Monday, April 28, 2008

Another Clinical Write Up Solid with the Ink of Comments, Dissaproval and Question Marks

"It is often said that great achievement requires in one's formative years two teachers: a stern taskmaster who teaches the rules and an inspirational guru who teaches one to break the rules. But they must come in that order. Childhood training in Bach can prepare one to play free jazz and ballet instruction can prepare one to be a modern dancer, but it does not work the other way around. One cannot be liberated from fetters one has never worn; all one can do is to make pastiches of the liberations of others."

Le sigh. this is probably true. but pastiches are really quite tasty. delicious empty calories.

Sunday, April 27, 2008

Disorder

"Medicine is my lawful wife and literature is my mistress. When I get tired of one I spend the night with the other. Though it's disorderly it's not so dull, and besides, neither really loses anything through by infidelity."

As with the usual william carlos williams, it is morally uncomfortable, and observationally truthful

Music for Despair and Frantic Academic Writing

(1) Beirut - all
(2) Kevin Volans - White Man Sleeps, Movement II, for String Quartet
(3) Yann motherfuckin Tiersen - Le Phare, C'etaci
(4) Bruno Coulais
(5) Yo Yo Ma, Edgar Meyer, Mark O'Conner - Appalachian Journey
(6) Belle & Sebastian - Boy with an Arab Strap (for fuck's sake don't tell anyone)

Jill Freedman: Ressurrection City

From the newspaper:

BACK in the 1970s, a gutsy blonde named Jill Freedman armed with a battered Leica M4 and an eye for the offbeat trained her lens on the spirited characters and gritty sidewalks of a now-extinct city.

Her New York was a blemished and fallen apple strewn with piles of garbage. Prostitutes and bag ladies walked the streets, junkies staked out abandoned tenements, and children played in vacant lots.

“The city falling apart,” Ms. Freedman said one day recently in recalling that era. “It was great. I used to love to throw the camera over my shoulder and hit the street.”


http://video.on.nytimes.com/?fr_story=5ba0a343c7ac4e948977db9f7a5d9161b0435fb2


One day in the spring of 1968, she came upon a man in Central Park wearing overalls and sitting on a mule. He urged her to join the protest encampment called Resurrection City.

“Oh, man, whatever this is, I’ve got to be there,” she recalled thinking. Quitting her job, she lived for six weeks in the plywood community, immersing herself in her subjects. Six of her pictures were published in Life magazine, a breakthrough that brought her confidence and recognition.

Back in New York, she lived for a time in a beat-up white Volkswagen bus, following the Clyde Beatty-Cole Brothers Circus as it traveled from upstate New York to Cincinnati, and producing images straight out of a Fellini film. She later trained her camera on the players in the ’70s art scene, capturing its decadence with a gimlet eye as she photographed happenings in SoHo, and Andy Warhol and Deborah Harry at Studio 54.

In 1975, Ms. Freedman began photographing firefighters in combustible neighborhoods like Harlem and the South Bronx. In an image titled “Brother Firemen,” two soot-covered firefighters, relieved to have survived a five-alarm fire, kiss.

She then turned her attention to police officers working in the Ninth Precinct in Alphabet City and Midtown South, which covered the raunchy blocks around Times Square.

“There are days I walk down the street feeling its ugliness on my skin like a sunburn,” Ms. Freedman wrote of those times in an unpublished manuscript, “other days when I can hardly catch my breath for the beauty of it.”

An oak dresser that doubles as a nightstand holds her negatives. In its drawers, preserved in glassine envelopes, are thousands of images: of a bewildered man dressed like a carrot, of youngsters joy-riding on the back of a bus, of a brawny firefighter playing Santa Claus, of men dressed like women wandering around in the dark.

And presumably much more is out there to be captured by her Leica. “I’d like to find what’s left,” Ms. Freedman said.

Boh-dy and sunlight

I woke up tremendously sore from yesterday's capoeira class. Sore like had difficulty sitting upright in bed. Coughed and it hurt kind of sore.

This is great.

I have been working out all week, in some loose way of reasoning, that (1) if all madness is somatisized, (2) i could work it off, like the law of mass action, or Le Chatelier's Principle: expulse some of the frenzy into the universe, and the system will continually shift it out until it leaves. (3) Therefore I will be less crazy. There is very little evidence for either premise, but the logic seems consistent.

Whatever the details of scientific fact, in one week my bodily self esteem has improved 50 fold. Mind you, bodies don't actually change very much in one week of activity: flesh still overflows from my constricting jeans and i can still make it sway rhythmically to most jennifer lopez songs. The difference is now i rather like it.

"I hurt myself today to see if i still feel." This appears to work even if you are not a melodramatic 16 year old, or red blooded great American song writer. The soreness of physical exertion to remind me that the self does not stop at my keyboard nor tumorously hypertrophied cerebral cortex. Once in my life, I was training in dance for 10 to 15 hours a week. I wasn't particularly very good, but after the betrayal of puberty, i found the body again--it could take up space, i could mark the world with my finger tips and toes. "The arms start at the back because they were once wings." I could be bigger, take up a whole room, launch into the sky, or disappear entirely.

Empowering. An overused word. But there is great power in rediscovering the body, its relation to space, to gravity, to pain, to existence, to other bodies. And there: three quarters of the story to the allure of sex...of medicine...of dance.

Now it is 80 degrees in San Francisco and all the girls are out in pretty dresses, men have thrown their shirts off, a great celebration of sweaty bodies, hairy chests, dangling limbs, and luscious muffin tops.

Saturday, April 26, 2008

Wanking, II

Actually, this is genuine joy of sharing, and requires no anonymity - its hard to mar john rawls with but a mildly obscene blog title.

Things that I am reading to finish this paper due 5 months ago

(1) THE LAW OF PEOPLES, John Rawls, Harvard University Press 1999

This book consists of two parts: the essay "The Idea of Public Reason Revisited," and "The Law of Peoples." Taken together, they are the culmination of more than fifty years of reflection on liberalism and on some of the most pressing problems of our times by John Rawls. "The Idea of Public Reason Revisited" is Rawls's most detailed account of how a modern constitutional democracy, based on a liberal political conception, could and would be viewed as legitimate by reasonable citizens who on religious, philosophical, or moral grounds do not themselves accept a liberal comprehensive doctrine--such as that of Kant, or Mill, or Rawls's own "Justice as Fairness," presented in A Theory of Justice.

The Law of Peoples extends the idea of a social contract to the Society of Peoples and lays out the general principles that can and should be accepted by both liberal and non-liberal societies as the standard for regulating their behavior toward one another. In particular, it draws a crucial distinction between basic human rights and the rights of each citizen of a liberal constitutional democracy. It explores the terms under which such a society may appropriately wage war against an "outlaw society," and discusses the moral grounds for rendering assistance to non-liberal societies burdened by unfavorable political and economic conditions.

(2) Justice and the Social Contract: Essays on Rawlsian Political Philosophy
Samuel Freeman, Oxford University Press 2007

John Rawls (1921-2002) was one of the 20th century's most important philosophers and continues to be among the most widely discussed of contemporary thinkers. His work, particularly A Theory of Justice, is integral to discussions of social and international justice, democracy, liberalism, welfare economics, and constitutional law, in departments of philosophy, politics, economics, law, public policy, and others. Samuel Freeman is one of Rawls's foremost interpreters. This volume contains nine of his essays on Rawls and Rawlsian justice, two of which are previously unpublished. Freeman places Rawls within historical context in the social contract tradition, addresses criticisms of his positions, and discusses the implications of his views on issues of distributive justice, liberalism and democracy, international justice, and other subjects. This collection will be useful to the wide range of scholars interested in Rawls and theories of justice.

(THATS ME. I am a wide range of scholar interested in this)

(3) Political Theory and International Relations
Charles R. Beitz, Princeton University Press, 1979

Charles Beitz rejects two highly influential conceptions of international theory as empirically inaccurate and theoretically misleading. In one, international relations is a Hobbesian state of nature in which moral judgments are entirely inappropriate, and in the other, states are analogous to persons in domestic society in having rights of autonomy that insulate them from external moral assessment and political interference. Beitz postulates that a theory of international politics should include a revised principle of state autonomy based on the justice of a state's domestic institutions, and a principle of international distributive justice to establish a fair division of resources and wealth among persons situated in diverse national societies.

(4) Global Collective Action
Todd Sandler, Cambridge University Press, 2004

This book examines how nations and other key participants in the global community address problems requiring coordinated efforts of two or more entities, that is, collective action. The global community has achieved successes on some issues such as eradicating smallpox, but on others, such as the reduction of drug trafficking, efforts to coordinate nations’ actions have not been sufficient. This book identifies the factors that promote or inhibit successful collective action at the regional and global level for an ever-growing set of challenges stemming from augmented cross-border flows associated with globalization. The author identifies modern principles of collective action and applies them to a host of global challenges, including promoting global health, providing foreign assistance, controlling rogue nations, limiting transnational terrorism, and intervening in civil wars. Because many of these concerns involve strategic interactions where choices and their consequences are dependent on one’s own and others’ actions, the book relies, in places, on elementary game theory, which is fully introduced for the uninitiated reader.

(5) Four Essays on Liberty
Isaiah Berlin, Oxford University Press, 1969
Reviews: `Practically every paragraph introduces us to half a dozen new ideas and as many thinkers - the landscape flashes past, peopled with familiar and unfamiliar people, all arguing incessantly. It is all a very long way from the austere eloquence of Mill's marvellous essay On Liberty, with which this collection's title seems to challenge comparison; but it is a measure of the stature of these essays that they stand such a comparison.' and "an exhilarating performance--this, one tells oneself, is what the life of the mind can be."

Tastelessness: A Touch Dazzling, wouldn't you say?

A life in writing
Il postino

Multilingual scholar George Steiner has for decades aroused suspicions for being 'a touch dazzling'. He has now made his peace with British anti-intellectualism.

Interview by Christopher Tayler
Saturday April 19, 2008
The Guardian: http://books.guardian.co.uk/review/story/0,,2274739,00.html#article_continue

Visitors to George Steiner's house in Cambridge are likely to be greeted at the door by Ben, an enormous Old English sheepdog. Like his owners, Ben is used to dealing with the press. "Monsieur Ben, the French call him," Steiner says. "French journalists in particular are always fascinated by him." Ben has appeared, Steiner notes, on the cover of a distinguished literary journal. Is it true that he has discriminating taste in music? "Ravel's Bolero - he growls. But he is fond of Tchaikovsky." "And Duke Ellington," Steiner's wife Zara, a Cambridge historian, adds from across the kitchen.

Ben has been getting more press than usual lately thanks to his brief but memorable appearance in Steiner's most recent publication, My Unwritten Books. "Given my age," Steiner says, "I am pretty near the end, probably, of my career as a writer, a scholar, a teacher. And I wanted to speak of things I will not be able to do." As "a kind of goodbye to what may not be", and "very much in the hope that others will take up one or two of the issues", the book details seven projects he'd have liked to carry off. These include studies of intellectual envy, comparative education, high culture and religion, Jewishness and Israel, and Joseph Needham's work on Chinese science. But most commentary on the book has focused on two chapters: "Of Man and Beast", which discusses Steiner's love of animals and describes all the dogs he's owned, including Ben; and "The Tongues of Eros", which concerns the relationship between linguistic and erotic activity.
Sex, Steiner thinks, is mediated by language in interesting ways. "I have every reason to believe," he writes, "that an individual man or woman fluent in several tongues seduces, possesses, remembers differently according to his or her use of the relevant language." This isn't an unexpected position for Steiner - who has written extensively on translation and "the polyglot condition" in general - to take. But eyebrows have been raised over his arresting examples of multilingual sex-talk, which draw on his own characteristically recondite experiences. A French lover, he writes, once distracted him "in, as it were, mid-flow" by using a tricky subjunctive pluperfect ("Proust may have been among the last to handle these with ease"). "V", whose dreams were filled with "cats, chamberpots and left-handed firemen", liked Viennese place names: "Thus 'taking the streetcar to Grinzing' signified a gentle, somewhat respectful anal access."

These confessions have caused a certain amount of amusement, particularly in England, where generations of scoffers have heaped sarcastic understatement and studied incomprehension on Steiner's unabashedly mandarin prose. It's hard to ask the charming and welcoming Steiner what exactly he was up to, and perhaps there's no need: he is 79, an age at which it's not unknown for men to dwell on the erotic triumphs of earlier years. Is there an arch enjoyment of arcane flourishes in his writing on sex? "Of course. Remember, I'm quadrilingual, which means I love this language freely, not by imperative imposition. I love its resources. I find so much writing colourless, small in its means, unwilling to take stylistic risks. Often it goes wrong, I am not the one to judge. Sometimes, I hope, it goes right." As for what he calls "the Private Eye view", Steiner isn't fazed by that sort of derision. "I've suffered from it," he says without rancour, "my whole life here."

Steiner was born in Paris in 1929, delivered - according to family lore - by an American doctor who then returned to Louisiana to assassinate Huey Long. His parents, Frederick and Else Steiner, were Austrian Jews who had taken French citizenship, and the children were brought up speaking English, French and German, to which Steiner later added Italian. His father, an investment banker, was "an agnostic, a Voltairean", Steiner says. But he "had deeply the Jewish sense that there is no higher vocation than teaching" and encouraged his son's classical studies. When rumours of war came, "Mamam was indignant. She said, 'They will die on the Maginot Line if they dare attack.' My father, bless him under the name of God, saw more clearly." Tipped off by a German former colleague while visiting New York on behalf of the French government, Frederick Steiner arranged for his wife and children to join him there in 1940.

After finishing his schooling at the French lycée in New York, Steiner studied at the University of Chicago and at Harvard. Then, in part because his "unofficial godfather", Lewis Namier, had more or less planned for him to go to Balliol before he was born, he "made the mistake of reading English at Oxford". The English faculty viewed doctoral candidates with suspicion - "they didn't know how to teach them, they regarded it as a German-American contrivance" - and even well-disposed dons were prone to murmuring of his written work: "A touch dazzling, wouldn't you say?" Even so, Steiner had a revelation after going down with pneumonia. "I came to in my Balliol room with water running down the wall, inside. And I heard the Scottish doctor saying to the matron, 'If I pull him through this, he won't mind much else.' I fell in love with England hopelessly at that moment. No bedside manners there!"

In 1952, through "pure impertinence", Steiner landed a job at the Economist, which lasted for "four of the happiest years of my life". Sent to interview J Robert Oppenheimer at the Institute for Advanced Study in Princeton, he ended up accepting a post there. But he soon wanted to return to Europe - "by rowboat if necessary" - and when the founders of Churchill College, Cambridge, went in search of a literature teacher with experience of scientific institutions, he was an obvious choice. He was already making a name as a critic with such books as Tolstoy or Dostoevsky (1958) and The Death of Tragedy (1961), and in Cambridge he became a star lecturer as well as a prolific contributor to literary magazines, helping to bring news of such figures as Walter Benjamin, Theodor Adorno, Georg Lukács, Paul Celan, Martin Heidegger and Claude Lévi-Strauss to the English-speaking world.

"They had to move me to the biggest lecture hall in Cambridge," Steiner says. "And the students packed it." But a charismatic generalist with an interest in continental theorists was not all the dons' cup of tea. Things came to a head when he was summoned to an interview for an English faculty job in 1969. The two senior members of the faculty were sitting waiting, armed with a copy of an article he'd written. One of them, speaking "in a dry chirpy voice", said: "I would like to read a sentence to you. 'To shoot a man because you disagree with him about Hegel's dialectic is after all to honour the human spirit.' Did you write this sentence? And do you believe it?" Steiner replied: "Absolutely." That, he says, "was the end of the interview", and although his college came through for him with "fantastic generosity", he decided to go freelance, inheriting Edmund Wilson's berth at the New Yorker.

During the 70s and 80s, Steiner became well known in a distinctive role: part Mitteleuropean Jewish sage, part brooding modernist dialectician, part scourge of both scholarly narrowness and French theory. He ascended to the lecture-circuit stratosphere and, sustained by a professorship at the University of Geneva, published numerous books, of which the magnum opus might be After Babel (1975). While academic honours haven't been in short supply, he has sometimes felt marginalised by the academic community: "Among stamp collectors," he wrote in 1992, "letter-writers are not always welcome." Early on, he published poetry, though "one morning I looked at it and I knew it was superb verse. And verse is the opposite of poetry." He's also "published a bit of fiction", including a successful short novel, The Portage to San Cristobal of AH (1981), though he has, he says, "no illusions" about its value.

"In Beckett's great phrase," he says, "I should have failed better." He laughs cheerfully. "That wonderful phrase." But, he adds, "unless you are absolutely first rate, which so few of us are, then what I call the letter-carrier function of the teacher is wonderful. To serve great works, to send the letters out hoping they get to a good mailbox, is a marvellous thing. I'm terribly proud, of course, of being in the National Portrait Gallery. I'm even prouder that they've named a room for me at the University of London. A lovely portrait there, and I've insisted that it be called Il Postino. That beautiful film of the mail carrier for Neruda . . . I am the postino. And what fun it's been, and what luck. I have students who are now in chairs in five continents. They invite me to their inaugurals. A tremendous reward."

Not that the mail he brings is always consoling. "No culture has a pact with eternity," he says. "The conditions which made possible the giants of the western poetic, aesthetic, philosophic tradition no longer really obtain." Steiner doesn't believe "there can be a Hamlet without a ghost, a Missa Solemnis without a missa", and if you say that the questions addressed by religion are "nonsense or baby talk or trivial, I don't believe that certain dimensions will be available to you. Particularly today, when the atheist case is being put, if I may say so, with such vulgarity of mind." Most writing "seems to me too often, in this country, at the moment, a minimalist art. Very, very non-risk-taking. Very tight - often admirably, technically. But finally one thinks of the nasty taunt of Roy Campbell, the South African rightwing poet: I see your bridle, where's the bloody horse?"

Yet Steiner has made his peace with British anti-intellectualism. Part of him thinks "it's absolutely deplorable that this country treats ideology and intellectual debate the way it does. But: we owe to this its ironies. Its tolerance. Its decision not to take too seriously what in other countries have proved fatal challenges. It is my conviction that had the infinite rhetorical genius of Adolf Hitler been tested at Hyde Park Corner, people would have said, 'Ah, come off it', and walked away. And this is magnificent . . . Why is an Enoch Powell so totally ineffective, thank God, thank God? Maybe because he was the only man ever to hold a major chair of ancient Greek at age 25. That's no good! That alerted unconsciously - I'm saying this lightly - that alerted the body politic . . ." He smiles and puts on a low English voice: "this chap was too clever by half . . ."

must...return...to....work....

Wanking

Have I told you lately that I'm depressed and lonely? I may have mentioned that i've gained weight; have been rejected multiple times for dates; still don't know the differential for acute abdominal pain; my favored candidates continues to fall short of clinching the nomination; am in risk of not completing my required coursework; spilled red tomato sauce on my white shoes , etc.

To make myself feel better, i am going to reflect on the fact that i now have a complete thesis committee. and they are all really sexy. So there.

They are loosely anonymous on the off risk of showing up in a google search associated with my rambling, blatantly unprofessional, and vaguely tasteless blog.

Ok. not so vaguely.

(1) JH, professor of bioethics and medical humanities, has served as a Fellow in the Townsend Center for the Humanities. She was a Co-chair for the Conference on Genomics, Science and Society at UC Berkeley in April 2003. She served on a Steering Committee for the Robert Wood Johnson Scholar’s Program on Health & Society. She is a reviewer for the Journal of the American Medical Association. She completed her undergraduate work at Yale University with a BA in Philosophy. She received her MD from Yale University, a MA and a PhD in Philosophy from Yale University. She has received the Martin Sisters Chair at UC Berkeley School of Public Health. She also received The Porter Prize for overall outstanding PhD. dissertation at Yale University. In addition, Halpern received a Greenwall Faculty Fellowship for 2005-2008. Her research focuses on emotions, the imagination and decision-making. She has recently published a book that Is A Big Deal, and is now writing another book.

(2) GM, professor of clinical medicine, received a MD from UCSF and is certified with the American Board of Internal Medicine. He is a member of the Core Faculty, Executive Committee and Advisory Board, and the Northern California Geriatrics Education Center. He also serves a member of the Board of directors of the California Council on Gerontology and Geriatrics. He is a reviewer for Annals of Internal Medicine and The Journal of Clinical Ethics. Currently, GM has received teaching awards from UCSF for the Preclinical Faculty and a special recognition Award for Humanistic Teaching from the JMP where he is is a clinical professor. He teaches the medical curriculum as well as various courses topics including death, suffering, aging and narrative in medicine.He is also Director of the nascent Center for Medicine, the Humanities and Law, which seeks to promote interdisciplinary education and research in the problems of medicine and society. Dr. M has additional interests in a broad range of ethical issues in medicine and aging, and he is the long-time chairperson of the Alta Bates Medical Center Ethics Committee and a member of the ethics committee for the Center for Elders' Independence. He is currently Co-Principal Investigator with medical anthropologist SK (PI) on a project addressing the quality of death for older people in a community hospital.

(3) CK, professor of law, Director of [a respectable] Center for Morality, Law, and Public Affairs joined the Jurisprudence and Social Policy Program at Boalt Hall in 1998. He clerked for Judge etc of the U.S. Court of Appeals for the District of Columbia and was a visiting professor at Columbia and Stanford law schools. His work focuses on moral, political and legal philosophy, and he has particular interest in the foundations of criminal, international and constitutional law. His book addresses the question of individual moral and legal responsibility for harms brought about through collective and corporate activity. His current work centers on democratic theory, the law of war, the metaphysics of criminal law and the nature of political legitimacy. He teaches courses in criminal law, and moral, political and legal philosophy.

(4) ST, professor of clinical medicine, received her medical degree from UCLA, and her public health degree from Harvard University. She completed the UCSF Family and Community Medicine residency at San Francisco General Hospital in 2002. Prior to starting fellowship, ST worked on a Family Medicine training program in Bosnia-Herzegovina. Stephanie started her fellowship in 2003, and is currently doing research on the role of medical assistants in redesigning primary care teams. Her research interests also include primary care workforce issues in developing countries and the development of Practice-Based Research Networks. She has presented her research at several conferences and is involved in the Global Health Sciences institute that is undertaking a capacity building effort with the College of Health Sciences in Tanzania.

In various combinations I have: Two medical humanists, two professional philosophers, three medical doctors, a legal scholar, an expert in global human health resources, a partridge and a pear tree--score. For real. in future may consider starting thesis related blog so as to work out ideas in public space, invite commentary on philosophical notions and policy issues in spirit of intellectual roundtable, without also inviting commentary on personal health, mental welfare, love affairs or fashion tastes.

Hmm. note to self: contemplate overlapping spheres of the private and public, rampant confusion re: propriety, and risk of California Board of Physician Licensure googling me in future.

Note 2 to self: google self before running for office.

The Mission

About a month ago, it struck my heart that i miss Oakland. I am not sure why...I think i was on my way to berkeley on a saturday, which was rare, and the trees, the hippies, the empty warehouses, that devastating skyline of the docks, like lumbering animals against the sea...something called. I put Berkeley and Oakland together but that is not quite right. And yet it is, kind of like their amorphous border lined with liquor stores. Some of my most loved friends are there, across the water. Borgesian libraries and my favorite dark crevices to salve my soul. A good capoeira studio But also hellsa sunlight and cheap rent. I've been flirting with ways to move back in the next few years.

Today, a sunny saturday, I am reminded why the mission is also making its way into my heart, for all its silliness.
(1) the sun is out

(2) dolores park is beautiful, has hills, children, dogs, a mighty california mission, and an endless sea of young gay men not wearing very much.

(3) I saw a lanky young white man wearing an election t-shirt that said "Jesse Jackson '88".

(4) i drank philz coffee this morning, got to overhear phil banter with his crotchety old man friends

(5) I ran into a kid from school, a very kind fellow who was on his way to the general hospital, to take a tour of all the toxic dumps in san francisco. "its a beautiful day for it!"

(6) I saw a cute boy whom i had seen once before, who made eyes at me, got me all fluttery, and then took a seat with his lady friend. A tease, and most definitely a pleasant one.

(7) outdoor facing seating at Revolution Cafe, which for all the hype, is really the most fabulous place to be on a sunny saturday afternoon, while spanish ballads croon, and the walls are lined with protest photographs from the No Borders Coalition.

(8) if you look down mission street, you can see the absurdly elaborate golden dome of city hall glinting in the sun.

(9) Heavily accented too cool suave Latin man with dark sunglasses and swept back pony tail tells his cell phone: “Ach these burning man peoples! You know they are freakies! The way they act, the way they dress...”

Thursday, April 24, 2008

Giving Back to the Community

My old college co-op is holding an alumni fund-raising party. The invitation notes: "We are charging $5 to $50 sliding scale. Thus if you recently graduated as an English, Philosophy, or Theater major, we only ask $5. If you graduated in engineering, law, or premed, cough it up!"

The Merchants

Like any successful cult, medicine steadily and efficiently continues to atrophy my relationships with friends, family, and any hope of having a beer with the potential father of my children.

Relatedly, my primary contact with other human beings is either (1) The claustrophically school related: classmates, teachers, students, patients or (2) commercial.

Currently my most regular non-school relationships are constituted by these people: (1) the grungy musician morning shift of Philz Coffee (2) the sleek hipster early evening and weekend shift of Ritual Roaster's (3) the three Mexican girls working at People's Cafe who sell me my lunch (part 1) ceasar salad (4) the French-Algerian crepe guy for my University Ave breakfast (4) My former co-workers and emergency latte makers at Yali's, who update me on their crushes (Iced mocha boy), grill me on my spanish grammar, and ask me whether i am a doctor yet (5) the amused filipina woman who knows to put hot sauce in my bagel at the Addison Annex, and the Morrocan owner who knows our entire class by favorite coffee drink and food allergies (6) the African guy in the Valencia liquor store who watches me stumble in go straight to the atm machine, and leave (7) the closing shift at the Whole Foods next door where i beg them to let me in, and I buy the same damn thing ever 3 days: tortilla chips, spicy salsa and hummus.

While there are risks to relying on these relationships to sustain my lonely lonely lonely spirit (see: barista not actually flirting with you, I-VIII), there is a great comfort, in their regularity, their familiarity with the only things that matter to me outside of school: coffee, breakfast foods, late night snacks, and the means to acquire these.

And there is that celebrated life blood of the big city service industry: The merchant class. The bombastic interrogations: whereyoufromyouspeakarabichowareyou, the ridiculous over the top jokes and generosity: foryouillputonawholeotherpotofcoffeebecauseilikeyou, and the winking flirtations: morningbeautifulsamethingforyoutoday? That like the aggressive carpet salesman in Turkey, the langorous alpaca merchants of the Andes, the fluttering cosmetic salesgirls in Beijing: there is some universal hardwire in that old world art of Making the Sell. Charm them, try 10 languages, flatter them, feign bankruptcy, mention your mother's kidney transplant, chase them down the street and bodily return them. And I realize what i really love about these people is that they are basically my father.

Like many of these folk, my father knows how to bargain in spanish, hindi, swahili, german, and japanese. Mind you, what i realized only in my early twenties, he doesn't actually speak any* of these languages. Critically, he knows the greetings, the capital, the current politics, and he's friendly as hell. Instant camaraderie. My father can befriend old British ladies, American ranchers, Kenyan professors and middle eastern drug cartels. As a buyer, he can reduce any professed price to half of what was offered and* get invited to the daughter's wedding that weekend. And as to women, never mind that he and old school devoted family man, or that his wife and three children are actually sitting right by him and snickering, or that he has just turned 60 years old, he can make grown women laugh with delight and flattery, while children and dogs adore him.

And as i am grinded through the self absorbed arts of medical training, a humbling and battering that lends itself to cling to any profession of self worth: we are doctors! we are ucsf! this is what matters! everything else is meaningless! The pomposity and self congratulations to some extent are justified: people work hard, they are clever, they are devoted, useful and passionate. But it is still good when one comforted to be a child of farmers and merchants, and that one's entire mental stability is sustained by a cashier's kindness.

Wednesday, April 23, 2008

What it is you think you're doing

"Without a doubt, capoeira brings together many elements, such as dance, music, fight, theater, ritual, tradition, and philosophy. But in essence, capoeira is a ritualized combat that functions as a vehicle of individual expression through which the capoeirista ­ a fighter, a philosopher on an introspective journey, and ultimately an artist that practices her art with his own body, emotion and spirit — finds her whole self."

The Audacity of Government

Episode 353 of NPR's This American Life: The Audacity of Government

It costs $.99 or you can call me, we drink beer and listen to it from my computer. It is not as charming and exquisite as their usual fare, but it makes up for it in mind numbing shock - but with some amount of exquisite charm.

I never wanted to take up bush mongering because the absurdity could go without saying. I was too cool to beat an easy horse. But its just so* good.

Criminal prosecution. That's all i'm saying.

Summary:

Stories of the Bush Administration, its unique style of asserting presidential authority, and its quest to redefine the limits of presidential power.

Prologue.

Host Ira Glass talks with Yale law professor Jack Balkin about what he calls the Bush Administration's "lawyering style," a tendency to fight as hard as it can, on all fronts, to get what it wants. Ira also plays tape from a news conference with New York Senator Charles Schumer, in which he takes the Justice Department to task for refusing to pay death benefits to the families of two auxiliary policemen who were killed in the line of duty, even though federal law grants those benefits. (5 minutes)

Act One. The Prez vs. The Commish.

Ira Glass tells the story of a little-known treaty dispute with far-reaching ramifications for our understanding of executive power. The dispute is between the President and one of his appointees...to the International Boundary Commission with Canada. This little-known commission carried out its function without fanfare or incident for over a hundred years, until a couple of retirees in Washington State built a wall in their backyard and, quite literally, set off an international incident. (23 minutes)

Song: "Oh, Canada,"


Act Two. This American Wife.

This American Life contributor Jack Hitt uncovers a strange practice within the U.S. Citizenship and Immigration Service. If a foreign national marries a U.S. citizen and schedules an interview for a green card, but the U.S. citizen dies before the interview takes place, the foreign national is scheduled for deportation with no appeal—even if the couple has children who are U.S. citizens. Jack talks with Brent Renison, a lawyer who's representing over 130 people in this situation, mostly widows, who are seeking to overturn the Immigration Service's rule. (20 minutes)

Song: "Goodbye," The Postmarks


Act Three. 44.

Ira Glass interviews Charlie Savage, a Pulitzer Prize-winning reporter for the Boston Globe, who's written a book called Takeover: The Return of the Imperial Presidency and the Subversion of American Democracy about the ways the Bush Administration claims executive powers that other presidents haven't claimed. Charlie talks with Ira about the current candidates for President and their views on the scope of executive power.

Charlie Savage's book comes out in paperback soon. (4 minutes)

Song: "Declare Independence," Bjork

Tuesday, April 22, 2008

Three Meditations on Impotence

(1) Going to capoeira with an ex-bf can amount to a lot of things. Like being lined up and ordered to kick each other. Like facing him while he taunts "come on you know you want to." Cue rapid milisecond progression at the speed of brain electricity, a jolt of 10,000 memories painbetrayalannoyanceragedespair and then face this boy, who is about 30 times stronger than you and has a blackbelt. Pretend to kick him but instead laugh and poke him in the stomach. When the line rotates again and now he is in the kicking line, snarl "come on, do it again." As per instructions he lays a clean kick on your chest, and you skitter across the floor. God's a real funnyman. Go on, brush your shoulders off.

(2) Spend 1.5 years in medical school. Memorize so hard the cardiac exam, all the vasculopathies, sting at all the red marks on your write ups. Stay up late into the night grunting over the minutia of the Review of Systems. Arrive primandproper at the clinic, so earnest about getting it right. Walk into a room where there is a sprightly tiny 73 year old woman. Discover on examination that she has no left carotid pulse. Listening to her heart, note that it goes glug glug gluuuuug glug--an arrhythmic squelcing. By your calculations instead of a cardiac pump she has some sort of bladder of viscous drain water in her chest. Also the entire left side of her brain is getting no blood whatsoever. however she is laughing and telling you about her grandchildren and the 47 blocks she walked today. You come to realize you have no fucking clue as to how the body works and are a miserable failure.

(3) Marry a man. Have him elected to the presidency. Undertake a powerful agenda as to your role as first lady to basically re-engineer the entire welfare state as we know it. Have it fail disasterously. Also your husband should engage in a sex scandal with a woman half your age. Ideally it incites a congressional hearing and the near impeachment of your husband. Accompany him as dutiful ashen faced wife at all press conferences. Some years later win the senate seat of a populous and powerful state. Eventually run a historical race to become the Democratic nominee to the presidency, with your husband as your bulldog. Have the subtext be: phoenix from the ashes of humiliation. Oh but have some sexy upstart whippersnapper undermine this entire plan. Also watch the entire political party you have devoted to crack in half beneath your feet.

There is nothing quite like the humiliation of a proud woman: that is the stuff of Shakespeare and Grecian tragedies: the fallen hero. Alas, I am neither Othello, nor Hillary Clinton, nor Britney Spears. I have incredibly little physical prowess, political power, or nationwide wide sex appeal. Alas, neither am I Shaw nor Mencken. Despite my hyper-education and bibliophilia, that normal respite of emasculated, nerdy wimps--the cruel wit and pen as laceration--fails me as much as my underdeveloped muffin top potbelly.

One way to understand this is to make sense of vulnerability, and that ancient business of fate. Because there is always (always) that possibility, to fall: we start, naked, screaming, dependent, and from which we struggle, rise, triumph, and then again, the final betrayals: loss, shitting ourselves while our kidneys fall out of our pants, death with a stupid expression on our face. Arguably, as women, or the disempowered rabble of various stripes, there are a myriad opportunities to feel frightened, suspicious, protective, angry, motivated to carry and/or discharge a handgun. Fear is powerful. Loss of dignity, is powerful. And to witness the humiliation of another--aversive, painful, like witnessing violence, the drops of blood that make cowboys weep. So one way to understand this is to go the way of the ancient Greeks, the Christians, Thic Nan Hanh: be humbled by our fragile existence, make peace with death, and develop the wisdom to fight the good fight, and let go the inevitable. And like the Christians, Thic Nan Hanh and Al Green, armed with this understanding, to face the suffering of others with courage, compassion, strength and friendship. We all need somebody to lean on.

Another way to understand this is with a knee in the groin call to arms. For example, in my troubles, I see there is a injustice that moves me to my new campaign: empowering the nerd girl. There are an inexcusable shortage of poetic resources from which the weirdo nerd girl may draw upon to feel sorry for herself. What sort of world is this, that the sort of role models these young women have are sports stars, nobel laureates, or Michelle Obama? Doesn't this culture realize voice-deprived minority of us just don't want intelligence, power, beauty, or strength of character? These are all tools of the capitalist system that rewards respectability. Fuck this oppression. And while the male* loser is celebrated in pop culture and positions of power (Jimmy Kimmel, Adam Sandler, George W. Bush, and a general public celebration of the peculiarly male fat deposition pattern in beer metabolism), the greatest height in female loser achievement is still Lisa Simpson. Who is to remain 8 years old for all perpetuity. That is fucking fucked up. And so on.

Yet another way is to note, that while rejection in love, failure in one's professed art, impotence to assert one's dignity, that all these hurt like hell, and that they connect one to the human narratives of many millenia, one can also hide behind obscenity, irony, and shopping sprees for overpriced skinny jeans.

Sunday, April 20, 2008

Democracy, etc

I was rudely interrupted in my self absorption by the news that there is now extensive evidence that the Bush Administration is full of Bad Bad People. Granted my understanding of international law is limited, but seeing as how these acts are illegal, and you know, deliberately aimed at undermining civil rights, the check of powers, the rule of law and ultimately fundamental human rights. What i am very curious to know: when shall we undertake criminal prosecution?

The expose:

Behind Analysts, the Pentagon’s Hidden Hand
By DAVID BARSTOW, April 20, 2008
The Pentagon has cultivated “military analysts” in a campaign to generate favorable news coverage of the Bush administration’s wartime performance.
http://www.nytimes.com/2008/04/20/washington/20generals.html?ex=1366430400&en=251986746e06e4a9&ei=5124&partner=permalink&exprod=permalink

Also, in my educated opinion, the NYTimes is a bunch of pussies.

"At this point it seems that getting answers will have to wait, at least, for a new Congress and a new president. Ideally, there would be both truth and accountability. At the very minimum the public needs the full truth. Some will call this a backward-looking distraction, but only by fully understanding what Mr. Bush has done over eight years to distort the rule of law and violate civil liberties and human rights can Americans ever hope to repair the damage and ensure it does not happen again."

CRIMINAL PROSECUTION. Not just crime, but crimes against humanity (see: torture, Geneva Protocol). These are the things that delight poets and philosophers--why are things that are so unambiguous on paper and any cockeyed reasonable assessment of history, turn out to be so fuzzy in real life? It just tickles my soul.

The Torture Sessions, op ed, April 20, 2008
http://www.nytimes.com/2008/04/20/opinion/20sun1.html?ex=1366344000&en=2410fe9cdc53598f&ei=5124&partner=permalink&exprod=permalink

Being self righteous and/or smart ass about politics is clearly out of fashion. 8 years of absurdity makes it no fun, one loses one's ballast of the outrageous. But still, once in a while a little fairy dust comes along, and the bards and jesters have work again. Won't you do your thang?

Barista not Flirting with You, part VIII

Oh he was.

He's ceased.

And now I hate him.

The trouble with entering the warfare of love with the intent to make a novel out of it, is that you forget the consequent ravaging, the burned villages, the smell of scorched flesh. If you will.

All part of the novel, of course. A harrowing existential journey, like a junkie's diary. In the mean time, however, you've lost 8 years of your life, your veins, your soul, and have contracted an assortment of deadly blood bourne viral infections.

Clearly this insufferable human being is not worthy of my canonization of him Into Art.

The coffee, however, is.

Ammended list of powerful people one should piss off at one's own risk: (1) waiters, given the proximity of their body fluids to your food (2) singer-song writers given the off chance that their version of your affair will play on a top 40 loop across the nation (3) dentists, hairstylists, others who weild very sharp objects near your head and (4) writers?

This raises two further question (1) how badly can you hurt someone with words and (2) am I writer?

The answer to Question 2 could lead me to a wardrobe change and an exciting new world of pick up lines ("medical student" is surprising not as productive as i had hoped. People just hide their cigarettes. Or the type of people who do get excited about the medical professions...get a little too* excited about it...)

Saturday, April 19, 2008

Clinical Write-ups

I HATE THEM. Which is unfortunate because I think meeting patients, gathering all the relevant facts, and then making logical and scientific sense of it all for diagnosis and treatment is the ENTIRE JOB DESCRIPTION. damnit.

Flirting with Women

Is a good idea. This is new for me, but seems to work. Me and her, clearly heterosexual (note: "clearly" applies, even if she ultimately turns out to be a man) (note: apple has recently released license for independent software development of iphone compatible gaydar; unfortunately release is being stalled by the fact that every fucking algorithm that is remotely possible fails in san francisco), we are comfortable in the fact that we are not nearly as cool as all the raging dykes at the Lex. Still! Pretty girls are pretty great, and flattering one is even better, and somehow, its self aggrandizing, because maybe i must be pretty cool too, if this sassy hipster bitch seems to get get giggly from my eye contact. It serves everyone, in this meta-meta-meta way, a grand ego circle jerk, if you will.

I have found the good i have been brought here to do.

Regarding the Pain of Others



I am fixated with this.

The abandoned Vice i found in a coffee shop--a rare treasure. The Fashion Issue 2008. I never know what to make of this...clearly it is attractive, full of waify anti-fashionable fashionistas, a lot of cursing, discomforting obscenities, startling and strange nude women and ad after ad of "edgy" t-shirt companies. This particular issue also has 4 pages of cats dressed in small hats and capes. There is some amount of stupidity and irony in it, but one can't quite get a good grip on it, as it has protected itself in an armory of insight as to the stupidity of other* things, and because it has an assortment of startling and strange nude people in it.

And this cover shot. It turns out to be the work of a rather famous, sexy photographer, who graces the New York Times magazine and undertakes ads for Puma. I thought at first perhaps the bear was nursing this man. I thought this because I hadn't actually drank my coffee yet. Correcting myself, i realized, the bear was actually mauling this man. And then again, i thought someone's death moment was still rather distasteful for a magazine cover, even for Vice (the magazine that no less once had a spread on Moscow prostitutes). In the end, i became fixated on the man himself, how delicate and beautiful he looked, perhaps because the bear was so much more powerful than he, or perhaps because whoever this young man was, he had had his hair impeccably styled before offering himself to a large and rather furious looking animal. That seemed rather brave.

You cannot see his face, but the photo is jarring...and...sexy. Many photos of women are strikingly beautiful, women are so frequently offered, stolen, caught by the camera: vulnerable, sexual objects...but done well, objects that move us anyway, in the way that dancers are not people, they are raw, transcendent, they are shapes they are emotions they are movement, whatever they are, they are not like us. But in photography, and i don't have a theory why, it can become so much more...sexual.

Just kidding, i do have a theory. It is because we are surrounded by images that try to sell us things, but very rarely surrounded by dancers. That's much too bad.

Here is a picture of just a shoulder, and a neck line that is prone, and no face. Anonymous, evokative. The light, the moles, its less-than-plastic. But clearly this fellow's torso is taut and masculine. The highly styled coif. And there is a motherfucking bear. Also the colors are nice.

The photographer is Ryan Mcginley. The magazine notes "That is a fully alive 450-pound black bear snorgling a wee naked kid named Brennan." I probably like this photo because i was fond of a young man who could easily look like the guy in the photo. He had the impressive audacity not to love me back. I hope he encounters a large furious bear. He would probably look just as exquisite.

See here: http://www.viceland.com/int/dd.php?id=611

Friday, April 18, 2008

William Gass on expressing frustration

"There are a number of difficulties with dirty words, the first of which is that there aren't nearly enough of them; the seocnd is that the people who use them are normally numbskulls and prudes; the third is that in general they're not at all sexy, and the main reason for this is that no one loves them enough."

"...Most of the time we are content to cry out 'fuck!' as if pinched, but the function of our wall words in slightly more elaborate curses, such as:

-may your cock continue life as a Canadian

or

-may the houseflies winter over in your womb

or

-may you be inhaled by your own asshole."

Thursday, April 17, 2008

Muffin Top

"Muffin-top" is a generally pejorative, slang term used to describe the phenomenon of overhanging flesh when it spills over the waistline of trousers or skirt in a manner that resembles the top of a muffin spilling over its paper casing. This generally occurs when an individual wears low-rise, hip-hugger pants, or midriff-baring tops that are too small.

According to William Safire, "Muffin-top fills a lexical void" and "describes the roll of excess flesh spilling out primarily in front but possibly all around.

"When the wearer's abdomen is flat, a display of flesh above and well below the bellybutton produces an eye-catching picture of what the Scotsman in Britain has called the Britney belly-flash. However, when the wearer's midriff is flabby, a vivid culinary metaphor is used: muffin-top. As every baker knows, a muffin is a small cake that rises above its metal container. When removed from the pan, its shape is round, with the top hanging over the base of the cake like a small, harmless mushroom cloud."



Muffin top - i has one. yum!

Wednesday, April 16, 2008

The (Dark) Art(s) of Medicine: Pimping

From Journal of American Medicine Association, 1989 Jul 7;262(1):89-90

It's hard work becoming a revered attending physician in a university hospital. The task daunts the newly appointed junior attending as he strides down the corridor of his first ward with his first team. Oh, he's made some changes in anticipation of his new position. He's wearing a long coat now, an all-cotton coat with razor-sharp creases and knit buttons. The stained, shrunken polyester white pants and tennis shoes have given way to gray, light wool slacks with a cuff and polished loafers. Framed certificates bear testimony to his intelligence and determination. He should be ready to take the helm of his ward team, but he's not. Something's missing, something important, something closer to art than to science. When physicians talk about the "art of medicine" they usually mean healing, or coping with uncertainty, or calculating their federal income taxes. But there's one art this new attending needs to learn before all others: the art of pimping.

Pimping occurs whenever an attending poses a series of very difficult questions to an intern or student. The earliest reference to pimping is attributed to Harvey in London in 1628. He laments his students' lack of enthusiasm for learning the circulation of the blood: "They know nothing of Natural Philosophy, these pin-heads. Drunkards, sloths, their bellies filled with Mead and Ale. O that I might see them pimped!"

In 1889, Koch recorded a series of "Puempfrage" or "pimp questions" he would later use on his rounds in Heidelberg. Unpublished notes made by Abraham Flexner on his visit to Johns Hopkins in 1916 yield the first American reference: "Rounded with Osler today. Riddles house officers with questions. Like a Gatling gun. Welch says students call it ‘pimping.' Delightful."

On the surface, the aim of pimping appears to be Socratic instruction. The deeper motivation, however, is political. Proper pimping inculcates the intern with a profound and abiding respect for his attending physician while ridding the intern of needless self-esteem. Furthermore, after being pimped, he is drained of the desire to ask new questions — questions that his attending may be unable to answer. In the heat of the pimp, the young intern is hammered and wrought into the framework of the ward team. Pimping welds the hierarchy of academics in place, so the edifice of medicine may be erected securely, generation upon generation. Of course, being hammered, wrought, and welded may, at times, be somewhat unpleasant for the intern. Still, he enjoys the attention and comes to equate his initial anguish with the aches and pains an athlete suffers during a period of intense conditioning.

Despite its long history and crucial importance in training, pimping as a medical art has received little attention from the educational establishment. A recent survey reveals that fewer than 1 in 20 attending physicians have had any formal training in pimping. In most American medical schools, pimping is covered haphazardly during the third-year medical clerkship or is relegated to a fourth-year elective. In a 1985 poll, over 95% of program directors admitted that the pimping skills of their trainees were "seriously inadequate." It comes as no surprise, then, that the newly appointed attending must teach himself how to pimp. It is to this most junior of attendings, therefore, that I offer the following brief guide to the art of pimping.

Pimp questions should come in rapid succession and should be essentially unanswerable. They may be grouped into five categories:

1. Arcane points of history. These facts are not taught in medical school and are irrelevant to patient care — perfect for pimping. For example, who performed the first lumbar puncture? Or, how was syphilis named?

2. Teleology and metaphysics. These questions lie outside the realm of conventional scientific inquiry and have traditionally been addressed only by medieval philosophers and the editors of the National Enquirer. For instance, why are some organs paired?

3. Exceedingly broad questions. For example, what role do prostaglandins play in homeostasis? Or, what is the differential diagnosis of a fever of unknown origin? Even if the intern begins making good points, after 4 or 5 minutes he can be cut off and criticized for missing points he was about to mention. These questions are ideally posed in the final minutes of rounds while the team is charging down a noisy stairwell.

4. Eponyms. These questions are favored by many oldtimers who have assiduously avoided learning any new developments in medicine since the germ theory. For instance, where does one find the semilunar space of Traube? Or, whose name is given to the dancing uvula of aortic regurgitation?

5. Technical points of laboratory research. Even when general medical practice has become a dim and distant memory, the attending physician-investigator still knows the details of his research inside and out. For instance, how active are leukocyte-activated killer cells with or without interleukin 2 against sarcoma in the mouse model? Or, what base sequence does the restriction endonuclease EcoRI recognize?

Such pimping should do for the third-year student what the Senate hearings did for Robert Bork. The intern, in contrast, is a seasoned veteran and not so easily rattled. Years of relentless pimping have taught him two defenses: the dodge and the bluff.

Dodging avoids the question, wasting time as well as a valuable pimp question. The two most common forms of dodging are (1) to answer the question with a question and (2) to answer a different question. For example, the intern is asked to explain the pathophysiology of thrombosis secondary to the lupus anticoagulant. He first recites the clotting cascade, then recalls the details of a lupus case he admitted last month, and closes by asking whether pulse-dose steroids are indicated for lupus nephritis. The experienced attending immediately diagnoses this outpouring as a dodge, grabs the intern by the scruff of the neck, and rubs his nose back in the original pimp.

A bluff, unfortunately, is much more damaging than a dodge. Allowed to stand, a bluff promulgates a lie while undermining the academic hierarchy by suggesting that the intern has nothing more to learn from his attending. Bluffs weaken the very fabric of American medicine, threatening our livelihood and our way of life. Like outlaws in a Clint Eastwood movie, bluffs must be shot on sight — no due process, no Miranda Act, no starry-eyed liberal notions of openness or dialogue — just righteous retribution.

Bluffs fall into three readily discernible categories:

1. Hand waving. These bluffs are stock phrases that refer to hot topics in biomedicine without supplying detail or explanation. For example, "It's a membrane transport phenomenon" or "The effect is mediated by prostaglandins." In many institutions, they may evolve directly from the replies of Grand Rounds speakers to questions from the audience.

2. Feigned erudition. The intern's answer, though without substance, suggests an intimate understanding of the literature and a cautiousness born of experience. "Hmmm . . . to my knowledge, that question has not been examined in a prospective controlled fashion" is a common form. Frequently, the bluff is accompanied by three automatisms: clearing of the throat, rapid fluttering of the eyelids and tongue, and chewing on the temples of the eyeglasses. This triad, when full-blown, will make the intern bear a sudden resemblance to William Buckley and is virtually pathognomonic.

3. Higher authority. The intern attributes his answer to the teaching of a particular superior. When the answer is refuted, the blame of ignorance comes to rest on the higher authority, not on the obedient, accepting intern. The strength of the bluff depends on just whom is quoted. An intern quoting a junior resident about pathophysiology is every bit as cogent as Colonel Qaddafi quoting Ayatollah Khomeini about international law. An intern from an Ivy League medical school quoting the "training" he received on his medical clerkship goes over like Dan Quayle explaining the Bill of Rights at an ACLU convention. The shrewd intern, however, will quote his Chairman of Medicine or at least a division chief, pushing the nontenured attending to the brink of political calamity. Did the chairman actually say that? The attending is powerless to refute the statement until he is certain.

Indeed, a good bluff is hard to handle. Sometimes the intern's bluff sounds better to the ward team than the attending's correct answer. Sometimes it sounds better to the attending himself. Ultimately, the cunning intern is best discouraged from bluffing by aversive training. Specifically, each time he bluffs successfully, the attending should counter by inducing Sudden Intern Disgrace (SID). SID is induced in two ways:

1. Question the intern's ability to take a history. This technique depends on the phenomenon of historical drift. That is, a patient's story will reliably undergo a significant change in the 8- or 16-hour interval between admission and attending rounds. The attending need only go to the bedside and ask the same questions the intern did the night before. Now the entire case is seen in a light different than that cast by the intern's assessment. Yesterday's right upper quadrant cramping becomes right-sided pleuritic chest pain. Yesterday's ill-defined midepigastric "burning" becomes crushing substernal heaviness radiating to the arm and jaw. Suddenly, the intern is disgraced. He will never bluff again.

2. Question the intern's compulsiveness. In less rigorous programs, this is easy. Did the intern examine the peripheral blood smear and the urine sediment himself? If the intern does routinely examine body fluids, a more methodical approach is required. In this case, results of the following tests, procedures, and examinations may be requested in rapid succession: Hemoccult slide test, urine electrolytes, bedside cold agglutinins and serum viscosity, slit-lamp examination, Schiotz' tonometry, Gram's stain of the buffy coat, transtracheal aspiration, anoscopy, rigid sigmoidoscopy, and indirect laryngoscopy. Once the attending discovers a test or examination left unperformed, he asks the intern why this obviously crucial point was neglected. (The tension may be heightened at this point by frequent use of the word "cavalier.") The intern's response will generally revolve around time constraints and priorities in diagnostic evaluation. The attending's rejoinder: did the intern ea t, sleep, or void last night? The scrupulous intern at once infers that he has placed his own needs before the needs of his patient. Suddenly, he is disgraced. He will never bluff again.

Clearly, pimping — good pimping — is an art. There are styles, approaches, and a few loose rules to guide the novice, but pimping is learned in practice, not theory. Despite its long and glorious history, pimping is in danger of becoming a lost art. Increased specialization, the rise of the HMO, and DRG-based financing are probably to blame, as they are for most problems. The burgeoning budget deficit, the changing demographic profile of the United States, the Carter Administration, inefficiency at the Pentagon, and intense competition from Japan have each played a role, though less directly. Against this mighty array of historical forces stands the beleaguered junior attending armed only with training, wit, and the determination to pimp. It won't be easy to turn back the clock and restore the art of pimping to its former grandeur. I only hope my guide will help.

Tuesday, April 15, 2008

Cosby and the White Man

http://www.theatlantic.com/doc/200805/cosby

Sunday, April 13, 2008

An Explanation, II

"She understood at the bone the willful transgression implicit in the literary enterprise—knew that to express one-self was to expose oneself, that to seize the stage was to court humiliation, that to claim the independence implicit in the act of writing could mean becoming like the women she described in Sleepless Nights, left to 'wander about in their dreadful freedom like old oxen left behind, totally unprovided for'—and she accepted the risk. Every line she wrote suggested that moral courage required trusting one’s own experience in the world, one’s own intuitions about how it worked." Joan Didion

Saturday, April 12, 2008

An Explanation

"Playfulness at a fully conscious level is extremely profound. In fact there is nothing more profound. Wit and playfulness are dreadfully serious transcendence of evil."
-Tom Robbins

One Form of Electricity

By PETER DIZIKES
Published: April 13, 2008
Beauty is truth, Keats declared, and truth beauty. Many prominent scientists have wished a version of this famous equation described their own work. The British quantum theorist Paul Dirac, for one, called his career “a search for pretty mathematics.” Most scientific aesthetes gaze fondly upon equations or arrangements of facts. A few, like the science writer George Johnson, also see beauty in the act of research. Johnson’s new book, “The Ten Most Beautiful Experiments,” is an appealing account of important scientific discoveries to which a variation of Keats applies: occasionally, beauty yields truth.

Johnson’s list is eclectic and his outlook romantic. “Science in the 21st century has become industrialized,” he states, with experiments “carried out by research teams that have grown to the size of corporations.” By contrast, Johnson (a longtime contributor to The New York Times) favors artisans of the laboratory, chronicling “those rare moments when, using the materials at hand, a curious soul figured out a way to pose a question to the universe and persisted until it replied.”

His selections include the canonical and the overlooked. The first chapter describes Galileo’s studying motion by rolling balls down an incline, often considered the founding experiment of modern science. Another chapter recounts Isaac Newton’s using prisms to grasp the nature of color. But Johnson also brings to life less familiar figures like Luigi Galvani, who illuminated the nature of electricity; Albert Michelson, who (with Edward Morley) determined the constant speed of light; and — a particularly inspired choice — Ivan Pavlov, whose famous dog experiments advanced physiology and neurology.

Johnson has a good feel for detail — Pavlov, in fact, rarely used a bell — and an easy touch with larger concepts. The vexing, counterintuitive Michelson-Morley result showed that light always appears to travel at the same rate, regardless of our relative movement or the mythical “aether” once thought to slow it down. As part of Einstein’s theory of special relativity, Johnson writes, this principle helped make clear that “there is no fixed backdrop of space, or even of time.” Instead, the speed of light is “the one true standard.”

Historians have wondered how much Einstein knew about the Michelson-Morley experiment, or if he reached the same conclusion independently. Johnson bypasses such discussions, although he could have noted this one (or explained why Michelson is more significant than Morley). Instead, he quickly sets the scene of each discovery and explores how each scientist sorted out a rich, messy mixture of evidence and theory — no fixed formulas here about how science progresses.

Johnson’s best chapter describes the ad hoc scientific duel in the 1790s over the nature of electricity between Galvani, who had accidentally discovered “animal electricity” in dismembered frogs (don’t ask), and a skeptical Alessandro Volta, who thought Galvani’s metal tools had generated the effect. Neither was entirely right. Their debate, however, helped prove that there is only one form of electricity (not many, as some thought), and that it flows through life, too.

Johnson’s lively book nicely evokes the lost world of the tabletop experiment. But are all remaining advances really beyond the reach of individual hands and minds, as he supposes? Might we still attribute major ideas to ingenious individuals, even if the ideas are tested by teams?

Certainly, Johnson is entitled to his nostalgia. Still, if lone scientists rarely push knowledge forward today, they rarely impede it, either. Consider William Thomson, Lord Kelvin, who appears here in a chapter on James Joule’s heat experiments. For all he accomplished, Kelvin later dismissed geological evidence about the Earth’s age, using his authority in thermodynamics to insist our planet was much younger than evolutionists like Charles Darwin and T. H. Huxley supposed. Kelvin’s conclusions were wrong, but it took decades to overturn his views. Sometimes, less individual influence is a good thing.

One other question lingers: What makes a scientific experiment beautiful? Johnson favors simplicity — not just clean, artful experiments, but those that let us replace convoluted theories with simple explanations. Galileo applied uniform mathematics to the motion of all objects, contradicting Aristotle’s idea that heavier objects fall at faster rates. William Harvey showed that one form of blood circulates throughout the body, not two. Newton proved colors are refracted light beams, not Descartes’s complex “spinning globules of aether.”

Historically, few people seeking beauty in science have displayed a baroque sensibility. The traditional aesthetic is classical, invoking the simplicity and symmetry of revealed forms — whether they have been revealed on a cluttered lab bench or through elegantly spare theorizing.

Indeed, the notion that scientific thinking is beautiful enjoyed a neoclassical revival, following the spread of Newton’s work in the 18th century. When Johnson says his 10 scientists found “an unknown piece” of the universal “scaffolding,” the architectural metaphor is telling. In this view, scientists who have sized up the world’s complexity and extracted lucid explanations are a bit like the engineers of ancient Greece or Rome who studied piles of stones and formulated basic building principles. We judge their work based on both form and function.

If Johnson’s aesthetic sense is conventional, however, his vision is broad. This tidy book finds beauty throughout science — even among dead frogs and drooling dogs.

Tuesday, April 8, 2008

Re: the continued race for the Democratic Presidential Candidate

"Democracy means simply the bludgeoning of the people, by the people, for the people." Oscar Wilde

Sunday, April 6, 2008

The History of Man: (1) Beginnings

"Man, it would seem, has descended from arboreal apes. They lived a happy life in tropical forests, eating coconuts when they were hungry, and throwing them at each other when they were not. They were perpetually occupied in gymnastics, and acquired an agility which to us is truly astonishing. But after some millions of years of this arboreal paradise, their numbers increased to the point where the supply of coconuts was no longer adequate. The population problem set in, and was dealt with in two different ways: those who lived in the middle of the forest learned to throw coconuts with such accuracy as to disable adversaries, whose consequent death relieved the pressure of population, but those who lived on the edge of the forest found another method: they looked out over the fields and discovered that they yielded delicious fruits of venous kinds quite as pleasant as coconuts, and gradually they came down from the trees and spent more and more time in the open on the ground . . . they soon discovered that if you live on the ground it is easy to pick up stones, which are more effective missiles than coconuts." - Sir Bertrand Russell

Barista Not Actually Flirting with You, VII (?)

Maintenant, a song by Rupa
[translated from french]

once again you find yourself here
face to face, next to me
tell me what do you see
when you look at me? look at me
here at the edge of a breath
here at the edge of a dream
you don’t know what to say, what to do
expectation on your lips
but i come like the wind
and i come like the spring
open your mouth and place my name inside
let it lie there on your tongue
i come like the sun
making the blue deeper
open up your door for me
love does not like to wait
but you say “not now”
you don’t have the time
what do you think
that life will come again?
no, too bad for you!
close your eyes and kiss me
the moment presents us with the present
the moment is now

Why the Brain Drain Matters

A sign at the entrance of the University Teaching Hospital in Lasaka, Zambia, after a series of confrontations between angry patients and over-stretched nurses and doctors:

"Kindly take note that members of the staff at UTH work under very strenuous and demanding conditions due to the increase in the disease burden and critical shortages of man power. It may take a bit of time...Assaulting any member of staff is a criminal offence." (Lancet)

alternative titles to this post
(1) I Motherfucking Swear That I Am Not Just Pissing Away My Life by Going to Medical School but Finding Every Spare Moment I Can to Sit in a Library Corner to Read John Rawls
(2) Stop Asking Me About my Thesis Topic
(3) What the Bloody Fuck Am I Supposed To Do About the World's Suffering
and
(4) Please, Please Assure Me That My Life Has Meaning.

Cheers.

Friday, April 4, 2008

Sacred Garment

It started as a soft ache. As most anxieties do.

Twinges in my forearm. Reaching into my hand. Deep rumbles, a twisting, a dissatisfaction, something awry.

The first dissected forearm musculature i saw belonged to a cat, in a high school anatomy class. I didn't even want that class; the physics class was too full. And there were the glistening pearly forearms of some mangy stray cat, stripped of its fur, and skin. Some company had drained this creature, ran through its vessels colored latex in bright primary colors.

The class was easy. I had a good memory then. I made a cartoon illustration of the four classes of biological macromolecules. Biochemistry would seduce me later. First it was the forearms. Every crouching cat, its powerful pounce, lay in these muscles, dense, sinewy and...glistening. Beautiful. Something about the ligaments, the connective tissue, they were luminescent, like opal ropes. Maybe because you can see the motion, the potential in this dead and pickled flesh.

"There is a vitality, a life-force, an energy, a quickening."

In the human anatomy lab, it was the hands that frightened us. The rest was unrecognizable, a tangle of burning smells and discolored meat. I brought a friend once, late night, to the lab. He was already well into his third year, he hadn't been in the lab in so long. He shuddered. "I felt the sudden urge to hold the motherfucker's hand." We solemnly stared at this human form, torso ripped open, ribs sawed, intestines lumped tiredly to the side, its leg sawed off above the knee. The heart was sitting in a pan nearby. It was once an old man and the cap of its head had been removed and there, an empty cavern behind a monstrous face, a joke of a face, a halloween mask that made no sense. The arm was dissected to the wrist, muscles peeled away and dangling. At the wrist the skin began again and there it was...a man's hand. Yellowed, but with fingernails, they lay at ease, like that of a fellow snoozing. A wife could recognize it. Did the man have grandchildren? Did he hold them? Was he a surgeon, a plumber, a trumpeteer? Did he use it to sign the consent form, to be there with us, with me, my scalpel still dripping formaldehyde?

The pain, my pain is soft and increasing. And the fear...how will I type? How will i play capoeira, open jars, write my notes, chop garlic, shake my fist angrily? Tens of thousands of dollars, spent on my education. I thought it all in my head, a good reason to wear a helmet, get insurance on the thing. And i see here, even in this world of ideas, my hands. I needs dem.

"The instrument by which life is lived"

Once, a great teacher, "one of dance's most beloved ogres" who was "aristocratic and fearsome, severe and blunt (but he was always right) taught this: "Without structure, you could have a million ideas, yet they wouldn't come to life. Become concerned with the making of rules and the breaking of rules...to be aware of space, time, energy, and shape."

"The body says what words cannot."

and. "Movement never lies."

I Cannot Feel Much Sorrow

It only takes a year to start draining empathy from future physicians, according to a study of medical students in the March issue of Academic Medicine.

Researchers measured vicarious empathy, defined as a person's vicarious emotional response to perceived emotional experiences of others. Students reported their agreement or disagreement on a nine-point scale in response to statements such as "I cannot feel much sorrow for those who are responsible for their own misery."

Medical student empathy for patients begins to drop during the first year of medical school. The decline was likely due to a year of stress and anxiety linked to the students' competitiveness and desire to overachieve on exams, said Dr. Newton, associate dean of undergraduate medical education at the Arkansas medical school. Scores decreased again after the third year in school, when students finished their first year of clinical rotations.

Jerome Groopman, MD, author of How Doctors Think and chief of experimental medicine at Beth Israel Deaconess Medical Center in Boston, said it is clear physicians become worn down by time pressures, work load and the diminishing sense of autonomy in the health care system.

"The public tells us they want physicians who are good diagnosticians and also caring people," Dr. Frankel said. "We start with students who are very caring but have no diagnostic skills and end up with physicians with great diagnostics skill but who don't care."

(Myrle Croasdale, AMNews)

Wednesday, April 2, 2008

Overheard

"Um, Dave? You are using too many literary allusions in your casual speech and people are complaining."

"It was six stories of dirt held together by 100 years of paint."

"Oh you like animals, do you? Well, would you like to see the rat's ass that I give?"

"Oooooh, I get it. I inform people against their will."

Intestinal Worm


A 60-year-old woman presented to the outpatient clinic with vague abdominal discomfort that had developed over the previous several weeks. There was no abdominal tenderness. Colonoscopy demonstrated a worm, which moved (video). The worm had a smooth, cream-colored surface and was 20 cm in length. It was removed with an endoscopic snare and identified as Ascaris lumbricoides. Typically, complications from A. lumbricoides are associated with mechanical obstruction, such as migration of a worm into the biliary tree or the development of a high worm burden in the intestinal lumen. In this case, the abdominal discomfort resolved after the worm was removed. At a 2-month follow-up visit, the patient remained healthy. (NEJM)