Monthly Archives: January 2013

A Moister Brownie…

4th pitch of Mean Green

4th pitch of Mean Green

…is not necessarily a better brownie, especially when it comes to dirty ice.

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The Southfork is not is stellar shape this year. Climbs like Moratorium haven’t seen enough water to form up properly, while South-facing routes like Ovisight haven’t seen enough cold.

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Mr. Mulkey has pulled off ascents of Pillars of the Community and the mixed start to Joy After Pain (the latter with help from a friend, see video and photos at coldfear.com) but even those climbs are beginning to sublimate away.

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We squeaked by the third pitch of Broken Hearts.

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On the return trip, it was gone.

6th pitch of Broken Hearts

6th pitch of Broken Hearts

Carotid Artery wasn’t even close enough for me to agonize over.

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Mean Green looked to be missing the fourth pitch, but it turned out that the ice was just so full of dirt, you could barely distinguish it from the rock.

The Valley from the top of pitch 5, Mean Green

The Valley from the top of pitch 5, Mean Green

It feels like the season has never gotten started this year; thoughts of Canada are already popping into my head unbidden.

Ten Sleep

Ten Sleep

We’ll give it a couple of more weeks.

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Cult of the Range-Fed Turtles

When my best childhood friend grew up, he decided to become an archaeologist. During his graduate training, he was in charge of  a dig in the Mississippi river valley which unearthed an odd structure. In the midst of the native people’s dwellings, was found a circular enclosure made of closely spaced wooden posts and containing a large pile of turtle shells. The undergraduates were eager to speculate about the purpose of the structure, but my friend cautioned them against it.

“We can’t be sure of its use,” he said”, and we can’t just guess based on what we might use an enclosure like that for today. We can’t just assume they were running a turtle ranch here. Why would they do that with a river full of turtles just a quarter-mile away? We have to put it in context of the surrounding village and the environment of the time, look for other examples and see if there are any modern structural analogs. Then we can make a guess, but it will still just be a guess.”

The next day the professor in charge of the dig came around on a rare site visit to see how things were proceeding. The students were eager to show him the mysterious ring of posts with its pile of shells.

Upon seeing their find, the professor remarked without hesitation, “Huh, must have been a turtle pen,” and promptly resumed his walking tour of the dig.

I don’t know if archaeology has an excuse for this kind of thinking, but medicine does:

Life is short. The art is long. Experience is difficult.

– Hippocrates

We can be forgiven for resorting to teleological assumptions now and again in medicine. With limited time and incomplete information, we must sometimes act on hypotheses which attribute function to structure and purpose to processes. Lucky for us, there’s plenty of slop in the system, so even if we’re wrong at the start, we usually get a second chance. We are trying to get away from teleology, though. “Evidence based medicine” and “scientific medicine” are the names that we have given that effort.

We are trying to get away from teleology because we have been burned by it. We thought that the body made pus to fight off bacterial infections, so for years, when we saw people with respiratory illness cough up phlegm with pus in it, we gave them antibacterial medications. We were wrong, not just about the purpose of pus, but in attributing a purpose to pus. Again, it was an understandable mistake, given the long history of debate regarding the merits of pus. Was it a good sign, or a bad one? Should we encourage or discourage its formation? It turns out we shouldn’t have been focusing on the pus at all, but on    the outcome of our purposeful intervention in the underlying process that produces the pus.

Purposeful results and final causes apply prospectively to human endeavors alone, and even there it’s often difficult to tell whether, when our actions are associated with the desired result, the outcome is due to our actions or simply due to fortuitous circumstances. Applied retrospectively or to processes and structures beyond our control, teleology is a sure mistake.

When we assign an endpoint to a process, we presume causation and correlation must be proven. Humans are notoriously bad at that. In systems which we can’t duplicate or control, we can always tell a causal story (I’m looking at you evolutionary psychology, intelligent design, cosmological fine tuning). But those stories are just interesting rationalizations, sharing the merits of a fairy tale in that they reveal more about us than the subject matter. Our fairy tales are harmless when they are about the universe, the origin of life, turtle ranches or anything else beyond our control. When we tell teleological stories about processes we do seek to influence (and can) we court tragedy.

The practice of bleeding was based on one such tale: the story of homeostasis. We still tell it today, but we tell it as metaphor instead of fact. The story is based on the simple observation that, when a person becomes ill, they go through a series of changes in their physical state which ultimately ends in either the restoration of their previous state, or death. Having observed other systems, the Greeks thought that the process of illness looked like a disequilibrium. Having observed associated changes in fluids which emanated from the body, they attributed the disequilibrium to an imbalance in those fluids. We can hardly blame them for the limits of their observations. We can’t fault their hypothesis. However, we can fault their method.

They didn’t just postulate an imbalance in the humors as a cause of illness, they presumed a balance of the humors as a state the body sought. The difference in these two points of view is subtle, but crucial. If  the balance of fluids is seen as descriptive  then restoring health by balancing the fluids remains a working hypothesis. It admits that other factors may determine the observed equilibrium. It leaves open the possibility that the observed flux of humors is a secondary phenomenon. Most important, it leaves physiologic equilibrium as a simple description, instead of presuming that it is a purpose with causal powers.

Given a description and a working hypothesis, physicians would look at their efforts to balance a patient’s humors with a critical eye. As a teleological assumption, with equilibrium as a “final cause” under Aristotle’s system, the idea creates an entirely different viewpoint. With  humoral balance rooted in the body’s design, variances in expected observations must be due to inadequate methods or incomplete knowledge of the humors. For this version of the “balancing the humors” hypothesis, failure is not an option.

Now, the ancient Greeks may have weathered this kind of assumption better than their heirs. They loved to fight with each other. In the face of inconsistent outcomes from humor-balancing interventions, they were likely to call Aristotle and Hippocrates idiots or just ignore the under-girding theory of causes altogether in favor of their own pet theory. Definitive statements naturally took a healthy beating in the Greeks’ intellectual environment. The Romans, and the Europeans who came after them, were much more pious.

As a result, no one questioned the teleological assumption, out of reverence for its sources, and the vital fluids persisted in medical thought owing largely to the idea of homeostasis by design. No matter how apparent the flaws in our understanding of the blood, bile and phlegm, they were somehow attached to the homeostatic goal of the body. As long as physicians saw that equilibrium as the body’s goal, they could reconcile any discrepant observations with the over-arching story and persist in practices such as bleeding. It fell to investigators outside of the medical profession to discover the secondary nature of the humors. Only then did the practices aimed at balancing the fluids truly begin to fade.

But long after bleeding and the balance of fluids fell by the wayside, the tale of homeostatic purpose continued to plague medical science. Physicians continued to view physiology as directed toward an end. For example  the heart was seen not to pump blood, but to be a pump. Therefore, medical students were instructed to never administer medications called beta-blockers to patients with heart failure.

Beta-blockers stick to proteins in the membranes of  heart cells called beta receptors, which normally bind adrenaline. Via the beta receptor proteins, adrenaline stimulates the heart to pump faster and with more force. In heart failure, the heart can’t contract forcefully or fast enough to keep up with the volume of blood returning to it from the veins. If the heart is a purpose-built pump, beta blockers should be anathema in the setting of heart failure. But in reality, when given to stabilized heart failure patients, beta blockers reduce long-term mortality by about one-third.

We don’t yet know exactly how these medicines achieve such a feat. We do know why they are not inevitably detrimental in heart failure. It is because the heart pumps, but it is not a purpose-built pump. The heart is instead a group of cells which inhabits a specialized niche in a system of many cells all with complimentary and competing characteristics, existing in a state of equilibrium which, in deference to tradition, we call homeostasis.

Our physiology doesn’t try to maintain homeostasis any more than erosion tries to form a natural arch. The arch forms (rather than crumbling like the sides of a stream-bed) because it is geometrically stable given the geology. The arch persists because it is geometrically stable, and so we frequently see natural arches where the climate and geology allow. Nobody marvels at this, speculating about a conspiracy between sandstone and weather patterns. Then again, few people have an emotional stake in natural arches. The same is true of our physiology, minus the low stakes. There is no overall homeostasis sensor or hormone in the body. There is no homeostasis conspiracy.

So, we have abandoned the notion of purpose in physiology, and that simple maneuver has allowed us to discover things like the survival benefit which beta blockers produce in heart failure. This move is the principle behind the randomized, controlled clinical trial. All along, it wasn’t ignorance holding us back, but the project of rationalizing our knowledge to traditionally understood, teleological models.

Of course, the questions driving evidence based medicine don’t start from nowhere. Scientific medicine asks questions based on the results of previous investigations and hypotheses derived from basic science discoveries regarding the components of physiology and their relationships. Some of these hypotheses are even most easily stated in terms of purpose. But those statements are now understood as metaphor, rather than bare fact.

Beyond the fecundity of this change in method, the move away from teleology finally brings some redemption for poor Hippocrates. Rather than using it as an excuse, we can understand his aphorism, “Life is short. The art is long. Experience is difficult “, properly again – as an admonition about method. Be skeptical. Remember that your viewpoint is limited. Watch out for overarching narratives. Good advice, and not just for medicine, but for all those turtle-ranch theorists out there (I’m looking at you intelligent design, cosmological fine tuning, evolutionary psychology…).

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Ice Climbing is Dangerous

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So we place tubular screws in the ice to secure the rope in case of a fall. But even placing the  protection is difficult enough to be controversial. You find them less and less, but there are some experienced climbers who feel it is safer to go without protection against all but a catastrophic fall. Their rationale is that the screws are too tiring to place and the placements are not predictably reliable.

As if it isn't hard enough - penalty slack

As if it isn’t hard enough – penalty slack

I disagree, of course, but I’m an optimist. I figure, if the screw hit an air pocket,  it may fail if I take a big fall on it, but that means it may not too, and I know that the ground will be even less forgiving. I have some data to back up my optimism. There are the drop tests done by Craig Leubben and Chris Harmston. Then there’s my anecdotal evidence. I know several people who have fallen on ice screws. The majority came away with fractures, true, but the screws held and all the climbers lived to climb again. In addition, I have personally witnessed two falls on ice screws.

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The first was several years ago. A friend and I were watching a couple of guys climb Jaws a waterfall in Rocky Mountain National park. The sun was baking the upper third of the climb and the leader wisely placed a screw just before he climbed out of the shade. About fifteen feet into the tropics, he started having trouble getting his tools to stick. He placed another screw and continued. After ten more feet, it was clear he could not go up any farther; the ice was just too thin and rotten. Things looked better off to his right though, so he struck out in that direction. It proved a false hope. Two moves into the traverse, he slid down several feet. He recovered, made two more tool placements, then popped off. The upper screw blew out of the ice without even stretching the rope. The shadow piece caught him after about fifty feet, just five feet from the ground.

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I witnessed the second fall just five days ago. A younger gentleman was climbing at our training area. I had led a solid line just to his right a few minutes before. He wanted to go a bit steeper. The line he chose had a little overhanging icicle about fifteen feet up and he launched for it. Rich had tapped on that feature on his way past it, and neither of us liked the sound it made. I almost said something, but I didn’t want to intrude. Tony’s a good climber; he would be careful. He drove an ice screw in the pillar below the icicle, hooked a tool on a feature in the middle of the hanging dagger, and took a tentative swing for the top of the icicle. As soon as the pick of the tool made contact, the whole thing cut loose. Fortunately, he had his legs out from under the falling chunk, so he missed having his bottom half skewered. The screw caught him just before his crampon points scraped the ground. The screw did not bend and the ice around the hanger hadn’t a chip in it. The fall factor had to be close to 1.5. I shall persist in my optimism.

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The Prelife

I have resigned myself to die many times over, but I have been lucky. I wasn’t shot in Paris. I didn’t fall off the North Ridge variation. I wasn’t killed by rock fall, or struck by the falling body. The avalanche didn’t push me over the cliff. I recovered from my pneumonia and I stopped rolling before I went under the car.

I have known others who had similar experiences and the same good fortune. One guy fell from the top of an ice climb and punctured his lung. When he got out of the hospital, he sold all his gear and quit climbing. Another locked the back brake on his motorcycle at 60 mph to slip behind the car he was passing. In doing so, he avoided a head-on collision with a truck, and barely kept his machine upright through the ensuing fishtail slide. After he pulled off the road and dismounted, he never climbed back on a bike again. On the other hand, another guy I know survived altitude sickness on Denali, came down and bought a para-glider  Then there was the friend who took fall after fall, and each time climbed farther from his protection than the last, until he began to eschew the rope altogether.

The first group, those who escaped a close call and chose to hoard the life that might remain to them, were wrong. Time kept in a vault sustains nothing in the end, it simply perishes. However, the second group, those who saw themselves as survivors specially blessed by fortune, were also wrong. No such privilege exists. Of all the people I’ve encountered who confronted death, the only ones who seemed to get it right every time were those who died.

I have seen a lot of people die. On the road, in the snow, in bed and on gurneys, the people I have seen die have done so in quiet, while the people around them wept and wailed. I think that arrangement reflects the truth more than any other set scene we might devise to frame the end of a life. Those remaining mourn for themselves; they are the ones who have lost something. The dying become quiet because they return to the prelife

The prelife is an individual’s condition before they come to be conscious, when their heritage and senses have yet to generate the identity necessary for experience. No one recalls the moment they pass from prelife to life any more than anyone recalls the exact moment that they fall asleep. No one fears or laments the time before they first woke any more than they fear the moment that they go to sleep, when they come to it (even if they are the worst insomniac existentialist).

It is easy for us to accept the necessity of our preconditions. It is more difficult for us to accept the necessity of our post-conditions, though they are actually much the same as the circumstances that conspired to bring us about, except of course, for the fact that we have been.

So, we make up bedtime stories for ourselves about afterlives. Stories of this kind are necessary to get us through the uncertainties of childhood when we lack the experience to allay our anxiety about the unknown. In those stories though, the dead are truly lost to us, as their lives become a token of their true existence at best. Worse, each person is lost to themselves from the start, as they are, in the end, separated from the determinants and contents of their lives as a whole and are left with a remnant, and a stagnant one at that, if we believe the claims of eternity in those yarns.

Read through from a mature perspective, the accounts of paradise sound more like dark, German fairy tales than lullabies. A ghost condemned to wander a pleasant meadow will be just as miserable as one who haunts a swamp. Lucky for us,  afterlife stories are only a class of fiction. We won’t be condemned to an endless disassociation. We may expect instead to return to the prelife when we die.

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Dr. Blue Thumb (with apologies to Cypress Hill)

Right Pillars

Right Pillars

The crop has come in. It may be no taller than G1 in Hyalite, but it is more potent, and much closer to home.

Central pillar

Central pillar

Overhangs, chandelier, steps – it’s all there for the pleasant terror of the community.

All ninja missions require video documentation for payment. Left pillars.

All ninja missions require video documentation for payment. Left pillars.

Maybe the Black Hills will sprout some more ice climbers after all.

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