How Not To Be Alone

Jonathan Safran Foer, in a wonderful essay, laments how technology (phones, texting) has made us prefer to use the diminished substitute to communicate. And so:

The problem with accepting — with preferring — diminished substitutes is that over time, we, too, become diminished substitutes. People who become used to saying little become used to feeling little.

This is beautifully phrased:

We often use technology to save time, but increasingly, it either takes the saved time along with it, or makes the saved time less present, intimate and rich. I worry that the closer the world gets to our fingertips, the further it gets from our hearts. It’s not an either/or — being “anti-technology” is perhaps the only thing more foolish than being unquestioningly “pro-technology” — but a question of balance that our lives hang upon.

A must-read meditation.

Alex Payne: Alone, Together, Technology

This is a must-read personal post by Alex Payne, in which he reflects the influence of technology in his life following a divorce with his wife:

I owe my life to technology.

I first realized it in my early twenties. Everything important around me at the time, I’d found on Craigslist: my girlfriend, my job, my apartment. It was a powerful realization: I could sit down with my laptop and, in a matter of hours or days, change my world in both superficial and fundamental ways.

That was years ago. Technology specializes over time. The life I just finished packing up wasn’t courtesy of Craigslist. It wouldn’t be, now. The modern web has six sites for everything, branded and polished and localized and full of options. House from Redfin. Cars negotiated online before ever walking into a dealership. Wife from OkCupid. Wedding invitations by email. Date-night dinners booked on OpenTable. Fast and friction-free.

I spent four years telling anyone who asked how we met that OkCupid’s matching algorithms must have been off. “We were only a seventysomething percent match, with like a twelve percent chance of being enemies. Guess they need to work some bugs out!” The joke’s on me, of course. I emailed the right person at OkCupid to apologize for the years of disparagement.

I could blame technology. Maybe stitching together a durable life takes physical work, needle callouses.

I think this was the second best line in the piece:

Maybe technology made it all too easy to slide into a life I wasn’t meant to have.

And the best:

I will owe the next part of my life to technology, but I will owe it more to experience.

Amen.

Again, a must-read in its entirety.

The Quiet Ones

We’re a tribe, we quiet ones, we readers and thinkers and letter writers, we daydreamers and gazers out of windows. We are a civil people, courteous to excess, who disdain displays of anger as childish and embarrassing.

This is a quote from a very thoughtful essay titled “The Quiet Ones” by Tim Kreider, published in The New York Times. Kreider laments that the beauty of quiet is disappearing, and there’s not much we can do about it:

Those of us who despise this tendency don’t have a voice, or a side, let alone anything like a lobby. There are anti-noise-pollution groups, but they can fight only limited skirmishes over local nuisances; the war is lost. It’s impossible to be heard when your whole position is quiet now that all public discourse has become a shouting match. Being an advocate of quiet in our society is as quixotic and ridiculous as being an advocate of beauty or human life or any other unmonetizable commodity.

I’d never heard of Kreider before reading this essay; his collection of essays We Learn Nothing has promising reviews on Amazon.

The Destruction of the 1 Percent

Chrystia Freeland pens a brilliant essay on the destruction of the 1 percent. She begins with the rise of Venice during the Renaissance and its subsequent decline:

In the early 14th century, Venice was one of the richest cities in Europe. At the heart of its economy was the colleganza, a basic form of joint-stock company created to finance a single trade expedition. The brilliance of the colleganza was that it opened the economy to new entrants, allowing risk-taking entrepreneurs to share in the financial upside with the established businessmen who financed their merchant voyages.

Venice’s elites were the chief beneficiaries. Like all open economies, theirs was turbulent. Today, we think of social mobility as a good thing. But if you are on top, mobility also means competition. In 1315, when the Venetian city-state was at the height of its economic powers, the upper class acted to lock in its privileges, putting a formal stop to social mobility with the publication of the Libro d’Oro, or Book of Gold, an official register of the nobility. If you weren’t on it, you couldn’t join the ruling oligarchy.

The political shift, which had begun nearly two decades earlier, was so striking a change that the Venetians gave it a name: La Serrata, or the closure. It wasn’t long before the political Serrata became an economic one, too. Under the control of the oligarchs, Venice gradually cut off commercial opportunities for new entrants. Eventually, the colleganza was banned. The reigning elites were acting in their immediate self-interest, but in the longer term, La Serrata was the beginning of the end for them, and for Venetian prosperity more generally. By 1500, Venice’s population was smaller than it had been in 1330. In the 17th and 18th centuries, as the rest of Europe grew, the city continued to shrink.

She then makes a compelling argument that such a decline will happen in America. The only thing I found at fault with the essay is an unsympathetic jibe toward Apple and its Maps app in the latest iOS.

On Investments and Time

Paul Graham, in this essay from 2010, makes a great point on investments (both in terms of money and our use of time):

In most people’s minds, spending money on luxuries sets off alarms that making investments doesn’t. Luxuries seem self-indulgent. And unless you got the money by inheriting it or winning a lottery, you’ve already been thoroughly trained that self-indulgence leads to trouble. Investing bypasses those alarms. You’re not spending the money; you’re just moving it from one asset to another. Which is why people trying to sell you expensive things say “it’s an investment.”

The solution is to develop new alarms. This can be a tricky business, because while the alarms that prevent you from overspending are so basic that they may even be in our DNA, the ones that prevent you from making bad investments have to be learned, and are sometimes fairly counterintuitive.

A few days ago I realized something surprising: the situation with time is much the same as with money. The most dangerous way to lose time is not to spend it having fun, but to spend it doing fake work. When you spend time having fun, you know you’re being self-indulgent. Alarms start to go off fairly quickly. If I woke up one morning and sat down on the sofa and watched TV all day, I’d feel like something was terribly wrong. Just thinking about it makes me wince. I’d start to feel uncomfortable after sitting on a sofa watching TV for 2 hours, let alone a whole day.

And yet I’ve definitely had days when I might as well have sat in front of a TV all day—days at the end of which, if I asked myself what I got done that day, the answer would have been: basically, nothing. I feel bad after these days too, but nothing like as bad as I’d feel if I spent the whole day on the sofa watching TV. If I spent a whole day watching TV I’d feel like I was descending into perdition. But the same alarms don’t go off on the days when I get nothing done, because I’m doing stuff that seems, superficially, like real work. Dealing with email, for example. You do it sitting at a desk. It’s not fun. So it must be work.

With time, as with money, avoiding pleasure is no longer enough to protect you. It probably was enough to protect hunter-gatherers, and perhaps all pre-industrial societies. So nature and nurture combine to make us avoid self-indulgence. But the world has gotten more complicated: the most dangerous traps now are new behaviors that bypass our alarms about self-indulgence by mimicking more virtuous types. And the worst thing is, they’re not even fun.

Do you have days like the ones Paul describes? The day breezes by, and you seem like you’ve accomplished nothing?

How Doctors Choose to Die

Ken Murray, a Clinical Assistant Professor of Family Medicine at USC, writes a powerful essay about how he wishes to die, as a doctor. I am not sure if his essay can speak for all doctors, but his is a strong and resonant message:

How has it come to this—that doctors administer so much care that they wouldn’t want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.

To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They’re overwhelmed. When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. Sometimes, a family really means “do everything,” but often they just mean “do everything that’s reasonable.” The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do “everything” will do it, whether it is reasonable or not.

The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. I’ve had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who’d had no heart troubles (for those who want specifics, he had a “tension pneumothorax”), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.

But of course it’s not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.

Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman’s terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.

But doctors still don’t over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had “died peacefully at home, surrounded by his family.” Such stories are, thankfully, increasingly common.

Several years ago, my older cousin Torch (born at home by the light of a flashlight—or torch) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learned that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, Torch decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn’t had in decades. We went to Disneyland, his first time. We’d hang out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favorite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don’t most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.

The full essay is here.