Aham is a sense or feeling of existence. The goal of drive can be to miss its mark, making it a powerful underlying force to sustain bad behavior and block awareness of anxiety. For instance, when Erica's fiance cancelled their engagement she became what she calls a serial dater. Erica, an attractive, second-generation Chinese-American, grew up with a single mother who had been abandoned by her husband, Erica's father, when they reached New York. Erica is now a successful entrepreneur with an MBA from a prestigious university. At first, she thought she was just having fun and getting over her ex. But what she really wanted was to get rid of her horrible feelings of rejection and abandonment. She had dated her ex, Ryan, since college, so she had in some ways lost sight of how men responded to her. In what became an increasingly driven process, she chewed up and spit out the men who pursued her. It was not simple naivete that led her suitors through her dating game. Initially she would claim a genuine interest in the would-be lover. I'll keep my mouth shut in that moment. Not because I'm paralyzed by political correctness, but because there is no point. She has cancer, we established that fact, so it's more important to move onto illness care and treat her disease. As Americans, we do what we want. It's one of our greatest strengths as well as one of our greatest weaknesses. We want the quick fix and none of the consequences of our bad habits. This entire health care journey is a slow and steady process, but that's the only road toward long-term success. As a nation we are on this trek together. Partisan politics, federal legislation, and fad diets won't help us.

Make the changes to be the best version of yourself to help put us on the path to a healthier America. Since May 26, 1986, when Dave Allured and his team made their discovery, explorers have mapped more than 136 miles of cave passages, making the Lechuguilla Caves one of the largest cave systems in the world. It remains the deepest limestone cave in the world. And it proved to be a bacterial treasure trove. It was here that Barton conducted the research that sparked Wright's interest at the conference. Combining her two passions--microbiology and caving5--Barton worked with Wright for over three years on an ambitious and at times life-threatening project that aimed to answer the question: Can there be antibiotic-resistant bacteria living deep inside a cave that has never seen any human activity? It required Barton to go far into the depths of the Lechuguilla Caves collecting samples of biofilms, which are multicellular communities of bacteria that are often attached to surfaces. In the course of the research, she would go into a region of the cave that's called Deep Secrets. 6 Deep Secrets is about 1,300 feet from the surface of the Earth. To reach it requires traversing terrain that is treacherous and terrifyingly beautiful. For example, being affirmed or rejected by significant others had the same type of positive or negative impact on self- esteem. In general, positive personal and interpersonal experiences increased self- esteem and negative ones decreased it. However, those with reasonably good self- esteem to begin with suffered less distress and recovered more quickly. Other theories of self- esteem, especially those favored by evolutionary social scientists, focus more on self- control than maintenance or protection. For example, the sociometer theory (Leary, 2004) proposes that self- esteem evolved to help us survive as a species. This idea is based on two important observations. One is that, as a species, human beings are extremely dependent on other people. According to evolutionary thinking, human beings emerged from primates who existed in small groups in which members helped each other to survive much

as a family would. This is the limitless feeling or self-awareness that we are here now, I Am. It's a pure and simple feeling. This feeling of existence is utterly present, and yet deeply peaceful and satisfying. It encompasses everything, it is one and undivided. It is this feeling of existence which unites us all. Ahamkara, the limited feeling of existence, is a compound of aham + kara. Aham, I Am, is pure being with no beginning and no end. It is universal and unmixed with any identification with experiences. With ahamkara however, we do not say I Am but I am (something. ) Kara means an act or action or any created thing; She was acting out a need to be wanted, longed for, and recognized. But beneath her awareness, these experiences triggered hurt and fear, and prompted a need for revenge against the same category of person who had hurt her. It initially seemed like Erica was reenacting the emotions of her jilted mother, yet Erica now inhabits the role of her fearful father, the Clot. If by acting out you relive a past need for recognition from others, you're doomed to repeat this most crucial emotional conflict in new relationships. Amazingly, we seem to not want to experience the parts of ourselves that we defend against, and in avoiding these feelings, often wind up missing essential knowledge of who we are. Crucial aspects of our self-experience are covered up. Clotishness driven by the need to not feel blocks self-awareness, self-acceptance, and self-love. It's a highly effective way to distort an intolerable truth. But being a Clot also defends us against things we truly want, such as being accepted, liked, and cared for by others.

If we let go of our acting-out behavior, we will be confronted by truths that are so difficult to bear that our minds have gone to extreme lengths to hide them. Life as a physician is notoriously hectic, laborious, and exhausting. Despite this workload, I find myself overwhelmingly fulfilled knowing that I help many people lead longer, healthier, and, importantly, happier lives. In some of the more challenging clinical scenarios, the physician's instincts take over to safely guide our patients through the darkest of moments. Yet I am constantly reminded of a maxim that we are taught as young physicians: We are doctors by profession, humans by emotion. During my first rotation on the internal medicine service, I was helping to take care of a young woman who was dying from advanced pancreatic cancer, her body ravaged by the consequences of years of unbridled alcohol addiction. As if to add to this insult, she had also been admitted to the hospital with a pervasive infection of head lice. This placed her in the hospital equivalent of solitary confinement--isolation. While other medical personnel coordinated her ultimate disposition of palliative care and hospice, she sat alone, cut off from the world and ostracized by her own family. I walked into her room one morning. After donning the yellow plastic smock, hairnet, and gloves required to enter patient's rooms according to isolation precautions, I gently pushed open her door and found her quietly staring out the window, tears pouring from her jaundiced eyes. The meticulous Barton, wearing her caving gear and carrying minimal supplies in her backpack, collected ninety-three different strains of bacteria from this nearly inaccessible cave. She brought them back to the surface, and, using the latest tools and technologies available, Barton and her colleagues carefully screened them against most known antibiotics to find out if these bacteria, which had never seen any commercial antibiotic or any human activity, were resistant to the antibiotics that were commercially available and used in hospitals. The bacteria from the Lechuguilla Caves, Wright and Barton discovered, held their own deep secret. Though the bacteria that Barton collected was from a part of the Earth that had been isolated from human activity, it was resistant to some of the most potent antibiotics, including daptomycin, which is used for treating MRSA. 7 To the skeptics who doubted Wright's original findings, he and Barton now had compelling evidence. Bacteria from a location that had been cut off from all human civilization for nearly 4 million years was antibiotic resistant. The research showed something even more peculiar: the resistance genes carried by the bacteria and the mechanisms by which they defended against the antibiotics were similar to what we see in patients who are resistant to chloramphenicol,8 a drug still used in many parts of the world to treat typhoid. This news was turning the whole field of microbiology on its head. The assumption, up until that point in 2012, had been that resistance was largely driven by human activity--excess, greed, ignorance, and hubris.

The general understanding was that bacteria develop specific genetic mutations in the presence of antibiotics. Some types of monkeys, for example, even have elaborate social orders in which it is important to establish and maintain their individual relationships with other monkeys. Early human beings, of course, depended on each other throughout their entire lives because they usually had to work together to find food, raise children, and get through difficult times. This situation gave rise to communal rather than individual values, a practice that dominated most of human history. Although it may look as though we are independent today, imagine what would happen if people stopped interacting with each other in an organized, interdependent way. Cars would break down, homes would go without heat or water, and most of us would have little food. In general, modern society would col apse and many, if not most, of us would die rather quickly, especially the young and the old. The point is that regulating social behavior is very important for human beings, so much so that some evolutionary researchers advance the idea that self- esteem developed as a way of helping people to control behavior in relation to the group to enhance everyone's chances of survival. Since evolution is concerned with the survival of the species in the future as well as the present, the sociometer is also very responsive to prosocial behavior. In this case, when the individual does something to increase the group's chances of survival, such as helping someone who needs it, discovering new resources, creating useful inventions, leading in effective ways, and so on, he or she receives positive social feedback. it is the something that follows I am. For example: I am stupid, I am clever, I am ugly, I am beautiful, I am poor, I am rich, I am smarter than you, I am a lawyer, I am a mother, I am a father, I am walking, I am sitting. The list is endless! These additions to aham are not in themselves inherently good or bad. They are temporary states we experience as we move through our life in the physical world. They have no independent existence. They need the consciousness of aham--I am--to exist. Aham itself is unchanged and unaffected by the addition of these actions and roles. The person who is awake and conscious, picks up these actions and roles, and when they are no longer needed puts them down again.