Tag: Fear

Categories
Preparedness Startups

Day 632 and The Yips

I think I might have a case of the yips. If you aren’t familiar with the term, it’s most commonly referred to as type of performance anxiety associated with experienced athletes. They suddenly find themselves unable follow through on techniques they otherwise know well.

Though as it turns out it’s not actually a form of anxiety at all, but rather a failure to consistently execute on muscle memory in experienced professionals which manifests as a loss of fine motor skills or a struggle to follow through on common chains of decision making, especially ones that are subconscious.

You might also associate it with analysis paralysis, a phenomenon in which someone has access to all relevant information but gets lost in decision making rather than simply acting on their reasonable informed instinct. One’s ability to simply execute what is in front of them is diminished not through lack of knowledge of experience but rather inaction.

I am an experienced startup operator. I am also a competent angel and early stage investor in private markets with a speciality in technology driven businesses. At this point, I’m not only well into my career with a number of concrete successes (I’ve built and sold companies) but I’ve also got generational memory from being the daughter of a startup operator. And yet I’m still nervous about swimming into the deep end of my investing career. I’ve got the the yips.

I hadn’t noticed that I had the yips till I came back from a wilderness medical incident technician certification course. I was doing a hands on course meant for front line first responders in rural and back country scenarios. It was heavy on scene and scenario execution so you could build muscle memory and quick response times.

In medical emergencies, especially in a wilderness context, you have limited resources and personnel. Acting swiftly with the knowledge and materials at hand is crucial. If you don’t take action, someone will die. Startups are famously resource constrained environments. Paul Graham of Y Combinator has an entire framework that assume you are default dead unless you take action to assure survival. This is as as applicable mindset for wilderness survival as it is for startups.

I had some sort of instinctual foresight that this wilderness medicine course would be useful not only practically in day to day life as someone who lives in Montana, but also as a mindset for my investing work on the chaotic thesis that the world is getting more complex. And that complexity has consequences for all of us.

The more chaotic the world, the harder it is to act with confidence as complexity builds.

Only by getting outside of my own skill set and professional world did I finally see how much I’m holding myself back from acting. Whether it is out of fear or analysis paralysis I do not know. But I do know that if one does not act the consequences can be dire. We are all default dead unless we make decisions to remain alive. There is no safety or progress to be found by staring at your problems and becoming overwhelmed by the challenge. If there is a cure for the yips it is to simply keep playing no matter how hard the game becomes.

Categories
Medical Preparedness

Day 630 and Sympathetic Nervous Response

One of the downsides of having any kind of medical bullshit is having to keep an eye on yourself. If you over do shit you’ve got no one to blame but yourself.

I’ve been doing a wilderness medical incident first responder course this week. I initially went into it slightly concerned with my ability to physically keep up given my ankylosis. I was easily the odd duck out in a group of former military folks, paramedics and wild land firefighters. If I’m honest I didn’t want to embarrass myself by showing too much frailty. I was already the only woman in the class. I didn’t need to be the cripple on top of that.

But over four days I’ve managed just fine. I did wound packing and splints. I did a number of incident scenario responses ranging from anaphylactic shock to heart attacks. I even did multiple mass casualty response drills. Today I managed one as a triage incident deputy and comported myself quite well.

I was feeling pretty cocky about how well I’d managed through the week. I was enjoying that sense of accomplishment right up until 5pm or so today when we had our last assignment of the day. We’d just finished up a drill with five patients who had been caught in a tornado. It was an hour of field work and triage outside. I was thinking alright maybe I’m getting the hang of thing. But no I was about to embarrass myself on one of the easiest tasks in the course.

It was time to pack up our own medical kits. We got a big baggie with all the supplies we could possibly need for our our first aid kits and dumped it out on the desk. Our instructor began going over all the items and how to pack them up into the bright orange brick that serves as your kit bag. I was doing my best to follow along but my brain was just not having it. I kept trying to figure out what items went where and how it was meant to go. And I was not remotely keeping up with the class or the instructions.

I’m starting to feel overheated and I’m struggling to concentrate. And it’s then I realize “oh shit I’m in a bunch of pain” and I realize I haven’t taken my pain medication for hours and it is starting to show. I just ran around in a big field doing triage for an hour. So I think to myself well I’m having a sympathetic nervous system spazz out. The pain and fatigue is sending me into fight or flight and I’m losing decent coordination and fine motor skills. I am becoming one of my own patients.

I didn’t finish packing out my kit. I had to excuse myself. I briefly considered if it would be funny to have a medical incident in a first responder course. But I was fully capable of treating my own acute stress response. I was getting worked up by an inflammatory response from my ankylosis and low and behold the pain in my spine was going to spike.

The end of the story is that I’m in bed and the non-steroidal anti-inflammatory drugs have kicked in. My pulse and respiration are fine. I’m no longer in fight or flight. And yes I’m a little embarrassed that packing a bag is what did me in. But on the other hand, that’s a very “Julie” way to learn a lesson.

Categories
Medical Preparedness

Day 629 and Working in Chaos

If you have been following along for the past couple of days you may have noticed I’m at a wilderness medical first responder course. I’ve been soaking up an inordinate amount of information. Part of the reason I am here is personal enrichment, but equally I am here because I’m working to understand chaos driven industries and the opportunities they present.

And the class is not disappointing. As we’ve have absorbed more skills and are moving further into the course, the chaos factor is being ramped up. The particularly enjoyable aspect of the specific course I am doing is that it is not just imparting book smarts. It’s designed to be much more hands on.

If it were a business school class they would probably refer to the methodology as case studies. But instead of ruminating on what you would do if you were management you are reacting as if you were the actual first responder on the scene. And the cases are getting more and more complex.

We started out with with the basics. We were deducing issues and imparting stabilizing treatments. But as we got more comfortable with figuring diagnostics and rendering basic aid the complexity ranked up. At the end of the day today we were presented with a car accident and four patients.

As we ran (literally) onto the scene we had to not only unravel what had happened but also treat several patients in varying degrees of distress. One of our patients didn’t make it. There was nothing we could have done. But we didn’t know that going into the scene. When we arrived we had no idea what happened and had to untangle the triage ourselves.

I was surprised at how challenging it was to leap into action. As the chaos of the accident presented itself our group of first responders had to decide on organizing ourselves and our resources. But the instinct is to simply begin rendering aid.

And that tension between acting and organizing in a crisis never goes away. You just get better trained at how to approach it. Working in the chaos is the job. I honestly thought I’d be better at it. Taking charge and working in uncertainty is something I enjoy. But as with any new skill, it takes work and practice. A certain amount of pressure is the only thing that teaches you how to work in chaos. And I’ve still got a long way to go.

Categories
Aesthetics Community Preparedness

Day 628 and Intensity

If my brain is a sponge I think I’ve been sopping up more than I am designed to handle. But I am holding on and facing a lot of new information and acting on it quickly.

I’m at a wilderness medical first responder class. And I’m the odd duck out on the class. Everyone else is living with much harder realities than I do. They are the ones that fight our wars. Provide our security. Fight our fires. They keep up with where our most vulnerable live. It’s an on the margin make your best call world.

My body can feel that this reality is very different from what I live with and on different class and wealth bands. People that are more buffered from harsh realities often don’t want to face the costs of our lifestyles. But we are not in a morally neutral systems. And a lot of violence still happens on the margins.

I feel somewhat invigorated by the immediacy of decision making in these chaotic environments. If you are in a natural disaster like a wildfire your capacity to react calmly under extreme conditions is a given. So naturally we arm these people with more agency and skills as it’s a set of problems with a lot of nuance and grey areas too.

I am frankly exhausted even though I didn’t do anything that intense. I did some traumatic brain injury drills. And I worked on how to properly stint and secure broken bones if you are in the back country and need to hobble back in to society. I learned a lot about agency and context and the need for high emotional intelligence as you cope with those who are in need or duress.

I suppose with that in mind, it’s no surprise that I’d like to enjoy a good long night of sleep and a big breakfast in the morning. One has got to enjoy living when you have the chance.

Categories
Medical Preparedness

Day 627 and First Responder

My hands are stained blood red. Despite a good scrubbing, my cuticles definitely show that I spent time packing wounds today. Ok, fake wounds. And it’s fake blood. I am taking a wilderness medical incident certification course. And it is very hands on. Literally.

A firefighter packing compressed gauze into a femoral artery simulator

I got the opportunity to take a spot in a course that one of my friends teaches. I’ve got so much exposure to medicine after the last several years of health challenges that I’ve been yearning to upgrade my knowledge to something more practical than my own personal biohacking. So when Tom offered up a spot in his medical incident certification course for wilderness response, I said you know what fuck it I’m going to do it.

And I’m so glad I did. Not because I anticipate needing to apply a tourniquet in the back country of Montana. Or that I’ll be faced with packing a groin wound to stop someone from bleeding out when they are hours away from the hospital. Though I am glad I now know how. But because I think hands on experience with a rougher world is experience I need to do my job investing in an increasingly complex, chaotic and unstable world.

I was absolutely enthralled by the first day. It was me and a bunch of other much more experienced EMTs, paramedics and wildfire fighters. I also met a number of extremely savvy folks who special in fire and emergency incident response.

I was very much thrown into the deep end of first responder world and I’m not ashamed to say I “died” on the very first scenario test as I’ve got no idea what I’m doing. But I’m soaking up as much information as I can as fast as I can. Though not quite as fast as arterial blood gushes. Yet. Ask me on Friday if I’ve improved.

I couldn’t tell you precisely why I think this kind of hands on exposure to emergency response is so crucial but something deep in my gut says that I cannot possibly invest in a changing world without having some on the ground exposure.

The folks who are fighting our worst wildfires and responding to our most intense natural disasters know something visceral about chaos and the fragility of modernity that the rest of us do a lot to suppress.

Just casual conversations as we went through lessons and practice opened up my mind to new areas of opportunity. I found half a dozen blind spots I didn’t know I had. The world is much more chaotic than the media and our social channels let on. But it’s also possible to tackle them head on. We are not helpless. And it’s not hopeless. And I’m feeling fully empowered to deepen my relationship to chaos as I learn just when and where I have more agency.

Categories
Preparedness

Day 626 and Learning

I’ve been slowly making my way through a Korean show on Netflix called Extraordinary Attorney Woo. It’s about a young woman with autism who has a gift for the law. It’s warm hearted and charming and a bit of a relief to watch if you have autism or are on the spectrum. I highly recommend it.

The show really pulls on my heartstrings. The episode I am currently watching features the struggles of 10 and 11 year old kids who are at after school academic centers. I won’t ruin the plot but a young man sets out to “liberate” the kids by letting them play. I found myself tearing up the show went about discussing the need for healthy playtime.

I hated going to school even though I love learning. I found so much of the pressures of school upsetting. Being inside, being around lots of people and loud noises, and just generally being obligated to things like homework and deadlines to be exhausting and anxiety inducing. I found myself tearing up watching these Korean kids in similar situations.

I was quite lucky to have a mother who sent me to Waldorf schools and even the occasional home school year. When I could pace myself I’d would rapidly out run the curriculum. I just needed breaks and playtime and my own opportunities to self direct. I hated discipline from the outside but had plenty of my own if given the chance to be self directed.

I’m still an autodidactic type as an adult. This week I am taking a wilderness medical incident certification course. I’ve got some strong sense that this is meant to wrap around some wider learning experience about the practicalities of living in a more chaotic world. It’s a bit of learning by doing. Some perspectives have to be unraveled first hand.

Categories
Chronic Disease

Day 621 and Pain’s Anxiety

Before I was diagnosed with my spinal condition ankylosing spondylitis, I didn’t really understand that I was in pain. I know that sounds weird, but I just knows I felt like shit. I hadn’t yet pinpoint the origins of the crisis in my own body. I was a stranger to myself.

Back then getting a diagnosis involved a lot of questions about my mental health. Are you anxious? Would you consider taking an anxiety medication just to see if it help? Are you sure it’s not all in your head? No doctor I’m not sure of anything that’s why I’m asking you.

The thing is I did feel anxious. My central nervous system was in a perpetual state of fight or flight from the pain. I had tachycardia. I was twitchy. I wasn’t a sleeping well. I didn’t want to be touched. It hurt too much. I was exhausted all the time and felt overwhelmed that no one seemed to know what was wrong with me. I’m lucky no one asked me if I was depressed or I might have been put on Prozac.

I’m one of the lucky ones. My chronic disease has a simple blood panel and physical exam to diagnose it. It only took me a few specialists to get to a rheumatologist.

I fear I would have been given an anxiety diagnosis and told it was all in my head if I’d had something more complex. But thankfully we untangled that any anxiety or depression I felt was simply a function of being in an inflammatory condition so acute every movement was painful. You’d have a racing heart and a fear of movement or touch too if everything was painful to the touch

The thing is I am scared of my pain. I do regularly get caught in fight or flight fear responses if the pain appears and I’m not prepared for it. I am militant about certain aspects of self care and my biohacking as I fear flares. I fear the drugs that are required when it isn’t controlled. It makes me anxious to need drugs at all to control my symptoms. Especially in America where a war on drugs has made it hard to need anything stronger than Advil.

Everything about pain and it’s treatment is anxiety inducing in America. And that’s a hard comorbidity to live with in a disease. As if pain wasn’t enough, the latent fear that you might not be believed lingers.

Categories
Preparedness

Day 620 and AQI

I am in the throes of a horrifying migraine. The take two Imitrax and pray type. It’s also the nausea inducing type so I’ve not eaten all day. I feel awful. And it’s mostly not my own fault even though I often like to blame flares in symptoms on my own lack of discipline or purity in maintaining some Platonic ideal of lifestyle or wellness regimen.

It is fire season in the west and I’m sure some, if not most, of my migraine is tied to the horrifying air quality that is choking out thousands of miles of California, Washington, Oregon, Idaho and Montana.

An AQI reading of western America on September 12th at 3:48pm Mountain Time from PurpleAir

The AQI or air quality index in my neck of the woods is 160. Unhealthy for sensitive individuals is the coy and somewhat misleading phrase used. It means in practical terms visibility is so bad I can’t see the mountains a few miles away.

Montana is at the moment free of any major fires. Our colder temperatures, lack of pervasive fire beetle blight, and reduced density makes it statistically safer than the Colorado front range when it comes to total fire danger. But it’s no safer from prevailing winds and the pollution from fire in other states. In order to escape from it entirely I’d probably have to leave the continent.

I’ve obviously opted not to leave my home region of the mountain west even if I have accepted moving to a more northern and protected corner of it. But there is a certain existential “No Exit” sense I have with AQI and fire season in general. It may just be my lot in life. Maybe it’s everyone’s lot. To give up your homeland is a complicated fight. I expect for some of humanity it must involve either certain death or the prospect of great riches

Categories
Aesthetics

Day 619 and Indoor Clothes

I have one issue on which I am a little obsessive compulsive. I hate when someone wears dirty clothes on a clean bed. It just drives me absolutely up the wall.

I suspect this is born of some totally rational preferences. I am very outdoorsy and always have been. As a child I spent as much time as I could negotiate at the barn. I worked as a stable hand as part of keeping my own horse’s board and feed paid. If you’ve ever kept animals or worked on a farm you know how barn clothes smell at the end of a long day. You don’t wear your barn clothes except when you are choring. It’s rude.

Then when I left Colorado for New York City I found another reason that your work clothes should be taken off at the door. Instead of smelling like manure, urine and stale sweat after a long day mucking stales you’d smell like shit, piss, the subway and traffic exhaust. City smells are no more polite to bring inside than barn smells. Getting splashed by a cab or sitting too close to someone who hasn’t showered in a while on the subway is just normal life in a city.

You can probably imagine now a routine in which I take off my outdoor clothes and swap them for my clean indoor clothing. I try to do this as fast as is possible. I can’t fully relax unless I know I’m in my indoor clothing. Because unless I’m clean I cannot get into bed. And there can be no dirty clothes on clean beds.

I simply will not let myself even get on top of the comforter of my bed with outdoor clothing on. If I want to get under the covers and fully relax at home, I better be in clean designated “indoor clothing.”

It still upsets my brain when I see a teenager on television lounging on their bed with shoes and jeans on. Maybe suburban sitcoms neighborhood are a cleaner environment than the one I grew up in?

Or when an adult couple is about to get it on and then tumble into bed with their coats and jackets and high heels. I just hate that. I shudder. I don’t want to bring dirt and shit into my love making. Sorry it’s just my preference no shame if that’s your kink. But absolutely not in my house.

I’ve finally fully trained my husband on this quirk. He keeps a clean set of pajamas to change into and is careful to keep barn clothes to the barn. As for me, I like this quirk. I keep a cleaner house because of it. Sure it’s a little weird but I love a nice clean safe place.

Categories
Chronic Disease Politics

Day 618 and Personal Politics

I hesitate to share too much detail about this but, I’m an opioid user.

Actually I’m not hesitant to share that at all, it’s in fact the core salient point I want to make today. I have a chronic disease and sometimes, blessedly more and more infrequently, it can only be effectively treated with pain medication.

Why am I talking about this? And in public no less? Because unless powerful people that have a degree of social, personal and political capital discuss things we deem unsavory we never make any damn progress on humanizing our inhumane responses. And our response to the opioid epidemic is inhumane.

The backlash to the crisis, a mash up of intense scrutiny, government intervention and rigid rules, has now reached a point where it is doing as much harm as the original crisis of overprescribing. And I hope my personal story allows you to see why.

My spinal condition (ankylosing spondylitis) can be so debilitating that the only way I can get out of bed to accomplish basic tasks is by taking a mild opioid called Tramadol. It’s not in the same category as OxyContin or Percocet but it’s not risk free either.

I’m lucky that my condition is relatively well controlled. I don’t need pain medicine all the time and I work very hard on alternative treatments in the hopes that I won’t need it at all in the future. I spent a small fortune making sure I don’t need a core useful medicine. Let that sink in.

I’m not an addict. I am monitored by a team of professionals. Every step of the way is in fact monitored extensively by state and federal systems along with massive insurance and hospital system oversight. It’s the closest I’ve come to experiencing the Panopticon. It’s life altering in its scope. My entire life by necessity has to revolve around when the system deems it safe for me to get a prescription. Not when my doctor thinks I need it. When Uncle Sam does.

I fucking hate relying on something so dangerous and so demonized but also so regulated. I hate that my entire private medical life is so closely monitored by the state. I hate all of it. But, on very bad days, the choice is immobilization or Tramadol. And I’m not at all ashamed to say I pick Tramadol. I want to be a working productive member of society and that’s hard to do when you are unable to move from the pain.

There is no grace in suffering but what it teaches us. And I’ve learned we use pain as a cudgel to control people in our society. That it is so effective is why I am both a libertarian and fiercely against the carceral state. One day it might be you suffering and you won’t deserve it either. And I pray that you will be shown grace in your personal circumstances.

But I’m lucky. I’ve got other pharmaceuticals, like biologic injections which treat inflammatory conditions, that I can rely on. I’ve got THC and CBD for their anti-inflammatory properties. I’ve got good old fashioned steroids like Prednisone. Which interestingly, my physicians universally believe is more dangerous than my Tramadol usage and did actually require an extended titration down as I was physically dependent on it, as your body stops producing the necessary hormones. They’d rather I use Tramadol for flares.

But you notice the government isn’t up in your face with a massive publicity campaign showing cops busting down Prednisone rings. There are no political advertisements showing how an opponent supports big steroid. Even though if you saw Donald Trump after he got Dexamethasone during his fight with Covid it was pretty clear he felt pretty good. Steroids have gotten me far more fucked up and also higher than any opioid ever has. But no massive surveillance program has ever come down on anyone for anti-inflammatory drugs.

Because that would be fucking ridiculous even though it’s just as addictive in driving physical dependencies , just as debilitating and depending on your body chemistry, just as “fun” as narcotics. Fun fact about me, I don’t have whatever chemical makeup that allows an opioid to give me a high. Which as I’ve learned is a saving grace. Not everyone does. That’s kind of the rub. The risk profile on opioids is a bit worse because some pharmaceutical executives lied about the percentages of people who get addicted. Or who found it’s side effects pleasurable in the absence of symptoms. They did not lie about the benefit of not being in pain.

And that ought to give you a good sense of the problem at hand. The iron law of prohibition strikes again. A massive bureaucracy imposing a fix that intervened in crude and inflexible ways is causing more suffering than it fixes. It wasn’t the intent but it is the outcome.

The iron law of prohibition is a term coined by Richard Cowan in 1986 which posits that as law enforcement becomes more intense, the potency of prohibited substances increases. Cowan put it this way: “the harder the enforcement, the harder the drugs.”

Because doctors were lied to about the risk profile of certain types of opioids in the first place, the backlash is now as bad as the original sin the pharmaceutical companies committed.

Regular law abiding people are getting fucked in their treatment plans because hard enforcement is making it harder to get the low dose drugs. We treat Tramadol users with arthritis with the same tools as as criminals addicted to illegal fentanyl. I know shocker that the American federal government can be as evil as Purdue.

But also historically you know it’s true. And now a huge portion of normal people like me, who just want the benefits of not being in constant pain, are being turned into an over surveilled over controlled population. And I’m not saying there are no risks. But who do you want deciding that? A doctor who knows you well? Or the government? Yeah I’d pick the doctor too.