Uncertainty.

The problem with experiencing a daily barrage of thoughts and ideas is the challenge to keep track of them. To make sense of them, line them in order and relate them to each other. To communicate them to others, or attempt to store them in your mind for future use, and hope that the idea's original form, after gradual rewiring of your brain over time, is still recognizable.

For several years I imagined myself to be a future writer, but never seemed to decide on how my perspectives or stories would be useful to others or applicable to their lives in any way. However, I have begun to recognize the sheer disorder of the universe we live in. We all share its chaos, and learn from each others' perspectives and strategies on how to make sense of it. How every cause and effect relationship depends, in part or in whole, on chance. Every decision we make is driven by uncertainty, because the world we live in is temporary order swimming upstream in a strong current of disorder, and our planet governed by starkly imperfect and greatly unpredictable living beings.

I decided at the young age of six that my calling was to be a physician, and in four months I will continue this journey by beginning medical school. But to say I have never second-guessed this decision would be a bold-faced lie. As an aspiring neurosurgeon, I am already haunted by foreshadowings of my inevitable shortcomings. Failing to give a patient the correct dosage. Patients dying on my table, or suffering from morbid post-operative complications. Submitting to the pressure of giving false reassurance to a patient's family. Failing to find a work-family balance under an overwhelming patient workload.

During the first of my two gap years before medical school, I was trained to count cards in blackjack, and have been playing for profit for over a year. I have been using the game to help gradually pay off my gargantuan student loan debt and reach financial freedom before or during medical school. The goal is to focus less on finances and more on achieving excellence in the medical field. It began as a means to an end, but has become much more. The dopamine surge of the game, and the ego boost of being treated like a high roller is undeniable. With time, however, I know these thrills will quickly lose their significance. The greatest takeaway from professional blackjack will be what I've learned from my action on the green felt; what it has taught me about the role of random chance in medicine and life, and how uncertainty influences human behavior.

Even with perfect bet sizing and playing strategies, I have sometimes lost several thousands of dollars in a single session at the tables. I have been involuntarily coached by self-proclaimed blackjack veterans who present their anecdotal evidence as more credible than the mathematics of the game. As a dealer once said to me after I lost a double down bet that upset the other players, "nobody knows what the hell they're talking about until the cards come out." And in truth, not even the seasoned card counter can precisely tell you which cards will appear next at any given time. They can only accurately estimate their probability of winning compared to the dealer's, and be the most prepared to win money over an extended time period. Even still, with a limited bankroll, some of the world's most talented card counters have gone bankrupt at least once, falling victim to their "risk of ruin".

Likewise in my future, the outcomes of many of my surgeries will depend on probabilistic factors beyond my human control. Like any aspiring surgeon, I strive to be the most skilled version of myself, but human capabilities fall pathetically short when faced with overwhelming resistance from the universe. Consider the mind-boggling complexity of the human body - better yet, just the human brain: one single organ, and the most complex organic structure in our solar system (and as far as we know during our fruitless search for extraterrestrial life, the most complex in our galaxy). A grey and white gelatinous mass in our skull composed of over 100 billion neurons, each with about 1,000 unique synaptic connections. A six-deck blackjack game has P = 312! possible permutations: an unfathomably large number, certainly with enough volatility to bring the most talented card counter to their knees. Now consider the complexity of the human brain by comparison. Clearly it cannot be reduced to "C = 100 trillion synapses", as the simultaneity of synaptic firings and environmental conditions are always changing its structure over time. As my professor in molecular neurophysiology once said to me, "anything can happen in biology". In short, to believe I will be prepared for anything in repairing or treating this mosaic structure would be extremely ignorant and pretentious.

A more broad sense of this reality dawned on me while reflecting on my past experiences to write essays for medical school applications, and has since dominated my perspective on how the universe works. The world as we know it, it would seem, is the result of billions of years of random interactions of molecules. Disordered transactions of energy that eventually manifested as order in the form of galaxies, solar systems and living organisms; order that is slowly eroding with the increasing entropy of the universe. Human progress itself is the result of virtually infinite numbers of events determined by a series of coincidental human interactions, relationships, emotions, decisions and transactions (Studies have shown that the human brain shows activity in the prefrontal cortex seconds before the person makes a seemingly executive decision. In this sense, even what we believe is our "free will" may depend on predetermined neural firings in the brain). Each of the nearly 8 billion individuals on this planet is the result of one single sperm out-swimming 500 million others to an ovum that is only available 1-7 days a month. Such a prominent cloud of uncertainty shrouds our existence that 84% of the human race believes, not unreasonably, in a supernatural being that pilots the ebb and flow of the universe.

To be continued.