were just gas, but figured it was worth mentioning. He ordered blood work and an abdominal ultrasound just to be safe.

At my follow up appointment with him after the ultrasound, he said (I didn’t actually get to see the images at this appointment) that it had come back showing “gallstones” and that he had referred me to a surgeon. This was shocking to me and seemed awfully drastic for something that only occasionally bothered me, so I told him I’d like to wait and see. (He also apparently had sent me a message that I missed about the gallstones and surgeon referral, so at the actual appointment I learned of all this from a casual remark along the lines of “So, you saw my message about the gallstones and the need for surgery…”) He agreed with holding off on surgery but recommended that I talk to a gastroenterologist about both the gallstones/abdominal pain and the reflux.

At the gastroenterologist, they listened to me describe my attacks, and said that it sounded consistent with gallbladder issues. (I have since learned that a whole host of GI symptoms can end up being gallbladder related.) They ordered two additional imaging tests to figure out what might be going on. The first is called a hepatobiliary iminodiacetic acid (HIDA) scan, and the second was an upper GI x-ray series with air contrast. I’ll describe the HIDA scan below, but first let’s review some basics.

What is a gallbladder? What is a gallstone?

The gallbladder is a small organ that sits just below the liver, in the upper right part of the abdomen. It’s a small sac (normally about 4 cm by 10 cm when full) that acts as a reservoir for bile, the chemical produced by the liver that helps break down fats in your food. When you eat a fatty meal, as that fat enters the upper portion of your intestines (the duodenum), it triggers the release of a hormone called cholecystokinin (CCK). CCK tells your gallbladder to contract, releasing bile through the bile duct into your duodenum to break down the fat.

BruceBlaus, CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons

Most gallstones form when the bile in your gallbladder contains too much cholesterol (which can occur for various reasons) and it essentially crystalizes and precipitates out as a solid. Some gallstones are “pigment stones” and are formed from bilirubin and salts that occur in bile. These are less common than cholesterol stones.

Gallstones cause problems because they block the bile duct, so when your body tells the gallbladder to contract, it does, but nothing happens. So it tries harder, and harder, essentially going into a self-destructive muscle spasm, and then you’re in excruciating pain. Small stones can actually get lodged in the bile duct, or even end up blocking the liver or pancreas which is a life-threatening emergency. Likewise, the gallbladder can become necrotic or burst, which is also life-threatening.

Larger stones are too big to fit through the bile duct (which is normally pretty tiny, just a few mm), so in some ways are safer than small stones, but can cause chronic inflammation of the gallbladder that can lead to significantly increased risk of gallbladder cancer, especially for stones larger than 3 cm.

Usually, gallstones are diagnosed via ultrasound. They can also show up in x-rays and MRIs. Many people have gallstones that don’t cause any problems at all, but once they start to cause problems, the problems generally don’t go away.

What is a HIDA Scan?

A HIDA scan is a test that lets doctors see how well your gallbladder is functioning. It uses a radioactive tracer (technetium-99) that is injected into your bloodstream. The tracer is incorporated into a chemical that is processed by the liver and passed into the gallbladder in bile. The tracer emits a small amount of gamma rays that easily pass through the body and can be detected and turned into an image of your gallbladder.

Before the scan I was told not to eat anything so that my gallbladder would be full of bile. The scan usually has two parts. First, they inject the tracer and you lie still on the scanner (basically a firm bed with a large boxy device above your abdomen) for about an hour. This lets the tracer get passed from your blood, through the liver, into the gallbladder.

Next, you are given something to trigger the gallbladder to contract. For me, they used an injection of CCK. I’ve also heard of some places that just have you drink a fatty drink like Ensure.

Triggering the gallbladder can cause an attack, especially if you have a stone blocking the bile duct. I was worried I would be in excruciating pain, but for me it wasn’t as bad as a real attack. I felt a sort of fluttering feeling as the gallbladder contracted, followed by nausea and tightness and discomfort similar to my attacks but maybe 10% as bad. This lasted for about 10 minutes and then subsided.

By measuring how much signal is coming from the gallbladder before and after triggering it to contract, the radiology technician calculates the Ejection Fraction (EF). Basically, how much of the bile in your gallbladder gets squirted out when it is told to do its job. Generally an EF of less than 35% is considered low, and can be reason to have surgery even in the absence of stones.

Recent research is also starting to suggest that an EF that is too high (“hyperkinetic”) can cause problems. Basically, your gallbladder overreacts and spasms when stimulated, dumping too much bile and causing pain and inflammation along with other digestive issues. The threshold for what is considered “too high” an EF is not well defined, but generally around 80%.

One thing I learned in reading about it is that there’s a pretty large uncertainty in the EF measurement. Many people get hung up on the precise number but often the more important thing is not what the EF number was, but whether the scan replicates your symptoms. If you have issues when your gallbladder is stimulated to contract during the test, it stands to reason that your gallbladder is likely the problem.

What nobody told me was that the gallbladder activity triggered by the HIDA scan can cause digestive issues for a day or two afterward, even if your gallbladder appears to be working properly. I felt odd the rest of the day after the scan, not exactly painful, not exactly nauseated, but “off” and restless and uncomfortable. That evening, I had a mild attack with my usual epigastric and upper back cramping feeling and restlessness. That was the first time I really thought maybe my symptoms were gallbladder and not just gas.

I reported my mild attack to my gastroenterologist, and a couple days later she called back with my results. My EF was 79%, which is considered normal (but is borderline hyperkinetic; many doctors are not current on the literature and/or don’t believe that biliary hyperkinesia is a real thing). But in particular because the scan and its after effects replicated my symptoms, she recommended surgery and referred me to a surgeon.

Is surgery the only option?

At this point I was getting super stressed out. It seemed like all signs were pointing to surgery for this thing that I had thought was a non-issue and almost didn’t bother mentioning to my doctor. It seemed very drastic to remove an organ from my body when it hardly ever caused problems, and the casual way that doctors seemed to just automatically jump to surgery really bothered me. I know it is a routine surgery (more than 1 million cholecystectomy surgeries are done in the US every year), but it’s not routine for the individual having the surgery!

I started compulsively reading papers about gallbladder issues, pros and cons of surgery, alternatives to surgery, etc. I joined online communities on Reddit and Facebook to learn more about whether surgery was really the only option, what to expect if I did go ahead of surgery, etc. There is a ton of interesting and useful information out there, but the social media communities also tend to self-select for people who have more complications: people who get better tend not to stick around. So although I learned a lot I also did not help my anxiety about surgery.

The general medical consensus seems to be that since you don’t really need your gallbladder to live, removal is the best treatment option if you have symptoms. Once your body starts producing stones, it’s likely to keep doing so until you have an emergency, so it’s better to do the surgery electively than risk a necrotic gallbladder or pancreatitis and emergency surgery. There are treatments that can help to dissolve stones if they are small and non-calcified, but the impression I got is that those treatments are still usually just delaying the inevitable.

There’s also a lot of conflicting information out there about the long term effects of removal. Some sources will say that you can basically go back to normal and eat whatever you want immediately, others say that you likely will end up having to make long term changes to your diet (but because those changes tend to be toward healthier eating anyway apparently it’s all fine?). Some people suffer from long term effects such as pain, diarrhea, reflux, gas, etc. collectively called “post-cholecystectomy syndrome” but it is unclear how many of those cases are directly related to the surgery and how many are due to other issues.

A rant about medical imaging

I was wracked with indecision and decided I needed more information, so I set about trying to ask the radiologist’s office to provide me with the actual imaging and radiology reports from my ultrasound and HIDA scan so I could see for myself. (I had not yet done the upper GI x-ray because, frustratingly, the gastroenterology office referred me to a place that doesn’t do that particular imaging. We had to go back and forth several times, with them asking me why I hadn’t done the x-rays yet, and me telling them that they needed to refer me to a place that actually does the imaging they were ordering.)

Of course, the radiology office’s website was broken and they had no patient portal. I called them several times and followed their phone tree to try to request my medical records, but just got a voicemail box that never responded. Finally, I just pretended that I was trying to make an appointment until I got to a real live person, who took my request and passed it along to their medical records people.

Medical imaging is amazing. The quality of the images and the fancy tools used to analyze them are just fascinating to me as a scientist who analyzes data and writes analysis tools for a living.

Given how advanced medical imaging technology is, you can understand why I was shocked that the only way to get a digital copy of the images was on a CD. I have not had a computer with a CD drive for probably 10 years. When they handed me the CD, it had a post-it note with instructions for how to access the files using a built-in image reader on the disk. Sounds great, right? If only I had a way to read the disk…

My wife took the CD to the library, where she was able to use one of their old computers with an optical drive to copy the files over to a USB drive. With the USB in hand, I booted it up and opened the image reader. Here’s what it looked like:

Very user friendly for English speakers!

That’s right, the tool was in Japanese. Not to be deterred, I opened up Google translate on my phone to see if I could just struggle through the Japanese interface and see my darn images.

But not only was the tool in Japanese, it also could not find the images. Navigating through the disk directories on my computer, there were files there, but nothing recognizable as an image.

I almost gave up, but in my frustration I posted about this on Facebook and a friend of mine came to the rescue. She suggested that I try a free medical image reader called ONIS. Amazingly, it worked and I was able to export my images as JPGs!

It really boggles my mind that this is how medical images are shared with people. I am a scientist and I figure out how to read and work with weird data formats for a living, and I was barely able to access the images. They’re shared on obsolete physical media, with a viewer that is not in English and also does not actually work to view the images. It’s just unbelievable.

What the images showed

I was shocked when I looked at the ultrasound report and the associated images. When my GP said that I have “gallstones” I figured we were talking grains of sand. Maybe gravel-sized. I do not have “gallstones,” I have GALLSTONE. Specifically, to quote the radiology report that came with the ultrasound images, I have “a dominant 3.3 cm calcified stone within the fundus of the gallbladder”.

Recall that a normal gallbladder is only about 4 cm wide and 10 cm long. That means I have a stone that is taking up a significant portion of the volume of my gallbladder. Just take a look at this image:

There’s, uh, not a lot of room in there! Note the dark shadow behind the stone, indicating that it is reflecting all of the sound waves. I think this is how they know it is calcified. I added a picture of a US quarter for scale.

I was really struggling to wrap my head around how big a 3.3 cm stone really is, so I put together another picture, comparing a 3.3 cm circle to other familiar objects:

I still can’t believe there’s a stone this big inside me right now.

Sometimes things are easier to understand in meme form.

(As an aside, the ultrasound was a full abdominal ultrasound, so they also checked out my other organs. It’s kind of weird and neat to have pictures of my liver, kidneys, pancreas, spleen, and aorta.)

The HIDA scan results were also interesting. As I mentioned before, despite the apparently enormous gallstone, my EF was 79%. You can see in this first image how they calculated that number:

The picture on the lower left shows the area that they used to measure the signal from my gallbladder (red) and the area they used to measure the background signal (green). The graph on the right shows the gallbladder signal decreasing by 79% over a period of 15 minutes.

Here are the individual HIDA scan images. They form a time lapse showing the tracer moving from my gallbladder into the duodenum:

By comparing with the previous image, you can see that the gallbladder is the faint blob on the left hand part of the image that fades over time as the gallbladder empties. The darker blob is the tracer in the duodenum – apparently some had already left the gallbladder prior to the CCK.

The Upper GI X-Ray

I’ll just briefly talk about this because it didn’t show anything remarkable. This test’s full name is Upper GI X-ray series with air contrast and upper bowel follow-through. It has a few parts. First, you drink a barium slurry while standing up and they take x-rays, next, they lay you down and have you drink to see if your esophagus works ok without the help of gravity. (Barium is opaque to x-rays, so it lets them take pictures of soft parts of your body like your digestive system that normally wouldn’t show up in an x-ray.) Next, you swallow a mouthful of what the x-ray tech described as “super pop-rocks” (based on the taste, I think it was citric acid and baking soda). This makes bubbles in your stomach (they tell you to try not to burp) which, combined with some barium slurry in your stomach, makes it easier to see how your stomach walls are doing.

Next you have to drink a really large amount of the barium stuff. It’s thick and weird but not too bad. Then they take pictures every 15 minutes for an hour or two and watch the barium move from your stomach through your small intestine. Finally, when it has gone all the way through your small intestine, they do some final images. This last part was extra weird because the radiologist comes out with a big plastic paddle with an inflatable rubber ball on the end, and he firmly pokes and prods your abdomen while more x rays are taken. (They use the paddle so that his hands don’t have to be in the picture.)

I don’t have the images from this test yet (they’re mailing me another CD…) but they were very cool to see on the screen. Like the ultrasound, it’s just kind of neat to have pictures of my own guts and bones. The radiology report said that everything looked ok, except that my big fat gallstone showed up on the x-rays (more evidence that it is calcified). So as far as we can tell, there’s nothing else going on other than the gallbladder issues.

Another small rant

I also want to mention the astonishing lack of communication between medical offices, and with patients. I am 99% sure that my GP didn’t tell me I had an enormous gallstone because he didn’t know. My suspicion is that the radiology office just sent the written report, which was read by someone other than my GP at his office, and he was just told the diagnosis: cholelithiasis (gallstones), which he relayed to me.

When I went to the gastroenterologist, they did not have the ultrasound results. When I went to the surgeon for consultation, he did not have any of the imaging results. Each time I had to verbally describe the situation to bring them up to speed.

I also have not yet been able to be seen by my gastroenterologist’s office yet since my initial visit where they ordered the HIDA scan. First the follow up was delayed because they kept ordering the x-rays from a place that doesn’t do them. Then the follow up appointment was canceled and rescheduled twice because they kept making appointments for me to speak with someone who is not on my insurance. This last time they canceled, they tried to book me an appointment in June and I had to flat out tell them (remember, their office is the one that referred me to surgery) that I am having surgery on May 10, and that I want to talk to a gastroenterologist before I have an organ removed from my body. They are squeezing me in to see the actual doctor on May 6.

More Symptoms

Since the HIDA scan and discovering the magnitude of my gallstone, I’ve been hyper-aware of every little ache and pain and discomfort in my body. I am not sure how much is just psychosomatic and how much might be related to either the HIDA scan irritating my gallbladder, or just my condition getting worse, but I have started to notice a more persistent discomfort in the upper right quadrant.

Earlier this month we took a road trip from Arizona to Texas to see the eclipse (which was spectacular). I normally don’t have to watch my fat intake but I also don’t normally eat fast food for every meal. A couple days into the trip I had my first real attack in over a year (if you don’t count the HIDA scan). In a hotel room, trying not to wake the kids, unable to leave them alone in the room to pace around the hotel: not my preferred place to have a gallbladder attack.

I had another attack shortly after getting back from that trip, and have generally been having more symptoms since. There’s a persistent ache or feeling of pressure where my gallbladder is. Sometimes it feels more like a bruise, combined with a burning sensation like from an overworked muscle (ok, probably literally is an overused muscle). I’ve also started to feel faint discomfort in the gallbladder area if I take a really deep breath and hold it, or stretch my arms over my head.

Surgery is the right choice

All of this might sound unpleasant, and it is, but it’s also reassuring in its own way. It is a reminder that I am having surgery for a reason. Even though I usually can eat whatever I want, recent experience shows that is not always the case anymore.

I also was reminded over Christmas, as I shared the gallbladder saga so far with family, that my grandfather died of biliary cancer (I knew he had liver failure, but had not remembered that his cancer started in the biliary system.) Given that history and the fact that gallstones larger than 3 cm in particular are associated with chronic inflammation and an increased cancer risk, it makes sense to get the surgery even if I was not having other symptoms.

I still am very apprehensive about what life will be like after the surgery. I love eating fatty foods (who doesn’t) and I would hate to trade a normal life with occasional discomfort for constant bathroom issues and nothing but bland food. But I try to keep telling myself that it’s the right choice, and that very likely I’ll be back to normal, minus the cancer risk and occasional attacks.

Conclusion

So, apologies for the very long post. I hope if you’re someone who knows me that this was a useful update about what’s been going on. And if you are someone who doesn’t know me I hope this was a useful distillation of various information about gallbladder issues and treatment. I also hope this illustrates a few lessons that I have learned:

If you have a health issue, tell your doctor. Worst case it’s nothing, but you might find out that you have an enormous gallstone!
Ask for your images any time you have medical imaging (but be prepared for the CD and the weird image format)
Advocate for yourself and don’t assume any of your doctors will communicate with each other

I plan to write a follow up to this post some time after surgery, once I have the energy. I’m told recovery is usually 1-2 weeks, but many people feel fine within just a few days. So we will just have to see. Here’s hoping it all goes smoothly.

The Most Important Thing in the Universe

August 30, 2021 / Ryan / 1 Comment

One of the side effects of studying science is an appreciation for how insignificant humans are in the scheme of things. It is pounded into your head at every opportunity. We are microscopic compared to the Earth, and Earth is not the center of the solar system. Our solar system is one of billions in our galaxy. Our galaxy is to the universe as grains of sand are to the beach. The universe is unfathomably old, and the Earth has been around for a good chunk of that time but humanity is brand new. In Sagan’s famous cosmic calendar analogy, in which the age of the universe is compressed down to a single year, humans don’t appear until minutes before midnight on December 31. On the scale of the universe in both space and time, humans might as well not exist.

Apart from a thin film of life at the very surface of the Earth, an occasional intrepid spacecraft, and some radio static, our impact on the Universe is nil. It knows nothing of us.
Carl Sagan

This is all true, and it’s important to teach people, especially people who plan to make it their business to study the universe. You need to face reality even when it makes you uncomfortable.

However, it’s a little alarming how gleefully some people like to drive this point home. There’s a sense of smug superiority, a feeling of being somehow above the petty things that concern “ordinary” people. I find this is especially true of certain fields (you get this much more from the physical sciences than biological and social sciences) and certain types of people (especially those who think they have something to prove).

As I have gotten older, I’ve started to realize that despite good intentions, this “minimize humanity” mindset leads to its own flavor of wrong-headed thinking. People begin to mistake feeling smart for being wise.

The test of a first-rate intelligence is the ability to hold two opposed ideas in the mind at the same time, and still retain the ability to function.
F. Scott Fitzgerald

This is one of those cases that Fitzgerald is talking about. Humans are indeed insignificant in both space and time when compared to the universe. But at the same time, we are far more important to each other than the distant reaches of space and time. Both of these things can be true. “Meaning” or “significance” are not laws of physics, they are human constructs. We as humans get to decide what is significant, and the scale of the universe is not the appropriate comparison. Our lives occur on the time scale of decades, and on the spatial scale of a tiny fraction of the surface of the Earth. So what if that’s small compared to the universe? It’s big for us.

Minimizing humanity might help avoid mistakes like saying that the sun goes around the Earth, or that we are at the center of the universe since most galaxies are flying away from ours. But it can also lead to dangerous reasoning like: If humans are insignificant, then how can we be responsible for climate change? Even if you accept that there are enough of us that collectively our actions are significant enough to mess up the planet, it can lead to a nihilistic view that it doesn’t matter. After all, we’re just a flash in the pan. Earth will survive whatever we do. Some species might go extinct with us, but others will adapt and flourish. So who cares? The sun will eventually become a red giant and consume the Earth, and the universe will eventually succumb to entropy. On the scale of the universe nothing matters, everything is insignificant and transient. So if nothing matters why should I care about anyone other than myself and my immediate gratification? A brief bit of hedonism before I return to the nothingness from whence I came.

Of course, that’s a cop out. An avoidance of the uncomfortable responsibility of deciding for ourselves what is meaningful. It’s easier to throw our hands up and say “well, nothing matters.”

LIfe has no meaning a priori. Before you come alive, life is nothing; it’s up to you to give it a meaning, and value is nothing else but the meaning you give.
Jean-Paul Sartre

Man is condemned to be free; because once thrown into the world, he is responsible for everything he does.
Jean-Paul Sartre

This minimization of Earth and of humanity also can trick otherwise smart people into fixating on the wonders of the universe and neglecting the wonders around them. I have been somewhat guilty of this. I was fascinated by science from an early age, and started studying space right when I got to college. I thought I had a pretty good understanding and appreciation for “mundane” stuff and was more interested in the exciting weirdness of the rest of the universe. But of course, I knew almost nothing about life, and now as I get older and have more life experience, I have come full circle: I feel less drawn than I used to be to the mysteries of space which have no bearing on human life, and am more interested in the richness of regular everyday life.

My point is not that we should not marvel at the universe, my point is that, in looking up at the stars we must try not to devalue the wonders that are right in front of us. The things that matter and can bring us real happiness are right here on Earth.

Think of your own life. All the memories and experiences that are stored in your brain. All the relationships, all the places you’ve been, all the things you’ve done. Think of your proudest moments, your greatest disappointments, your loves and your losses. Think of the things you have created, the mark you have made on the world, whatever forms that takes. Just take a moment to recognize the richness of your life and everything you know and have done. These things don’t lose their significance because the universe is vast and ancient. The universe doesn’t get to decide what is significant to you. You do.

Now consider: there are 7.9 billion other people on this planet. If you looked at one face every second it would take 250 years to look at everyone (and in that time, billions more would be born). Every two years, humanity’s collective experience spans more time than the age of the universe. That’s a lot of people. And what really boggles the mind is that every single one of them has just as rich and vivid and intricate a life as yours. Every one of them has their own favorite places and favorite foods, their own family, their own memories. Every person has things they have created, songs they have sung, dreams they have pursued. Every person has their own story.

Every place and every thing in the world plays a role in countless people’s stories, and has a story of its own. That big tree in the park is just a tree to you, but to someone it’s where they shared a sunny afternoon with their first love. To someone else it is where they were sitting when the doctor called with bad news. To someone else, it’s where they take their family photo every year.

I think about this a lot when traveling or looking at a map: every place that you see is someone’s home. Every house, apartment, street or park, is at the center of someone’s whole life. When you really think about this and stop relegating these things to mere scenery, the world feels anything but small.

It feels even larger when you fold in time as well. Consider not just the significance to people alive today, but the countless lives going back tens of thousands of years. We hear so much about how all of human history is the blink of an eye in geologic or cosmic time, but at the human scale, our history is almost unimaginably deep. We’ve been here long enough for every single patch of the earth’s surface to be rich with human history. Most of it forgotten, but all of it real.

Lately I’ve gotten much more interested in history, especially ancient history and prehistory for this reason. Just as it is eye opening to think of all the places you visit on vacation as someone’s home, it fires my imagination to consider people as real and complex as you and me living thousands or tens of thousands of years ago. Real people peering out over the wilderness of an uninhabited continent, or cautiously trading with tribes of Neanderthals, or waging a forgotten war on the ground we walk every day, or struggling with the timeless day to day tasks of raising a family. I feel the depth of history stretching out into the past, at once unreachable but intimate in our shared humanity.

I came across this on my social media feeds after I had written this blog post.

Yes, we humans are insignificant on a cosmic scale, but so what? We don’t live on that scale, we live on a human scale. Nihilism is a cop-out. We are responsible for deciding what is significant and meaningful, and as anyone who has held a newborn can tell you, it has nothing to do with size or age. You can hold the most important thing in the universe in your arms.

For small creatures such as we, the vastness is only bearable through love.
Carl Sagan

Election Eve Thoughts

November 3, 2020 / Ryan / 0 Comments

It has been a hell of a year. It is not the end of the calendar year, but tonight is the night before Election Day and it feels like the nation is balanced on the edge of a precipice. It feels like all the horrors of the last four years, and particularly of this last year, have been building to this point and now we are collectively holding our breaths. There are another couple of months in the year, but this feels like the right point to pause and reflect. It feels important to capture how I’m feeling right now, as we sit here at the brink and wonder what happens next.

I have been very quiet here on the blog. My last post was a video game review in July, and before that a post in April about the pandemic and how it hadn’t been too bad so far for me and my family. Since then, a lot has happened, and I’ve had a lot of thoughts about it that I would normally share here, but at a certain point it got to be too much. What could I say in the face of all that was happening? What good would it do to add my voice to the noise? I would just be echoing what everyone in my carefully curated social media bubble was also feeling and saying. How could I find the words to do justice to the pain and suffering that others are feeling, from which I am sheltered by layer upon layer of privilege?

I still have all of those doubts, but as I sit here freaking out about the election, I need to do something. Writing helps me process, so I’m going to write. I am going to resist the urge to rehash everything terrible that has happened in the last 6 months, or for that matter the last 4 years. You have all lived through it. You know.

I’m just so tired. The constant anxiety and outrage and despair and depression as I watch my country and the world succumb to the worst that humanity has to offer has culminated in sheer exhaustion. That is the other reason that I have not written much here, or anywhere else, this year. I’m just emotionally and mentally exhausted, so by the end of the day when I have time to write, I don’t have the energy to do it.

I’ve been trying to be kinder to myself about that. In this of all years, I have been trying to stop the negative self-talk that says I must spend every moment being productive. The last few years, and especially 2020, have taught me the value of “mindless” entertainment. It is ok that I just want to curl up and eat comfort food and play video games or watch dumb shows. Seeking out comforting non-productive activities is fine. There is nobody but myself who sets the expectation that after working all day and parenting into the evening, I should then do something “productive” instead of something fun and relaxing. Maybe someday I will have the energy for that, but right now I don’t and that’s ok.

I don’t know what will happen tomorrow. Odds are that Biden will win and Trump will lose, but the odds favored Clinton in 2016 too. That collective trauma, and the subsequent damage that Trump has done to to country and to each of us over the last 4 years, will be with us for a long time. I deeply hope that tomorrow is an absolute incontrovertible Biden blowout. Even if that happens, I worry about the violence that Trump’s cult will inflict, and the damage a lame-duck Trump and Republican senate will do. If the election is close, it’s going to be a huge mess. Trump has already said he will declare victory prematurely and fight against counting all of the votes cast, turning to the Republican-stuffed courts to overrule the will of the voters. If Trump wins, I don’t know what I will do. It will affirm the lesson that we all learned in 2016, that a huge portion of this country is so much more selfish and hateful than we want to believe. I don’t know how I can live in a country that looks at what Republicans have done in the last 4 years and says “yes, more of that please.” But I also don’t know how I could leave.

Another thing that this year in particular has taught me is the value of focusing only on those things I can control. There’s a reason the famous “serenity prayer” is so famous. Along the same lines, in Buddhism they talk about how much of the suffering we experience comes from “clinging” to the way we want things to be, rather than facing the way things are. It is a lot easier said than done, but there have been moments this year when things got to be too much that I have taken some solace in narrowing my focus on what I can control.

I cannot control what happens tomorrow. I have done what I could by donating, writing letters, and phone banking (though I am disappointed in myself that I didn’t do more calls), but in the end the results of the election are out of my hands.

I think what makes this so hard is that with the memory of 2016 fresh in my mind, and the events of this year so relentlessly bad, I’m afraid to hope. But, in the end I do hope. I hope that the country steps back from the brink, that new leadership finally gets the pandemic under control and stops the needless loss of life, that this election is remembered as the point where the country had a stark choice and chose wisely, and began the long work of fixing what is broken. I hope that soon we can all rest a little easier, and turn our efforts toward that work with a little more optimism. I hope.

Finding Balance – Part 2: Yin and Yang, Happiness and “Heroes”

January 16, 2020 / Ryan / 2 Comments

In my previous post I wrote about how the book “Feeling Good” helped clue me in on the major causes of my (mild) mental health issues. It turns out, the need for approval from others and the constant pursuit of external achievements in lieu of real self esteem can lead to anxiety and depression. Right after reading that book, I read a collection of essays, speeches, poetry, and other short writing by Ursula K. Le Guin called “Dancing at the Edge of the World”. Some of the insights in Le Guin’s writing really resonated with what I had just read in Feeling Good, and I’m still thinking about them.

Dancing at the Edge of the World is a strange book, and I wouldn’t recommend reading the whole thing to anyone but the most die-hard Le Guin fan. Some of the essays are brilliant but quite a few are academic and esoteric, and I suspect most of the speeches work better as speeches than on the page. However, despite the challenges, I found it provided the clearest summary I have yet read of the core themes and philosophy underlying Le Guin’s work. In particular, the interconnections between her interest in Taoism, her feminism, her writing, and her general philosophy of life.

As far as I can tell, Le Guin didn’t believe in an afterlife or God or anything supernatural, she just uses Taoism as a way to recognize a dichotomy that pervades much of society between those things traditionally grouped under Taosim’s “Yin” and “Yang”:

Yin	Yang
Dark	Light
Passive	Active
Moon	Sun
Gathering	Hunting
Containing	Penetrating
Protecting	Attacking
Wilderness	Civilization
Nature	“Man”
Circle	Line
Flexible	Rigid
Consensus	Authority
Decentralized	Centralized
Soft	Hard
Home	Exploration
Repetition	Novelty
Stability	Change
Female	Male

Throughout the essays in the book, Le Guin makes the case that our society is profoundly and deeply biased toward the “yang” or masculine attributes and often downplays the importance of “yin” and those things traditionally considered feminine.

This should come as a surprise to nobody, but the framing in terms of Taoism’s dichotomy was a new spin on it for me. It takes our society’s misogyny and links it up with other biases, some of which are listed above, that may not be as obviously gendered.

She also digs deeper and addresses why there is a pervasive bias in favor of “yang” traits, and proposes that it links back to storytelling. In particular, the following quote from her brilliant essay “The Carrier Bag Theory of Fiction” really resonated with me. In the essay, she discusses the very reasonable theory that, contrary to long-held consensus (among mostly male anthropologists), it is likely that the first tool used by early humans was not the (masculine) spear, but the (feminine) “carrier bag”: Something in which to put gathered food.

It is hard to tell a really gripping tale of how I wrested a wild-oat seed from its husk, and then another, and then another, and then another, and then another, and then I scratched my gnat bites, and Ool said something funny, and we went to the creek and got a drink and watched newts for a while, and then I found another patch of oats…. No, it does not compare, it cannot compete with how I thrust my spear deep into the titanic hairy flank while Oob, impaled on one huge sweeping tusk, writhed screaming, and blood spouted everywhere in crimson torrents, and Boob was crushed to jelly when the mammoth fell on him as I shot my unerring arrow straight through eye to brain.
That story not only has Action, it has a Hero. Heroes are powerful. Before you know it, the men and women in the wild-oat patch and their kids and the skills of the makers and the thoughts of the thoughtful and the songs of the singers are all part of it, have all been pressed into service in the tale of the Hero. But it isn’t their story. It’s his.
Ursula K. Le Guin

Humans are storytellers, and so we are biased toward the sorts of actions that make for an exciting story. Things with danger, adventure, change, and heroes. And when all of those story-worthy things are culturally defined as the domain of men, it’s no wonder that the result is a bias in favor of men and anything seen as masculine, and against women and anything seen as feminine.

LeGuin goes on to highlight how this bias toward the “masculine” is pervasive in science fiction, choosing in particular to pick on Arthur C. Clarke’s 2001: A Space Odyssey:

Where is that wonderful, big, long, hard thing, a bone, I believe, that the Ape Man first bashed somebody with in the movie and then, grunting with ecstasy at having achieved the first proper murder, flung up into the sky, and whirling there it became a space ship thrusting its way into the cosmos to fertilize it and produce at the end of the movie a lovely fetus, a boy of course, drifting around the Milky Way without (oddly enough) any womb, any matrix at all? I don’t know. I don’t even care. I’m not telling that story.
Ursula K. Le Guin

I highlight these two quotes not just to convince you that you should go read everything by Le Guin (though you should) but because they were particularly resonant for me given the circumstances in which I read this particular Le Guin book. I was on paternity leave, taking time off of work to take care of my growing family and was feeling anxious about it. Why was I feeling anxious? As I discussed in my previous post, taking a lot of paternity leave is not as widespread as it could/should be in my workaholic field (or in American society in general), and I had some level of irrational paranoia that people would disapprove of how much leave I was taking.

The Le Guin essay helped to get at a reason for this paranoia: taking paternity leave is an act that, at least temporarily, prioritizes traditionally feminine roles (caring for family, staying at home, domestic life) over the more “masculine” roles (being the primary earner, going to work, prioritizing career, etc.) that I have been taught that people expect from me, even if I would prefer something more balanced. And as Feeling Good taught me, I’m overly susceptible to letting my mood get wrapped up in speculations about what people think of me.

It’s not just paternity leave; Le Guin’s framing of our cultural misogyny in terms of bias toward “heroic” or “yin” or “masculine” traits resonates in other ways.

In the section of Feeling Good that tries to help the reader overcome the obsession with achievement, there is a fictional dialogue that pits a chronic overachiever against their former high school classmate who is happier and less addicted to achievement. The overachiever went to a prestigious school, got a PhD and has a lucrative, jet-setting, influential job. The more well-adjusted person is a high school teacher and coach with a family and a happy, more locally-oriented life. The point of the dialog is to take the idea that achievement (traditionally defined) makes a person more worthwhile to its ugly logical conclusion to show just how absurd it is, so the overachiever comes across as a completely unreasonable jerk.

Unfortunately, although it’s not a perfect match, I do see some of myself in that jerk. Even though the overachiever in the dialog is supposed to (and does) come across as an awful and unpleasant person, I’m ashamed to admit that there is a part of me that still thinks they have a bit of a point. It whispers in the back of my mind that, really, if you think about it, your life is more worthwhile if you are famous and influential and achieve things that will last long after you’re gone.

And this brings us back to the bias not just toward masculine traits, but “heroic” traits. A hero is someone who is famous and influential, whose actions changed the world, about whom stories are told. In short, a hero achieves a sort of immortality. Conscious or not, I think that taste of immortality is why our society has a bias in favor of these traits.

(I feel like I’m lacking the appropriate words here. “Heroic” has positive connotations, but what I want is a word that means roughly the same thing but is more neutral, because my whole point here is that equating “heroic” traits with positive, and therefore implicitly saying that “non-heroic” traits are negative, is a big part of the problem. Since language is failing me, I’m going to keep using “heroic” as shorthand. So, just pretend I have found a less-loaded version of the word and am using that instead.)

Humans learn by telling stories, and almost every story that we tell reinforces this bias, to the point that it becomes a real challenge to conceive of stories that really center on the “yin” attributes. Le Guin talks about this challenge, and I think her conscious effort not to tell variations of the same old heroic, masculine story, while still working in the fantasy and sci-fi genres that are so dominated by that story, is a large part of what makes her stories so refreshing and distinctive and interesting. (It helps that she’s a good enough writer to pull it off…)

Alas, not all authors are Ursula K LeGuin, so we exist in a culture that is steeped in stories that almost all reinforce the same traits. Reflecting on myself, and my own motivations, it’s hard to deny the influence, and it is also hard to deny that a lot of the angst I’ve been working through in the last few years has been a process of breaking through those patterns of thoughts and values and acknowledging that I am in a stage of life where, essentially, my focus is shifting from “yang” to “yin” and that that’s okay.

Though I don’t love to admit it, part of my desire to become a scientist was the alluring myth of the “great scientist” whose amazing contributions to science not only advance our understanding of the universe, but also earn a place in the Pantheon of great scientists. Of course in reality, science is a collaborative effort where most big discoveries are made by teams, but that doesn’t fit the narrative. That doesn’t provide the story with a singular hero.

Not only is science a team effort, I have also discovered that I don’t really like being the leader of the team. I’m much more comfortable and effective in a supporting role. For example, my work to improve the accuracy of ChemCam’s measurements feeds into almost every paper and discovery the team has made. The cumulative impact is almost certainly greater than if I had focused my efforts on leading a few scientific papers. And yet it has been really difficult to come to terms with the idea that I prefer doing “behind the scenes” work. I feel guilty that I am not writing amazing papers that end up getting all the attention of other scientists and the press. There’s a part of me that is still the anxious grad student, irrationally worried about what my advisor would think of my path and my preference for the less flashy work (there’s that approval seeking again). I hate that I feel a pang of jealousy when friends publish big, attention-grabbing papers. A part of me feels like a failure for not living up to the “great scientist”myth. The bias toward “heroic” or “yang” traits, toward constant striving for the next big achievement, is strong.

It shows up in my goals for the future as well. I’m not content to just want to be a good science communicator, there’s a part of me that will see it as a failure to be anything less than the next Carl Sagan. I’m not content to just try to write a book, I’ll be a failure unless I am the next George R.R. Martin. Of course, this part of me is almost entirely counterproductive. It has not spurred me to make great strides in either of these areas, it just needles me enough to attempt things and then abandon them as I stress out about the impossible expectations I impose on myself. It maintains a constant cycle of anxiety and disappointment in myself, but never gets channeled into a truly motivating force for long enough to break free and rise to the level of something positive like inspiration. My hard drive is littered with fiction and nonfiction writing projects abandoned in the first chapter. Heck, even this blog has a good number of aborted posts in varying states of completion, in large part because of the unrealistic expectations I set, and the paranoia about what people will think. (This blog post came perilously close to being one of them.)

The good thing is that with the perspectives afforded by Feeling Good, Dancing at the Edge of the World, and more generally the realignment of priorities that comes with maturing and having kids, I am gradually starting to move toward a more balanced attitude.

A good example of this is how I feel about being an astronaut and human space exploration in general. In college when people asked me if I would go to Mars if I was given the chance, I said yes with minimal hesitation. I even considered applying to be an astronaut a few times. But as I have gotten older and built a family and a life and grown to appreciate the Earth, my answer has changed. The temptation is still present – the bias is strong – but it’s no longer an easy decision. I have a lot more to lose. My default answer would now be “no” and it would take convincing and a lot of caveats and guarantees to change that to a “yes”.

A corollary to that is how my attitudes toward building a Mars base have changed. For a long time I was strongly in favor of it, both scientifically and as an “insurance policy” in case of a global catastrophe here on Earth. Now I see the idea of Mars as a “lifeboat” for Earth as deeply flawed and problematic. It provides a comforting fantasy as if it is a valid option, and people cling to it rather than facing the more important but more difficult challenge of changing our society so that we become good stewards of the wonderful planet we live on. People gravitate toward the “yang” option (exploration, colonization, risk, heroism) and shun the “yin” option (staying where we are, taking care of our home). We’re sitting here destroying the literal paradise that is Earth and saying, “Don’t worry, the billionaires will save us. With their rockets we could maybe eke out a miserable, dark, cold, dusty, claustrophobic existence in underground shelters on Mars,” as if that’s a solution.

Anyway. I’m getting off track. The point is, my perspective on things is changing, and one way to frame that change is as a shift from thinking that is strongly biased toward the “heroic”/”masculine”/”yang” traits to an attitude that is hopefully more balanced. I don’t need to be the great scientist, I am happy to support others. I don’t want to colonize a new world as much as I want to take care of our home. I am not that interested in jet-setting around the world, I’d rather stay home and enjoy time with my family.

A major theme in this shift of perspective can be summed up as coming to peace with the idea that I am not exceptional, and that is ok. To be clear, I’ve never had the kind of self esteem that allowed me to go through life thinking “I’m exceptional.” But despite that, I have spent a lot of angst convincing myself that I need to make a mark of the world so that when I’m gone there will be some evidence that I lived. It’s that lure of the immortality of the “hero.”

I’ve achieved some things that I’m proud of and my name is on a number of scientific papers that will hopefully be read for a long time into the future. Or if not read (let’s be realistic), then at least they’ll exist. There will be evidence in the world that I existed and did a certain type of science. But when push comes to shove, I’m a pretty boring, normal, privileged white dude. My life is mostly like the life of millions of others. When I am gone, my friends and family will miss me, but then they will go on with their lives and that will be it.

There’s a flaw in the sort of thinking that says that you’ve only left your mark on the world if people remember you, or if you did something that has your name on it. That’s a very “hero-biased” way of looking at things. Sure, writing the great American novel or making a major scientific discovery or walking on Mars or becoming president or any number of other ways to be famous and influential can guarantee that you’ve left some sort of mark, but that’s not the only way.

The truth is that we are all constantly making our marks on the world, whether we, or others, recognize it. We should think of our influence not as a discrete achievement or event that plants a flag and announces “here is my legacy” but more like concentric ripples, expanding away from ourselves into the world as we move through our lives. Everything we do has an influence, and the world is too large and chaotic to know when any given action or choice will go on to have a profound effect and when it will amount no effect at all. All we can do is try to make good choices, be generous with our time and our resources and ourselves, and try to leave the world better than we found it.

I’m not saying that we should not pursue big goals, nor am I implying that simply being a good person is sufficient to effect positive change in the world. I’m saying that the amount of recognition that we receive for the things we do has little to do with the significance of the legacy we leave when we are gone. I can work hard and get recognition for achieving major goals like publishing scientific papers and writing books, but it’s entirely possible (and perhaps more likely) that the greatest impact I’ll have on the world is through things that get much less recognition like raising my kids, donating to good causes, and doing political volunteer work.

More important than recognizing that I don’t have to do things that get recognized by others to leave the world a better place is the recognition that no matter what I do, big or small, my legacy will be ephemeral. Here I’ll bring in another book I recently read: Conqueror, by Conn Iggulden. It’s the 5th book in a historical fiction series about Genghis Khan and his successors. I was not expecting to find insight into the topics of this essay in a book about Mongol warlords, but books can be surprising that way. Conqueror focuses on Kublai Khan’s rise to power, and the final lines of the book are Kublai talking to his son:

“I would like to change the world,” he said.
Kublai smiled, with just an edge of sadness in his eyes.
“You will, my son, you will. But no one can change it forever.”
Conqueror, Conn Iggulden

Maybe part of this process that I’ve been going through, this shift in perspective, is a growing acceptance of the fact that life is ephemeral and a realization that trying to deny that fact is the recipe for a lot of pointless angst. Taken the wrong way this could be seen as nihilistic and depressing, but it’s actually kind of liberating.

I have been trying to pay attention to what actually makes me happy and here’s what I found: happiness comes from the ephemeral, from living in the moment, from being so caught up in the present, in the sensations, the feelings, the task at hand, that self-consciousness falls away. You can’t think your way to happiness. You can’t set it as a goal to achieve.

This is not a particularly new insight. None of this post is, really. But it’s one thing to hear some of these things in the form of quotes and platitudes and another to really internalize them. To use a physics analogy, it’s the difference between being given the equation and deriving the equation from first principles.

Looking back over this post, I worry that it comes across as implying that “masculine”/”yang” traits are toxic and “feminine”/”yin” traits are good. That’s not my intent. It’s good to have goals, to try to achieve great things. But the point is that our culture, our stories, my educational background, my professional life, all have a strong bias toward the “yang.” Toward constantly striving to live up to the “heroic” ideals. This often leads to neglecting the richness of the “yin” side of life, which is a recipe for the anxiety and depression that I’ve been struggling with.

I’ll end with one more relevant quote from a book I recently read. This time from “A Little Life” which is one of the best books I’ve ever read but is also devastatingly sad. It deals with what makes life worth living even in the face of horrible suffering, and at one point the main character thinks:

It had always seemed to him a very plush kind of problem, a privilege, really, to consider whether life was meaningful or not.
Hanya Yanagihara, A Little Life

This quote puts its finger on one of the reasons I feel uncomfortable about these long, over-earnest, self-indulgent, pseudo-philosophical blog posts. I have a wonderful life, and it is because I don’t have to do things like work three jobs or worry about whether my family is safe that I have the luxury of analyzing all the reasons why I sometimes feel anxious for no good reason. It makes these blog posts feel embarrassing and faintly obscene even though (or perhaps because) they do capture and help me process the thoughts that rattle around in my head. So, just for the record, I understand that posts like this warrant at least some eye rolling, especially from people with real problems.

If you’ve made it this far, thank you for letting me indulge in this privileged rambling. This post in particular was difficult to write. It ended up far longer, and took far longer to write, than expected. It makes me uncomfortable to post this, but that discomfort probably means I’ve hit upon some important themes that are worth posting. Bottom line, here are my take-away lessons:

My life is shifting from a focus on achievement and a general bias toward “yang”/”heroic” type traits to a focus on home and family and a greater emphasis on the “yin” side of things.
Despite deeply ingrained biases in culture, stories, professional settings, etc., the shift toward a more balanced life is not only okay, it’s healthy and good.
That said, some of my anxiety comes from the conflict between that cultural bias and my shifting priorities.
Stressing out about leaving a legacy through my actions is just a recipe for anxiety. Life and everything in it is ephemeral, and fighting against that truth is a losing battle. Better to focus on living in the moment, accept what is happening in that moment without judgement, and do things because I enjoy the process rather than to achieve some lofty goal.

Intrinsic Value

May 20, 2019 / Ryan / 2 Comments

Immigrants and asylum seekers provide a net economic benefit to our country.
Universal health care would be less expensive than our current system.
It costs less to provide affordable housing than it does to leave people homeless.
No one who works full time should have to raise a family in poverty.
Every dollar spent on NASA returns about ten dollars to the economy.

We have a problem with how we think about the value of things. As a society, and as individuals in that society, we are almost incapable of talking about why something is worthwhile or the right thing to do without talking about its monetary value. Or, if not monetary value, then at least pointing to its usefulness.

This makes sense. Our civilization is made possible by the fundamental notion that we understand the world around us by studying it and measuring it. If you can’t quantify something, whether it is the mass of an electron or the return on an investment, how do you know that it’s real? There are countless examples of the folly that comes from ignoring rigorous science and instead operating by gut feeling alone. That sort of thinking is what gives us astrology and homeopathy and antivaxxers and climate change deniers. In many ways our reliance on quantifiable facts is a very, very good thing.

But there is an important distinction between an observable quantity grounded in the real, physical world, and the observation of non-physical quantities that we ourselves assign to things. There’s no law of nature that shows that something should have a value of $10. Monetary value is a convenient abstraction that allows us to more efficiently exchange goods and services. Some might argue that there are mathematical laws that show that a certain item should be given a certain monetary value. After all, we have the field of economics, don’t we?

But we must always remember that Economics is a field of study dedicated to a complex topic that we ourselves invented. It behaves in many ways like a physical science studying fundamental truths, but it applies that mathematical approach to studying the nuances of an artificial concept. Don’t get me wrong, those nuances are very important. Economics has meaningful things to say and implications for our lives. But economics is not physics.

It is easy to fall into the trap of assigning a numerical value to a qualitative concept and then relying on that value so exclusively that we forget that there is any other way to conceive of value. We create an imperfect model of reality and then forget that reality is not the model. IQ is not the same thing as intelligence. Standardized test scores do not measure everything a student has learned. A high Body Mass Index does not guarantee that you are fat. A low credit score doesn’t necessarily mean you aren’t trustworthy.

Our insistence on talking about everything in terms of monetary value or economic benefit is an extreme case of mistaking the comfortingly simple artificial metric for inconveniently messy objective reality. We are so deeply steeped in a capitalist society that prioritizes monetary value over everything else that it is difficult to even conceive of other types of value. We are like those cultures who do not have a word for the color blue and therefore are challenged to even recognize it. We lack the framework to fully conceive of or acknowledge other types of value without consciously exerting effort to do so.

A distressingly large portion of our society has taken this a step further, and not only prioritizes monetary value above all else, but actually uses it as a proxy for moral virtue. Morality is so uncomfortably hard to define around the edges, but net worth is nice and straightforward. If someone is poor then obviously they made bad choices or didn’t work hard enough. If someone is rich, it must mean that they are reaping the rewards of hard work rather than fortunate circumstances.

I was watching “Won’t You Be My Neighbor,” the documentary about Mr. Rogers the other day, and it had a disgusting moment showing talking heads on Fox News blaming Mr. Rogers for a supposed “entitlement culture” among kids these days. How dare he tell a generation of children that they are special just for being themselves? Why should these kids think they are special if they haven’t earned it? What a bunch of fragile little entitled “snowflakes.” The documentary then used the exact words I have had in mind since I started writing this essay: “intrinsic value”. The idea that everyone is special and worth caring about, not because they have earned it, but because they are human beings with intrinsic value. That everyone deserves to be treated with dignity and respect and celebrated just for being uniquely themselves. The documentary points out the deep Christian roots of this message: Mr. Rogers was a minister after all, and the show was his way of preaching the fundamentals of his faith, without ever mentioning religion.

There is not much that I find more depressing that witnessing half of our country give up on this idea of intrinsic value and human dignity while claiming to be Christians. They insist on preserving the sanctity of life in the womb (sometimes at the expense of the life of the living woman carrying that child), but once that child is born it’s a freeloading, entitled snowflake that needs to prove its worth.

These false Christians question whether people deserve health care, a home, food on the table, education, if they haven’t “earned” them. A little while back there was a Republican congressman who tweeted:

Yes! It absolutely should be. It is a fundamental sickness in our society that would even question whether some people deserve to eat.

Imagine if we lived in a society where people actually acknowledged the intrinsic value of other humans. Where everyone was guaranteed food, shelter, a basic income, healthcare, and a good education. Imagine the explosion of creativity, innovation, happiness and well-being that would result. Imagine allowing everyone to spend their one precious life doing what they love, even if it doesn’t pay well, or at all.

Imagine actually valuing human life.

Yes, it would cost money. Billionaires would have to pay some taxes. But it is not at all clear to me that the economic cost would be greater than the economic benefit, and it is absolutely clear that the intangible benefit, the lives saved, the lives raised out of poverty and misery, the freedom from suffering, would be worth it.

It’s hard to get there from here. We live in the real world, where the monetary cost of things is an important consideration. I understand that. I understand that even if we do acknowledge intrinsic value, we often need to be able to fall back on economic value for the sake of argument, to convince those that may not share our values. That’s ok. Often the right thing also makes good economic sense too. But we must not fall into the trap of making the economic argument so much that we forget the real underlying reasons for our positions.

Immigrants and asylum seekers provide a net economic benefit to our country. If they did not, would that change whether they deserve a safe place to live and raise their families?
Universal health care would be less expensive than our current system. If it was more expensive, would that change whether or not everyone deserves to be healthy?
It costs less to provide affordable housing than it does to leave people homeless. If it cost more, would that change whether people deserve a roof over their heads?
No one who works full time should have to raise a family in poverty.* Does someone who does not or cannot work full time deserve to raise a family in poverty?
Every dollar spent on NASA returns about ten dollars to the economy. If there were no economic benefits or spinoffs, would it be worthwhile to explore the universe?

*This line is taken directly from the Democratic party platform

The Fire at Notre Dame

April 26, 2019 / Ryan / 0 Comments

Notre Dame de Paris burned last week. As I watched along with the rest of the world, helpless to stop the loss of centuries of history, there were moments when I had to fight back tears. It may seem strange for an atheist and scientist to feel the loss of a religious building so acutely, but I love cathedrals, and Notre Dame in particular holds a special place in my heart.

I love cathedrals because, in attempting to build structures invoking the glory of God, humans instead have demonstrated our own potential. Cathedrals show us that despite the cruelty and pettiness and meanness that we too often see in the world, we are also capable of breathtaking beauty when we work together toward a common goal. They demonstrate that we can do anything if we set our minds to it, even if it is the work of many generations. Cathedrals show us that physics and engineering can work hand in hand with artistry, and in fact can become art themselves. When I walk into a cathedral, I am in awe, not of God, but of humans. Imagine what we could do if we once again devoted our time and ingenuity and resources and hard work to a common goal. What could our modern cathedrals be?

Notre Dame de Paris is special to me. I first visited in the summer of 2001 on a whirlwind trip to Europe with a bunch of other high school kids as part of the People to People program. To give an idea of how little I had seen of the world up to that point, one of the highlights of the trip for me was seeing mountains with snow on top of them. I had spent my whole life in the midwest and the biggest mountains I had ever seen were the Appalachians.

Notre Dame was the first cathedral I had ever seen, and it took my breath away. The experience of entering from the hot, bustling noise of a summer day in Paris through the intricately carved doorway into the cool, quiet, interior, of looking up into that impossibly high vault, then down the length of the cathedral to the distant altar, of marveling at the stained glass windows, is one that left its mark on me. Of all the experiences from that trip, that first astounding view of Notre Dame became the touchstone for the whole trip for me. It encapsulates the wonder I felt at the sudden broadening of my horizons, the internalization of what had until then been just the abstract knowledge that the world is huge and fascinating and full of rich history beyond anything I had experienced.

The woman in blue, singing beneath the rose windows.

I have had the privilege of returning to Paris twice on work trips, once in 2012 and again in 2015, and both times Notre Dame was one of the first places I visited. In 2012, I went to Notre Dame immediately after arriving and dropping my bags at my hotel. It was late afternoon when I got there and I inadvertently walked in on a service. There was a woman in a blue robe on the dais, illuminated by spotlights mounted high up on the walls, and her voice was impossibly beautiful in that impossibly beautiful building. On that same trip, I returned to the cathedral later with two colleagues from work, Ken Herkenhoff and Nathan Bridges. We waited in a short line and then climbed up the towers to the walkways that afford the classic views of Paris, with the chimeras in the foreground and the Eiffel tower behind. From that walkway you also get a stunning view of the roof and spire of the cathedral, all of which are now gone. Nathan is gone now too; he passed away unexpectedly two years ago. Whenever I see Notre Dame, I am reminded of him.

The fire at Notre Dame is shocking because we like to think of monumental buildings like cathedrals as eternal. Yes, we know intellectually that in the past they have burned and been renovated and rebuilt and expanded, but that was all in the past. We have a certain arrogance that now, in our modern era, disasters like that don’t happen anymore. There’s a feeling that we live in a post-historical world that is somehow special and different from all the time that came before, and that we will be able to preserve things as they are forever. Of course that’s nonsense. Anyone who is paying attention to what is happening in the world should be all too aware of how the world is changing.

Even without superstition, it is hard to not to see the symbolism of the fire. It reminds me of the poem Ozymandias, about the folly of believing that current glories can last forever. It is a reminder that even the most apparently permanent human creations can be lost at a moment’s notice, just as a human life can be suddenly lost, and that we should appreciate and cherish the beauty in our lives while we have it. The fire represents the loss of a beautiful and irreplaceable relic of a bygone era, but there is also an element of hope. More of the great old structure survived than many expected during the blaze, thanks to those who took swift action to limit the damage, many risking their own lives in the process. What looked like total destruction has turned into a chance to rebuild, honoring the long history of the structure but also a chance to put the mark of our current era on it, preserving a record of ourselves in the long history of the edifice.

There are lessons here to be learned.

How did I end up an angry liberal activist?

October 31, 2018 / Ryan / 2 Comments

Frodo: I wish none of this had happened.

Gandalf: So do all who live to see such times, but that is not for them to decide. All we have to decide is what to do with the time that is given to us. There are other forces at work in this world, Frodo, besides the will of evil.

A few weeks ago, I wrote a furious blog post about anger. I was livid about the impending confirmation of Kavanaugh to the Supreme Court. I was so stressed I was not sleeping well, during a week when I was already sick, and I needed to write to get some of the emotion out of my head and onto the page.

The post had some good writing in it, if I may say so. I talked about how the anger of the Right is a petty and insular anger, a defensive curling-inward, seated in fear of losing a privileged place in society. I contrasted that with the anger of the Left, and particularly of those who have not traditionally held power. I had fun with the image of liberal anger as a volcanic eruption, long dormant but growing beneath the surface, unstoppable once unleashed and leaving the world changed but fertile, ready for new growth to replace what was burned away.

It was cathartic to write, but I took it down after posting it for less than a day. If I’m being honest, it was a bit over the top. I decided that, in the midst of all the negativity, my righteous anger was not was the world needed at that time.

After taking down the post I asked myself a question: Why am I so angry? What is it about Trump and the Republicans that bothers me at such a visceral level that not only do I rage about it ad nauseum on social media, but it has driven me to become a genuine political activist, attending rallies and canvassing for the Democratic party?

Believe me, I have a lot of other things I would rather do with my limited free time. None of this is fun for me. I’m an introvert. I avoid conflict. I hate inconveniencing others. So activities like canvassing are very draining for me. I would much rather write and talk to people about things like my adorable toddler, or good books and movies, or cool science. I have a dozen other hobbies or interests that I’d love to spend my time on. But instead I am pouring my energy and time into politics.

Why? Why am I so angry and stressed out that I can’t sleep at night? Why not ignore politics and enjoy my life again?

These questions have been rattling around in my head since I took down that furious blog post, and I think I’ve finally figured out the crux of the matter. It’s because the modern Republican party is diametrically opposed to two of my most deeply-held core values: Truth and Empathy.

Truth

“The truth may be puzzling. It may take some work to grapple with. It may be counterintuitive. It may contradict deeply held prejudices. It may not be consonant with what we desperately want to be true. But our preferences do not determine what’s true.”

― Carl Sagan

As a scientist, I’ve dedicated my life to truth. My worldview is built on the idea that we can understand the world around us, even when it behaves in unexpected or counterintuitive ways, by observing, testing hypotheses, and making corrections when we find out that we were wrong. Science has also given me a healthy appreciation for how unbelievably much there is to know in the world. Nobody can be an expert in everything (alas), so we have to trust in the expertise of others while still thinking critically and, as Sagan famously said, demanding extraordinary evidence to back up extraordinary claims.

The corollary of placing a high value on truth is placing a high value on honesty. During the 2016 election I went so far as to make this figure comparing the prominent politicians from the two major parties. There are two notable things here. The first is that yes, both parties misrepresent the truth or outright lie more than I would like. But the difference in the extent to which they lie is striking. Trump barely seems capable of telling the truth, but Pence and Romney are not far behind despite their more “traditional” political personas. The contrast between Trump and Clinton, especially in the blatant lies, is frankly breathtaking. If you were to set ideology aside and vote strictly based on the honesty of the candidates, it is clear which party you should vote for.

Let me put it this way: There are things that are true and things that are false.

It is true that the planet is warming and that greenhouse gas emissions are a dominant factor. The best scientific models predict we are rapidly headed for a world of droughts and famine, refugees fleeing coastal cities, mass extinctions, more destructive storms, and more.
It is true that voter fraud is vanishingly rare and that voter suppression is widespread.
It is true that trickle-down economics doesn’t work, that cutting taxes on rich people just means they get richer while deficits skyrocket and poor people remain poor.
It is true that police officers and indeed the entire criminal justice system exhibits bias against people of color, and that in many cases that has deadly results.
It is true that having more guns leads to more gun deaths.
It is true that sexual assault is common and false accusations of sexual assault are rare.
It is true that health care cannot be treated as a free market and that doing so costs people’s lives.
It is true that seeking asylum at our borders is not illegal, and that immigrants are less likely to commit crimes than native-born citizens, and that they provide a net benefit to the economy.
It is true that the greatest threat of terrorism in this country comes from right-wing white men.
It is true that the modern Republican party is following very closely along the path that led to the rise of fascism in pre-WWII Europe.

Do these statements sound partisan? They’re not. They’re just true. There should be nothing partisan about truth, yet the Republican party has worked so tirelessly at distorting the truth for so long that actual truth sounds like a liberal attack.

To solve the many and complex problems facing the world today, we must start with truth as a foundation. Lying to win elections harms everyone. Lying so regularly, so consistently, so deliberately that nearly half the country lives in an alternate reality where the facts are exactly reversed is literally threatening the stability of this country. In just the past week it has led to a mass assassination attempt, a racially motivated double-murder, and a massacre at a Jewish synagogue, and those are just the crimes that have made national headlines.

All of the true statements in the list above highlight real problems that need to be addressed, but we as a nation cannot address them if one party consistently, relentlessly, lies about all of them. It is enough to make a person think that Republicans are more interested in obtaining and holding power than they are in helping people.

Empathy

And that leads me to the second core value: empathy. I am not a religious person. I don’t think there is a being on high who determines what is right and wrong. Without an external definition of morality, I try to keep things simple: something is “Good” if it helps people, something is “Bad” if it harms people. The more people helped or harmed, the more good or bad. Empathy is the guide for this morality. If you want to do “good” and good is defined as what helps people, then by necessity you have to put yourself in their shoes and do unto them as you would have them do unto you. There is a reason the Golden Rule appears in every major religion.

I don’t think that there is an afterlife where we are rewarded or punished based on our actions in life. I think this is it. We get one life, and when it is over we are gone. The only things that remain are our genes, the people who remember us, and the changes we made in the world. That means I place a high value on making positive changes in the world. It means that I push myself to recognize how profoundly lucky I am, and that I take responsibility for my privileged life and try to pay some of my good fortune forward. Part of paying it forward is supporting policies that will help as many people as possible, even if that means I have to sacrifice a little bit.

When you look at the policies and behavior of the modern Republican party through the lens of empathy, it becomes clear that the party is completely morally bankrupt. Its policies are all about prioritizing the individual over the well-being of the broader society. An “every man for himself” mentality that promotes distrust and fear, rather than a “we’re in this together” mentality that promotes cooperation. Republicans reject the idea that there is a social contract and prefer to believe in the myth of the self-made man, ignoring the fact that the social contract is literally why humans are so successful as a species. (No, you might say, we are so successful because of our intelligence! But the leading theories of human evolution suggest that we evolved our intelligence primarily so that we could keep track of our social interactions among larger and larger groups. We are smart because we are social.)

Republican policies are just profoundly selfish. The obsession with taxes is the best example. Republicans prioritize a rich person’s right to obscene wealth over the well-being of society. Heaven forbid rich people pay a fraction of that wealth that will have no meaningful impact on their own lives for government services that could literally save other people’s lives. There appears to be this disturbing conflation among Republicans between wealth and morality. Rich people are rich because they somehow deserve to be. Poor people are poor because of some moral failing that makes them that way (typically laziness). The moment you suggest that success might not be entirely based on hard work, that some people work hard all their lives and remain in poverty while others are extremely successful and have sailed through life with minimal hardship, Republicans get upset.

There is also this strain of victimhood among Republicans that is fascinating and betrays a complete inability to put oneself in another person’s shoes. Republicans point to things like the #MeToo movement and Black Lives Matter as part of a broader societal shift that persecutes white men. They wring their hands over the possibility that false accusations of rape might ruin a man’s life ignoring the fact that (a) sexual assault or the threat thereof literally does ruin many women’s lives, and (b) credible accusations or even blatant admissions of sexual assault often carry little or no consequences (see, for example Donald Trump and Brett Kavanaugh).

“When you are accustomed to privilege, equality feels like oppression.” – Author Unknown

“Conservative” Christians likewise have a bizarre persecution complex that Republicans are only too happy to tap into. They claim there is a “War on Christmas” when Christmas dominates literally every aspect of American life for the last two months of the year. They claim persecution when people protest putting the Ten Commandments on government buildings or putting creationism in textbooks. Meanwhile actual religious minorities are victims of hate crimes like the recent massacre at a synagogue.

Possibly the worst of all to me is the attitude toward immigrants and refugees. It frankly terrifies me that someone could be so heartless and consumed by hate and fear that they see parents and children fleeing thousands of miles to build a better life and rather than welcoming them with open arms, Republicans think the logical response is to lock them up in prison camps. When confronted about why they are imprisoning children, they say “well, their parents shouldn’t have broken the law” as if that is a reasonable response. What a dark and terrifying fictional world Republicans live in.

Why I’m So Angry

The Republican party has become a party that whips up white nationalist fervor in its base to protect the staggering wealth of its donors and the power of its politicians. It is the party that cuts taxes on the rich and pays for them by cutting benefits for the poor. It locks children in cages. It cuts funding from schools. As I type, it is using American troops as props in a desperate stunt to whip up racist fear of a convoy of refugees desperate for a better life so that it can win an election. Across all issues, at all levels, if there is something that will benefit normal people, the Republican party is against it. If it will benefit the rich and powerful, they are for it.

They say that in any situation where you have two groups who disagree, that you should be careful not to fall into the trap of characterizing the other side as “Evil”. That when that happens, both groups will just become more and more entrenched and the differences between them will never be resolved and often will become worse.

But what happens when one side is genuinely evil? I looked it up and the definition of “evil” is “profoundly immoral” or “morally reprehensible” or “causing harm.” Explain to me how the Republican party does not fit that definition.

The Republican party is literally undermining the pillars of our democracy. They are preventing people from voting. They stole one Supreme Court seat and filled another with a horrible man because they knew he would rule in their favor. Experts in the ways in which democracies fail are sounding the alarm. The Republicans are following the playbook of the Nazi rise to power in Europe with terrifying precision. The president’s rhetoric has inspired his supporters to commit or attempt heinous acts of violence, and instead of walking the rhetoric back he and the rest of the party just double down. The Republican party is in favor of policies that will kill people and ruin lives, whereas the Democratic party is in favor of policies that might raise taxes or cut into corporate profits or allow brown people to live here in peace. You can’t look at that and shrug and say that it’s not clear which party is morally right.

The Republican party lies constantly to advance a profoundly selfish and immoral agenda. What they stand for goes against my two most deeply held values: Truth and Empathy.

That’s why I’m so angry. That’s why I can’t just ignore what is happening. That’s why I resist even when it would be easier not to.

Do Good

Create Something

Have Fun

Value/worth

Good

Achievement

Meaning

The Gastroenterologist

Surgery Prep

Surgery: Pre-Op

Surgery

Post-Op

Recovery: Pain

Strep Throat? Really?!

Recovery: Sleep

Recovery: Food and Digestion

Conclusion

History and Symptoms

Doctors and Tests

What is a gallbladder? What is a gallstone?

What is a HIDA Scan?

Is surgery the only option?

A rant about medical imaging

What the images showed

The Upper GI X-Ray

Another small rant

More Symptoms

Surgery is the right choice

Conclusion

Truth

Empathy

Why I’m So Angry

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