Hospital

The Last Walk 3

            I suppose if one had much experience with cancer, as oncology professionals do, one would discern a pattern in the progress of the disease.  Karen’s oncologist, Dr. G, tried to give us a sense of what we could expect.  This was in July.

            First, he said, there is a small chance chemotherapy would completely kill the cancer.  Karen might be cured and live for years.  Much more likely, however, chemo treatments would achieve “control” of the cancer.  In Dr. G’s words, this meant each round of therapy would kill much of the cancer but not eliminate it.  We could expect the disease to return every time.  By a kind of natural selection it would return stronger, more able to resist drugs.  Eventually, even using different anti-cancer drugs in the chemo cocktail, the disease will kill Karen.  “Control” thus means that Karen might live a year or as long as five years.  Perhaps 70% of cases achieve control.

            What Dr. G left unsaid (I’m drawing conclusions on my own here) is that 5% and 70% leaves a quarter of the cases in which chemo has little or no effect.  Without treatment, Dr. G said, the cancer would kill Karen in six months or less.

            The “typical” history of the disease is a generalization from many cases.  Dr. G summarized for us not only from his own experience but the medical literature.  But Karen’s case is not the typical case; it is one particular case.  She and I will go through the ups and downs of this cancer, and it’s not conforming to expectations. 

            I had to take Karen to hospital.  Here’s the story as far as we know it.

            Chemo knocks Karen’s blood chemistry for a loop.  Kills cancer?  We hope so.  It definitely reduces her hemoglobin.  Blood with reduced oxygen carrying capacity produces deep fatigue.  So: cancer à chemo à lowered hemoglobin à fatigue.  She had her first transfusion eighteen days ago.

            Karen also takes medications for pain.  Lots of them; I won’t go into details.  Let’s just say they are powerful.  Pain meds act on her nervous system (duh); combined with the extreme fatigue they interfere with her mental functioning.  She starts a thought or a sentence and can’t finish.  She falls asleep in mid-thought.  So: cancer à pain meds (+ fatigue) à confusion.  After 30 years as a clinical psychologist this frightens Karen.  Most of those years were spent administering neuropsychological tests; she is familiar with the various stages and forms of dementia.  On Sunday, amid tears she feared people using that word about her.  It’s the drugs, I said.  “My brain is structurally sound,” she answered, lucid for a few seconds.

            Then Karen noticed that her left leg was swollen.  That was the last bit of evidence.  I took her to hospital.  Emergency Room staff worried at first about a blood clot.  Testing seemed to show that wasn’t the problem, but her kidney function was off.  They ordered transport to a larger hospital.

            On Monday, at St. Vincent’s she had her second transfusion.  Over the next two days, her fatigue lessened, but only a little.  The hemoglobin problem was solved (temporarily anyway), but pain meds and messed up blood chemistry were still there.  It turns out that chemo sometimes causes certain kidney diseases.  Who knew?  On Tuesday we thought maybe her chemo cocktail would have to be changed.  She’s due for chemotherapy next Tuesday.

            Tests: ultrasound pointed to problems with the right kidney.  They wanted to perform a CT scan “with contrast,” which means injecting a special dye into the patient; this test is top of the line.  But the dye is nasty stuff and dangerous if the patient’s kidneys are working properly.  On Wednesday, an ordinary CT scan, without contrast, revealed a kidney stone. 

Many years ago, my father suffered terribly from kidney stones.  But this stone is good news!  The problem may be correctable without compromising Karen’s chemotherapy.  Surgery is scheduled for Thursday.  Meanwhile, hospital staff has more carefully calibrated her pain meds, and she sleeps more peacefully.  I hope she can come home a day or two after surgery.

            This, and other “Last Walk” posts, are collected, along with many other essays, on my blog: storymeaning.blogspot.com.

           

           

Fictions?

Discrete Events and Narrative Lives (Part 3)

            Last week I introduced the “skeptical worry.”  The skeptical worry builds on undeniable facts about our personal stories.  First, the narratives we tell often deceive us about the likelihood of discrete events in the future—Allen Average’s chance of getting a hit in his next at-bat is unchanged by the fact that he already has three hits today.  Second, the stories we tell about ourselves, including those we tell to ourselves, are very often factually wrong about our past.  We forget things, we fill in the holes of memory with inventions, and we over or underemphasize things according to our narrative goals.  Third, at best our self-stories are comprised of a tiny fraction of the events that made up our lives to this point.  We remember very little of what we did last week, and the distant past is a fog. 

Therefore, the skeptical worry concludes, we ought to regard our self-stories as fictions.  Our narratives are merely stories, which we make up.

I think it is philosophically and morally important that we not regard our self-stories as fictions.  A person’s self-understanding, her identity, is wrapped up in her self-story.  Our narratives tell us who we are and what we ought to become.  Getting self-story right is crucial to living a good life.  I’m going to argue for my position, but before I do so, I will dredge up yet another undeniable fact that seems to support the skeptical worry, and that fact is this: sometimes our lives change in dramatic ways.

A car accident kills a mother, leaving her husband to care for two children.  The other driver in the accident is convicted of driving under the influence; he is sentenced to prison.  A drug-addict wanders into the gospel mission and gets sober.  A middle-aged man visits a casino for the first time and starts gambling compulsively.  Someone receives an unexpected inheritance.  In such stories, people change; sometimes we say, “She isn’t the same person anymore.”  The dramatic change may be sudden, as in the case of a stroke, or gradual, as in the case of a prisoner who changes from an angry twenty-year-old on the day of sentencing to the restrained and wiser forty-five-year-old who is finally released.

We have story-telling devices for describing such changes.  “That was my life, gradually sinking into despair, until I entered therapy.”  “Everything was fine until the recession hit.  We lost our jobs and in ten months we were homeless.”  These story-telling devices make sense of the before-and-after; they show how someone who “isn’t the same person” in one sense is, in another sense, still the same person.

Philosophers theorize about such things.  They ask: What is it that constitutes a person’s identity over time?  In what sense is the old woman the same person as the little girl of seventy years ago?  Is it because the current 75 year-old body has come into being through countless incremental changes of a 5 year-old body?  Is the rule “same body, same person” (provided the earlier body gradually morphed into the later one)?  Or do we need to have some kind of psychological connectedness to the earlier self?  Is the rule “same mind, same person”?  Or should we say “same soul, same person”?

As you might expect, Philosophy of Mind, the branch of philosophy that explores these questions, is complicated.  Students’ eyes sometimes glaze over when exposed to philosophers’ arguments and counter-arguments.  The questions become abstruse.  We need to remind ourselves the matter is important, and it troubles non-philosophers.  To quote Supertramp:

There are times when all the world’s asleep,

The questions run too deep

For such a simple man.

Won’t you please, please tell me what we’ve learned

I know it sounds absurd

But please tell me who I am.

“… tell me who I am” is the plaintive cry of ordinary persons, not only philosophers.  If I don’t know who I am, how can I act responsibly?  And who am I, if not the subject of my story?

Someone might argue that moral agency and/or responsibility hangs on one’s status as a rational being, not on the accidents of one’s history.  The eighteenth century philosopher Immanuel Kant would be a representative voice of this view.  Our moral duty is to obey the categorical imperative, Kant said.  The details of one’s life—one’s family, culture, century, health, and other such—merely create specific situations.  One’s duty as a rational being is to interpret the categorical imperative for each situation.

I suspect there are other philosophers who would agree with Kant’s conclusion—narrative doesn’t matter morally—without accepting his overall philosophy.  Kant was, after all, the quintessential modern philosopher.  Post-modernists reject his basic assumptions.  I think a post-modern philosopher like Richard Rorty would argue that we should regard our deepest moral intuitions as nothing more than accidents (not the product of “Reason” with a capital R).  And yet, Rorty would say, such judgments are our deepest intuitions, so we may as well go forward with them.  Kant thinks we can know our true duty without history.  Rorty thinks there is no “true” duty, because our stories are fictions; nevertheless, our intuitions about duty are all we’ve got.

I don’t believe in autonomous reason.  (One of the chapters in my dissertation is about Kant and what I call “the myth of autonomous reason.”)  I don’t believe in moral duty without history.  Against Rorty, I don’t believe ironic convictions can carry the freight of real moral living.  They don’t answer the cry: “Please tell me who I am.”  

We need to know who we are.  In spite of the reasons behind the skeptical worry, it won’t suffice to regard our stories as fictions.  Next week I will suggest a way forward.

Welcome Russian Readers

What's Going on in Russia?

     In recent weeks Story and Meaning has been visited more often by people in Russia than any other country, including the United States.  Today, the total number of site visits from Russia surpassed 1000.  I've been blogging Story and Meaning for more than four years, so 1000 visits may not seem like much.  Nevertheless, I'm pleased and flattered that people continue to read it.
     Thank you!

Skeptical Worry

Discrete Events and Narrative Lives (Part 2)

            Sabermatricians know that Allen Average’s success in his first three at-bats today says nothing about his chances of success in his next at-bat.  Therefore, they are deeply skeptical about many explicit or implicit narratives we often hear about baseball players:

“Bobby Bewildering has a career .290 average against left-handed pitchers, but for the last week he’s 1 for 14 against them.  His manager will be second-guessed for leaving him in the game to face Lefty Lou in this crucial situation…”

Or:

“Pre-season prognosticators pegged Our Town Heroes as a sub .500 team, but the Heroes are in the thick of the pennant race.  Baseball analysts don’t know what to say about the Heroes’ success.  More and more of them are adopting outfielder Cam Comstock’s notion that knowing when to hit is as important as knowing how to hit.”

Now, it may be true that Bobby Bewildering has hit lefties poorly for a week.  It may be true that the Heroes have been clustering their hits and producing more runs than one would otherwise expect—and they may have been doing this for three or four months.  These are facts about the past.  But these facts do not imply that Mr. Bewildering will continue to struggle against lefties or that Our Town Heroes are likely to continue clustering their hits. 

As I say, then, Sabermatricians are skeptical of narratives.  They do not believe in “grit” or “team chemistry” or “momentum.”  They do believe in luck, in the sense that an inferior team can beat a better team on any particular day.  After all, terrible teams win a third of their games and truly great teams still lose a third of the time.  In the course of a long season, the eventual champion team will have lost games to the worst team in the league.  At some point in the season, a really bad team will win four or five in a row; that does not mean they have “turned their season around.”

Many Sabermatricians would agree: When it comes to predicting the future, narrative doesn’t matter; talent does. 

There is an obvious limitation or exception to that slogan, well known to Sabermatricians.  Talent changes over time.  Young players tend to get better as their bodies mature and they practice their skills.  Old players’ talent tends to regress; inevitably a time will come when they are no longer able to play at an elite level.  It is a player or team’s true talent that determines the probability of success in any discrete event, but talent does increase and decrease over time.

I muse about baseball and discrete events not merely to indulge my inner baseball fan.  The Sabermatricians’ skepticism about narratives connects with questions in philosophy.  It turns out that narrative is a contentious and mysterious thing.  Here’s a quote from Louis Mink that points to some of the issues:

Stories are not lived but told.  Life has no beginnings, middles, or ends; there are meetings, but the start of an affair belongs to the story we tell ourselves later, and there are partings, but final partings only in the story. … Only in the story is it America which Columbus discovers and only in the story is the kingdom lost for want of a nail. (1970)

I said in part 1 of this essay that we live narratives.  Of course, I also pointed out that in doing so we often deceive ourselves.  The probability of discreet events seems immune to the stories we tell ourselves.  Along comes Mink, saying that we do not live stories; rather, we tell stories.  Perhaps the greatest self-deception is that we explain ourselves to ourselves by telling stories about ourselves.

Are the stories we tell about ourselves accurate?  Plenty of psychological research answers: Not very.

When people tells stories about the past, including stories about their own past, they tend to emphasize some parts and neglect other parts.  In extreme cases some people may repress painful memories or invent episodes wholesale.  Much more often, the storyteller simply fills in the parts he doesn’t remember with plausible details.  He may dwell on the humorous or scary or disgusting elements of the story because these parts fit the point of the story.  Over time, when storytellers tell their story repeatedly, the story gets standardized; the teller uses almost exactly the same words over and over.  This doesn’t mean the story is accurate; it only means it has been reduced to a formula.

A worry begins to emerge.  Call it the skeptical worry, parallel to the Sabermatricians skepticism about baseball narratives.  “Look,” the worry says, “People don’t remember their past accurately.  Most of us have only fragmentary memories of any part of our lives.  It could not be otherwise.  Thousands of seemingly important things happened to us when we were x years old, but we don’t remember most of them.  And psychological research shows that those we do remember have probably been warped by the ways we have told them.  Therefore, the stories we tell about ourselves ought to be regarded as fictions.”

We must admit the skeptical worry gets lots of things right.  Our memories fail us.  The stories we tell ourselves can mislead us about the future, and they may misrepresent the past.  Nevertheless, I reject the skeptical worry.  I will begin explaining why I reject it next week.

Two days late

Discrete Events and Narrative Lives (Part 1)

            Suppose your favorite ballplayer, Allen Average, comes to bat in the eighth inning.  His team trails 5-4, there is a runner on third, and two outs.  The defending team only needs one out to end the inning.  You really want Allen to get a hit, which would bring in the tying run.  Now, Mr. Average is not a great hitter, though he plays excellent defense (which is why the manager puts Allen in the lineup most days).  Allen’s batting average is almost exactly the league average.  Ordinarily, you wouldn’t feel much confidence in this situation, since as an average hitter Allen fails to get a hit more than 70% of the time.

            But today is different, you feel.  This is Mr. Average’s fourth plate appearance of the game.  In his first three at-bats, Allen got a hit each time, and one of them was a double.  Allen is having a really fine day hitting!  Allen is “seeing the ball well,” as professional players often say.  As he approaches the batter’s box, you’re feeling a fine mixture of dread and hopefulness, the heart of baseball fan experience.  On this occasion you’re feeling more hope than dread.  Today is Allen’s day!  He’s going to get a hit—at the very least, you feel he has a better chance today than on other days.

            Your feelings deceive you.  Sabermatricians have explored this question thoroughly.  (SABR is the Society for American Baseball Research.  You never may have heard of it, but it’s real.  There are thousands, many thousands, of nerdy baseball fans well trained in statistical analysis.  They have spent millions of hours researching questions like this one.)  They have asked the question this way: take any player who has had a recent string of success or failure up to time x, what are his chances of success at time x+1?  Baseball gives multiplied thousands of examples to check, and the result is clear.

A baseball player’s career average, his average up to time x, gives a much better prediction of his chances of success in any particular at-bat (x+1) than his earlier success or failure today.  Given that Allen Average has had good success in his first three at-bats today, what should we say about his final at-bat today?  Answer: his prior success today is irrelevant; Mr. Average’s chance of success in his last at-bat is approximately equal to his overall success rate.  Recent success or failure doesn’t matter.

            One way to summarize this lesson is to say that at-bats are discrete events.  Each event, we might say, is causally independent of the others.  They are affected by a player’s underlying talent, but not by recent success or failure.  Today’s narrative (Allen is having a fine day hitting!) has no discernable effect on the immediate future.

            Imagine another illustration from a different sport.  A basketball player, Tom Terrific, prepares to shoot a free throw.  Mr. Terrific is a good shooter; over his career he has made 85% of his free throws.  Tonight, though, Tom is not shooting free throws very well; he has made only 6 of 12 free throw attempts.  What are his chances of making this next free throw?  Statistics from professional basketball answer clearly: Tom’s chance of success on his next free throw (x+1) is indistinguishable from his career average.  His earlier failure tonight doesn’t matter.

            When it comes to predicting the future, it seems that narrative doesn’t matter much.  And this bothers some people.  We want to think that since Allen Average is having a good day he has a better chance of getting a hit on his next at-bat.  We fear that since Tom Terrific has missed half of his free throws, he is unlikely to make his next one.  But we’re wrong.

            Sometimes people turn narrative expectations on their head.  Since Allen has three hits already, they say, Allen is “due” to make an out.  Tom is too good a shooter to keep missing, they say, so he is almost sure to make the next one.  Again: not true.  The next at-bat, the next free throw—in general, the next discrete event—is independent of recent events.  Narrative just doesn’t matter, at least in the short term.

            But people live narratives.  Even when we know better, we let the story of our lives direct our thinking.  Here’s an example.

            Once or twice a month, I play Settlers of Catan with some friends.  If you’re familiar with Settlers, you will understand my example easily.  If you’ve never played, the point will still be clear.

            In a game not long ago, I had ten resource cards in my hand when it came to my turn.  I rolled a seven, which meant that I lost half my resource cards.  (Game rule: anytime a seven is rolled, players with more than seven resource cards lose half of them.)  A significant setback!  The next time it came my turn, again I had a large hand, and again I rolled a seven.  Agh!  More resources lost!  My next turn: yet again I lost half my cards due to rolling a seven.  Three times in a row!

            Now dice rolls are discrete events.  There is a 1/6 chance of rolling a seven on any particular roll of two dice.  By the laws of probability, a person will roll a seven three times in a row, on average, once in 216 chances.  So it’s not impossible.  It does happen—rarely.  But what about the next dice roll, the x+1 roll?  Since dice rolls are discrete, independent events, the fact that I had three sevens in a row said nothing about my odds of getting another seven.  The chance is still 1/6 of rolling a seven.  As a university professor I teach logic.  I know this.

            But we live narratives.  Losing all those resource cards had torpedoed my chance to win the game.  I was frustrated.  So: just before my next turn, I traded cards with another player, giving up three for one, to trim my hand to seven cards (thus making me immune to the seven rule).  That is: I made a bad trade, a trade that further reduced my already tiny chances to win the game, because I feared rolling yet another seven.  Obviously an irrational decision!  But I was living a story, a frustrating story.  Narrative can induce crazy behavior.

            By the way, I rolled another seven.

           

           

Adding to the House

The Last Walk 2

A society grows great when old men plant trees

whose shade they know they shall never sit in.

Greek Proverb

He who plants a tree plants a hope.

Lucy Larcom

            Building an addition to one’s house isn’t quite like planting a tree.  In deciding to build, Karen and I justified the expense to ourselves by saying we could recoup our costs someday when we sell it.  In theory, adding to one’s house is just another investment.

            But context changes things; it even changes the meaning of things.  The real reason for building an addition, no matter what we told ourselves about resale prices, was to give James and Jennie more room.  Our son and daughter-in-law have lived with us for more than a year.  They’ve been careful to keep themselves to their small bedroom, and the addition would give them more space.  We contracted with Matthew, our builder—and quickly modified the plan to add a concrete pad for a hot tub.  A hot tub, we thought, might help with Karen’s persistent back pain.

            Then we learned Karen’s cancer has returned.  We enter a new phase in our life together, our last walk.  For Karen especially this changes the meaning of the addition and the hot tub.  It changes her garden.  (Make no mistake, the flowers, shrubs, trees, and garden paths are all her doing.  Sometimes I dig holes where she tells me.)  In a few months or years someone else will have her house and garden.

            In the long view, this has always been true.  We all know we will die someday.  We know our houses and gardens will pass to others.  Our accomplishments will be forgotten.  (Quick!  What do you know about your great grandmother’s great grandmother?  Your descendants won’t remember you either.)

            We know we will die.  Usually, we don’t think about it.  Now that we’ve come to our last walk, Karen and I have to think about it.  We’ve lived in our house 23 years.  Who will be here 23 years hence?  What will they be like?  How will they change the garden?  Will they like the hot tub?

            Of course, the Greek proverb is not only about trees.  It’s about caring for people we won’t live to see, people who won’t remember us.  We “plant trees” by building houses, growing gardens, teaching children, and so on.  There are myriad ways to contribute to a good world for those who come after.  One might even “plant a tree” by voting!

            As her strength allows, Karen will tend her garden, write more music and make more photographs.  Small things, perhaps, like building an addition to one’s house.  Or like planting a tree.