In the middle of nowhere…


Well…today I am reflecting. This may come as an unusual twist to my recent writings consisting of acute stressors in life that usually just piss me off…

So today I am considering life from the victory conditions of one of my favorite video games of all time. Generally I like video games, particularly complicated ones. The one I am thinking about today is easily one of my favorites because it is complicated enough to focus the entirety of my thought processes. This indirectly brings peace to me because when I have to focus the entirety of my mental faculties on not getting my ass kicked by the computer, I don’t have any capability to turn to more destructive thoughts.

This particular game, based on WWII, was largely developed by enthusiasts over a decade. While the functions are relatively easy but numerous, the volume of information which must be learned to effectively play the game takes years. After each battle in the campaign, you are scored as:

Decisive victory: you have achieved all predetermined victory objectives and inflicted at least 10x the destruction on the enemy as it inflicted on you.

Marginal victory: you have completed all or a majority of predetermined victory objectives and inflicted 5x the destruction on the enemy as you suffered.

Draw: you have achieved a minority of victory objectives and or caused casualties equal to <4x those inflicted on you.

Marginal defeat: you achieved some of the victory objectives, but with losses equal or greater to those you inflicted.

Decisive defeat: you either achieved none of the victory objectives, and/or lost >3x the amount of casualties inflicted on the enemy.

My life is a marginal defeat. I have my moments, and those moments are usually really good, but they are few, and the losses suffered while not always catastrophic, seem to outnumber the gains.

So this begs the question, if I am losing, why don’t I change something? As if I don’t constantly try to change something… It doesn’t take me too long to figure out if I am winning or losing at something, even when I am perhaps holding on to a vain effort longer than I should.

But I seem to exist in this strange void or limbo. I am simultaneously part of things but also not a part of them. Here are some examples.

Nationality. So far I am still an American, I know I should probably ditch that citizenship, all objective measures determines the drawbacks exceed the benefits, but I can’t seem to bring myself to it. Perhaps sentiment, but perhaps just so I have some form of group identity. After all, I am a Polish National too. (US law allows a person to have up to 3 citizenships, and I do think it would be cool to get a 3rd just to be one of the rare people who have 3. I have actually met a couple of those people, and that is a trophy not many can claim) But if you ask any Polish person, they will tell you that I am not Polish. Not because of my language skills, but because of the way I think and see the world and life. It is a world of possibilities, of opportunities, of dreams and goals, not some mindless grind of be born, go to school, get a monotonous job, get married, have kids, retire, die. Another characteristic feature that distinguishes me from my Polish counterparts is that like most Americans, I believe I can win. At whatever I am doing. Not just do it to some minimal level of competence and/or getting a trophy for coming in 9th. (They give out trophies for 9th place?) But be number 1. The best. The top. The undisputed heavy-weight champion of the world. Now while there are Polish champions, in the greater Polish society, they are generally outcasts, so, I win the outcast award too, simply for trying to be the best.

Conversely, despite my having to go through the headache of filing my yearly tax returns as Americans are the only people left in the world that get taxed as expats, filing special treasury forms for my bank account and life insurance to make sure I am not some hidden millionaire evading my share of US taxes, which is outright laughable with my income. If you ask many Americans, I am definitively not an American. I can’t really figure out why, the reason I am most often told is because “you do not live in America,” but by that standard it would be fair to say any American not living in America is not really American, and that would strip citizenship from some unsuspecting people, like military service members.

So on paper, I belong to both the USA and Poland, but in the practical sense…I belong to neither. The middle of nowhere.

My career, which went from something really good to an utter disaster after moving to Europe (it is not just Poland, Poland has done a lot for me, and I tried living in the UK, that was a disaster not worth repeating) has convinced me that it is Europe in general that is bad for my career. Especially since most places, my previous titles and skill set doesn’t exist or has no perceived value.

Officially I am a doctor and a scientist. What kind? I like to think a good one, but that is one of those “you don’t fit in” issues too…

When I went to medical school it was with the goal of becoming a critical care surgeon. It never occurred to me that medical specialties and practice were different outside of the US. I mean when you hear that America is always the best, you just assume everyone is trying to be like them…Yea, I was naïve and not well-traveled once too, I must apologize for not being born omniscient. (Don’t tell my daughter, she thinks I know it all right now, so I figure I have 3 or 4 years left before she decides I don’t know anything.) It didn’t occur to me to research that it might be different. So not knowing what I didn’t know I just showed up. Forget culture shock, it was everything I knew to be true in life wasn’t shock. Even buying food at a restaurant was simply unfamiliar. I had never paid for food by the weight before, nor had to order each piece of the meal separately to make it look like the picture on the menu…

But as medical school drew to a close, I discovered that returning to the US was not a realistic option. I was now a “foreign medical grad” and as such no matter what I did would rate somewhere on the resident desirability scale between some guy off the street and everyone else rejected this position. It was potentially destructive for me, my family, and any hope of finding a job above poverty wages. My parents are gone, and with the exception of some really good friends, there is nothing else to go back to. But this section is about career, so I simply figured…well then I will just invent it here…

That is turning out to be nothing short of a disaster. In addition to struggling with languages, I am in a culture where such lofty aspirations are actively fought against by all of society. In addition to being outcast for trying to break the 1000 year old status quo, for the benefit of people here! I find myself beset by problems like people not wanting to help me in my endeavors at all. People who take active measures against my efforts for their political gain, and of course…not belonging to any group but being between two of them…the middle of nowhere…

The quick quick summary is that throughout Europe, there are surgeons and there are anesthesiologists. (The latter is also the domain of both emergency as well as intensive care in all but the UK). So in order to make the critical care surgeon specialty work, the path of least resistance would be to get specialty in both. Probably for the only time in my life, I tried to take the path of least resistance, but it doesn’t seem to be that way to me.

When I am asked why I would do such a thing, I summon up all of my passion for helping people in desperate need and give my very best altruism as an answer. It has never been met with “really that is awesome” or even “cool”. Usually it is derision. “Why bother”, “you’ll never make money doing that”, “it will take forever”, and my all-time favorite…”Who do you think you are?”

So when I go to work in surgery, the surgeons without exception are quick to point out that I think like an anesthesiologist. When I work in anesthesia I am told I am too much like a surgeon. I once again seem to be both, but neither. The middle of nowhere… After the last two years I really self-identify more as a surgeon. I haven’t actually finished specialty training yet, trying to do 2 essentially makes me the world’s longest doctor in training, but from the point of view of mindset, surgeons are all about doing. Identify something needs done and do it. Granted there are limits to this for most surgeons, and that limit revolves specifically around operating on patients and very little before or after that act, but my experience with anesthesia is they like to set up systems requiring minimal intervention and are extraordinarily routine driven. That just doesn’t mesh well with my idea of individualized care; especially in environments like the OR or ICU where doctor to patient ratios are so conducive to it. I also don’t like to call for help for simple skills like chest tubes…

Besides, when I was in the UK, the A&E docs always referred to me as a surgeon, so at least 1 group made me feel like I was part of another instead of saying “well, he is like us, but not.” Yes, I know they were only saying that because I worked in a surgical service and they didn’t want to claim me as their own…but…marginal defeat still means some level of objective was achieved…

So what kind of doctor am I? I am in the middle of nowhere…

Now because not having great employment opportunity as at once being part of different things but not all of one doesn’t pay well, I supplement my income by teaching. I also like to do research to change what I see as substandard practice…

Many of my colleagues think that most PhDs are either good researchers or good teachers…and 5 pages in, let me just sum it up…I like to be good at both, and both groups identify me as “not theirs” and I find myself in the middle of nowhere again…This is a recurrent theme for me…

I recently was told by a friend on Facebook there is a superhero named “Dr. Strange” who did his MD and PhD simultaneously…That made me feel like a superhero, because I did exactly that. Looking back it was hard, and I suffered, but for the only time I can remember, I was learning at a rate that actually required my maximum effort and focus…Now I have a lot of time to waste. I would like nothing more to be involved and learning at that rate again. It was challenging. Exciting. Full of discovery. It also came with many compliments about being smart for the first time in my life.

But I haven’t had anyone call me and ask to be on their superhero team…Sort of makes that a hollow victory and lessens the super-ness of it…If anyone thinks you are a hero for being smart, let me set that right to rest too… I have been ostracized, even tortured my entire life for being smart. Nobody likes smart people and I have no idea why? Fear? Envy? I could theorize all day…I even had a girlfriend dump me once because she said it wouldn’t work out because she likes when everyone tells her how great she is, and it didn’t happen too often when she was standing next to me, so I was taking all of the attention she wanted.

What is it like to be smart? Well…I was once dating a different girl who asked me “do you dream in pictures or words?” I thought this was a silly question…both of course…like everyone else…that is when she told me that was not like everyone else. She then went on this speech about lucid dreaming, and how awesome that would be… I asked her quizzically, “you cannot do that?” All of my dreams are that way, ever since I can remember. It’s better than a movie, stop, rewind, rewrite the script, different camera angel, zoom in, zoom out. That is how it always worked for me. It never occurred to me it wasn’t like that for everyone.

I take sleeping on a problem to another level entirely…Consciously, while I sleep… my mind works constantly. It never stops 24/7/365. Just like many other things on this list, it never once occurred to me everyone was not like this until somebody told me.

Patterns. I can quickly spot patterns in everything. Even when others tell me there are no patterns at all. While not perfect, it makes my ability to predict things very accurate a high percentage of the time. It permits me to anticipate and prepare for problems before they happen, in most cases, or avoid them entirely. My wife hates it when I blurt out the next line in a movie that neither of us have seen before or figure out the ending ½ through the movie. (90s movies are the exception because for some reason they thought it is entertaining to essentially change the whole movie part way through). I am also never invited to escape rooms or murder mystery dinners… This happens passively, no effort required.

Complex thought processes. When I look at a conundrum or problem, I don’t do it with compartmentalized information. There is no such thing as simply “what I know about medicine” or “what I know about human behavior.” When a problem arises I identify every piece of information that I have (information I have is the limiting factor, and I want to be first in line if they ever invent the brain plug like in the matrix to learn things) as being relevant to the problem or discussion at hand, as well as identifying how, and what impact it has. Plus it is fast…This also has the added benefit of allowing me to imagine in real time what somebody is telling me as they say it. It helps a lot in pattern identification and breaking down lies, untruths, and cons.

Form without substance…Dogma and church-like rituals that don’t stand up to even basic scrutiny cause a hard stop in my thought processes, like a computer dividing by zero.  This then has to be reconciled and it usually takes me a minute or two to do it. That is when I am not just looking at people like “what the fuck were you thinking?”

“Ninja like reflexes” is how my reactions are often described. From practicing martial arts, catching dropped surgical tools, or dodging stuff people teasing or hazing me throw at me. So fast is the recognition and process it looks like slow motion to me most of the time. It comes with the added bonus of being able to process the geometry of throwing it back too, and in my mind’s eye, I can even imagine the equation angles.  As it happens. During one part of my fire career i was given the nickname “slide rule” for essentially taking the arc out of throwing a basketball though its hoop. It seemed totally unnecessary to use an arc.

Like a sponge…As I mentioned before, the only time in my life I was pushed to my maximum ability to absorb (and consequently integrate) information was while simultaneously studying for an MD and PhD. Short of that level of intensity, learning is effortless, and if experience is a wise teacher and a fool can learn from no other, I am no fool, because when you tell me your experience I can internalize it to the point I can smell the smells, taste the tastes, hear the noises, and tell you how you felt.

Calm to the point of appearing apathetic. Since most of the time thoughts go through my head faster than most actions, I don’t have to act as quickly as I think. Coupled with anticipation and pattern recognition, I can position for success in moments to come, rather than racing to catch up. Actually when I am racing to catch up is when I make the most mistakes at things. Second is when I am prevented from positioning myself for success and having to wait to react.

If you are thinking just now, “wow” this is like a super power… It’s not, it is a terrible curse that alienates people from you, causes people not to believe or trust you, makes them jealous, fearful, and constantly questioning how it is even possible. Which is a crazy question anyway, because it is as natural as anything you do. I have read everything from psychology to neuroscience, psychiatry, every article on the benefits of being left-handed…I have no idea how it is possible, it’s just natural, the way it has always been and it pisses teachers off to no end too. I try to be humble about it, I try to suggest rather than pontificate. But I admit, I sometimes quickly run out of patience for people who think I am not capable of understanding a single topic I have not been involved in for 20 years. I am also merciless when it comes to insulting my intellect, because I have suffered dearly because of it my entire life. When I am standing there telling somebody an answer to a conundrum while they totally ignore me and go on making mistakes trying to figure it out, it doesn’t make me think too highly of them either,because it seems to me, a preventable mistake. An obvious one at that.

When I was young, my dad, who was super smart (he worked in a factory most of his life, wasn’t even a foreman, and his hobby was subscribing to an astrophysics publication and working out the published data equations by hand while he ate dinner), but not formally educated because of lack of money and social status told me that a smart person only ever has 2 choices in life. They can help people or take advantage of them. I chose to help. It doesn’t make you rich. It doesn’t make you popular. Almost nobody ever wants you around until there is a problem and you can expect to be ditched right after it is solved. But for the disaster that is my life…the victory objective I achieved in my marginal defeat was not purposefully or maliciously taking advantage of anyone. Even when my council has been wrong, I have always believed to my core I was trying to help for the benefit of somebody else.
In closing…It’s better to be lucky than smart, but being stupid is bliss…Stupid people are never alone, there is always a big group of them ready to welcome other stupid people in.

well…7 pages…enough of my mawkishness. I need to go chase down another victory objective to make sure I am only being marginally defeated by life. What else can be done..? As another great mentor once said “if you are not winning then you are..?”

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