First Principles and Anesthesia

Everyone who studies philosophy reads Rene Descartes' Meditations on First Philosophy; I read it in five separate classes (and wrote a paper in each). This seminal work established the foundation for philosophy of mind and metaphysics. The premise of Meditations is to build from scratch a framework with which to view the world; he begins by doubting every single belief he has, and the rest of the meditations struggle to rebuild those beliefs. Hence, he derives from first principles those beliefs which have merit. Indeed, he even doubts himself until in the treatise, he writes, "I am, I exist" which has since then been colloquialized "I think, therefore I am."

But how does this relate to anesthesia? Anesthesia, unlike medicine, relies strongly on first principles, and I love that. The physiology and to some extent the pharmacology of anesthesia build upon simple laws of physics, chemistry, and biology. EKGs can be represented through Kirchoff's law, hemodynamics through Ohm's law. The administration of anesthesia follows the gas laws and Dalton's law of partial pressure. The action of drugs follow chemical laws of pharmacokinetics and pharmacodynamics (remember Lineweaver-Burke plots?). Much of the basics of anesthesiology can be reasoned out with a thorough understanding of the first principles - the basic sciences.

On the other hand, medicine cannot easily be derived from first principles. Vesicular lesions on the lip with a positive Tzanck test imply herpes simplex 1 infection; shortness of breath, fatigue, and swelling in a person with a history of heart attacks implies congestive heart failure; hyperpigmented skin in combination with fatigue, dizziness, weakness, hyponatremia, and hyperkalemia imply Addison's disease. Although some aspects of these diseases can be derived from known principles (Tzanck cells are multinucleated giant cells seen with herpesviruses, heart failure manifests if blood cannot be effectively pumped forward, and aldosterone is key to sodium and potassium homeostasis), there's some aspect of pattern recognition and memorization.

I really like medicine and the subtleties of differential diagnosis. But I think my background in philosophy and my demand for rigorous proof lend itself to thinking from first principles, whether in terms of philosophy or physiology.