Dude! Bruce Lee! Dude!

One of my life long idols is my grandfather. He was a school teacher, had a master's of fine arts, was handsome, loved by the ladies, a fellow of virtue and known to win all the fights in his youth. He owned a motorcycle. And his hero? Bruce Lee.

It cannot be overemphasizedd how cool Bruce Lee is. He is so cool!



This guy was phenomenal. Who on earth has been fitter? here is a listing of his feats:

Lee's striking speed from three feet with his hands down by his side reached five hundredths of a second.
Lee could take in one arm a 75 lb barbell from a standing position with the barbell held flush against his chest and slowly stick his arms out locking them, holding the barbell there for 20 seconds.
Lee's combat movements were at times too fast to be captured on film for clear slow motion replay using the traditional 24 frames per second of that era, so many scenes were shot in 32 frames per second for better clarity.
In a speed demonstration, Lee could snatch a dime off a person's open palm before they could close it, and leave a penny behind.
Lee would hold an elevated v-sit position for 30 minutes or longer.
Lee could throw grains of rice up into the air and then catch them in mid-flight using chopsticks.
Lee could thrust his fingers through unopened cans of Coca-Cola. (This was when soft drinks cans were made of steel much thicker than today's aluminum cans).
Lee performed one-hand push-ups using only the thumb and index finger.
Lee performed 50 reps of one-arm chin-ups.
Lee could break wooden boards 6 inches (15 cm) thick.
Lee could cause a 200-lb (90.72 kg) bag to fly towards and thump the ceiling with a sidekick.
Lee performed a sidekick while training with James Coburn and broke a 150 lb (68 kg) punching bag.
In a move that has been dubbed "Dragon Flag", Lee could perform leg lifts with only his shoulder blades resting on the edge of a bench and suspend his legs and torso horizontal midair.

A. Badass. Motherfucker.



That's really all I have to say.

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Summary points of health care reform

A nice summary

(1) Expands coverage to about 33 million people by 2014 (50% private, 50% public support); 95% eligible Americans would be covered: 83% now

(2) Does this by a combination of expanding Medicaid coverage, mandating that all individuals be covered (with certain exemptions), and mandating that private businesses cover workers for firms with >200 employees (WalMart issue)

(3) Estimated costs of $965 billion/10 years

(4) Pays for expansion by combination of increased revenues and cost containment

(5) Lets states create insurance exchanges to broaden and cheapen insurance options for those not covered

(6) Extensive and income-adjusted subsidies for low income families

(7) Penalizes employers that don’t provide coverage

(8) Expands Medicaid coverage to all under 65 population with incomes <133% of Federal Poverty Level

(9) Require states to maintain CHIP thru 2015

(10) Increases taxes on high income persons, beginning 2011

(11) Cracks down on Medical Savings Accounts, “Cadillac insurance plans” and Medicare Advantage Plans (to get new coverage $)

(12) Some charges to health insurance plans and pharma

(13) Health insurance reform
--Eliminates preexisting conditions
--Jawbones insurance plans re “loss ratio” (>85%)
--Kids can stay on parents’ plans until age 26
--Eliminates lifetime expenditure caps
--Covers prevention services
--Gradually closes the doughnut hole for Medicare Part D

From Steven A. Schroeder, MD from talk: Revisiting American Health Policy: Why Change Comes so Hard

A great distance

"You cannot be a happy go lucky stoner and be a resident at the same time," a beloved friend chides. He is still himself but there is the intern's fatigue about him.

I am looking at this website: http://bohememusings.blogspot.com/

Although the young woman is much more stylish than i ever had much inclination to, her prattlings about cake and prettiness are eerily similar the sort of thing that filled my journals at 22, with the additional insouciant reference to Heidegger or LSD or some other nonsense. I read it now with marvel and a feeling of...coldness, such creatures exist? such beauty, such frivolity, imperviousness to the misery and blood and shit of this world? I suppose they are called young women.

So is it really med school that has numbed it all up, or is the inevitable revelation of decay?

The only constancy appears to be cake. I suppose the beauty persists, pervades, moves and seeps from lace and plastic bangles, to the detritus of daily life.

Tomorrow we begin again

k. its a Nike commercial. But u know, its good. i like it.


Sometimes you need a soundtrack.

The swirling inside

Fascinating

The B.N.P. says it stands for many things, but chief among them is an implacable belief that Britain belongs to indigenous white Britons. Until a judge struck down the provision last month, the party had a whites-only membership policy. It favors an immediate end to immigration and the repatriation of people of foreign descent.

In 2006, the party won 12 of the 51 seats on the Barking and Dagenham Council, its strongest showing anywhere in the country. This time, it hopes to secure 14 more seats, enough to take control of the council, its 300 million pound annual budget and its 9,300 employees...

“I’m not a racist, but they’re letting so many of them in,” complained Bill Greed, 66, speaking of foreigners. “They come and sign on for benefits. A lot of the children in schools don’t even speak English. There’s so many illegal ones that the government can’t even find all of them.”

The B.N.P.? “I agree with what they’re saying, but not with how they go about it,” Mr. Greed said.

Mick W., a 20-year-old maintenance worker who did not want to give his last name because he is employed by the Borough Council, said his family waited a decade for decent public housing while immigrants with large families leapfrogged ahead.“I don’t mind the ones who come and get a job,” he said, “but all they do is claim, claim, claim.”

From NY TimesVoters’ Concerns on Immigration Spin British Campaign

And i think i understand this. I can empathize, this cautiously worded frustration of one's own neighborhood, limited resources now distributed over larger denominators of outsiders. And surely here, in this other land, we are all immigrants, and a little bit self conscious no, of what we are taking, no?

And yet. And yet .What is it, the berkeley education, perhaps? And yet, i, the devoted anglophile, who gazed longingly at the filthy Thames as a child and heart swelled with utter love for the gilded smoggy face of the London towers and curls up at night with Bertrand Russell, who thinks affectionately of all things british, fetishist of Newton and tweed and has been thoroughly chained and colonized in the English language to obliteration of whatever tropical deviance there might have once been...a great snarling rises and says Shut the Fuck Up. The gold on your clock faces is from the mines of brown nations, you have built your empire with guns, your delicate tea cups are filled with the sweat of my distant grandparents, you deliberately incited war and broke the backs of millions to build a wealth the world had heretofore never seen and now you grumble when the gates break down.

But this is not fair of course. All of the wealth did not go to the Barking burroughs. And the english were very good at abusing those within their society as well as those in distant lands. And here i am, a plump little fruit of colonization, enjoying a saturday morning in the distant protestant bastion of California, drinking coffee from columbia and pasteurized milk. The sins of our fathers can so quickly dissolve in the crisscrossing lines.

Conveying the Art

Junior Physician: "How did you get such good judgement?"

Senior Physician: "Good experience."

(Long Pause)

Junior Physician: "How did you get such good experience?"

Senior Physician: "Bad judgement."

The One to Blame

Describing the path of medical training (or most schedules of work in American society) the notion of working 90 hours a week (benevolently reduced from the previously typical 120 hours) or showing up to work 6 am Monday morning and leaving at 2 pm on Tuesday morning, and all the while handling several sharp objects, toxic medications, and various tubes jammed into the actual veins and bowels of very ill fellow human beings--well its all sort of odd. Doctors in training are of course made of the very same veins and bowels, and have those same pesky requirements of other mammals, namely sleep, food, and the occasion to stop standing. In the medical profession such inconveniences are consoled by profusely attending/manipulating those other* needs of social mammals: acceptance, hierarchy, self importance and a good boy! pat on the head.

It all seemed very strange and i like most sensible people (including Congress) was skeptical of this tradition. [j/k neither I nor Congress nor most people are very sensible at all, but it is no less a reasonable stance]. I was then very shocked to realize the origin of this barbaric method of training that seemed oblivious to the triumphs of industrial society and the invention of the weekend, was invented by no other than my long hero, the pathologist and great teacher, Dr. William Osler.

"Perhaps Osler's greatest contribution to medicine was to insist that students learned from seeing and talking to patients and the establishment of the medical residency. This latter idea spread across the English-speaking world and remains in place today in most teaching hospitals. Through this system, doctors in training make up much of a hospital's medical staff. The success of his residency system depended, in large part, on its pyramidal structure with many interns, fewer assistant residents and a single chief resident, who originally occupied that position for years. While at Hopkins Osler established the full-time, sleep-in residency system whereby staff physicians lived in the Administration Building of the Hospital. As established, the residency was open-ended, and long tenure was the rule. Doctors spent as long as seven or eight years as residents, during which time they led a restricted, almost monastic life.

He liked to say, "He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all." He is also remembered for saying, "If you listen carefully to the patient they will tell you the diagnosis" which emphasises the importance of taking a good history.

The contribution to medical education of which he was proudest was his idea of clinical clerkship — having third- and fourth-year students work with patients on the wards. He pioneered the practice of bedside teaching making rounds with a handful of students, demonstrating what one student referred to as his method of "incomparably thorough physical examination." Soon after arriving in Baltimore Osler insisted that his medical students attend at bedside early in their training: by their third year they were taking patient histories, performing physicals and doing lab tests examining secretions, blood and excreta.

He diminished the role of didactic lectures and once said he hoped his tombstone would say only, "He brought medical students into the wards for bedside teaching." He also said, "I desire no other epitaph … than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do." Osler fundamentally changed medical teaching in the United States, and his influence spread to medical schools across the globe."

The prisoner in every man

"It is generally thought that common-sense is practical. It is practical only in a short-term view. Common-sense declares that it is foolish to bite the hand that feeds you. But it is foolish only up to the moment when you realize that you might be fed very much better. In the long-term view common-sense is passive because it is based on the acceptance of an outdated view of the possible. The body of common0sense has to accrue too slowly. All its propositions have to be proved so many times before they can become unquestionable, i.e. traditional. When they become traditional they gain oracular authority. Hence the strong element of superstition always evident in 'practical' common-sense.

"Common-sense is part of the home-made ideology of those who have been deprived of fundamental learning, of those who have been kept ignorant. This ideology is compounded from different sources: items that have survived from religion, items of empirical knowledge, items of protective skepticism, items culled for comfort from the superficial learning that is* supplied. But the point is that common-sense can never teach itself, can never advance beyond its own limits, for as soon as the lack of fundamental learning has been made good, all items become questionable and the whole function of common-sense is destroyed. Common-sense can only exist as a category insofar as it can be distinguished from the spirit of enquiry, from philosophy.

"Common-sense is essentially static. It belongs to the ideology, of those who are socially passive, never understanding what or who has made their situation as it is. But it represents only a part--and often a small part--of their character. These same poeple say or do many things which are an affront to their own common-sense. And whent hey justify something by saying 'It's only common-sense', this is frequently an apology for denying or betraying some of their deepest feelings or instincts...

"There is another reason why they sense that Sassall's way of thinking is a privilege, but as a reason it is less rational. Once it might have been considered magical. He confesses to fear without fear. He finds all impulses natural--or understandable. He remembers what it is like to be a child. He has no respect for any title as such. He can enter into other people's dreams or nightmares. He can lose his temper and then talk about the true reasons, as opposed to the excuse, for why he did so. His ability to do such things connect him with aspects of experience which have to do be either ignored or denied by common-sense. Thus his 'license ' challenges the prisoner in every one of his listeners."

From John Berger, "A Fortunate Man"

On Primary Care

I think the appeal of primary care which i didn't appreciate until i saw patients have really bad or no primary care is that it appeals to the editor in people. The power of the word is not the word itself, but like sculpture, all the words removed. Like the good news story with impeccably gathered facts, the complicated patient has a million and one rabbit holes to be lost in, and sometimes they are worth pursuing with full investigative and management gear on. But sometimes not, and if you let all the jumble sit there as it is, you lose the point all together. And so it becomes the fine art of editing--reducing medications, streamlining self care plans, construing an elegant model of health that engages the patient, yourself and all the other people invested in this person's well being. Medicine has always prided itself in the elegance and cleverness of its diagnostics, but it seems to me (at least in American medicine) this idea of the elegant therapeutics is still relatively new (perhaps the Cubans have long been far ahead?), what with the forced hand by economic factors and the revelation that you can't put 80 year old people on 27 different medications and think thats going to be totally innocuous.