Scaring the Epistemology Out of Me

Though the acute illness is over, I am still suffering notable emotional aftershocks of Covid - first severe ennui now yielding to anxiety. To distract myself, I am re-reading a series of seven short-ish novels comprising “The Homeland Connection” series by Lior Samson, a pen name for Larry Constantine. Constantine is expert in computing and software engineering, including malware and network security. He makes very good use of this knowledge in writing this series of plausible, disturbing, entertaining thrillers. He is also an excellent technical novelist adept at creating real, human characters.

Rather than attempt to review these very well-written and entertaining stories, however, I am moved to share with you the very disturbing, overarching impression with which they have left me: I am no longer even close to being able to understand the technical world in which I live and on which my very survival has come to depend. What with layers upon layers of software code insinuating itself surreptitiously and interacting in incomprehensible ways, these stories show the internecine power struggles on networks and in the ether all around us all the time. These stories recount malware destruction of gas pipelines, airliners, power grids, automobiles - virtually anything with SCADA systems running.

I am reminded of a short stunning color film from 50 or so years ago. It begins with an overview of a beautifully landscaped back yard with a manicured lawn. It is green, serene and aesthetic; peaceful. The camera then begins to narrow its field and reveal what is actually happening between those blades of grass and among the clumps of soil: a brutal life and death struggle, where predator devours prey, everywhere and continuously.

Similarly, I am reminded of one of John Walker’s reviewed books: “The Last Man Who Knew Everything”. . That man lived long ago and there is zero danger of anyone confusing me with him. This does, however, stand to exemplify the inequality between what is collectively known and what can possibly be known by one mind. There is something I find profoundly disconcerting about my obvious inability to keep a small grip on the some of the essential reality of the present day.

In other words, superficial appearances of smooth, serene, reliable functionality can be deceiving. And, at the cyber level, apparently, such e-predation is similarly pervasive, over networks and in the ether, everywhere. The degree to which I have been (mercifully) oblivious to this, is shocking. It forces upon me the knowledge that modern technology has left me in its wake, with my head barely above water. I fear I have become an anachronism, with no alternative but to hang it up and stop even trying to keep up.

It all seems at a different level than the effort I make here on Scanalyst. Here, I can read posts and watch videos which explain in some detail many things about which I already have some inkling. When it comes to computation and networking - especially at the levels within levels of AI, machine learning, malware, etc. - however, I am lost. Danté comes to mind" “Abandon hope all ye who enter here.”

13 Likes

Thomas Young may have been “The Last Man Who Knew Everything”, but there was a great deal he did not know, because those who followed him and built upon his work, such as James Clerk Maxwell, discovered large domains of knowledge which were entirely mysterious during Young’s lifetime.

Today, we have expanded the domain of knowledge by orders of magnitude beyond what was known to Young (and Maxwell, and Einstein), and it is inevitable that it has become too large for a single human to master during a limited lifetime. But this is good—it means we know more, and can do more, and perhaps may eventually be able to augment our ability to learn, remember, and live longer to enjoy it all.

Having spent (or mis-spent) half a century in computing, I’ve had the opportunity to see a field grow from the stage where one person could, in less than ten years, pretty much understand everything from the level of transistors in logic gates to operating systems, programming languages, and applications, to today, where there are numerous specialties within the field such as machine learning, parallel computation, functional programming, etc., each of which may take an entire career to master and devoting the time to do so will rule out mastery of the others.

Again, I view this as a good thing.

Yes, I wish I could know it all, but I happened to get into the field during the brief window when that was more or less possible. But it’s much better to be able to do so much more today, standing on the amassed shoulders of multitudes, than it was 40 years ago when computing was 5% about how to solve the problem and 95% how to fit it into the severely limited memory and computing power available to us in the Bronze Age.

A week ago, I had a total replacement of my right hip. Although “doing my homework” before submitting to the knife, I know that the outcome (so far, better than expected) was largely dependent upon things such as development of the anterior, minimally-intrusive approach, non-cemented hydroxyapatite coated titanium prostheses, and propofol (“milk of amnesia”) general anæsthesia, none of which I really understand but am very glad were developed by those in specialties other than mine before I was able to benefit from them.

I’d say, don’t worry about not understanding it all, nor feel guilty deferring to others (but Доверяй, но проверяй), but rejoice in how much we’ve learned together and hope we can keep this marvelous engine of discovery and preservation of knowledge going despite the efforts of those who would destroy it.

14 Likes

Wishing you good luck with recovery from the operation!

5 Likes

Cheer up! That happened a long time ago.

We depend on electricity for all kinds of things – but how many of us could operate an electric power plant? Or build such a plant? Or identify where to find the iron ore to start making the material for the plant? On the other hand, how many of the people who could do those things would know the first thing about medicine? As Adam Smith pointed out in 1776, specialization is one of the key factors in the higher productivity which makes civilization possible.

The problem may be that specialization is based on trust. We trust the auto mechanic who fixes the brakes on our car. We trust the politician who sends our money to a far-off country to fight a war against a nuclear power. Or do we? How should we maintain trust in a world in which we are all mutually dependent on each other?

9 Likes

Great stuff John! The last year for me has been a realization that I do know it all!! (Or more accurately—I know where to focus.)

My foundational focus is that no matter the environment (technology’s exponential growth) the human condition is rooted in the unquenchable lust for Power.

And “they” will do anything to get that Power.

6 Likes

I hear your lament. But be of good cheer! You and I have come to the ending of our lives - we have a relatively limited amount of time left. While we may not know how much, we do know our “use by date” is at hand.

That gives us unique perspective. We have lived through much change, both good and bad - and may actually be able to tell the difference.

I was in the ED the other day to get some stitches put in my chin. I got to talking with the personable ED MD, and when he found I had also been an ED MD - for a mere 43 years - he said I shouldn’t have retired but gone into government to fix our problems. But I responded that one thing I had learned is that government will not “fix” anything. You know that too.

So sit back and let the kids do the magic. Our time has come to enjoy what is left of life. Our job is to enjoy the simple beauty of things that were beautiful 500 years ago, only now no one has time (or perhaps even the real interest) in doing so. You no longer have to “know” all this stuff; you merely have to enjoy what you wish, be it reading - here or books - going for walks, sitting at some favorite spot to see the landscape, or (me) driving my car at 120-160 MPH on the express lanes of my local roadway system.

And sit back and contemplate on the awesomeness of God. The kids are too full of their own knowledge and intensity of life to do that yet. But you and I know He is. Just knowing that makes up for all the electron “gates” and what-have-you you no longer can follow. ?Will the power grid fail. Perhaps, but you and I will not affect that one way or another, so why worry about something you have zero control over. Just enjoy - you have earned that.

9 Likes

I’ve thought for a long time that what happens to us all is that the paradigms and, yes, prejudices we’ve had our backs against all our lives begin to wobble and crash over. And then, the poor old frail critter we’ve become—just overnight! —is frightened, tremulous, and has no self-confidence. “Willst undo this button?” asks the newly decrepit and senescent King Lear. When we first see him, the known world is within his gift. He passes through impotent rage , “I will do such things! What they are I know not, but they shall be the terrors of the earth!” Awful, maudlin regret: “O I have ta’en too little care of this!”
I saw my parents, those glamorous and benign Titans, wither into this. And now…oh I won’t even say it. Sad beyond belief when one’s only consolation is the sure and certain knowledge that the now vigorous and arrogant young will find all this out for themselves.
But not before they’ve HAD the world they want. I sometimes feel maybee I should just endorse every asinine thing my daughter and her friends say. Their word is, or will be, law, after all. Until THEIR Lear moment comes.

8 Likes

My wife had both hips replaced 5 months apart, via the same technique. This has restored her mobility to that of 25 years ago! Having presided as an anesthesiologist over many such operations, I can attest that the new approach and materials represent a significant advance. I’m glad you are doing well.

Just in terms of anesthesia taxonomy, propofol is categorized as a sedative/hypnotic and is used for sedation, as compared to general anesthesia. General anesthesia is said consist of three elements: amnesia, analgesia and relaxation. Propofol alone does not confer all three - mostly is provides lack of awareness, sedation, sleep, some amnesia; not much by way of analgesia or relaxation (but for relaxation, surgeons might be trying to hit moving targets - even though unconscious and amnestic, patients would try to withdraw from the painful stimuli, reflexively) . In the old days, diethyl ether provided all three components (though it had many disadvantages). Modern inhalational agents are much better, but beyond what I want to say here.

For the vast majority of hip replacements, the main anesthetic is spinal or epidural anesthesia, either of which reliably and completely block sensation and motor function from the waist on down. The surgery could thus be done with that as the only modality - there would be zero pain or sensation - but who wants to hear the sounds of carpentry being performed on his/her body? Thus, in addition to the regional anesthesia (like spinal, epidural, or any of a variety of nerve blocks), patients are sedated to the point of unconsciousness with a propofol infusion (often combined with midazolam and fentanyl) for emotional comfort during surgery. Though subjectively, it feels the same as general anesthesia, patients continue to breathe spontaneously, usually while breathing extra oxygen through a nasal cannula to account for any hypoventilation which occurs during “unconscious sedation”. With this technique, patients awaken within a few minutes of the infusion being stopped. The numbness from the spinal takes an hour or so after that to wear off.

So much for my little technical area of (receding with the edge of the observable universe) expertise. I do want to thank you for your reflections on my musings. I very much want you to know how meaningful your heuristic efforts are to me: Ratburger, Scanalyst posts and comments, your book reviews, The Autodesk File. These are important parts of my everyday life and help keep me engaged in life (though I have relapses, as when I wrote the OP) and intellectually curious. I find myself wondering at times whether my existence makes any difference; just in case this question arises for you, I want you to know that, without any doubt, your existence and activities make a very positive difference in my life, so Thank You!

10 Likes

I think you are on to something important. I think about this frequently. Yes, indeed, the lust for power over others is the central motivation of those who presume to be “saving the world”. But maybe it goes deeper? At various times during my life, I have attempted many balms and poultices in efforts to ease my own rolling existential angst. I think a good bit of the addictive behavior practiced in the world today, is a dysfunctional effort at holding at bay the sure knowledge that we are vulnerable and mortal. Who can bear to live in that conscious awareness 24/7? We need respites and there exist healthy and functional ways of living more comfortably, like relationships, work, creativity, play, etc.

So, I hypothesize that the lust for power and control over others may represent a form of denial of our human vulnerability and mortality. The rationalization goes like this: “Maybe I’m not so vulnerable and mortal after all, if I am not powerless - if I have the power to control you and, with my ongoing efforts (think rabid SJW here), more and more of society and the world. If I can only accumulate enough power, I may just not die after all”.

5 Likes

In my case, in the interview with the anæsthesiologist on the eve of the operation, she provided the two alternatives of propofol “general” or epidural spinal block, but noted that with the latter I would be fully conscious and aware of the hammering and sawing down south and that the procedure could take around 90 minutes. I opted for the propofol and, according to the disclosure and consent form, that’s all they used. When I woke up in the recovery room (it was like bing—wide awake, with no hangover or after effects), there was no numbness or inability to move my lower extremities at all, although it’s possible something had been used and worn off before I regained consciousness.

They did, before administering the propofol through a catheter in my arm, have me “pre-breathe” pure or enriched oxygen for a minute or two before lights out. I presume the triangular oxygen mask stayed on throughout the surgery, but it was gone when I woke up. There was an ECG, blood oxygenation, blood pressure, and respiration rate display up on a screen at the start of the operation. This remained for 48 hours (or maybe 24, it’s been a while) afterward back in the room.

8 Likes

Interesting. It’s hard for me to piece together exactly what you had. If there was no numbness when you awakened, then you almost certainly didn’t have a spinal or epidural. It sounds like maybe she didn’t want to you opt for either of those. I say this because telling a patient he would be fully conscious and aware of the hammering, is simply not done in any modern anesthesia practice. There would be no reason to do it that way and she surely knew patients are not likely to say “that’s what I want”.

In the old days, when I would offer patients a choice of general vs. regional anesthesia, patients would often tell me that “I just want Pentothal”, by which they meant they wanted general anesthesia. I would then explain to them that Pentothal is merely the induction agent - the drug that first makes them unconscious - that once they were unconscious, they would receive several drugs to keep them asleep. As it was not really possible to use Pentothal as the sole agent in conducting a general anesthetic then, it is a similar challenge (with no good reason for even trying to do so) to try the same thing with propofol today.

The fact you had to pre-breathe oxygen before you fell asleep is a clue you did, indeed, have general anesthesia. Induction doses of propofol invariably result in a period of apnea. Pre-oxygenation (washing out nitrogen and replacing it with oxygen in the functional residual capacity of the lungs) is a universal procedure when safely inducing general anesthesia. It permits a much longer period of oxygenation of the tissues in the event ventilation of the lungs with oxygen is delayed for some reason. I cannot, of course, be sure, but I would be surprised if you did not receive other medications besides propofol during the anesthetic. Did you have any pain when you first awakened? If not, that wonderful fact would be hard to explain without any opioids on board. IA common technique of general would include an infusion of propofol combined with intermittent doses of midazolam (amnesia) and fentanyl (analgesia). One of the less-publicized advantages of the anterior approach to hip replacement, is the lack of necessity of muscle relaxation. In GA where that is required, paralytic agents would also be used (modern versions of curare).

7 Likes

There was no pain at all, just a feeling of “tightness” where I assume the muscles had been retracted to gain access to the joint. Subsequent to the operation, the only analgesics I’ve been given are ibuprofen and paracetamol, three times a day with meals.

8 Likes

Sounds pretty slick. You stayed two nights, yes? My wife was discharged home six hours post op! - in pain - both times, with prescriptions for oxycodone for a week. Orthopedic surgeons are divided when it comes to post-op NSAIDs like ibuprofen. Some, like yours, use them. Others believe they can inhibit the normal inflammatory process which is part of the healing/remodeling process of bone. My wife was not allowed to resume hers (which she is prescribed for lupus) for an entire month.

It may be that some newer dosage forms of the injectable local anesthetic - liposomal bupivicaine - are in wider use in Europe than here; maybe you had that. These long-acting (said to be > 48 hours) agents may explain what sounds like a very good experience.

7 Likes

That’s interesting. In late September I had a 10 hour long vtach ablation, tweaking the wiring in the lower half of my heart, at the Mayo Clinic in MN. From the post-op report (I remember nothing that day after they said they’d give me something to help me relax) the first hour was under a sedative level of propofol, after which they decided to intubate and (from the report) increase the dose to an anesthesia level for another 9 hours.

7 Likes

I’m glad to hear you got through that procedure. Yours was one of the longer ones; such ablations can be very complicated. Intubation, often conflated with general anesthesia, almost always requires medications in addition to propofol. Yes, it may be the main sedative, but given the degree of stimulation from the endo tube (think a garden hose stuck into the windpipe), usually an amnestic like midazolam is included and and opioid, like fentanyl to blunt the gag reflex. As well, muscle paralysis is often required (in addition to facilitate placement of the endo tube) during such procedures so that breathing may be intermittently suspended to prevent respiratory displacement & movement of the heart.

6 Likes

Thanks, I’m glad I got through it too :slight_smile: and appreciate the info. I was given rocuronium and sugammadex to reverse it but no benzos from the procedure med list, plus at some point a mg of dilaudid. I’m a mallampati II, normally pretty easy (not my first time…) but from the notes “Patient’s neck was flexed due to procedural positioning and conversion to GA mid procedure, Do not anticipate difficulty in the future.”. I have brief memories of being in a head block and strapped in but it’s pretty fuzzy for some reason. I asked if I could be as awake as possible to watch (like my first ablation, was in and out) but guess they didn’t think that was good this time. I have another coming up in a couple days, for aflutter and afib, and will see what they say. Lots of high tech equipment and monster monitors for all that mapping. More fun to watch on somebody else, though.

I spent 15 years as a paramedic, my post-programming career, and retired 5 years ago. I’ve transported patients (we did a lot of long distance transfers) that were receiving propofol but never seen mention of an anesthesia dose before and was curious.

I didn’t mean to hijack the conversation, @johnwalker 's recovery is much more interesting, surgical recovery from an engineer’s standpoint. I liked “bing–wide awake”. I hope he’s doing well.

7 Likes

Thanks for the plug for the Homeland Connection series. (Anonymity is over-rated anyway.) I am delighted that they got you thinking, which is what I aim for with readers–besides providing an entertaining read. Your reference to polymath Thomas Young (who knew everything) raises some interesting questions about what it means to know something–or everything. Physics has yet to integrate quantum theory and general relativity, but one could say that if you understand (to some degree) both of these, you pretty much understand everything (to some degree). Of course, my daughter, a biochemist would disagree; to her everything is chemistry! What I am getting at relates to the power of theory (in the scientific sense, not the popular misuse). The exponential explosion of knowledge means that no person has any hope of mastering everything in the sense of the facts and the details. Increasingly, we are confined to ever narrower specialties, boxed in by disciplinary boundaries, with limited perspective outside of our singular “expertise”. However, good theory enables understanding that goes beyond current facts and details and even the potential for straddling disciplines. I had the great fortune to study at MIT at a time when general systems theory, cybernetics, information theory, and systems thinking were in the very air we breathed in every classroom. That theoretical meta-perspective has served me well in careers in computing and software engineering, family therapy, organization development, and industrial design. I’m still mining that foundation in my current work on human systems. So, one might think of theory as a lever that gives insight into areas that one might not be able to master but can understand in useful and practical ways. Neither the information capacity of the human brain (74 terabytes by a good recent estimate) nor its speed has expanded as the totality of human knowledge has, so such multipliers are essential tools if we are to continue to function as effective, knowledgeable citizens in this complexifying world.

If it makes you feel any better, I too no longer feel like I can “keep up” in the very technology specialties in which I was once a leader. Terra incognita. Here there be dragons.

9 Likes

Welcome to Scanalyst! I hope you will stick around. I do apologize for attaching @ProfLarry to your nom de plume. I could penetrate your anonymity with a brief search, unskilled as I am, I think anyone can.

3 Likes

Thanks for the welcome. No apologies necessary, since I and my pen name are publicly linked anyway. In fact, pretty much anyone who wants to can track me down, and as a journalist I’ve learned tools that enable tracking almost anyone. I once met an author at a book event who went only by her pen name and when I questioned her faith in anonymity challenged me to find out who she was. Took me a few hours. If you want to continue the dialogue about the Homeland Connection offline, you’ll find an email address at the back of the books.

As you mentioned, the vulnerabilities of so many systems are underappreciated. All the attack vectors referred to in my fiction have already been demonstrated or are known in the cybersecurity community, so, yes, cars, planes, pipelines, power plants, the electric grid, natural gas distribution,…all vulnerable, and certainly in ways far beyond what inside-outsiders like me know about. Analysts argue that one reason we haven’t seen more physical attacks is detante. The real players are too wary of starting an escalation. Random hackers are not so much the real threat, but nation states are deeply involved in stockpiling zero-day vectors and attack toolkits for use “in case.” It’s nuclear cold-war mutual-annihilation thinking all over again. And we don’t have Kennedy and Kruschev at the helms.

6 Likes

Exactly. If you have a confirmed zero-day exploit in a system, especially one such as network infrastructure, SCADA firmware, or generic firewalls protecting such systems, the last thing you’d do is expend it in an attack with minimal consequences. Instead, just like all of the ICBMs in silos or on patrol in boomers, you’d reserve it for the Main Event, should it eventually come.

From fifty years of writing and fixing software, my rule of thumb if that for every bug you’ve found, there are probably ten you haven’t, and if they are potential vectors of attack, the black hats have probably found a few and are holding them in reserve if your software provides them a way to accomplish their nefarious goals.

This is not reason for despair. It should motivate us to make our systems less vulnerable to system-wide failures, which may increase cost by making the platforms on which they are built more diverse. Large-scale replication of identical systems introduces the same kind of risk in technological ecosystems as monoculture in farming.

7 Likes