I am therefore I think

Abstract

The simultaneous beeps of multiple pagers and the overhead announcement signalled the ominous. The large team overpowered the room inhabited by the unmoving, corpse-like patient. Fresh-faced workers stood by to take over chest compressions as others secured the airway. The attending physician orchestrated this symphony, a desperate call of life back into the body. With each forceful compressive thrust, the corpse jostled, seemingly shrugging in contempt of the resuscitative efforts. No pulse at 14 min of cardiopulmonary resuscitation. At last, following yet another push of adrenaline and compressions, someone shouted, ‘I have a pulse’. The returning pulse was confirmed by others, resuscitation efforts slowed down, and the room began to empty. The wave of caregivers slowly receded. Within the time taken to brew a pot of coffee, the all-too-familiar code recurred, this time with the family at the bedside and insisting upon full efforts. At the 48th minute, the supervising physician called the code, while the family greeted the news first with protest and eventually, acknowledgement and acceptance. In a mixed wave of regret and relief, caregivers exited the room, leaving family members to begin their journey of grief. For early career physicians, these moments of professional duty spark hope and ambition, a drive to overcome the natural history of disease, and the need to win in a perceived game against nature. Observing death and loss over time may lead one to deeply introspect and reflect on the haunting question—do we really end with the physical body? The medical profession is steeped in understanding the physical body with most efforts channelled into maintaining satisfactory physiologic function. Can we transcend these limits through an exploration of spiritual insight or is this considered taboo in the realm of scientific evidence and proof? Can the exploration of existential questions regarding the cause of creation, the observable world, the self, and the interaction between the three herald a new paradigm of care—a paradigm focused on the human being centred within the human form? (Figure 1). The medical profession is steeped in understanding the physical body with most efforts channelled into maintaining satisfactory physiologic function. Can we transcend these limits through an exploration of spiritual insight or is this considered taboo in the realm of scientific evidence and proof? Can the exploration of existential questions regarding the cause of creation, the observable world, the self and the interaction between the three herald a new paradigm of care – a paradigm focused on the human being centred within the human form? The observable world is caught in a constant flux of change; at any given moment, the world represents a series of effects resulting from a series of causes. Observed effects consequently evolve into the cause of future effects. The physical universe represents a web of interacting causes and effects, and the pursuit of both science and spirituality is the understanding of the singular causeless cause. Science and spirituality, however, diverge in understanding the world of cause and effect. Science mandates demonstrable proof and validation, whereas spirituality requires inferential knowledge and scriptural wisdom. Considering a given effect, we must account for various interacting causes, some of which are visible and modifiable or non-modifiable and others are invisible and non-modifiable, recognized only in the effect. In the example of our patient succumbing to an acute coronary syndrome (ACS), cigarette smoking was a visible modifiable cause and genetic predisposition a visible non-modifiable cause. The disruption of dormant plaque within a major coronary vessel was the invisible cause. When ACS in an individual patient remains complex and incompletely understood, what can be said about the interaction of the innumerable causes and effects that are responsible for the visible universe? Conceding its complexity, what is this universe made of and what is it that adorns a material object with status of life? The material construct of the universe is coupled with an immaterial component, say energy, where the interaction between the two is famously described by the equation E = mc2. Many schools of philosophy consider consciousness to confer sentience to inert objects. The most obvious demonstration of this principle is the absence of ‘life’ in a corpse. The physical body represents a conglomeration of organs and systems that facilitate interactions with the world. Sense organs permit the absorption of the changing outer world through sight, hearing, touch, taste, and smell into the inner landscape that then formulates a response. However, who is the real experiencer or the ‘self’ in relation to the experience or the world? Could it be that the physical body in its travail of growth, maturity, and decline is animated by a timeless experiencer-entity (the self) that persists after death? Could it be that the adage ‘I think, therefore I am’ is better phrased as ‘I am, therefore I think?’ The phrase ‘I think, therefore I am’ implies that consciousness is created by the brain, where the self is a result of thought. On the other hand, ‘I am, therefore I think’ provides the framework for a phenomenon that is causative for brain activity. Biologically, brain activity requires blood flow, energy metabolism, and other inherent factors, which enable electrical and chemical pathways associated with cognition. In other words, brain activity requires upstream sentience. Further, causative factors ad infinitum require an invisible inherent intelligence enabling the precise mechanics of life. This inherent intelligence is sentience or consciousness, the focus of exploration in religion and spirituality as well as an empirical science that combines philosophy, psychology, physics, sociology, and religion. While science provides an objective, third-person framework of consciousness (I think, therefore I am), spirituality is concerned with its subjective knowledge that transcends objectivity (I am, therefore I think). While the former emphasizes becoming, the latter is concerned with being. Neurobiology and behavioural psychology demonstrate that the sense of self is formed in early childhood in response to the relationship with primary caregivers. This ‘I’ becomes the lens through which we view ourselves and the world, fuelling our quest of becoming. In this sense, the phrase, ‘I think, therefore I am’ is true—the self is reinforced in the choices primed by it and influences the unfolding of life. Spirituality aims at transcending the becoming altogether to be liberated from the self’s restless quest of becoming into ‘being’, where consciousness upstream from the self is discovered to be our true identity. Innovations in healthcare technology fall squarely in the category of becoming, where longevity is sought in the vein of consumerism, driving costs, metrics, goals, and litigation. However, no innovation or technology can confer contentment or freedom from suffering, which is the symptom of becoming. The shift in perspective from becoming to being can only occur at the individual level that can translate to a natural transformation of goals at the societal level. A paradigm shift in the understanding of the self can provide acceptance of the finitude of the physical body and allow for more meaningful conversations throughout the doctor–patient relationship since mortality remains unacceptable to patients and caregivers. Although death is the only certainty, the prospect of the end of becoming is frightening. To alleviate this primal fear, it behoves us to consider the concept of self beyond biology and a shift in perspective to ‘I am, therefore I think’. None of the authors have any conflicts of interest or any relevant disclosures.