"Bugle Notes" - "This Is Water"

“There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says, “Morning boys. How’s the water?”

And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, “What the hell is water?”

These are the opening lines of acclaimed author David Foster Wallace’s last book “This Is Water”. It was published shortly after his death in 2008. He posits the question to university graduates, “How do you measure the value of the education they received?” What followed was a thought - provoking examination of what he called “the capital-T Truth”. The challenge we all face he wrote, in understanding this “capital-T Truth”, is overcoming what he called “your default setting”. This is the place you go in response to life’s many challenges. It is the way you automatically and even subconsciously believe something is true even though you may be wrong. Why? Because we all believe, to one degree or another, that we are “the absolute center of the universe, the realest, most vivid, and important person in existence.” Anything else we reject or don’t recognize, just as the two young fish did not know what water was because their natural default setting did not recognize it as separate from themselves. Their world was all about themselves.

Wallace writes that our default setting of seeing things only as we see them and rejecting other possibilities has in our present culture yielded extraordinary wealth, comfort, and personal freedom - “The freedom to be lords of out tiny skull-sized kingdom, alone at the center of all activities.” He goes on to write, though, that the kind of freedom that is “most precious” we do not hear much about “…in the world of winning and achieving and displaying”. This freedom involves attention, awareness, discipline, effort, and being able to truly care about other people and to sacrifice for them, over and over. Isn’t this what we have all done, sacrificed for others over and over during the arduous years of schooling and training and even beyond?

Do you live in “your default setting” blinded to what is real and truly important (“What is water?” as the young fish asked)? Or do you choose to live a life with an awareness of what is so real and essential, yet so hidden in plain sight all around you, that you have to keep reminding yourself over and over, “This is water. This is water.”? In doing so, you can have that “precious freedom”- you can truly care about those entrusted to you. You can then do what you do best, better – making a difference in the lives of others and doing so with compassion and caring every day.

Life is precious, the work you do important, and the impact you have on others life-changing. May the busyness of medicine and its’ inherent frustrations, not cause you to lose sight of what is important, why you went into medicine, and the difference you make every day. What is my “capital-T Truth”? It is to live a life that counts, to make a difference in the lives of others every chance I get. What is yours?

Thank you for the privilege of serving you any way I can.

Andy Lamb, MD