War Stories of the ER

I always had to check the pockets of my scrubs before I put them in the laundry.  Inevitably I would leave a roll of tape or IV tubing in my scrubs, especially on a busy night shift.  By 7:00 am, you're thinking more about your head hitting the pillow than what the hell was in your pockets when you make the sleepy drive back home in the morning.  

Your brain gets numb after dealing with 8 trauma alerts in a 12 hour shift.  The trauma surgeon is the juggler in charge.  It's their job to mitigate and assess risk, prioritizing the most critical from the least.  Not to mention performing mentally demanding surgery on top of that, at 3:30 in the morning and they've only had 6 hours sleep in the past 36.  Trauma surgeons are fucking crazy.  They have one of the most mentally and potentially emotionally stressful jobs, and work anywhere from 60 to 100 hours a week.  They don't do it for the money, but the adrenalin and passion for what they do.  But after being up for 48 hours straight, it becomes a grind like anything else.  

They dedicate at least 12 years of their life, and hundreds of thousands of dollars in student loans, to do a job that pays 26 times less than your average corporate CEO.   Consequently nurses and all other medical staff really don't get paid what they're worth.  Six of the trauma alerts are from a bad car accident.  The other two are gunshot wounds, one self inflicted and the other probably gang or drug related. To give you some perspective, the trauma bay is designed to handle two trauma patients at a time.  I can handle four in a pinch.  To accommodate 8, you start cannibalizing normal rooms and converting them into trauma rooms.  The rest of the emergency room comes to a grinding halt as critical patients require double or triple the staff to monitor and stabilize.  It was times like these that the team you worked with became close to you.  You had to learn to anticipate their moves, react and work as a team under conditions that were less than ideal and where time was short.  

An an EMT, part of my job was to anticipate the equipment and setup the docs would need to handle for whatever comes through the door, often with little more than 20 minutes notice.  In many ways it operated very much like a little platoon.  The trauma surgeon gives the orders, the nurses and medical technicians carry them out,  the social workers, x-ray technicians, and respiratory teams all had to maneuver around each other and the patient at just the right time to get the job done.  The trauma surgeon decides who is the most critical and needs to go to imaging first (usually CT scan), or if they're really fucked up (they're going to die in the next 30 minutes without surgical intervention), they go straight to the operation room.  In cases where we're handling eight trauma alerts at once, it becomes a cacophony of organized chaos.  Trauma doctors love that shit, but I suppose that's what makes them good at their job.  

Patients that would come in got assigned a number on something called the Glasgows scale.  Any number less than 12 and it's a good bet at least one of them will need a chest tube because they have a punctured lung and it needs to be drained before they drown in their own blood.  Trauma surgeons could be picky on the size of the chest tube they preferred and each one had their preference.  It was our job to learn the little preferences of each surgeon, some preferred big chest tubes while others preferred smaller, some liked to get a CAT scan first, while others preferred just a chest x-ray before going to surgery.  When they say medicine is an art, this is what they mean.  Medicine is an art in very much the same way Sun Tzu calls war an art.  In emergency medicine, your enemy is death and it's your job to outmaneuver the various ways death can take the patient until they're stabilized.

 
I always found a strange sense of purpose in knowing that the only thing keeping someone from crossing into the arms of death was some idiot like me, getting paid $12 an hour to repeatedly squeeze a rubber bag of air into someone's lungs, because all the available mechanized respirators are in use because the hospital budget got slashed last fiscal quarter.  Great, here I am stuck in a room with the suicide guy, pumping air into his lungs that he tried to deprive himself of only hours before, waiting for a respirator to be freed up from another floor.  The trauma surgeon decided he was brain dead from the mechanism of injury alone (a bullet to the brain), and we were just keeping him alive until next of kin could be notified.  It's difficult not to become emotionally jaded after doing this job for years, and the medical staff had their own unique black sense of humor that I came to embrace. We would pass around emails entitled "Suicide: Doing it Right the First Time" listing the various ways one could end their life using good sound medical techniques that were by comparison, far easier and much less painful than using something as sloppy as a gun. Medical staff all have one thing in common: they're mostly overworked, underpaid and have finite resources.  Suicide attempts would inevitably earn the scorn of medical staff who had to delegate precious resources to someone who didn't even want to be alive.  The first dozen suicide patients you take care of, you have sympathy and empathy still left in the tank.  When that number goes over 100, you start wondering if you're just wasting your time.  Which is the perfect opportunity for a poop joke

  This might seem abhorrently inappropriate, but dark humor is a common way to cope in otherwise fucked up situations, and it's probably the norm in every emergency department.  

Reverse Engineering Truth Models

I always found it a bit odd that most articles and arguments I read do not come with a disclaimer or transparency statement regarding the philosophical baggage the author is dragging into a debate.   Claims of truth, in whatever I was reading, often ignore or sidestep the question of how the author is gleaning the truth in general.  What biases and philosophical baggage is the author packing into their assertions?  When a politician makes a claim regarding the economy, I immediately want to know where they're coming from so I can evaluate not just their specific truth claim, but the process by which they're making their claim. 

Trying to answer questions like these involves reading between the proverbial lines, and trying to discern things like the intent and meaning of the author strictly by their use of language.  It's often a tricky proposition.  There are always philosophical caveats when claiming to understand anything with a reasonable degree of certainty when reading into the context of language.  

The exercise of trying to extract or read into the words of a story can be very much like a cross between psychoanalysis and trying to predict the future by reading tea leaves.  Dead authors who never commented on the intent of their work would probably find the academic field is especially rife with all kinds of wild speculations regarding their "real" intent, as post doctoral students crank out thousands of pages into literary journals, publishing their carefully cultivated theories, or be doomed to perish in the wasteland of academic and professional impotence.  

Some academics might object that I'm using an economic and materialistic literary lense to evaluate and summarily write off a large portion of what they see as a legitimate invesitgation and analysis of the truth that makes up the bedrock of most arts and science departments.  The short answer is yes, I am.  While I agree that literary theories can sometimes yield useful intuition pumps, they fall drastically short in providing useful epistemic models in their attempts to discover the multitude of hidden true meanings within the same fucking text, that has been analyzed and deconstructed a thousand times, in a thousand different ways.  

There are many other good reasons we must look critically at carefullly preeened truth models that can only exist when we tacitly agree to accepting a certain level of philosophical bullshit in discourse.  There is a staggering range and depth of philosophically broken truth models available for purchase, as societies become increasingly more complex and interconnected, the bullshit gets deeper.  

Psychologists and sociologists might classify most of the highly specialzed academic truth models as part of the normal range of mental schemas, that have simply been engineered, tweaked, socially elevated and peer reviewed to the status of literary and philosophical theories that generate the requisite amount of bullshit.   

In journalism, you're taught to temper your biases and to keep a story balanced by incorporating different viewpoints of the same set of facts, often by citing multiple sources. The idea behind this approach rests upon the agreed assumption that the truth of a story is independent of the interpretation of the story itself.  It incorporates elements of third party verification to ensure the story can hold up to future scrutiny, and to standards of evaluation that we agree are meaningful. Standards like logical consistency and evidential support that have proven to be accurate in forming the knowledge base by which we literally bet our lives and societies on.  Much like in politics, in philosophy, voting with your feet and experiencing the results is the only useful way of evaluating the efficacy of our belief systems.

Whenever you read an article, or evaluate an assertion or argument that claims to support X, there is often an epistemic pattern that can be identified in how these claims are made.    

From what I've observed, most claims of truth in public discourse fall into at least one of the following schemas that dominate public discourse.  With the broader acceptance of psychological compartmentalization, an often confusing multitude of schemas counterintuitively exist in the same individual/discourse, depending on how and when they're applied.  The complexties and sublties of individual and social psychology play a large role into how these schemas develop and get expressed.   

They can either give rise to nuanced and carefully thought out worldviews, or more often than not, end up a confusing mess of contradiction and disingenuous assertions.  It is important that the author defines the epistemic boundaries to which their claim of truth is being made, in proportion to the scope of the assertion.  In short, extraordinary claims do not just require extraordinary evidence, but must also be coherent with the rest of what we know.   

Truth Parrots 

Truth parroting is a name I've given to those who interpret and believe almost everything they read and hear by another authority. These schemas cause individuals to parrot back information to others with little to no individual analysis. Thoughts of checking alternative sources or committing any resources to fact checking or alternative lines of thinking don't enter into the truth equation.  Post hoc reasoning (after the fact) is pretty ubiquitous because it's easy (read: lazy).  They help create the circle jerks and echo chambers of whoever or whatever is weaving the narrative that's already been accepted as true.  Correct easy answers are emphasized, questioning the questions or the authority who defines the questions is strongly discouraged using this model.      

Examples:  

Your crazy nextdoor neighboor who is always trying to convince you Obama is a secret Muslim, or Jesus is the only way to salvation. Or your other crazy neighboor who is trying to convince you all corporations are all out to kill you and vaccinations cause autism.      

Truth Trolls

Truth trolls are a growing demographic, mostly as a result of a post-religious world where disenfranchised believers are left with a bad taste their mouth from being disillusioned. They see all claims of truth as equally meaningless, and all information exists in a kind of solipsistic mind fuck where you can choose your own adventure after you've become disillusioned.  This group is a recently growing cultural phenomena that has moved into void where religion used to occupy.  The guiding principle is the truth isn't something you'll ever have access to anyhow.  The question of meaning is all that really exists, and that's up you and you alone to determine what that is.  Correct answers are completely dependent upon your "personal reality", and questioning the questions or authority of the narrative is zealously encouraged, often to the point of absurdity.

Examples: Political pundits, entertainers, comics, academic writers, existentialists.       

Truth Police      

This group falls into this category are mostly employed and paid to analyze and deliver whatever information they're given under certain rules of engagement.  They create the narrative by which we get our media and provide the authoritative mindset by which information ought to be interpreted and processed.  It is their job to disseminate and inform the public in a way that's socially acceptable and codified by rules of conduct according to the ontological baggage they're bringing to the table. They invoke authority when convenient, but can delve into the abstract design space of philosophy when confronted by academics with varying degrees of success.

Examples:  TV and news journalists, religious leaders, heads of state, scientists and some philosophers.

Truth Miners

Truth mining is a term that describes the process by which one determines the truth status of a possibile truth within the design space.  The design space is simply the mathematical representation of all possible truths compared to the potential number of possible falsehoods. That is, we assume the set number of false claims vastly outnumber the set of actual truths that correspond and desribe reality, which we test to the point of pragmatic ubiquitous consistency via independent confirmation.

Stated differently, the major premise of the design space is the number of possible truths far outnumber actual truths instantiated within the universe or multiverse.  This means any random claim is likely to be false rather than true, given we agree that possibilities and actualities occupy different categorical states of existence.  Sure, it's easy to imagine a unicorn in your mind, but we agree that's an entirely different category of existence when we talk about actual unicorns that exist the same way horses do.  

Examples:  mathematicians, physicists, philosophers

Consilience

It is my assertion that the truth can best be discerned when you take the patterns of historical truth and incorporate this data within contemporary methods which yield a high degree of accuracy given a clear scope.  In short, what is true for the caveperson ought to be true for the post-human in terms of ontological consistency in what we collectively value as true belief. 

This is the meeting point of where abstract thought becomes solidfied into our personal lives and defines who we are.  It is what makes us unique among the other animals in that we can have some degree of conscious control in how we evolve and grow as a species by stipulating the standard by which we determine the truth within the social contract by which we agree to live by, and define the multitude of standards by which we measure the status of all truth claims. 

In short, we have to agree imaginations of the truth and true belief have a useful existential delineation that facilitates understanding across the board.  In more simplistic terms, what we believe is true now is amenable to new information as we progress and learn. When debate and discourse allows for any claim to be accepted as "true" without stating why it's true, we've already agreed to swallow an existential poison pill that blurs the line between false and true belief.  

The consequences of accepting this position are disastrous on the social contract and corrosive to society at large.