Dwelling on these worst-case scenarios was crazy-making. But spinning simulations is also essential to being human.
By BRIAN BLUMUpdated: FEBRUARY 27, 2020 18:21Running simulations(photo credit: TNS)
As I sat in my doctor’s office, I was prepared. I had assembled a thick folder with all the latest research on my chronic cancer the pros and cons of continuing immunotherapy along with newly released data that pushed the average duration of remission for follicular lymphoma to an encouraging 10.5 years.Moreover, I had run countless simulations in my mind, imagining every which way the conversation could go: my doctor agreeing with my assessment, my doctor pushing back, my doctor sharing bad news.The bad news simulation stemmed mainly from the first item on the agenda for our appointment: the results from my latest PET CT – the same one that had been the source of such “scanxiety” over the previous weeks.I tried with all my might to imagine how my doctor would give the all-clear, but I found myself gravitating again and again to the flip side: how she would gradually ease into the presentation of a negative outcome.“The results were a bit surprising,” I imagined she would begin. Or, “The treatment doesn’t seem to have worked as well as we’d hoped.”I envisioned my reaction, as well. In some versions, I would receive the news stoically and ask smart follow-up questions. In others, I would slump into my chair, holding my wife Jody’s hand.In some simulations I would cry.Dwelling on these worst-case scenarios was crazy making. But spinning simulations is also essential to being human, says Prof. Moshe Bar, head of the Gonda Multidisciplinary Brain Research Center at Bar-Ilan University. It has to do with the true purpose of memory.“Before I studied it, I thought of memory as a big photo album, one that you pull out to reminisce on your kids’ bar mitzvahs or a trip to Europe,” Bar told me during a recent interview I conducted for The Jerusalem Report.The main function of memory, however, “is to help the brain predict, to prepare for upcoming events and encounters,” Bar explains. “In order to anticipate, you have to lean back on memory. Every decision – and we make hundreds or thousands of decisions a day – involves some kind of foresight, some kind of simulation about the future.”
Those can be simple ones, like what to order for lunch (by remembering what you’ve enjoyed in the past).They can be strategic ones, like anticipating an offer and counteroffer (by calling up past negotiations).And they can be defensive, like preparing to receive bad news.Memory, in this way, is more a survival tool than an entertainment platform, Bar says.Brain researchers like Bar refer to two types of memory: “semantic memory,” which you use to describe something generic – such as a typical “breakfast” consisting of scrambled eggs and toast – and “episodic memory,” where you recall the specific breakfast you had yesterday morning.Episodic memory is key to generating detailed and potentially accurate simulations. It’s “the scaffolding [needed] to mentally time travel,” explains Kim Mercuri, a clinical psychologist at Australian Catholic University. “In order to go forward, you need to go back.”Episodic memory is your identity. Bar adds, “It’s your own history, your own desires, your own fears.”While running simulations can trip you up if they transform into obsessions, most of the time they are quite helpful.“What would you do if upon landing [at the airport] you discover that the airline has lost your luggage and you are scheduled to give a talk in two hours,” Bar ponders. “It has not happened, but if it does, you will be ready. If you ran this simulation in your mind early enough, you might have packed extra clothes and other essentials for your talk in your carry-on.”Negative simulations can give us the courage to move forward with something difficult. When I was first diagnosed with cancer,, I steeled myself emotionally for the chemo to come by simulating in my mind how my family would feel if I were gone – my children without their father, my wife without her husband.But a simulation can only go so far, especially when the news comes out of the blue. When my doctor started the conversation by stating exactly what I’d foreseen – “the results were a bit surprising” – I was ready, but it still didn’t blunt the shock.As we huddled in front of her computer, she pulled up the images from my PET CT showing a new tumor on a lymph node near my pelvis, and two smaller ones in my chest.“How could this happen?” I sputtered. After all, I was still in the midst of “maintenance” immunotherapy and my previous PET CT had shown no evidence of disease.I had sailed through most of the treatment with so few direct side effects, that – a persistent but expected low white blood count notwithstanding – I was convinced I’d be one of the 10-year-in-remission patients.My doctor shook her head empathetically. “There are statistics,” she said, “and then there’s Brian.”She tried to reassure me. “You’re not dying,” she stressed several times. “There are more treatments we haven’t tried yet that could result in a durable remission,” although many are harsher than the chemo I’d already endured and that had apparently failed. There are clinical trials, too.She ordered a new biopsy to figure out what we’re dealing with.I took it all in, but for the most part, just sat there quietly, without words, my mind stuck on stun.For the moment, I was all out of simulations.The writer’s book, Totaled: The Billion-Dollar Crash of the Startup that Took on Big Auto, Big Oil and the World, is available on Amazon and other online booksellers. brianblum.com
