Medicine, a Power That is Finite (a review of the book Being Mortal, by Atul Gawande)

This book couldn't have come at a more opportune time, when my cousin and childhood friend lay in the hospital bed incapacitated from glioblastoma, the aggressive brain tumors the late senator John McCain succumbed to. His condition has been nosediving as of late, and he has recently begun to suffer from dysphagia - loss of ability to swallow. He has voluntarily stopped eating for fear of suffocating. He has not been all that coherent, and is in the late stages of the disease. What is the purpose of staying alive in this debilitating condition that continues to decline?

And this is exactly Mr. Gawande's point in "Being Mortal"; that the purpose of medical science should not be solely about prolonging survival, but to enable well being.  If that entails the patient making choices that shorten life span at the expense of quality living, then that's a fair tradeoff. "Over and over, we in medicine inflict deep gouges at the end of people's lives and then stand oblivious to the harm done" (pg. 249). Mr. Gawande is referring to physicians' tenacity in keeping terminally ill patients alive with surgeries, procedures and medications that leave patients in a reduced state of well being with little to no control over their fate.

Physicians should inquire with patients what their minimum requirement for living is, e.g. a patient may wish to continue watching Football on T.V. and eat chocolate ice cream. They should then ensure no treatment or procedure hinders the dying patient's wish.

"I knew a man who once said, 'Death smiles at us all. All a man can do is smile back'," Maximus in Gladiator. Let us hope medicine helps us smile back when our time comes.

If a man speaks or acts with evil thoughts, pain follows him - Buddha (A review of The Sociopath next door, by Martha Stout)

I became interested in exploring sociopathy after I finished watching the eight-season Showtime series, Dexter, about a seemingly sociopath blood spatter expert working in the Miami Metro Homicide unit.  Dexter was trained by his homicide investigator father and Evelyn Vogel, a neuropsychiatrist specializing in profiling psychopaths, to be a benevolent serial killer.  Dexter would investigate, hunt down and kill other serial killers and murderers.  What got me interested in the subject was Dr. Vogel’s reassurances to Dexter that as a sociopath, Dexter was perfect and “exactly as nature intended you to be”; “I believe that psychopaths are not a mistake of nature. They're a gift….They're Alpha wolves, who helped the human race survive long enough to become civilized. An indispensable demographic.”, to which Dexter replied “Well, one of your indispensable demographics is still out there killing.”

So I pondered whether the 4% of the population inflicted with ‘lack of consciousness’ is a necessary order of life, and to this book I went looking for answers.  As a point of reference, the incidence of anorexia in the general population is 3.43%, and schizophrenia which gets a lion’s share of mental malady coverage is only 1%.  Sociopaths affect society far more profoundly than many popularly debated and written about psychoses, but when a sociopath commits a publicized crime, the sociopathy diagnosis is often lacking.

Prior to watching Dexter, I had the impression of violent and evil strongly associated with sociopathy, and I suspect most people do as well.  This, as Dr. Stout argues, is not the case.  Sociopaths can have differing tendencies, and many are nonviolent, but most are deviant and share the following characteristics:  Lack of empathy, guilt, connection to others, love.  “The absence of an intervening sense of responsibility based in emotional attachment is associated with an endless, usually futile preoccupation with domination, and results in substantial life disruption and eventual deterioration.”

Along the way, I got answers to:  What is the purpose of conscience?  Lack of conscience, why is it such a negative thing, and why does it lead sociopaths to commit evil acts?  Why can’t people with lack of conscience behave normally otherwise?  What sorts of behaviors are a consequence of lack of conscience?  Are there remedies or cures for sociopaths?  Do they want to be helped? What are the signs to look for in a sociopath, and how do people protect themselves in an encounter with one?

Great book even though it may be dated from its 2005 publication year.

Failed to realize my lifelong dream.... for now!

On a Sunday afternoon a couple of weeks ago (4-23-2018), I searched for the lowest priced homes in Laguna, hoping one of those piece of feces 1-2 bedroom shacks on the mountainous two-lane highway to Laguna Beach would pop up on Zillow.  Lo and behold, I came across these manufactured homes across from the Montage Beach for an average price of less than $200K! One in particular - pictures to the left - caught my attention.  It was a 600 sqr. ft. one-bedroom newly built unit for $147K.  The catch is, you don't own the land, and you pay a hefty $3K a month rent for the land, which includes association fee.

So I excitedly plunked down my $5K deposit, obtained the lease contract from the builder/land owner whom we shall not name here, and began reviewing the terms..... O M G!!!!  I stopped reading and taking notes on page 9 of the 40-page agreement.  The terms were so egregiously stacked in favor of the builder at the expense of
the buyer that I saw no chance of negotiating this monstrosity to anything resembling a balanced contract.

The contract term was 20 years, which was a relief at first because seemingly, I the buyer, would have a long term commitment from the land owner to stay in their location.  But everything else royally blew.  The worst provision was that the land owning company had the latitude to make any changes to the contract at any time, which would leave the seller to either accept the amended terms or pick up his house and move it off premises.

Pluck that!  So to make a long story short, I got my deposit back and didn't look back; quite relieved, actually, that I didn't get myself into a regrettable and long term massive financial commitment.  Now, I read and write contracts for a living, but what about the rest of the unsuspecting population who don't read or understand the fine print???