This, as any would be, is certainly a valid way to respond to a brush with death. But implying that this is somehow a lesson to be learned by everyone, suggesting that others should live their life this way, seems misguided to me in context.
Contemplating your mortality shouldn't necessarily convince you to double down on your current priorities (especially if those priorities are centered around banal platitudes like "doing something remarkable with your life," which are probably masks to keep you from thinking about what really motivates you.) It should cause you to reevaluate them.
The fact that you will die, the fact that everyone you know will die, and the fact that eventually the universe might become a field of equidistant neutrinos means that it really, really doesn't matter what you accomplish. All roads, if you stay on them long enough, lead to the same place. There will be no progress. There will be no one remarking.
I would say that the lesson to be learned from thinking about death is just that there's no reason to adhere to anyone else's values, or to feel pressure to do anything in particular. You should do what you want, what makes you happy, even if it's humble.
Existential steps backward can be a tool to remove yourself from things that aren't really helpful, like for example a hyper-competitive capitalist rat-race justified by language like "fight the status quo" or "great visions of the future" that, instead of contributing to humanity, is mostly really about love, insecurity, and fear of death (like so many human pursuits).
"Fighting" here, the battle between the heroic pursuit of accomplishment on the one hand and the "insidious machine called quo" on the other, is just the author reporting his own conflicts about what he wants to do. Part of him wants to expend massive amounts of energy attempting to out-compete the people he sees as his peers. But another part of him doesn't want to do that, which is why he loses motivation and doesn't always end up behaving the way a hero-CEO might. There is not some kind of evil, inherent inertia at work that all people must fight against. Instead, there is only ambivalence and subconscious motives.
In my opinion, if you really internalize death and it's implications, the notion that you can justify prescribing ways of thinking or behaving just starts to look absurd.
It is extremely hard to comprehend how short life is. Most people actively avoid knowing. They tell themselves stories about eternal life, or they act like they have all the time in the world. When circumstances conspire to wake us to the transitory nature of life, it can be incredibly valuable.
I violently disagree with the notion that the heat death of the universe "means that it really, really doesn't matter what you accomplish." That's like saying it isn't worth cooking a beautiful meal because 48 hours later it will all be poop. That there's no point to love if the body will soon be dust.
Nothing lasts, but that doesn't mean that nothing matters. If you want intuitive proof of that, go rent Rivers and Tides:
I interpreted ForrestN's statement much differently: "it really, really doesn't matter what you accomplish." Given that emphasis, I don't think what ForrestN said is incompatible with your analogy.
The point is that the heat death of the universe means that some things, like the drive to "contribute to humanity" are not goals that are inherently superior to other goals, such as "cooking a beautiful meal."
This point is clear when ForrestN says "there's no reason to adhere to anyone else's values, or to feel pressure to do anything in particular. You should do what you want, what makes you happy, even if it's humble." Cooking a beautiful meal certainly falls under the category of "humble things that make you happy."
I love that you made a contemporary art reference (my field) even if Goldsworthy isn't such a good artist.
It is worth cooking a meal if you want to. It's worth making a line of rocks. It's worth programming a cute tumblr theme. Just don't pretend like you are doing those things because they are inherently better things to do than watching TV or lying in bed. These activities are all animated by your feelings about them, which your brain can't turn off regardless of how steeped in death you are.
You think Goldsworthy's work is beautiful. I don't. And that's fine. Not everyone has the same feelings and preferences. I'm not saying no one should "fight," just that they can't really argue on the basis of death that other people should.
That's like saying it isn't worth cooking a beautiful meal because 48 hours later it will all be poop. That there's no point to love if the body will soon be dust.
What a fantastic answer to that assumption. I'm writing that one down in a corner of my mind for later use (sometime between now and the heat death of the universe). :-)
Really well put. But to me, you bailed out, or at least contradicted yourself with the phrase, "instead of contributing to humanity."
You set up a nice concise statement of Sartrean pointlessness, and then you appear to invalidate it completely with such a broad notion full of Big-Picture-Feel-Good-Meaningfulness as "contributing to humanity." You just kind of slipped that in there as if we all Know What You Mean. As if it wasn't the exact same species of content-free sloganeering as "fight the status quo" or "great visions of the future."
Finessing an emotive appeal to purpose in the midst of purposelessness with an abstract notion of 'humanity' doesn't make it any less vacuous, at least given the thrust of the rest of your comment.
Sorry if that comes across as harsh -- I actually liked your post and thought it was well-written. But if we're all just dissolving slowing into equidistant neutrinos in an eventual cosmic Cold Death, why should 'humanity' writ large have any more purpose attached to it than my own or any individual 'humanity'? Is that really 'internalizing death'? Moreover isn't the notion of internalizing death and absurdity merely another 'prescribed way of thinking' among many equally pointless strategems?
...and things have gotten pretty dark for HN on a Sunday Night. Flaming Lips anyone?
It isn't necessarily clear that ForrestN advocates "contributing to humanity." I think that was more of a statement that while goals like "fight the status quo" are ostensibly for the purpose of "contributing to humanity," they're actually motivated by "love, insecurity, and fear of death," without making any value judgments on these goals. That is, ForrestN is explaining how fighting the status quo doesn't even fulfill the stated motives of those who wish to fight against the status quo.
I probably wasn't clear enough. I was saying the opposite, arguing that an appeal to contribute to humanity is not viable in the face of death. And further that most people who think that is what is driving them are really being driven by something else.
Not sure how much I buy this. I had a similar situation to the OP in high school - a friend and mentor passed away and in the wake of his life I felt the need to Find My Purpose and conquer the world. While I realize with almost a decade under my belt that ForrestN has point - any individual mark tends to blur and disappear, I would still argue that during the days where I am fighting for something, those are the days where I feel good and alive. The days where I let ambivalence win are a waste.
I will say, the biggest difference in how I view the mark I want to make is that my scope has widened. Creating a product that changes the world, spending time with family, helping pass laws that make life Better according to my admittedly limited worldview all work.
The crux of your argument is the claim that, if the universe becomes a field of equidistant neutrinos, no action or thought in the meantime matters. The implicit assumption behind this view is that events only matter to the extent that they leave a legacy. In particular, it asserts that things only have ultimate meaning if they extend to temporal infinity. I believe that how one reacts to Curtis's post, and to your statement, depends on the following question: to what extent can something temporary and finite have meaning?
Imagine this scenario:
A man stands on the shore, miles from any other human presence. He is desolate, alone. For the past twenty years of his life, he has worked ceaselessly on a critical open question in mathematics, the solution to which would make it feasible for humans to travel across galaxies. Educated at the best institutions, mentored by the greatest geniuses of his day, and encouraged by his incredible past successes in the field, he had begun to work on the problem with as great of fanfare as can exist within an academic community. Gradually, as he had toiled without progress, his reputation had faded and he had become increasingly reclusive. Eventually, divorced and estranged from his family, he had pruned away every aspect of his life outside of this one question. The man walks slowly back and forth, wracking his brain for what had gone wrong in all his previous approaches, what key had escaped him.
In a blazing flash of insight, he understands. The wrong turns, the twisted equations and garden-path lemmas, the towering perplexity of twenty years - gone. He understands. It is true; it is real. With the mere publication of one proof, even the sketch of the dazzlingly unlikely intuition, humanity will dance across the stars within a century.
In the next moment, a titanic wave engulfs the coast, obliterating him in one painless moment.
Does his epiphany matter? This is the limit of your supposition: a moment of supreme realization and an achievement that only a few among billions could hope for, lasting as short a time as could matter to a human being. What you think of meaning in human life depends on what you answer to that question. If you believe that his epiphany does matter, you also believe in the meaning of temporary things - of what leaves an impression, but not a legacy.
In this case, the "fight against inertia" does matter, but only as the genuine pursuit of a deeply felt aim, rather than lust for meaning swaddled in the language of social contribution. To use the language of "Drive," people feel most fulfilled when they have autonomy, mastery, and purpose; less pedantically, we are only happy in the deeper sense when using our abilities to their fullest extent. Chasing your visions and striving for achievement matter as a consequence not of the goal, but of advancing towards it. It is important to know that your goal matters to others, and that you have the means to achieve it, but it does not register on the scale of personal meaning whether it is ever achieved. Only the motion, the overcoming of inertia, differentiates between personal meaning and lack thereof. Mathematically, although everyone's life begins and ends at zero, that fact in no way diminishes the value of the integral in between.
Happiness, success, passion and meaning are four qualities that attract some of the most contentious attention from both HN readers and young people in general. I would argue that they share a common quality: they are only achievable at the highest level as byproducts of action, not goals in and of themselves. Pursuing them directly drives them away; if the young Mark Zuckerberg had been in it for the money, he would have gone to Microsoft, and if the young Steve Jobs had made it his goal to find meaning, he would have stayed on perpetual pilgrimage in India instead of starting Apple. The victory of ambivalence and subconcious motives comes from mistaking the yearning towards these things for the path that leads to them.
Internalizing death, if you believe in the meaning of temporary things, does justify certain ways of thinking and behaving. It means knowing that you will, relatively soon, be rendered forever passive and motionless. In the meantime, you may as well move.
My point isn't that everything is meaningless necessarily. I would say that the more one thinks about death the harder it is to make arguments for meaningfulness. I wouldn't make an argument for meaninglessness, I would just say that you can't really extrapolate a positive value system from the fact that life is short.
It feels like you're arguing in favor of narrowing our vantage as a way to preserve meaningfulness, which is totally valid to me. But it's basically using a belief (the meaning of temporary things as you put it) as comfort. My point, as was pointed out below, is that you may as well move but you also may as well stay still.
As an aside, it seems strange that Jobs is the illustrative example here, as if it's primitive that we should all want to be Him. Given the option to gain a problematic and presumably painful personal life and what I understand was a totally unnecessary early death along with creating apple and "changing" an arbitrarily tiny subset of human history, that seems like a very easy thing to decline. I take his decision to avoid treatment to reflect profound pain that I would love to avoid.
I concur with most of your arguments, I do concur with you that there seems to be over importance given to Job's personal-life than it should. But, your last paragraph about Job's life seems to be out of line with your philosophy. You are claiming that Job's death was unnecessary. Unnecessary in whose terms? Is the purpose of life living the longest possible life? Here, by saying that his death was unnecessary or untimely, you are implying there is a time for a person of his stature to die. Now, its no more about making decisions that make you happy or not worrying about the shortness of life, or the lack of meaningfulness of life, but rather you are now preaching how somebody should live their life(or make certain decisions) just like the author or the article is trying to do.
P.S- I do think Steve Jobs contributed greatly to his field and I admire him & his products. The arguments made above are purely for discourse
I guess I was making the observation personally that my priorities are very out of sync with wishing for Jobs' life. I don't think anyone else should have the same priorities as I do. I'm terrified of dying and would like to life as long as I can. I would also feel badly if I knew I died earlier than necessary for psychological reasons.
ForrestN is not (as I interpret) saying that nothing matters. Just that evaluating the "matter-ness" of something based on some objective like making a difference to humanity is baseless. If staying passive makes you happy, then take that route. If proving mathematical theorems makes you happy, then take that route.
You seem to be saying that the pursuit of a goal in of itself matters, something that is not really at odds with what ForrestN implies, which is that the end product (the result of accomplishing a goal) doesn't really matter, given that all paths end at the same destination.
I especially take issue with your last sentence, which feels like a cop-out. "You may as well move" is a poor reason to move. "You may as well stay put" has just as much validity.
"Does his epiphany matter? If you believe that his epiphany does matter, you also believe in the meaning of temporary things - of what leaves an impression, but not a legacy."
There are two things here I'd like to comment. First, the question is incomplete, it can be either "does his epiphany matter to the man?" or "does his epiphany matter to the reader?".
The first version has the obvious answer "Yes", of course it matters for him, he doesn't know he'll die soon, nor does he care at that moment.
For the second version the answer, for me at least, is also "Yes", but for a different reason than the one you give. I say his result matters because now we know (we'll we don't theoretically as he didn't get to tell the world) that the question has a solution which means that somebody somewhere will be able to rediscover. I think knowing there is a solution is a huge win for any hard question because you know there is a purpose in your search.
The fact that you are going to die isn't a scary thought in itself, whats scary is the 'when' part.
>>especially if those priorities are centered around banal platitudes like "doing something remarkable with your life," which are probably masks to keep you from thinking about what really motivates you.
Let me tell you why this is true. Its true because "doing something remarkable with your life" isn't a goal at all. At the maximum its really a vision. A goal is something that can be measured. Wanting to make $5 million in the next five years is really a goal. And its a interesting goal to chase. No matter how much interesting and challenging work I may be doing, realizing the fact that nobody knows about it beyond my cubicle is the biggest demotivating factor in my life.
I don't want to want to work on the project that forces to jolt down 100K lines of code, no matter what that project is. I want to spend most of time in life having fun, doing recreational stuff. And I'm sure many want to do the same.
Realizing that given the effects of age on energy, vitality and vigor a person can have, coupled with uncertainty about death that you may really have to sprint in your early part of your life, so that you can have all the fun in some part later.
Some time ago I came across an elderly man in some difficulty lying in the street in London. While waiting for an ambulance he 'died' (no heart beat, no respiration, no signs of life at all, blue lips and gums) and I immediately did CPR on him until the ambulance arrived. Months later I learnt that he survived.
Any brush with death makes you seriously think about your own mortality. I know that watching this stranger's eyes go dead was quite life changing for me.
This is a field where a surprising amount of progress is being made. People still tend to assume that CPR is mostly a token effort so bystanders feel like they're doing something. In reality, high quality CPR + rapid access to an AED can give just about any heart a fighting chance at beating again (assuming the underlying problem is transient or easily treatable... if your LAD cardiac artery is 100% occluded and half your heart has died, there's no coming back from that...). Techniques like 'hands only CPR' are dramatically increasing the willingness of bystanders to get involved and do something productive.
The area where really exciting progress is being made is in improving the rates of survival to discharge from the hospital. Techniques like the therapeutic hypothermia mentioned in the article are rapidly gaining acceptance. ACLS (Advanced Cardiac Life Support, the standard of care for acute cardiac emergencies, including cardiac arrest) now suggests that providers should 'consider' therapeutic hypothermia whenever a return of spontaneous circulation (ROSC) is achieved (I know 'should consider' doesn't sound all that exciting, but the American Heart Association is an (understandably) conservative organization, and doesn't make broad based recommendations without a fair amount of data to base them on).
I could ramble on about this for a long time, there's a lot of exciting research being done (continuous compressions, continuous EtCO2 monitoring for evaluating compression efficacy and alerting when ROSC has occurred, even really controversial stuff like withholding Epinephrine (a large scale study from Japan has shown that while Epi increases the odds of achieving ROSC, it may _decrease_ the odds of survival to discharge)). This is a topic near and dear to my heart. I volunteer with my local ambulance service, and I'm very close to my New York State Paramedic certification (just need to take the exam). Calls like the ones described in the comments here are exactly why I love doing this... The overlap between my work in EMS and my day job (development) is bigger than you might think... Debugging is debugging... the stakes are just a lot higher.
No offense to your passion, but I thought that CPR can be quite dangerous and ineffective. Don't many doctors wear DNR tags because of this?
The wikipedia article [1] has some information on this. The survival rate is something like 4% even though immediate recovery is around 40% (they survive long enough to get to the hospital, where they die due to the underlying condition). Meanwhile, the person has to suffer with the pain of broken ribs or other damage from the CPR attempt.
As a paramedic, the "DNR" thing is part "folklore", part reality, but not for the reasons you cite.
If CPR is ineffective, the result is death. Dangerous? Not particularly.
Most people wearing DNR tags (aside: even a DNR tattoo on the chest is not considered legally binding against "heroic measures", unless signed by a physician) do so to provide some measure of what the patient might want (due to life expectancy, illness, etc).
Survival rate to discharge is HIGHLY dependant on many, many variables - I mention elsewhere that in certain parts of the country, due to concerted education and well managed/funded EMS systems, survival rates can approach 50% to discharge. You are right, though, successful CPR isn't going to negate the underlying cardiac condition.
If CPR buys a patient a year to five years, the pain of broken ribs is probably fairly minor in the grand scheme of things.
There are, as mentioned, a whole host of advances. My home EMS system does some fairly deep analysis of all CPR attempts and works to revise protocols, including what drugs to administer, through to 'continuing compression through defib shock' (studies done on medical students showing it to be a viable possibility).
Ultimately, education is the key - the ability to get skilled compressions more quickly on the chest, continuing to perfuse the brain and other organs has a huge impact in survivability, as well as damage done.
It's not the CPR that's particularly damaging. Yes, ribs are dislocated (though rarely broken), and cartilage is torn. Those are fairly minor complications though. The 'damage' is done by the medications we push. Drugs like Epinephrine are very good at getting your heart to beat again. A recent study in Japan suggests that that may be at the expense of your brain, and other vital organs. Other drugs commonly used in ACLS resuscitation are equally nasty (Amiodarone, for instance).
You're absolutely right that we've gotten very good at getting a heart to beat for a few more days until it succumbs to the damage done to the rest of the body (that 40% figure you mention, though out-of-hospital rates are still much lower than that). The exciting research being done is to improve long term outcomes for cardiac arrest patients.
More and more research is showing that the key to a good long term outcome is early compressions, effective compressions (push hard and fast), uninterrupted compressions, and early defibrillation (with an AED or manual defibrillator). Over the past 10 years, resuscitation algorithms have been streamlined to minimize 'off chest' time. Compression to breath ratios have changed (from 5:1, to 15:2, to 30:2). A great deal of emphasis has been placed on keeping the rhythm checks that happen every two minutes as short as possible. We're now teaching people to continue compressions while the defibrillator is charging (and under ideal circumstances, you could easily continue compressions throughout the shock). Intubation is performed without stopping compressions.
The focus of all of these changes is to decrease the number of time compressions are stopped. Every time compressions are stopped, it takes some number of compressions to get the pressure built back up in your circulatory system. Fewer interruptions means fewer 'wasted' compressions, and less time that the brain isn't getting perfused. This is obviously key to a good neurological outcome.
We like to think all our fancy drugs and advanced interventions are doing something effective, but in reality, 'basic' treatments like CPR and defibrillation are what really save lives, and more importantly, save brain.
I don't believe that wasn't a shot at dmix so much as a "Well, I didn't know this previously, but evidently he lives near me because I saw him the other day".
It made me change focus on my own health and the health of my family. It was one of the factors that caused me to change job and the sort of work I was doing and make other changes in my private life.
It's all good, but if you haven't had a close relative or a close friend die or come close to it, then no amount of preaching - Live now! Fight the momentum! Live it to the fullest! - is going to do any good. You have to experience it, unfortunately there's no other way.
My dad died suddenly two years ago. Just like that - here he is, poof, here he is not. I tried to capture the feelings in a written form and then have people relate. It does not work. It is a sort of experience that no one will re-live willingly. It's just too damn dark.
Going on 10 years, similar experience. People don't understand how much suddenness of the death affects you. What I have come to realize is that there is no right way to deal with people dealing with death. And that everyone will deal with death differently. I remember at my dad's funeral stuff the number one line I heard from people was, "if you ever need anything..." I didn't know what that meant then, or now. But its a good line.
As a side note, I was in AP comp sci at the time with only 4 other students. Our teacher was an ex marine computer programming since the punch card days and really strict and emotionless. My indian friend that was in the class with me said that it was so sad and quiet in class the next day that they could hear the teachers heartbeat. I'll never forget that line.
I agree that words cannot convey the experience of loss. But I don't think that means that you can't do some good with it.
The trick for me has been to try to exemplify and communicate the lessons I've learned, not the process by which I learned them. Being more joyful in the moment. Being more compassionate in the face of suffering. Facing death and loss squarely when it does come up. Declining to participate in the American game of pretending that death does not exist.
Also, I think you can sometimes talk effectively about the direct experience of loss. For example, I got a lot of positive feedback on this, despite the darkness of the topic:
This is very true. In a way, now I think that protecting children from the fact of (natural) death is counter-productive. I think that when a relative dies it is important to make children part of the grieving process and to show how important family and friends are, how important it is to show support for the bereaved, and how important it is to live life knowing that it does not last for ever and that it is important to see the 'big picture'.
I would like to add, condolences for your loss. I lost my parents recently too and it has slowed me down and made me appreciate my family and my life more, and made me less spoilt.
It's a great post, but to me there's another message that Dustin - understandably - hasn't focused on: "perfect health" is often (usually?) an illusion.
Given what I've learned about health in recent years, I can't accept that this guy really was in perfect health; if he was, he wouldn't have suffered a major cardiac arrest while simply jogging on a treadmill.
I think it's mostly a failure of modern medicine and modern attitudes towards health that most of us walk around feeling and looking like we're in "perfect" health, only to find all too late that a severe condition was lurking undetected.
The answers may lie in fields like Quantified Self [1], or PG's suggestion of Ongoing diagnosis [2].
But whatever the case, we're only just starting to scratch the surface of an area that I think this post demonstrates is hugely important.
> I can't accept that this guy really was in perfect health;
I guess that depends on why you mean by 'perfect health.' He may very well have been in perfect health by every outward appearance. There are a large number of surprisingly minor things that can make you dead in an instant.
A brief primer on electrocardiology... Each heart beat is divided into several phases. An electrical impulse in generated in the two small chambers at the top of the heart (the atria), causing them to contract. This is the first small bump in an EKG, and is called the 'P' wave. After a brief pause, the impulse is conducted to the big chambers at the bottom of heart (the ventricles), causing them to contract. This is the big wave on an EKG, called the 'QRS complex.' After that, there's a period of time where the cells in the ventricles are recharging. This is the final bump in the EKG, called the T wave.
If the heart is shocked (physically or electrically) during that recovery period, it can throw the heart into a fatal dysrhythmia where all the muscle cells in the heart are contracting chaotically. This is what happens when a baseball, lacrosse, or hockey player takes a blow to the chest and goes into sudden cardiac arrest... The blow happened during that very narrow window or time.
It's possible for your own heart to do that to itself though... It's very common for healthy people to have occasional 'premature ventricular contractions' where some random cell in the heart decides it's pissed off and wants to contract early. These are generally harmless, and happen all the time without anyone noticing. Every once in a while though, one of those PVCs occurs during that recharging phase, which can be very bad... So, a 'perfectly' healthy person _can_ throw a PVC, end up with an R-on-T contraction, and whamo... they're dead. Is it common? No, it's extremely rare. Does it happen? Sure does...
I guess that depends on why you mean by 'perfect health.'
I know :)
He may very well have been in perfect health by every outward appearance.
Exactly what I'm saying.
There are a large number of surprisingly minor things that can make you dead in an instant.
Yes, but my contention is that the likelihood of these things happening is influenced by the degree to which your health is "perfect".
some random cell in the heart decides it's pissed off and wants to contract early
Again, from my point of view, the likelihood of this happening, or the potential harm that can come of it, is influenced by the level of perfection in one's health.
Your comment is very informative btw, so thank you.
I know we're talking about areas of health that are not yet very well understood, which is why there is scope for discussion, and why there are no irrefutable facts that can close the debate.
But this is exactly what I'm taling about; I'm hoping for a time when medical science has progressed to a point where these issues are very well understood, and seemingly random cardiac arrests like this can be preempted and prevented. I believe it's possible.
>But this is exactly what I'm taling about; I'm hoping for a time when medical science has progressed to a point where these issues are very well understood, and seemingly random cardiac arrests like this can be preempted and prevented. I believe it's possible.
This is simply a discussion of semantics, and I feel kind of silly for arguing it in the first place. You're absolutely correct that most of the 'random' sudden cardiac deaths that occur are in fact related to a previously unknown preexisting condition. Wolff-Parkinson-White, congenital long Q-T, and a variety of cardiomyopathies (most of them congenital as well) can easily predispose someone to dropping dead.
Wolf-Parkinson's, that's me. I was a highly-trained and mostly-healthy bike racer and would occasionally get a rapid, arythmic heart beat under certain conditions that would last for sometimes hours. Finally went in to get it checked, and when I asked "doesn't that result in sudden death in athletes?" He said if it hadn't killed me by now it probably wasn't going to. One heart ablation and it hasn't bothered me since.
My rambling point is that, yeah, "perfect health" sometimes isn't. And a few pieces of heart tissue that grew just a little differently could have meant I'm not writing this despite being a life long endurance athlete. I can't say it's changed my outlook on life much, though.
Sorry for the late reply, I don't have reply notifications set up. During the ablation itself, I felt nothing because I was drugged. However, they have to repro the problem in order to know what to zap. That was an interesting process with all kinds of non-painful (though not entirely pleasant) stuff to feel. The details are still up if you care: http://psychocross.blogspot.com/2007/10/next-in-continuing-s...
Most commonly, this is going to be attributed to a ventricular arrhythmia, likely due to hypertrophic cardiomyopathy. This has nothing to do with cholesterol, lifestyle, diabetes, etc.
I wasn't referring to cholesterol, lifestyle, diabetes, etc - or at least not only those things.
I'm talking about any condition at all that diminishes one's health condition from being "perfect" - regardless of whether the cause is genetic or something else. Some of these can currently be understood and diagnosed (but usually aren't), whilst others may become understood, diagnosable and curable in the future.
To me, hypertrophic cardiomyopathy would disqualify someone from being described as having "perfect health".
I can't accept that this guy really was in perfect health; if he was, he wouldn't have suffered a major cardiac arrest while simply jogging on a treadmill.
That may or may not be the case. I suspect that the vast majority of cases of sudden cardiac arrest are attributable to risk factors, but probably not all. Our bodies are pretty incredible, but not perfect. Sometimes they just malfunction.
Do you have any evidence for that? Cardiac arrest is a pretty major malfunction.
I'll grant that there may be a few cases of spontaneous malfunction among people with systems functioning optimally.
But I'd wager that given the knowledge someone had cardiac arrest, the odds of something being wrong with their system are higher than 99.999%.
Specifically, I'd be interested in cases of spontaneous cardiac arrest among hunter gatherers or other groups that largely avoid the 'diseases of civilization'.
See my parallel comment. Aside from a possible genetic defect, it's quite possible that this person is healthy by all normally measured features. In the general case, a hunter gatherer lifestyle would likely have triggered this sooner, if anything.
A genetic defect, if not impacted by lifestyle, would do the trick. However, 'normally measured features' may not fully capture cardiac health.
I'd still like to see studies of cardiac arrest among hunter gatherers, or as another poster commented, primates. Lots of genetic problems can be impacted by lifestyle (epigenetics).
I don't know about about the condition you posted to say how lifestyle affects gene expression in that case.
Assuming the disease isn't strongly affected by gene expression, my statistics are likely off then. Wikipedia listed the condition as having a .2-.5% prevalence.
Specifically, I'd be interested in cases of spontaneous cardiac arrest among hunter gatherers or other groups that largely avoid the 'diseases of civilization'.
+1
It would also be interesting to know about any similar studies on the most advanced species of non-human primates.
I think we largely agree - differing only on the interpretation of the word "perfect".
In my interpretation, perfect health means this type of malfunction doesn't happen. But these days, such perfection is very rare, though it's possible with sufficient knowledge and access to diagnostics.
I had a good friend over for dinner recently, and learned that he had recently suffered a heart attack. Not a really bad one, but there aren't exactly 'good' ones either. Pretty scary, as he's still in his 30ies, like me, in good health, no smoking, not much drinking, some exercise, eats ok, and so on.
still in his 30ies, like me, in good health, no smoking, not much drinking, some exercise, eats ok, and so on.
This is the problem. In the absence of proper diagnostics, people look at popularly touted risk factors like age, alcohol/smoking/drugs, exercise, diet, etc. But these are highly generalised factors that don't take into account: genetic/congenital/epigenetic conditions, stress/emotional issues, environmental factors, and other factors that are difficult to understand by themselves, because the human body is so complex.
The only way to truly determine the extent to which someone's health really is perfect is with detailed individual diagnostics.
As I said in the initial comment, we're only just getting started in developing adequate approaches to diagnosis that may become widely accessible, but I think it's the key to preventing unexpected attacks in your friend and Dustin's friend.
Not to be a downer, but I suspect that we are decades away from meaningful diagnostics that would get you anywhere close to being able to declare someone in "perfect health". In fact, I will say that we are 20 years away, and we always will be.[1] For someone who believes that "perfect health" is of little meaning in an adaptive evolutionary framework, this isn't a big issue, but it could be disquieting to some.
Let's say you sequence everyone's genome and can do it for $0 per person. Even if you could, having a genome sequence gets you only so far. We don't know what many genes do; even less so do we know what changes in their structure or in their regulatory elements may do. We have useful, powerful ideas coming from evolutionary biology, but these won't be enough to let one feel confident about health claims.
And this says nothing about infectious, environmental, and behavioral components to risk.
[1] = I know that the fusion "20 years away and always will be" actually refers to the fact that if insufficiently funded it will always be 20 years away. But most people don't know that part of the reference, so I will ignore it at will.
I hope I didn't come off as pessimistic in the general case with regard to medical advances! We see important medical advances every year. I was referring to the notion of being able to verify "perfect health".
I'll have to disagree with you on that. Genetics is the wrong approach to dealing with all this and was a wild goose chase. Regenerative medicine is the correct approach, the body has all the mechanisms already to regrow itself, after all, it did grow in the first. Regrowing the body and keeping it from being a cancerous growth is the actual challenge. Noninvasive surgery like radiosurgery, focused ultrasound, and photoacoustic surgery is the correct approach along with floating growth factors. This is not really biological engineering but electromechanical engineering and well within grasp. A proper effort would get this done within a year.
For those of you who haven't had a CPR refresher in a few years, they now heavily promote the use of AED's [Automated external defibrillator]. The prognosis for recovery after CPR alone is in the single digits and moves well, well into the double digits if supplemented with an AED.
Gyms, schools, and works areas should all have a $1000.00 AED onsite. I was surprised that he had to wait for the ambulance to arrive before being defibrillated, since he was in a gym.
Remember things like this when people complain about "modern Health and Safety red tape". "Oh we need to have a this and a that and failed out inspection! Get off our back, let me create jobs."
So do you practice what you preach and carry one of these with you where ever you go, or in your vehicle? If not then why do you feel the government should impose that on a business? Why not make a law that says every business has to have a trained EMT on site during business hours. I'm sure that would save even more lives...
We have that. In germany the Berufsgenossenschaft mandates that every company with more than 2 and up to 20 employees has at least 1 person trained in first aid on site. Companies larger than that need 5% - 10% of the personal trained, depending on what work is done.
* First: It's employees. Founders don't need to be employees. In fact, I'd say most are not.
* Second: You have to go through a basic first-aid course when you get your drivers license. So most people actually are basically trained. I think you have to refresh that course every two years to comply with the regulation, but that's a refresher only. It's really a basic first-aid class that's required if you're a small company.
* Third: This is the kind of regulation where you get a slap on the hand the first time you violate it. So I'd assume the answer is "Basically nothing"
Btw: Paul Grahams view on the regulations in germany is a bit outdated. SAP started in a garage. And you don't need 20k to start a startup. You need 25.000 Euro to form a GmbH which is one kind of a LLC. There's a lot of reasons why big startups mainly happen in the USA, but the garage issue is none of them.
Right, and that is probably a negligible cost as you can get first aid training for free in a lot of places. The point is the op is advocating that businesses be required to buy expensive equipment that they themselves probably wouldn't be willing to spend the money on.
I need to pay that persons training, the wage for the lost day of work once a year. The training cost itself is negligible, but a day not billed to a customer costs me ~ 800 USD. I can nearly pay an AED for that.
However, given that a colleague nearly died from a stroke (he completely recovered) and another colleague permanently failed to show up for work after a bike crash, I think that having more people solidly trained in emergency procedures can't be a bad thing. And a one-time investment for medical equipment mandated for companies from a certain size on might be a good thing to consider.
This is so true ... I lost a cousin at a young age due to hypertrophic cardiomyopathy induced cardiac arrest and he could have been saved with an AED (simply restoring a normal rhythm). If you're interested in helping to promote the availability of AEDs in the U.S., check out http://gregaed.org/. If you do nothing else, learn CPR, artificial respiration and how to use an AED. You don't know who you'll end up helping (and hopefully you'll never use it) but you might also save someone's family a lot of suffering.
Definitely, there's really no excuse if you're a company. If nothing else it's a moral booster for the employees. I really wish AEDs would get even cheaper so they became ubiquitous outside of work.
In Stockholm there's this system which enables emergence services to send out alerts to people with the proper training and/or equipment in the area of a heart failure.
What are the legalities involved here? If you attempt to help are you opening yourself up to potential blame and legal action? What about DNR wishes the person may or may not have, or religious beliefs?
Nobody wants to live in a world where people find a dying person laying on the floor and let him die because they're afraid of legal issues. The law protects you from such nonsense.
Even if it didn't, in my opinion, no person worth a damn would allow that consideration to color their response.
A few months ago there was an incident in China where a young girl was run over by a truck while crossing a street. Nobody stepped in to help, precisely because they were afraid of the legal consequences. The entire thing was recorded on video, and it got a lot of exposure. It was horrific, the kind of thing one wishes you had never seen or heard about.
On the other hand, and thankfully this was a much minor event, my wife once got a traffic ticket for moving her car a few meters past a red light in order to make room for an ambulance. Something like that is enough to make you think twice.
Can't speak about China, but most states in the US have laws to protect people with the proper training from legal exposure (for example if you're giving proper CPR and break a patient's ribs). http://en.wikipedia.org/wiki/Good_Samaritan_law#United_State...
I just watched it, after googling for it. As a dad, I'm sick and want to go home and hug my kids. I can't understand how these people lost their humanity, but I've certainly lost mine towards them.
Counterpoint and proviso: know what the hell you are doing. It's easily possible to do more harm than good if you don't know better.
For example, whenever a motorcyclist gets into a crash, people get the bright idea that they need to get the helmet off. No, the helmet is bracing their neck, which may very well be badly injured, so sometimes if you just pull it off, now the guy's a quadriplegic, and since you were just "trying to help", the law shields you from legal responsibility even though you just crippled someone for life.
The helmet must be removed for unconscious injured. If the person is fully able to respond you should leave the helmet on unless asked otherwise, but you must remove the helmet when the injured looses consciousness. Not taking the helmet of may have the injured die of blood or puke inhaled or just his tongue blocking respiration. So you're damned if you do and more damned if you don't.
Be careful when you remove the helmet, always remove glasses first, open the helmet and pull carefully straight "upwards". Keep the spine straight. Just before you completely remove the helmet use one hand to support the head, so it doesn't bump down. If there's a second person to help, one supports the neck and the other one pulls.
Just refresh your first aid class and do the best you can. It's in pretty much all cases better than no first aid.
Better yet, become a trained first responder yourself. And urge your family members and colleagues (and anyone you spend significant amounts of time with) to do so as well.
By the time a trained rescuer arrives, the biker is dead or has massive brain damage from oxygen loss. So whatever you do can only be better than doing nothing.
I agree with that, but in the specific case of AEDs it's hard to get something badly wrong to the extent that you actively harm: the main failure case is not doing something properly that could've been done. So you should definitely yield to someone who has better training, if available. But if there isn't such a person available, the AEDs thesmelves are completely automated and intended to be used by non-experts (experts use EDs that aren't fully automated): they sample the heart signal for several kinds of situations that can be corrected by defibrillation, and then apply the right one if detected. They won't fire at all if they're not placed correctly and/or if it isn't one of the situations where defibrillation would help, so you can't accidentally give someone the wrong kind of shock that makes the situation worse.
I heard from a guy (not Chinese national but married to one) who lives in China saying that in China, don't help anyone having accident on the street. He said there are many cases where when you help, you end up paying the bills because the person (or his/her family) would tell hospital that you cause the accident. Simply because they don't have money.
EDIT: He added that if you do want to help, make sure you have witnesses that you're trying to help.
Basically, you are immune from liability unless you either: 1) are a licensed professional acting within the scope of your employment, in which case normal professional liability rules would apply; or 2) do something that a court finds grossly negligent.
Unfortunately, it may cost you quite a bit of time and money to convince said court that what you did was not grossly negligent should someone press the issue.
Good Samaritan laws cover a layperson attempting to do good (so long as you're not doing something a reasonable person would realize to be actively harmful).
In most states, "ignoring" a DNR order is covered similarly. Point of interest:
Even as an EMS provider, with a patient who has a valid and active POLST (Physician's Orders on Life Sustaining Treatment - a more detailed DNR, that offers advice on comfort measures, intubation, and the like) - if the family wants heroic measures (CPR, etc), then we are required to do so (though my personal moral and ethical compass has issues with this).
Just over a year ago my favorite uncle died suddenly in a freak car accident. Besides his immediate family, my mother and I were the very first ones to make it to the hospital where he was DOA. They took us in to see him one last time before he was sent to the morgue or wherever they take the bodies of those who die in the hospital. Everyone says great things about people who are recently deceased but I must stress that he was an extraordinary man. Really. And I thought that long before he died. Seeing his lifeless body there was shocking. What got to me the most was seeing the lifeless expression on his face. He was a man who was always smiling and more full of life than anyone I've met. The contrast between the live man I knew and the heap of dead flesh I saw will stay with me forever.
From that day on I have thought about death at least once a day since and always remind myself that every fear I have and every psychological block that keeps me from being who I want to be and doing what makes me happy is an illusion. It's not real and it can't hurt me. But it also reminds me that my hopes and dreams are meaningless too. But if I'm going to be alive I might as well live happy regardless, right?
Unfortunately, the problem is that knowing this has not changed my behavior. There's this weird mental barrier between knowing you have a short life and need to really live it and actually doing it. And so despite knowing this truth and coming to realize it in such a traumatic way, I still don't live it nearly as often as I should. I suspect many people are like that. I don't know why that is but I hope someday we can figure out how to go from knowing how we need to live to really doing it in a real way.
Those in the UK (or soccer fans in general) will be more aware of this due to incidents involving Marc-Vivien Foé who collapsed and died during a game, and more recently Fabrice Muamba who survived a cardiac arrest (his heart had stopped for over an hour but was receiving CPR[1] during this time).
After the Foé incident there was a lot of promotion of the Cardiac Risk in the Young charity in the UK http://www.c-r-y.org.uk/ who do ECG and Echocardiogram screening for those between 14 and 35 for a donation to the charity.
I got myself tested a couple of years in a row (until I turned 36!) as I was doing a lot of long distance (>200 miles a day for multiple days) cycling and my HRM showed me that I've got an atypical heart (resting heart rate down to ~40bpm at my fittest but I could regularly see >200bpm on my HRM whilst playing 5-a-side and I could average ~185bpm for an hour without feeling uncomfortable at all). A chat with the cardiologist after the scan(s) put any fears at bay, whilst mildly unusual there's nothing fundamentally wrong with my heart, if anything it's just a little smaller than average (hence the high HRmax).
Thoroughly recommended and you won't be wasting their time as you'll be helping support the charity by donating.
1. From, among other medical staff, a consultant cardiologist who just happened to be at the game, the same cardiologist later treated him throughout his stay at hospital.
This really reminds me of Paul Graham's post from a while ago, talking about things people in the future will think are weird about our time.
One of the things that struck a chord with me from pg's post: In the future, people will get regular health checkups to prevent problems before they happen. I don't know about this particular case, but it makes a lot of sense to me that many people who seem to be in perfect health, might not be. Today, the extent of checking up on yourself is mostly taking a blood sample, talking to a doctor, etc. And it's not done that often, either.
In pg's future world, people would check themselves out several times a year (maybe more), with machines that catch many of the most basic problems. In fact, I'd wager that one of the most promising avenues for advancing humanity is to develop better, more affordable tests to check for common problems that we can cure with some foresight.
In my final year of university, I worked on a project to build a device that induces therapeutic hypothermia. Following graduation, 3 friends and I decided that there was enough need for this device to pursue the venture full time. We won a few business plan competitions, received funding through a small incubator, and set out to improve the outcomes of cardiac arrest patients.
Two months in to full time work, the four of us were walking back to the office from from lunch when one of my colleagues collapsed of a sudden cardiac arrest. Similar to Dustin's friend, mine was immediately treated with bystander CPR and first responders were on the scene within 5 minutes. Unfortunately however, my friend was not as lucky as Dustin's. He is no longer with us today and it's devastating to think that his life was taken at the age of 24 by a cardiac arrest.
As someone who has been extremely close to this topic for the past year, I can't stress enough the importance of basic understanding. People who seem to be "very healthy" can still be impacted by cardiac arrest. A sudden cardiac arrest is not the same as a heart attack. Bystander CPR and the use of automatic external defibrillators can have a significant impact.
"SCA kills more Americans than lung cancer, breast cancer and HIV/AIDS combined." [1] So please spend some time understanding the risk factors that contribute to cardiac arrest, take a CPR course, and educate those around you. I really believe that a single individual can have a significant impact in a situation such as this.
All reasonably-sized gyms should have Automatic External Defibrillators (AEDs). CPR on its own is not incredibly useful on its own (although it does buy you time for paramedics to arrive).
They're only about $1k, which is about 25% of one of the treadmills. I'm surprised it's not mandated by law.
A very close friend was in a car accident that put him in a category 3 (GCS) coma for two weeks. Worst two weeks of my life... Until my girlfriend was electrocuted and hospitalised for two weeks barely able to move her body. Worst two weeks of my life... Until I lost a close friend overnight. Bam. Gone. Forever.
Life is meant to be lived. Unfortunately, that is a lesson you can only learn by yourself.
Yes and no. This is a very personal, very delicate subject, almost impossible to be expressed in or understood from a single random post at a random blog. Sadly, constant repetition of this particular appeal usually leads to cheap, bleak, even personally and socially irresponsible substitutions like YOLO movement that have very little in common with the level of awareness and appreciation of being alive that OP has acquired (and lost, and acquired again).
>even personally and socially irresponsible substitutions like YOLO movement that have very little in common with the level of awareness and appreciation of being alive that OP has acquired (and lost, and acquired again).
I'm pretty sure YOLO is a joke. At least I've never heard anyone say it without at least a hint of facetiousness in their voice.
I know the person he's talking about in this article, he's an old friend of mine from primary school, he's only a little bit younger than me. It was a shock to everyone. He was incredibly fit, in the prime of his life and everything.
I'm on the other side of the world from him now, but it was still a bit of a wake-up call. Inspired me to go travelling, something I'd been putting off for ages.
As a tangential aside, reading the opening paragraph of this article reminded me - in the US, if you have cardiac arrest, you want to have it either the counties surrounding The Mayo Clinic in Minnesota or Puget Sound:
While cities like Detroit, Chicago and New York have less than 10%, down to 2% survival for /witnessed/, VF/VT (ventricular fibrillation / tachycardia, the rhythms an AED can shock) arrest (i.e. the "best" cardiac event to have), Rochester Minnesota, and the three counties of King, Pierce and Thurston (Seattle, Tacoma and Olympia) have above 40 to nearly 50% survival.
Heart attacks in young people (under 35) are rarely related to smoking or high cholesterol (unless accompanied by morbid obesitas) and more often undiagnosed heart or congenital issues (hypertrophic cardiomyopathy, et al.), related to drug abuse (cocaine, weight loss drugs) and/or eating disorders (bulimia).
Memento mori, carpe diem, but know that your chances of being struck with heart attacks at a young age are very slim. If it runs in your family, get a screening, but other than that, don't worry too much.
My grandfather is 96, he's been on dialysis for nearly 2 years now. He has zero kidney function and a tumor that has literally taken the place of one of the kidneys. His mind is sharp and he's totally lucid.
He won't let us sell his cars. He believes that he's going to get better. He talks about it all the time. "As soon as I get better, we'll..."
It doesn't matter if one lives 20 years or until the heat death of the universe, everyone has the same experience. Death is unexpected and unwelcome. And completely inevitable.
As for death at 20, I'm with you, but as for the latter example, I'm open to suggestions on ways to prevent the heat death of the universe. I'm not entirely sure there's anything I can do about that.
It's not trite. Especially when things aren't working, and it would be so safe and warm and simply to stop wanting to do extraordinary things and sink back into momentum, inertia, the rhythm of everything that has ever been or will be. Not that I wish any of you to have a huge loss, or near loss, but once you do it is galvanizing - if you let it reach you at the core. As others on this thread have said, memento mori.
There are plenty of other cardiac abnormalities that can cause sudden cardiac death. Wolff-Parkinson-White (and other conduction pathway disorders), prolonged Q-T syndrome, etc...
An interesting bit about Steve Jobs (from the biography) was that he had a foreboding feeling that he'd die early. That also seemed to encourage him to work against the status quo before it was too late.
He's given the typical FOOLISH response people give after brushes with the death plague - live life to the fullest.
How about instead thinking of ways to fix the problem. That can also be considered - living life to fullest - and also fixing the problem.
In his case, he could have considered how can cardiac arrest be better dealt with. Have drones nearby that automatically go towards the patient and revive them. What's involved in that, collecting the data, manufacturing drones etc. etc.
The entire world is focused with having the latest shiny bullshit from the mall/walmart. Go there and see the masses of consumerist idiots picking up plastic crap and clothes like monkeys. How about they instead spend that time crafting a pitch for a new invention that solves a death-related problem on kickstarter. There are 7 billion people, probably only a few thousand of them are working towards actually worthwhile things.
Living life to the full doesn't have to mean buying or building crap to fulfill child-like urges to see shiny things, it can instead be using the "god given" brain to tackle the most important challenges, of which survival is number 1. Animals probably look at humans and think what retards, they themselves spend all their time trying to survive.
"Running at the gym" ..so many people do it, but wouldn't the energy be put to better use building something? Running barefoot outside would be my choice.. getting grounded and Vitamin D. Gym running is a weird sensation, and unnatural: it's more a striding exercise. Gyms can also be very dirty. But good that he recovered, he should try and work out the how and why so it doesn't happen again.
Contemplating your mortality shouldn't necessarily convince you to double down on your current priorities (especially if those priorities are centered around banal platitudes like "doing something remarkable with your life," which are probably masks to keep you from thinking about what really motivates you.) It should cause you to reevaluate them.
The fact that you will die, the fact that everyone you know will die, and the fact that eventually the universe might become a field of equidistant neutrinos means that it really, really doesn't matter what you accomplish. All roads, if you stay on them long enough, lead to the same place. There will be no progress. There will be no one remarking.
I would say that the lesson to be learned from thinking about death is just that there's no reason to adhere to anyone else's values, or to feel pressure to do anything in particular. You should do what you want, what makes you happy, even if it's humble.
Existential steps backward can be a tool to remove yourself from things that aren't really helpful, like for example a hyper-competitive capitalist rat-race justified by language like "fight the status quo" or "great visions of the future" that, instead of contributing to humanity, is mostly really about love, insecurity, and fear of death (like so many human pursuits).
"Fighting" here, the battle between the heroic pursuit of accomplishment on the one hand and the "insidious machine called quo" on the other, is just the author reporting his own conflicts about what he wants to do. Part of him wants to expend massive amounts of energy attempting to out-compete the people he sees as his peers. But another part of him doesn't want to do that, which is why he loses motivation and doesn't always end up behaving the way a hero-CEO might. There is not some kind of evil, inherent inertia at work that all people must fight against. Instead, there is only ambivalence and subconscious motives.
In my opinion, if you really internalize death and it's implications, the notion that you can justify prescribing ways of thinking or behaving just starts to look absurd.