Wednesday, February 15, 2012

The Road Most Traveled: Implied Assumptions

Our thoughts become our words, our words become our actions, our actions become our character, our character becomes our destiny.” ~ Gandhi

Combinatorial Perceptions, the Synapses of Knowledge and Behavior

We go through life with the prism colored and cut to our own internal fancies. I trust what I believe in, don’t you? After all that is the mainstay of the argument of our very existence. The earth will turn and “the sun will come out tomorrow.” This is an innate belief conjured through the lens of historical facts and present day observation. And although we cannot yet pile-on the gravitational force onto the theory of everything – from the factual to the absurd, we know instinctively that the magnets do tend to pull at the iron filings and are in some way involved in repelling the MagLev high-speed trains.

Unlike when we fall from a height, it is the feeling of the heaviness of our mass that we feel that is the culprit, rather than the gravitational tug on that mass, because we don’t feel that force, so to speak. We can reconcile this in our minds through the implicit assumption now and the explicit proofs of science later. 

Something like, “I think this now and it makes sense and about that theoretical business, well I’ll deal with it later.” When it is all said and done, the “now” implicitly climbs the vaunted throne of knowledge. The “then” becomes the esoteric and governs during those heady discussions of material and forces of science. I mean seriously, this concept, that the reason why a chair holds me up is because of the small yet powerful (weak) Van der Waal forces otherwise, I would go through it like goo and as a matter of fact right through to the other side of the planet, brings in some circumspection and doubt. Here the chair holds me, and that, is an explicit conviction while the Van der Waal forces is the implied esoterica. 

But let me not get carried away here.

Our world keeps turning over a new thought, a new science and those that live in it develop the axioms for their survival. These implied concepts may never be proven but in or minds we surely believe in their sacrosanct definition and existence.

M101 (A trillion star galaxy)

We look outside and there are people, cars and houses out there. We stare out at the moon, the stars and even with Hubbles’ bubbles of exciting galactic images do we ever fully comprehend the light-years of the distant between galaxies. No! Yes, there in lies the security of our existence, only so far as the eye can see and that is the verifiable truth!

A dividing cancer cell

The other day a man in his fifties walked in with a diagnosis of colon cancer. He had a full head of hair, a sallow complexion, a wide eyes stare and a brain that could eat the mathematical formulae for lunch. He was brilliant. Entirely wrapped in his own world, he would give you logic that would be difficult to disprove ` akin to his simple proof of -1=0 on a napkin. Most people would shy from this kind of a discussion and they did. He worked as an analyst for a mid-sized firm and had oodles of materialistic things. His hands were thin but held a tight grip in a handshake. He was no one’s fool. He asked questions and weighed the answers as one weighs the travel bag before going to the airport -does it meet the measure of an extra $50 or not? In his case the weighing scale was in his beautiful mind and the decision from that weighing was instantaneous. The blue veins on the back of his hands throbbed with the intensity of the hidden arterial pulse of energy. – He would ask a question and then his eye would dilate into large pools of deep blue to intake the response including the full focus of the demeanor of the respondent. He was a human machine of incredible mental prowess, a Holmes, a Mason, a Newton, a Riemann and a Fermat all coalesced together in one. Unfortunately he also was to become a victim to the disciplines of his character and convictions and to the vicissitudes of nature.

“What stage is it doc?”
“Stage four.”
“And the probability of survival?”
“Quantify that, if you would please.”
“Okay five year survival is 19.2% and that is up from 9.1% in the last decade.”
“What is the Median?”
“Now around 30 months and that is up from 14.2 months.”
“Hmm…” His hand cradles the chin in repose. “So, what is the duration of this chemotherapy?”
“The plan is to give you four months worth and reassess response.”
“So, 4 out of 14 gone.”
“Or 4 out of 30 given today’s therapy.”
“So I have to be 1 out of 5 to live 5 years?”
“And the odds are 80% against me?”
“Well not exactly.”
“Why not?”
“Simply put, I have 4 out of 5 chance of not surviving 5 years, and I have a 50% chance of living 30 months and a 20% chance of surviving 5-years with the best that you have, correct?”
“That is right. However if you are the 1 then for you it becomes 100%, doesn’t it?””
“Can’t do that to me doc..” he said with a knowing smile.

The interview was over from his perspective. His eyes went to half-mast and he had receded into his cave of comfort. His mind had harkened to the comforts of numbers that balanced, of graphs that correlated, of tables that comported themselves to the linearity of reason. The beautiful mind had gone back to its cave of statistical existence.

The orderly and methodical reasoning was at work. He was in good physical health and everything to look forward to. The decision would be simple. Faced with the odds and the projected albeit anemic benefits for a fifty-year-old the odds calculations would automatically announce the need for that 50%  and that 25% chance of survival, helped along by the strength and character of a firm and resolute mind, rather than the sure and ultimate premature loss of life without such a fight. It may have been his version of loss aversion?

Let me take you to a risk-taker’s short interlude. He knew that he had, had a bad hand in a game of poker, yet he continued, thinking that the next shuffle of the cards would change his fortune. He doubled his gamble to recapture his losses only to lose it again.

Or the market trader that bet five times as much on margin and lost his house, family and a life he had enjoyed. The vile contempt of loss-aversion had bitten again. 

All such behavior nuanced via the delicate tendrils of the assumptions based on a dictates of a past trying to change the future. To escape such a behavior is the balance between reality as it is and what we want it to be. The mind keeps saying “this is true, because I say it s true.” To escape such a firmament of durably wired synapses in our brain is a monumental task requiring great strength and fortitude, and the fundamental understanding of the prejudice that exists within. Once understood, the bonds of these enormous shackles can begin to disintegrate. But not until then! Not until then can we liberate ourselves from the bonds that prevent us, that control us, that also perversely, sometime preserve us. We are wired to be suspicious of all shadows at night, for fear of a hidden predator, or all things that slither in the grass or fins that break the water’s surface. These are predicated on self-preservation and are totally juxtaposed with all other implicit assumptions that follow along. The few good assumptions become admixed with the many gained on the edge of a limb and pretty soon the story of our life’s journey can be predicted onto the future. 

Lack of certainty is precisely what makes conclusions more reliable than the conclusions of those who are certain: because the good scientist will be ready to shift to a different point of view if better elements of evidence, or novel arguments emerge. Therefore certainty is not only something of no use, but is in fact damaging, if we value reliability. ~ Carlo Rovelli

The bright shining paradigmatic ball becomes tarnished.

Months later on a chance meeting, the wife of the patient with stage IV cancer happened to cross the doctor’s path.
“Are you the doctor who spoke with my Joe?”
“I am sorry, who are we talking about?”
“Joe! You know, the man with the advanced cancer who wanted all the statistics and then refused therapy.”
“Oh yes. I am so sorry for your loss.”
“You know he wouldn’t take the treatment because he saw his uncle die of cancer in a miserable state. He did not want that to happen to him.”
“He was a smart man and he calculated his odds carefully to come to his decision.”
“Do you think he could have lived longer?”

What do you say to a question filled with such horror? Do you lie and say, “No” to appease the wails within and salve the wounds of a loss. Or do you say “Yes, there was a better chance for lengthening his survival,” and destroy any sense of peace in this poor soul’s mind that is wreaking with guilt and feelings of loss. Or do you simply, speak the implied truth and say “We may never know,”  - splitting the difference between a lie, a hope and the existent reality. An untimely frost had shuttered the blossoms of that beautiful mind and we will never know what else he may have been capable of doing, much like a Mozart 

or a Ramanujan.

The winds of change are nothing but the whispers of the mental dictates. We embark on journeys that are predicated on a long ago desire, stifled before but with age fully expressed. Without such a compass we are rudderless in our action. The guidance we seek comes from the long ago, far away memory that fills the chest of our imagination with implied assumptions. The origins of these assumptions are hard-wired into our mental framework. They dictate the cause and manipulate any adverse even explicit instructions to the contrary. Such is our existence, predetermined, focused and ruled by an autocratic frontal lobe dictator that has taught us our rules of governance at the feet of our youthful exuberance along with all the misunderstanding, miscalculated assessment and ignorance or all three.

At best, we nurture the fantasy that knowledge is always cumulative, and therefore concede that future eras will know more than we do. But we ignore or resist the fact that knowledge collapses as often as it accretes, that our own most cherished beliefs might appear patently false to posterity. ~ Kathryn Schultz

Such is life.

His was a journey destined to meet the fork on the road of his life. It was a mental predicate based on an implied assumption gathered from the travails suffered by a loved one that he did not wish to repeat for himself and against all the known potential odds stacked in his favor compared to then, he made a choice based on then without the rules that governed life, now.

The strength of the implied assumptions trump even the most explicit convictions of human endeavor. 

We become the victims of our incessant cerebral chatter. 

We lose the “todays” due in part to our “yesterdays” and in so doing lose walking down a different path to a different future, to a different world.

We will never know which road is better.

1 comment:

  1. One of the reasons I look forward to reading your "art painted with words" is I never know where I'm going to go. It's helpful to learn how different patients determine the health path they chose.


I’m reminded of the piece written by Ken Murray "How Doctors Die." Dr. Murray's friend, like your patient, chose quality of life vs. aggressive treatment. When patients have such aggressive forms of cancer and their chance of recovery is so slim, I deeply respect the choice of declining further medical intervention. Thank you for including the images to your post. They are like frosting, giving us a completed treat.