The Homunculus Fallacy applied to the Physics of Anaesthesiology

Fullmetal Alchemist fans on board! Each Homunculus had a tragic origin spiced up with a seriously complicated personality, coupled with a specific superpower. Incidentally, they are named after the seven sins. (Who said you can’t suck in general knowledge from Mangas and Anime?)

If I had to choose, I would fit into King Bradley’s shoes probably. Why not the Elric brothers? First, I am no hero and well, Bradley’s personality strangely appeals to mine- Calm and surprisingly pleasant, even with a sense of humour when compared to the other homunculi, and then goes ‘batshit’ crazy as Wrath.

Rambling on- Homunculus just means a small human. Small and human? Is that even possible? Humans tend to think that they are ‘bigger’ compared to others in a specific aspect or sometimes, for some of the dumbest out there, in all aspects.

Let’s address the elephant in the room: the idea that bigger is always better is as outdated as a flip phone. Yes, we all know the myths and we know the need for some to ‘augment’ specific portions of their body. Well, sometimes Body dysmorphic disorder is a real thing, as evidenced by the DSM-5. Other times, well, it is just the slow-witted homo sapiens praising himself about the size of his gun. By the way, when I said gun- I meant the arms!!!  You warped and corrupted mind!

Let's be honest and get to the space between the legs. We’re not all walking around with mythical proportions. And even if you were, the world isn’t waiting for you to show up and flaunt it, unless you want to end up in prison. People care far less about what’s dangling between your legs and more about what is up there lodged on your neck. Really. They care about how you treat them, how you can make them laugh and how well you listen.

If you’re constantly measuring yourself against some unrealistic standard of size, you're missing the bigger picture.

Let’s put that into perspective- If a warlord gifts you a massive bazooka and knowing you never shot someone, orders you to aim, what happens? Well… you will probably fire in the wrong hole (pun intended)!

Here we are now, the bigger picture- Is bigger always better? Let’s take a walk along History Lane.

The ancient Greeks and Romans were obsessed with perfection, particularly in the realm of human beauty. The Greeks were fanatical about the “ideal” body. They sculpted marble statues of gods and athletes that were not just idealized in their proportions, but also exaggerated in a way that showed strength, control, and power—no surprise, it’s the same things we often associate with ‘bigger is better’ today.

Then came the Romans. Being the practical empire-builders that they were, they took things to a new level- The colossal size of Roman architecture, with its massive columns and statues, reflected their belief that their empire was unstoppable.

Fast-forward to the Renaissance period, the time of rediscovery which led to a renewed emphasis on the human form and its idealized proportions. Artists like Michelangelo were intrigued about ideal proportions (remember, Michelangelo’s David, anyone?) and Da Vinci, with the Vitruvian Man, followed the same concept. Now look at those works of art properly. Nowhere can you see something akin to a third upper limb between their legs that can flap up to the head, isn’t it?

Finally, the 20th century-an era where size (particularly male size) would begin to be marketed in new ways. From Hollywood to Bollywood, the notions of masculinity, feminity and power became increasingly visual and objectified. Think about the heroes of the 1950s and 1960s: Marlon Brando, Steve McQueen, Clint Eastwood—tough, strong, physically imposing men who were as much about raw power as they were about looks.

At the same time, you had the growing popularity of muscle culture, thanks to figures like Arnold Schwarzenegger and the burgeoning fitness industry.

This trend continued into the 80s and 90s, where advertisers and movies sold us the idea that a man’s worth could often be measured by his physical size—whether it was the strength of his body, the size of his car, or, well… the size of his other ‘assets’. A woman’s worth according to society, you might ponder? Well, do I really need to extrapolate on that?

In the 21st century, bigger is still better—or so we’re told. The media, pornography, advertising, and even social media influencers all perpetuate the idea that bigger is superior.

The ironic twist: despite all the advancements in society and science, we still cling to this antiquated belief that bigger is better. We’ve made exceptional progress, but when it comes to this, we’re still chasing the same illusory dream that started centuries ago.

Well, where the hell is the Physics and Anaesthesia in all of that? I forgot all about it!

Anaesthesia, where the Dose is King. Sure, you’ve heard about people in movies going under with dramatic effect: the “count backwards from ten,” and then—bam—lights out. But here’s the kicker: if the dose is too big, it’s like trying to fill a bathtub with a fire hose. You will get the job done… with catastrophic aftermath. 200mg of propofol to an 18-year-old, 70kg football player gets the job done. 70kg but 75-year-old Gogo? Well, I hope that you prayed to all your Gods before starting.

Too much anaesthesia can send you into a deep, unintended coma-like state, or worse, the feared Guedel stage 4. Your body might procrastinate about shutting down vital functions because it's overwhelmed by too much of the drug in your system. You stop breathing and your heart slows to a crawl. And while your surgeon is enthusiastically standing scalpel-in-hand, you’re off to the neverworld, waiting for the Narkotiseur to sort out the “oops” moment(hopefully).

So, when it comes to anaesthesia, it’s a balancing act of precision. The goal is not to knock you out like a sledgehammer; it is to gently lower the curtain of consciousness, allowing your body to rest and surgeons to patch you up while you’re none the wiser. Surgeons, please, do take note of the above points!

Overestimating a patient’s need for anaesthesia- It doesn't just risk putting them into an unsafe zone—it can also affect their post-op recovery. Longer recovery times, postop delirium or decline in cognitive function can be a very bad outcome, especially for elderly people. So, let's not forget, not every patient is a hulking football star with a high metabolism.

Like Goldilocks and her porridge—Anaesthesia should be not too hot, not too cold- just right.

What about physics (and more anaesthesia) in all of this?

Well, enter the Hagen-Poiseuille equation, and why is it about to ruin your "bigger is better" fantasies?

In simple terms, this equation describes the flow of an incompressible fluid through a pipe (Okay, bear with me, there is a point to all this!):

Q = ΔPπr⁴/ 8ηL

• Q is the flow rate
• ΔP is the pressure difference between the ends of the pipe
• r is the radius of the pipe (or vessel)
• η is the viscosity of the fluid (how thick or sticky it is)
• L is the length of the pipe (or the vessel)

This equation is the life of fluid dynamics, and this equation also shows that bigger isn't always better, especially when you factor in the other variables like pressure, viscosity, and pipe length. So, just because you have a larger radius (or a bigger pipe) doesn’t guarantee you’ll get a better flow.

Let's not forget the length of the pipe(L)- the longer the length/journey, the harder it is for the fluid to flow. So, you’ve got this magnificent, enormous pipe, but it stretches for miles, and now you’re facing all kinds of friction and resistance.

This is exactly the problem with expecting bigger to be better in many aspects of life.

You get that bigger house, work up to the bigger paycheck and suddenly, you're carrying more responsibilities, dealing with more friction, and managing the long-term consequences. So now your "bigger pipe" just means more effort for the same, or maybe worse outcome. Great… You’ve got the tool, but you’re struggling to make it work.

So, the next time someone tells you that bigger is always better—whether it’s in terms of your career, your car, or well… you know what? Just remember the Hagen-Poiseuille equation and the history lesson:

‘Bigger’ might seem like it’s the answer to all your problems, but life is actually a delicate dance to find the perfect balance to reach Nirvana!