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Baby Burrito MD, Austin, TX (2026)

04/25/2026

And the Enlightenment fixed it, right?

The Enlightenment was complicated. The most relevant part to this discussion of value of life is that mercantilism and colonialism resulted in the 13 colonies in the “New World.” Against native peoples that were here for at least thousands of years, Europeans fought and poisoned and traded and betrayed their way into a foothold on the eastern coast here, and they brought their slaves with them. The economy of Europe reached across the ocean and perhaps overextended. There was now a European colony here with European philosophy but out from under the full power of kings and aristocracy.

A coalition became a revolution. French-English rivalries created a window, and America was born without a king.

The Declaration of Independence finally ratified the words: “all men are created equal.” One life is just as valuable as another, we said.

We had a chance.

You can call it realpolitik or delicate experimentation or you can call it greed or untouched prejudice. We were freed from kings, but slavery was left untouched by the Constitution. Native American peoples from shore to shore were systematically exterminated and uprooted by the government. Women were not given the ability to vote until 1920. Lives were not made equal by the establishment of America.

We can catalogue the attempts to better establish the values of lives since then: the Bill of Rights, the 14th and 15th and 19th Amendments, Labor struggles, the Civil Rights movement, the Me Too movement, on and on.

Even now, is this truth self-evident, even within America? Does a vote = a valuable life? Does America treat other lives outside of its borders as equal to her own citizens?

The United Nations tried again to establish the value of a life and so did the Communists, and they failed for different reasons.

It’s valid to ask whether such a thing as the value of an individual life can be legislated, within a country and across a world.

04/23/2026

We humans spin multiple stories at the same time.

Throughout history, as we build big enough groups, we promote leaders that will make decisions for our group. Bigger and bigger groups meant more layers of government and bureaucracy. The higher echelons of power became separated from the common man over many generations, and people in power naturally found ways to stay in power.

Both the people in power and the common man looked around finally and asked, how did we get here? The way to tie our multiple stories together with a minimum of cognitive dissonance was to tell each other that our leaders were placed in their positions by God.

Family name and blood and title—those were what set people apart, that’s what made your life valuable. A common belief—a shared story—was as powerful as an army at your back. It did not matter whether your king or noble was stupid or industrious, rich or cash-poor, sometimes even if they had land or not. Their blood meant they were worth so many more peasants.

God said so.

And that’s how it was for absolutely thousands and thousands of years in all kinds of different flavors in so many different cultures.

What changed? Economies and philosophy and science… what we call the Enlightenment.

04/21/2026

As we developed language in our ancient groups, we made stories to explain where we already were. Origins and fables and great comic-book battles and fantastic yarns around our campfires. We told them until our children and our grandchildren knew them and they became legend and myth and religion. We wrote them down and we added rites and rituals and gave names and bodies to our best and worst qualities.

Over so many generations, these stories—like food and land—became another thing to fight over, and we did fight. Some of the stories died out with their people. But there were a few that persisted, some said by God’s direction and some said by truth and some said by their ability to effectively cohere a group around shared meaning.

And within many of these conquering groups, there were some reformers who brought out new lessons from these stories, lessons that would help keep the peace or help to include or exclude a neighbor. And some of these lessons were beautiful, and some were not. But in a few of the religions there developed ideas around the worth of an individual’s life.

Judaism claimed that each person was made in the image of God, and saving one life is equivalent to saving a whole world. Islam claims that taking one life unjustly is equal to killing all of humanity, and human dignity is granted by God to all human beings. To a Hindu, all life forms are divine and part of a journey toward enlightenment. And to future Christians, Jesus told stories of a Shepherd God who would leave 99 safe sheep to rescue one in trouble.

While it is wonderful to consider that so many of us in our religions have similar tenets that support the value of life, we must ask why—at the group and state levels at least—we continue to violate these tenets on a regular basis.

Part of the problem is a simple human one: it’s fine to have a law, but if a law is not or cannot be tangibly enforced, then it’s just words on a page.

The idea was there, but governments that enmeshed themselves with the world religions decided which laws to enforce and which were left empty. For so long, the tenets around the value of life were so much lip service.

04/16/2026

More to say on this, but lately I’ve been thinking about how powerful story is, and I’ve been thinking about the story of Abraham and Isaac where Abraham took his son up the mountain to sacrifice him to God. His only son, his only chance of passing on his genes, and Abraham was willing to sacrifice Isaac only to be stopped by an angel, the story goes.

While this is the story I grew up with, this one wasn’t in isolation in history and broader cultures. There were plenty of other societies around at that time that would sacrifice children or young women on altars to their religions. It’s hard to say what sort of stories would lead people to this, but the existential threats of famine and uncontrollable weather and disease demanded a story that then demanded a sacrifice that was paid.

Even more would sacrifice their own sons to armies and war. I wonder about the usefulness of the Abraham and Isaac story: give us your sons or you do not love God enough. Your sons will only die if you do not trust God enough. We are not like the child-sacrificing societies around us that we are going to fight.

Then conscriptions come easy. To ancient Israel, to the Crusades, to World Wars, to anyone who wishes to unite the State with a powerful story.

We are capable of taking as powerful a biological instinct as we have and submitting it to a social story.

If we are convinced enough, we might decide the lives of even our children are valued less than the story.

Dizzying when you think about it.

04/12/2026

Where do we get the idea that one life is worth as much as another?

Like many things in life, it evolved over a much longer time than you think, and now we see the result and take it for granted.

Through a biological lens, it makes so much sense for social animals to protect progeny that bear versions of their same genes.

By the time humans developed enough intellect to put language to it, we had already been in small communities where most people were related. As part of being social—that’s how we survived long enough to evolve—we developed attachment to our young as well as the emotions that rewarded and reinforced that attachment. The emotion served survival.

The development of language and reason followed emotion, helping us distribute tasks over a slightly larger community. All of this supported the reproduction of our young and our genes and the survival of our species in the face of a world that was brutal and not at all in our control or understanding.

All of those millions of years of evolution are still with us today, and our family’s lives are often still the most valuable to us, more than anyone else’s. That’s biological and subjective and conflicting with so much of what we purport to believe.

Once we had large enough groups and we came into contact with other larger groups, something interesting happened. The potential conflict was genes vs genes, and those people had a choice: genocide against the other group, or an uneasy truce built on language and negotiation: if you don’t kill my progeny, I won’t kill yours.

And so one life finally becomes uneasily equated with another life, despite different genes.

04/08/2026

I did not post my traditional Lent contemplations this year, partly because I want to do something a little different: I want to spend some time looking at life instead of death. Here goes.

-——

I spend a lot of time in my job contemplating and reinforcing the value of one person’s life.

This Easter, I’ve been thinking about how much a life is really worth, to each of us. My own life, my wife and my kids’ lives—those are pretty easy to calculate. What I’m talking about is another person’s life, just another person down the pew at church or one living in the White House or one sifting through rubble in the streets of Iran.

I know what I’ve been told and taught, and I greatly admire the idea that each life is worth just as much as another. It’s what I was told in Sunday School, and it’s what the Hippocratic Oath says, and as a country we claim that each vote at least is worth the same.

But lately it seems less clear that we all agree on that.

I have been thinking about how violence cheapens our value of life, even on a walking-around, daily life basis. So many numbers dead in a war so far away, whether they are American or Iranian, it’s still a number.

But that’s my point: violence not only devalues the dead, but it devalues the life of the aggressor too.

The story of violence says that we must be ready both to kill and to die. Over what? The story doesn’t always say. But be ready, it says. Be ready to pay the price of your life, terms to be negotiated later and not by you.

It feels strange to me that this story is so pervasive, though it shouldn’t be. This violence is our base nature, always there, the mitochondria of our personalities. In fact, it’s taken so much evolution and work and story and revolution to get us to where we can even believe that one life is worth just as much as another.

The idea that one life is worth just as much as another is as far away from our base nature as a skyscraper is from a cave.

02/09/2026

Though I am—according to some medical assistants—the whitest man on earth, I really enjoyed Bad Bunny’s halftime show.

I’ve been watching the discourse about the TPUSA vs SB broadcast, blah blah blah, and I’ve been reminded of two things: 1) there’s no dictating taste to people and it’s not worth trying, 2) I am really glad that I’ve got a job that exposes me to so many cultures and ways of life.

Despite not wanting to dictate “you should like this” to people, I wondered, “why should I even make the case to people to try new music?” And I think once you go there, it’s the same argument for being open to travel or new foods or new cultural stories or whatever.

If I am presented with something new that someone says is cool, what do I lose by saying that I don’t want to even look at it? A lot, I think.

The more I say no, the more I calcify my shell over my life until it takes less and less consideration to say no. Inside my shell, it is comfortable and safe, but increasingly I see the outside world as something that can only bring danger and discomfort, and then it’s a threat! Eliciting an unconscious threat response complete with emotion and physical reaction!

It’s true that to say yes is to be vulnerable, and vulnerability sucks. In this case, it’s tough to admit that I don’t know Spanish and I can’t dance like that. But the reward...

The reward is that I am presented with something new! Finally! After all this boredom and routine, there is all this new symbolism and story and rhythm to explore. And also something old and surprising to find that we share: A kid sleeping on some wedding chairs, a kind neighbor with a treat, attraction and dance and joy—the stuff we have in common as humans across cultures.

It keeps you from getting old before your time, this curiosity. In his show, Bad Bunny brought Puerto Rico to us and showed us a little of what it’s like to live there, and that’s an artist reaching out from his own vulnerability.

The more we say yes to new things, the more we see these acts of vulnerability as gifts to us, and the more and easier we can respond in time. That’s true love.

01/27/2026

Over the weekend, I’ve been deeply sad and angry over the events in Minnesota, so much so I have struggled with figuring out what to say, without just preaching to the choir.

What angers me most is this: I miss believing that by being an evangelical, I was part of a group that truly loved our neighbors as ourselves, that we collectively took that as gospel. And I am very tired of hearing that Christianity is not political when Jesus’ answer to “who is our neighbor?” is one of the most political answers in history.

There are some that will give the Sunday school answer that “everyone is our neighbor,” and even if that is not what Jesus says, the humanist in me does believe that every human deserves mercy and dignity: Good, Pretti, Floyd, Brown... somehow even the officers that killed them too deserve basic rights.

But what the “there’s truth on both sides” crowd waves away is the wisdom and compassion of Jesus’ answer. The neighbor is the one who had mercy on the suffering, who suppressed his disgust and ego and got down in the dust and blood and picked up the crushed body, who crossed ideological and racial and religious lines, who spent money and reputation to care for someone who could not take care of themselves and could not pay him back.

At one time, that is who I thought we were in our church. I believed we were people who mourned with those who mourned and wrestled with truth, instead of taking the most expedient road away from uncomfortable feelings. And the disillusionment makes me angry.

What gives me hope is watching the people of Minnesota brave the cold and terror and take care of each other. I’m sure some are religious and some are not. I’m only happy to be the same species as them, and I hope I will do the same when my time comes here in Texas.

Even if these reasons took me out of church, the words and love of Jesus are a “core memory,” as the kids say. As I get older, I’m convinced Jesus is more in the street than the church anyway, and I think these events illustrate that in real time, as sad as they are.

Hugs to all of you, but most of all to those who are suffering and struggling with neighbors under the boot of the powerful.

12/26/2025

In October, I went to Chicago for some training, and I made a trip to the Art Institute downtown where they have Monet, Van Gogh, Seurat, Hopper, and so many more. I wouldn’t call myself some kind of art scholar, but I appreciated getting to soak in something Austin doesn’t have too much of.

A lot could be said about it, but what struck me this time was when I got very close to a Monet and a Van Gogh, I could see the individual brushstrokes within a large masterpiece. Sometimes even the markings of an individual bristle of the brush was fossilized into the paint.

When I saw that, I felt this electric connection across time with these geniuses. Unearned, to be sure. But here was where Monet decided some purple was needed, and it was like he had just daubed it there an hour ago.

Van Gogh would have made that stroke without even knowing anyone would admire it at all. He died without any recognition in his lifetime. But 135 years later, here is this connection that was and is meaningful to me.

The past couple weeks have been challenging for me in my work, but I have had a precious few patients come in before the holiday and told me, “You really listened to me, you heard me, and you made me feel better. Thank you.” And here is this connection again.

I believe it is connection that most of us are after, a real recognition between two beings which is much harder to realize than we thought when we were younger. To make ourselves understood, to be seen, to display our real selves in the world and for it to be welcomed with safety. So many of these artists had to display this genius in order to display themselves, and some were rewarded and some were not.

But now, whether we’re in the museum or in the clinic, we get real close, close enough to see the marks of history and the blemishes, and we’re blessed if we can drop our guard and our egos enough to see each other, to recognize the greatest thing: we are just two humans in a room.

Merry Christmas.

12/23/2025

A few months ago, by the recommendation of a wise friend, I read “The Status Game,” and it’s helped put a few things into focus for me, both in clinic and out.

As brief a summary as possible: we sort ourselves into siloed groups that are smaller and more powerful to us than we give them credit for. We all play games—mostly subconscious—for rank within these groups, and the need to do so is a very old evolutionary instinct. There are roughly 3 types of games within these groups: dominance, virtue, and success.

If you have watched “There Will Be Blood” (great movie, and actually Paul Dano is excellent), it’s a perfect example of this concept. The oil man (DDL) is playing a dominance game, and the preacher (Dano) is playing a virtue game. By the end, they’re both playing a success game, and DDL gets the upper hand and drinks Dano’s milkshake.

In any case, Christianity is a virtue game in many ways, one that I played semi-consciously for many years. When you’re within that paradigm, it’s hard to imagine any of the other games or see them as permissible/moral. Especially when other Christians played at success or dominance, it was very confusing and seemed hypocritical.

There’s more to say about this, but for now I’ll just say this new framework has at least helped me understand better what’s going on in current events psychologically. I would not say I am completely contained within that Christian silo anymore, and that has actually led to a little less stress without as much to reconcile.

I am hoping that all this will translate into compassion for people I strongly disagree with as well as for myself, even if none of us change our minds. I’m sure I’ll still be writing about that for many more Christmases.

12/22/2025

I read recently that perfectionism is “a heightened sensitivity to signs of failure.” I’ve been thinking about it since then, I guess trying to decide if that’s a perfect definition.

A while back, I read Brene Brown’s “The Gifts of Imperfection,” because I wanted to get into her writing and I thought this one would be easy because “I’m not a perfectionist.” About a third of the way through listening, I remember sitting alone in my car and saying out loud, “Well, sh*t.”

Claiming to be a perfectionist sounds like a coded self-compliment, when really it’s just a gigantic pain in the ass. It’s hard to start something because it will never turn out right, you have no patience in yourself, everything is being graded in real time by meaner versions of the muppets Statler & Waldorf.

But “sensitivity to failure” doesn’t sound right to me. I think instead “heightened sensitivity to shame” is closer.

Failure is just something not working, but shame is much deeper: Wondering what people or God will think of me, dreading a bad outcome because of how it will wreck my identity, the desire to hide myself and my work. It’s all shame-based.

And then, if it’s triggered, the need to work hard again—too hard—both as a logical necessity and as a sacrifice toward the universe shifting the outcome. Because when you’re going for something as ridiculous as perfection, it’s only too tempting to reach for superstition as a desperate lifeline: if I destroy myself, the patient will get better.

Anyway, that’s the form my monster takes. I think everyone’s manifests a little differently, but more and more I see this cycle rooted in shame rather than failure—more social than logical, more emotional than a simple scoreboard.

Once we see the cause, maybe we can address it more directly. Maybe perfectionists need ways to discharge their shame on a more frequent basis than others, and finding ways to be vulnerable in a safe way with safe people has to be the first step of a long-term discipline.

12/21/2025

This year I have been using AI in my clinic. I was hesitant at first, but it creates my notes for me and saves me time. Honestly it has taken off a lot of my mental load between clinic days, and it’s helped me spend more time with my family.

While I joke that intelligence is so hard to find that I will take the artificial kind, I have watched too many Terminator movies to be completely comfortable with where we’re headed.

This year I felt a little smug about the #1 charted Christian song at the time being AI-written, that is until I found out that the (fire) motown cover of an Eminem song on my OR playlist was also AI written. I found out that one of the major insurance companies is using AI to evaluate our authorizations for cases (resulting in convenient-for-them delays).

It’s permeating our lives at a time when there is a touted “loneliness epidemic” in our society. As AI grows, you wonder what effect it will have on our relationships. Will it lead to less isolation or more?

Already we are using it to answer many of our questions on a regular basis, and it’s not going to take too many leaps before it becomes a bit of a mirror to us all, something we bounce every part of our lives off of. The convenience of it is distressing.

It will be easier after all to work with a programmable co-worker than our traumatized, mouth-breathing, problematic, flesh-and-blood models we have now. As those work relationships disappear, will we forget collective action? Will we be easier to divide and terrorize and subdue? Can our caveman brains withstand the emotions and distorted need-fulfillment of this new arrangement?

Clearly I don’t know. As an introvert, it feels odd to advocate for more people-time. But the truth of an unexpected social interaction, the gratitude behind listening to another person share something difficult, the shared achievement of working together toward a goal... these and more mean so much to me and make me more human.

We are entering a phase where we will not have to have these social structures and relationships. It will be up to us to choose to have them instead. How well will we do?

Baby Burrito MD

04/25/2026

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