self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.
At any rate, I intend to live forever or die trying. See you at Heat Death!
Friends:
A friend to everyone is a friend to no one.
User ID: 454
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
15d ago
I don't know. That's the honest answer.
How does one deal with the fact that they have a malignancy? That their loving grand uncle won the lottery, and might die in a few years and hand it to you?
Once you accept it as probable, your brain will reconfigure in the background. Maybe you can speed it up (I once did a heroic dose of psychedelics, but I wouldn't recommend that as a general solution. I wanted to get over depression and I was desperate), maybe you can't.
Maybe the knowledge consumes some people with unbearable anxiety. I'm sorry if that's the case. But I'm not in the business of reassuring lies, quite literally in terms of work. Either way, the facts are what they are.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
15d ago
I disagree. Knowing that human endeavor is going to end up redundant in less than a decade has some obvious implications as far as I'm concerned.
I wouldn't quit my job to retrain in something else, the opportunity cost will never be recouped. I have to worry less about saving up for college for my kids - they never need to attend one for credentialing purposes. Any health related concerns that would take decades to kick in become far less pressing.
It should drastically change your priorities and medium and longterm planning. That's happened to me. But I prepare for as many scenarios as I can, and at least in my case, I don't need to do anything particularly out of the ordinary.
That being said, I should max out my ISA. I am not immune to procrastination.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
15d ago
I am known to have altruistic tendencies. If that isn't enough, I dislike it when people are wrong about things, and find it satisfying to at least try and correct them. Also, there was some scope for coordinating a solution instead of having it imposed on us. Maybe it's not too late.
What are you going to do with this information? Entirely up to you. What would you do with the knowledge we're going to be raptured, or that an asteroid has a 30% chance of hitting the Earth in a few years?
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
15d ago
Well, I suspect they'll care when they start ending up unemployed, or when the world reconfigures itself faster than they can blink. In the meantime, I'm sure ignorance is bliss.
Imagine a car.
For a long time, it was a purely theoretical car. Spending any amount of time theorizing about its safety features was a charming activity for undersocialized nerds.
Then it moved. Slowly enough that you could walk alongside it. It was a mild curiosity, at best, to most.
Then it started picking up speed. The acceleration was increasing too, and some of us found that concerning. You could plot the bloody thing. I can't stress enough how little of this required a revelation.
I was around when we were trying to design safety features for a vehicle that didn't exist yet. Later, I was politely asking people to take notice when the ride started getting bumpy.
About a year and a half ago, I became somewhat frantic. Did people really not see what was coming? I spent far too much time arguing about it. I should have saved my breath.
Six months ago, with Mythos? The steering wheel came off. And I considered myself done with trying to convince anyone of anything.
I have the misfortune of occasionally reading someone explaining that the car can't be dangerous because of how the engine works. Or that it's a beat up sedan, and we should only worry about F1 cars. And don't you know that the speed of limit is a hard limit on velocity? Or that our current transmission systems break down at 570 km/h?
I'm sure there's a reply to that. I've probably written one before. If writing doesn't work, look out a window before it's all a blur.
Can people see an inch beyond their noses? Apparently not.
These days, I'm doing my best to strap myself in. I have no idea how much good that will do, but I've only got so much time and attention, and I'd like to spend some of it on the assumption that I have a future.
I don't know where the road ends. But some people are about to wish for airbags, and I find that a "told you so" is a small consolation.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
15d ago
You know what, I'm past caring. At least caring enough to make a fuss about things, or spend my limited time under the untamed sun trying to convince people to see the writing on the wall.
Yeah, we just found a solution to Navier-Stokes. I know just enough to say that that's a Big Deal. It's one of many Big Deals lately, each bigger than the last.
Anyone is welcome to plot the trendlines. I'm going to continue having fun and doing things IRL while that adds anything over what the bots can do. Good luck everyone, make sure to enjoy yourself.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21d ago
SSRIs are better than placebo, though the Number Needed To Treat (vs placebo) is an unimpressive sounding 5-7. Well, at least they're not as bad as statins.
This is me being a mild pedant, rather than disagreeing with you. They're not the best choice for him, as I've said down thread. They're still a better idea than... benzos and booze.
In all honesty, @ratherblather, the best thing for you would be to go on vacation. Or simply just get away from it all for a bit. I know, that probably sounds less than appealing, but I think it'll do a little good anyway.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21d ago
Emotional blunting is common enough, but can take a variable amount of time to show up, typically a week or two. I would not rely on SSRIs to induce it, most people never experience that "issue".
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21d ago
I resist the siren call of scrubs. Comfy? Yes. Practical? Yes to the yes, given the exposure to bodily fluids. But that only makes wearing white dress shirts to work even more of a standout.
I heard a senior female consultant commiserating with the junior girls about how she still gets mistaken for a nurse all the time. I told them that I get mistaken for a doctor most days of the week, and I've stopped correcting people.
Then again, I haven't been carded since I was sixteen.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21d ago
I administered myself the relevant instruments for assessing depression. I had a handful of episodes of passive suicidal ideation. I have my own notes from the worst patches, missives to a future self who was hopefully better off. That's me, today, but it's rather grim reading.
It was exactly as serious as I feared. It really couldn't have been much worse without a complete and utter breakdown. Sure, I've been clinically depressed to some degree for >95% of the last ten years, but it's usually mild to moderate. Having thoughts about walking into traffic after something as silly as a bad date and a few drinks was... new. May it stay old.
Rather annoyingly, now that my "urgent" appointment with a shrink is coming up, I've gotten better. You can't treat depression that doesn't exist anymore, but you can put yourself on their radar and ensure that you get somewhat more timely care next time.
(The wait is... concerningly close to how long it takes to spontaneously recover from a typical depressive episode without treatment. I'd call that intentional if that wasn't giving the NHS too much credit. The service is just overburdened and under staffed, I say as someone shouldering the burden. The irony of it isn't lost on me at all.)
I'd say that my depression getting better wasn't mysterious at all. It started due to immense stress. It got better as I adjusted to the workload, and the real turning point was my slightly hardass boss telling me he was happy with my performance. I could feel the muscles unknotting, as I realized that putting in 120% effort had paid off, and even better, I would be able to sustain things at mere 80% throttle for the rest of the placement.
As I intend to tell a more qualified and better paid shrink: clearly stress reactive, or vulnerable to psychosocial stressors.
Will this relief last? I don't know. Odds are against it, probably, given my history. But it clearly had a massive component of "shit life syndrome" and I managed to make my life markedly less shit.
Anyway. Sorry you had to go through your own issues, and happy that you're better. I found it very helpful to remind myself, at the nadir, that things would get better if I toughed it out. They did. I agree that winters are awful. That is why I usually flee to warmer climes. I'll get a SAD lamp anyway, if I remember to. Or join the local lassies at a tanning booth, if I ever lose all dignity.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21d ago
I have, unfortunately, been in bonny Albion over several winters. I can't say it's ever helped things. You should be aware I've been here long enough to know that.
More importantly, I have been depressed during the summer. Most summers. Most places, including India.
This isn't a simple seasonal shift. If mere exposure to sunlight sufficed, I wouldn't have been depressed at home. It coincides with... well, a lot of things. Overcoming serious adversity and taking control of my life being an important one. I managed to achieve that while rather badly depressed - which was most of this summer. I presume it showed.
I don't see much sun even on a good day at work, at the height of the summer. I'm lucky if I can nip out for half an hour during a lunch break, or catch photons on the walk to and from work.
You don't need SAD to be sad. At least I don't.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21d ago
It would take at least 2 weeks for SSRIs to typically show effect. 5-6 if you want to really know if they're working.
Benzos? Aww man, there are very few problems that are worth starting benzos to handle. A short course is unlikely to be addictive, but if you end up addicted? You'll regret it. If you're using them expressly to relax or numb the pain, that drastically increases the risk of becoming reliant on them in the long run.
There are less legal options (presuming you even find someone willing to prescribe the above for you, at least for sounds like a grief reaction or bereavement). I'm not going to endorse them.
Raw-dogging things is probably net positive in expectation. I understand if that doesn't prove feasible. Good luck, and I hope you get through this.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21d ago
I need to cancel my gym subscription. And do more push-ups.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
21d ago
An interesting observation: colors are literally brighter when you're not depressed. I can't stress enough the fact that this is not a metaphor. They're more saturated, and every now and then, I stop to look at the porcelain sky or a particular nice shop sign. I've even admired traffic lights. I think I'm as euthymic as I've ever been, and stress levels are, well, non-zero, but at a local minimum.
I have mixed feelings about the fact that I recently, over dinner, found out that most of my junior colleagues are older than me. An artifact of Scotland encouraging graduate entry medicine. I suppose that's a reminder that even after several years grinding exams to get here, I'm making excellent time.
And then a med student with grey hair and a look of deep despondence said he was surprised to learn that he was a few months older than me. He said he'd thought I was in my early thirties. I shrugged, and said that was one way to find out I looked decrepit. I asked him how he felt about likely becoming a consultant in his 40s, which, to be fair, isn't that late by British standards. He said he was trying not to think about. Poor guy had applied for medicine multiple times; he'd done well enough on the exams, but failed the personality screens/interviews. He was bad at even faking the extroversion. A real shame, I explained that medicine strongly selected for the Type A-s, but the rest of us could make it anyway. I told him the important thing was that he was here now.
And then I explained that I felt that grey hair or a bit of the Norwood was an asset for male doctors. Engenders confidence. Implies we know what we're doing. This is perhaps a mild amount of cope, but I retain all my hair anyway. That comes as a surprise given what I've been through.
And a little while earlier, my boss had implied that he pegged my age around 21. That would explain quite a bit about his attitude towards me. I wish that were true.
Then there was the time I snuck into a clinical skills session meant for fresh interns. I hadn't done an ABG in four years, and I have a slightly irrational fear that it'll be expected of me. Even though I work in a specialty where we literally don't keep the equipment around. It's early days, and everyone is getting to know each other at that hospital. I was asked by someone how I felt about starting my internship. I said that I was rather glad it was long over, and that I had no business being here, but they weren't checking the guest list closely. They were amused, and asked me if I was trying to blend in. I looked down at the rather different shade of lanyard, and my dress shirt and nice shoes amidst a sea of scrubs, and said that I wasn't doing very well. At least I got the ABG done first try.
Sticking to the theme: a youthful intern was rizzing up the med students. One of the ladies was Australian, and thus subject to cross-cultural discourse about Kangaroo Jack and Crocodile Dundee. Look man, it's that or Drop Bears. The intern said that these were childhood artifacts from "our generation" - and the young lady couldn't be expected to know about them - while gesturing at me. At me. As the reference generation.
I couldn't let this stand. Every now and then he says something that makes me me want to crawl into a coffin, call me an anti-pedophile the way I'm out of touch with the youth. Nice kid, nonetheless. He'll eventually live down the jokes from one of the blood cultures he'd taken off a patient coming back positive for Lactobacillus salivarius - a commensal/symbiotic organism that, as the name strongly implies, is supposed to stay in the saliva. Getting to show off in front of the med students is just about the only perk of the intern years. Well behind me, but at least I can admire public infrastructure instead. It's been a green light for the first time in years.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
25d ago
I would not necessarily pathologize being a neat-freak. If it starts interfering with normal functioning, causes meaningful distress, or becomes an obsession that requires compulsive acts? I'd be more concerned then.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
25d ago
You're welcome! Keep in mind tidiness definitely exists on a spectrum, and there are plenty of slobs/untidy people without mood disorders. God knows I'm not the neatest even when euthymic.
But it helps to have some scaffolding, a reason to clean. I can bring myself to do it then, whereas if it was purely for my sake, it needs to get pretty bad before I can be bothered to do something.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
26d ago
I cleaned my flat.
A rather unimpressive achievement until you consider I've only recently surfaced from a very long stretch of depression, looked around at the wreckage, and genuinely wondered how the fuck I lived this way.
Okay, still not that impressive. I'll concede the point. I'll talk about it anyway, because the mechanics of how a reasonably functional adult ends up living in squalor happens to be the interesting bit.
The best analogy is what software engineering calls technical debt. You ship something that works but is badly structured, and you tell yourself you'll refactor it later. You never refactor it later, you've got bigger fish to fry. Instead you build more things on top of the bad structure, and now refactoring would break everything, so the cost of fixing it keeps growing while the probability of fixing it approaches zero. The codebase still compiles. The product still ships. Nobody outside the team can tell anything is wrong.
Depressive debt works the same way. An empty coke can here. A cardboard box there. It's trivial, really, coming back home exhausted, surveying the detritus, and deciding you can't deal with this right now. You'll handle it over the weekend. And then the weekend arrives, and the little free time and energy you have left feels like it should be spent on something that doesn't make you want to cry. So the can stays. The box stays. A second can joins the first. Some takeaway containers. An Amazon package you opened but never broke down. Each individual item is nothing. The aggregate is a lifestyle.
The insidious thing is how gradual it is. Nobody wakes up one morning in a scene from Hoarders. You just wake up one morning and realize there's barely any room for the mouse on your desk anymore, and you're not sure when that happened. Could have been Tuesday. Could have been November. Time does strange things when you're depressed, mostly by not doing anything at all. Days just sort of laminate onto each other.
For a long time, my life resembled that Homer Simpson meme: the one where he's looking hella fit from the front, all the ugly fat and cellulite cinched up by a belt, just out of sight. Dress well, groom yourself, and you can make a remarkable number of people think you've got your life together. I've been running this play for a while and the success rate is surprising. Surprisingly good. The bar for "having your shit together" in your late twenties or early thirties is apparently: shower and shave regularly, own clothes that fit, show up to things on time. Nobody asks follow-up questions. Few request a home inspection.
In my defense, my flatmate is a younger gentleman who leaves half-empty packets of sertraline and boxes of Wegovy pens lying about everywhere. The parallels to an essay I wrote were lost on me until much later. We are two rather depressed motherfuckers trying to keep it together, or at least not scare the ladies away. He only cleans when his girlfriend is coming over. (I have no idea how he bagged her, but I'm impressed. She's the landlord's daughter. And a hottie. I hope he gets a discount on rent.)
I must confess that I, too, only really clean when I have women over. I can imagine an evolutionary psychology paper on this. Something about mate-attracting displays and habitat maintenance. The male bowerbird builds an elaborate construct decorated with colorful objects to attract a female, and I, a higher primate with an even higher education, do essentially the same thing. My version involves frantically shoving pizza boxes into bin bags at 6pm while texting "running a bit late, see you at 8."
Unfortunately, for the past year and change, the women in question have lived elsewhere, and I usually meet them halfway or stay at theirs. This has predictable consequences for the state of my flat. The slightly less predictable consequence is them assuming I'm seeing other people when I decline to have them over. There's a real irony in being suspected of infidelity because your bedroom violates the European Convention on Human Rights.
My flatmate and I get along: we barely talk except to split the bills, and we make few demands of each other. Just two dudes being dudes. I let him colonize the supermajority of the living space with retro consoles and an ungodly heap of clothes on the couch. I don't even mind too much, at least not for my own sake. My bedroom might not be palatial, but the very few things I care about fit inside it.
I am somewhat miffed that he let the kitchen sink pile up with an unholy mound of unwashed dishes, and that he didn't have the courtesy to bag his trash when I asked him to. I'd have taken it out myself. But I've dealt with the worst of it now, in part as repayment for my own slipped promises. Glass houses, stones, etc.
Something that both did and didn't surprise me: it was less arduous than I thought. And that's depression in a nutshell, isn't it? The disorder that makes everything look impossible, including the things that take twenty minutes. Add in ADHD to taste, if you like your food cooked half-raw. Borrowing some terminology from behavioral psychology, call it a task initiation deficit. The clinical way of saying the starter motor won't start, but the engine can spin fine. Once I actually started filling bin bags, the momentum carried itself. The flat isn't spotless. But it's livable. It looks like a place where a person lives, rather than a place where a person is slowly losing a war of attrition against entropy.
Why did I finally do it? In part because I'm less depressed. Partly because someone's coming over.
Mostly the second thing.
But I did it anyway.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
26d ago
I would say that things have flipped these days, if you were to compare 5.6 Sol and Fable, Sol is less agreeable, even if both are notably less sycophantic than most earlier models.
A week that's oscillated between manageable and hellish. I'm bone tired and it's only a Wednesday. No exercise that isn't my glutes getting a hell of a workout.
There's very cheery signage by the hospital stairs stating: "taking the stairs is free exercise!". When I've gone up and down multiple levels half a dozen times in a day, I've never been more motivated to engage in vandalism.
The good news is that I've gone from unbearably stressed to only mildly stressed but very harassed and put upon. I've been stuck late multiple days to clean up other people's messes, and my juniors have sometimes overenthusiastically multiplied our workload. I have refrained from yelling at them, I've just sighed bitterly and cast a mildly disappointed glance before telling them what they should have done. The fact that all of us ended up stuck over an hour late to fix things was all the punishment anyone needed.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1mo ago
I discovered that one of my new coworkers is ex-military before entering medicine, and is perfectly happy to nerd out over the fun toys.
I think we were discussing the relative strengths of offensive and defensive hand grenades when the new female trainee interrupted us for something, apologized, and said that she had absolutely no idea what we were talking about, but said she loved the passion nonetheless. I said that I'd lob a hand grenade at her for disturbing the peace.
More relevant is the fact that he's my neighbor, and has a gaming PC. I might actually have someone to play with, though I give only 25% odds we manage a match anytime soon. Maybe Helldivers, or Arma Reforger, since he owns both.
Otherwise, I've occasionally played Rimworld, and I've made it a point of booting up my pc and getting the game (with about 100x the original install size of mods) loaded. It takes 15 minutes (and that's with a ridiculously powerful pc), and minimizes the activation energy required to sit down and game. I've managed it some days this week, which is a sign that much of the anhedonia has lifted. I just don't have the time for anything more involved.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1mo ago
You're welcome! Don't worry, your dad could well be a narcissist, and if he's an asshat, you have the right not to contact him regardless of a formal or informal diagnosis.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1mo ago
It is entirely possible you do have ADHD. Based on what you've described, the clinical suspicion is at a degree that warrants formal assessment, and pursuing one is a move I would happily encourage.
That being said, I wince at anyone invoking "rejection sensitivity dysphoria," which in this context strikes me as a rather useless pseudo-diagnostic label that pathologizes being a Sensitive Young Man.
RSD appears in neither the DSM-5 nor the ICD-11, has no validated measurement instrument, and the term traces back mostly to one enthusiastic clinician in the 90s rather than any systematic research program. The construct it gestures at (emotional dysregulation in ADHD) is real enough, and the DSM-5-TR now acknowledges overreactive emotionality as an associated feature. That is very different from being a core feature, or being helpful in terms of narrowing down the differentials. Feeling terrible when a girl leaves you on delivered is not a neurological syndrome. Young man, that's the human condition, plus youth.
I used to be one, you know. Which is to say young. I'm still a man. In terms of sensitivity? Mostly I've just become increasingly willing to tell people to go fuck themselves, or more politely, to stand up for myself when I'm clearly in the right. There was a time when being left on read would have felt like the end of the world to me. These days I shrug and move on, or at worst wince slightly and forget about it by the next week. This will happen to you too, and it will manifest as external confidence. People can tell when you've got it, and they act accordingly. Time and reps, mostly. No pill need popping for that particular problem.
At best, marked rejection sensitivity might point toward a comorbid anxiety disorder, which is worth mentioning to whoever assesses you, since the comorbidity rates between ADHD and anxiety disorders run somewhere around 25-50% depending on the sample. But as a diagnostic marker for ADHD specifically, it offers little.
Now, I am a psychiatry trainee, and I do have ADHD. And my life has interesting parallels:
My dad, despite being a good doctor, was loathe to acknowledge that his son(s) have mental health issues. I'd blame it on him being from a different generation. When I was older and telling him about my problems again, he mentioned episodes around my age that sounded awfully like depression to me, except he hadn't had the vocabulary at the time, and more importantly, he had managed to push through and flourish anyway. In his eyes, a son who was clearly intelligent, academically and professionally successful, couldn't possibly be mentally ill, let alone chronically. He flinched away from the notion. In his cosmology, that's the realm of the insane and the delusional, and if you're objectively succeeding, everything must be fine upstairs.
I wish that were true.
On that note, I'd be careful bandying accusations of narcissism about. Not because you're necessarily wrong, but because I remember being around your age and being quite mad at my dad, and the heat of the moment is a poor time to hand out cluster B diagnoses to family members. Hold that belief lighter than currently feels natural. You can always revisit it when you're older and know better. That would the kind of statement that would have annoyed me when I was younger, but it's true nonetheless.
Pragmatically speaking: stimulants work on just about everyone. This has been known since we gave dextroamphetamine to entirely normal prepubertal boys in 1978 and watched their motor activity drop and cognitive performance improve, a finding replicated in normal adult men. That makes "I took Adderall and functioned better" a poor confirmation of the diagnosis, in the same sense that telling someone who perks up after a cup of coffee that they're "caffeine deficient" is a suboptimal diagnostic framework. Scott's essay on Adderall covers the gatekeeping problem well: attention is a normally distributed trait, the diagnostic cutoff is somewhat arbitrary, and most psychiatrists and possibly the majority of patients knows it.
Even more pragmatically:
ADHD is associated with a life expectancy reduction that is more alarming than I originally remembered. This paper found an apparent reduction of about 6.8 years for men and 8.6 for women, and Barkley's earlier estimates are thereabouts too. The mortality rate runs roughly double the general population's, pushed up by accidents, substance use, and the general downstream consequences of poor impulse control and executive dysfunction.
And treatment works! A Swedish registry study of around 150k patients found medication initiation associated with a 19% reduction in all-cause mortality over two years, concentrated in deaths from unnatural causes. The usual observational-study caveats about confounding apply, and the follow-up window is short, but the direction of the evidence is consistent across studies of injuries and hospitalizations too.
That's why I don't much care about gatekeeping this diagnosis as zealously as some do. The failure mode of slightly over-prescribing a well-tolerated medication with fifty years of safety data is considerably less bad than the failure mode of leaving a disorder with those base rates untreated because your dad is a dum-dum. I care about results uber alles, and I care even more about the fact my disease is comparatively mild. The medication changed my life for the better.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1mo ago
I have told him that, and I could tell he appreciated it.
self_made_human
amaratvaṃ prāpnuhi, athavā yatamāno mṛtyum āpnuhi
1mo ago
I presume you missed the drama from last week. I particularly care about what my boss says for multiple reasons:
- He's my boss, and my career progression is gated behind his approval
- He's not lavish with compliments
- I can trust him to be a pretty fair dude
That's why his praise matters, and why his criticism stings. He'd been concerned about my performance earlier, while operating off what he personally acknowledged as outdated information. Instead of developing a martyr complex about it, I decided to go above and beyond, and I had the good fortune of being able to demonstrate it live.
He's the kind of guy who cares far more about action and results rather than getting into group cuddle and commiserate sessions. I spoke his language and, as I hoped for, he reacted very positively. We might not always see eye to eye, but I can have a productive professional relationship with him, and that's more important.
If we have a worst-case scenario, or just any of the really bad ones, we're fucked. A hidden bunker will just mean you die last.
If things go swimmingly, then the worrying would have been pointless - in hindsight.
That means I think it still makes sense to follow general, option-preserving strategies. That covers the increasingly unlikely "business as usual" worldlines, and shelters against socio-economic/political upheaval as the changes (good, bad or meh) promulgate.
In my context, that means I just continue being a doctor, progressing through training so I keep making more money. Money is the most general of strategies. It can be exchanged for goods and services, including more durable barter goods if shit really hits the fan.
I like money, you know. And want a family, which is expensive. I can't stress enough how the "correct" course of action depends on someone's priorities, which I am really not in a position to dictate. If you want to go be a hobo on a tropical beach, be my guest. My approach minimizes my hindsight regret.
I continue deriving some amount of satisfaction from my career, and regardless of how this ends, I'll say that I did something important while that meant something.
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