Saturday, May 19, 2018

"I'm Sorry That I Got Fat, I Will Slim Down" - Wesley Willis

The spring in Portland shows glimpses of itself many times over before fully revealing it's gloom shattering nature. Days of 43 degrees and a kind of ethereal drizzle drone on and on. It was a night like this one. Wet, cold and just perfect was the kind of day that saw me see Wesley Willis perform live. EJ's was a rock club off of Sandy Boulevard, which occupied a building having been relegated to the inglorious task of housing a pawn shop. Sandy takes a diagonal approach as it passes over Burnside, the north-south dividing line, due northeast. It used to be a deer trail connecting the Columbia and Willamette rivers, which meet and mix on their journey to the mighty Pacific. In the year 2000 it was a mixed use major thoroughfare, off of which, in a quirky brick gilded building, yours truly was about to witness one of the greatest performances of his life.

Wesley Willis, may God rest his soul, was a man I'd never heard of before I sauntered into EJ's that cold and rainy night. Occasionally I indulge myself and ponder the various ways I can divide and organize the various phases and, at times, significant differences between these phases I look back and think that this was a "pre-9/11" night. I lived in a relatively care-free and hopeful future, on that was built on 8 years of consistent economic boom under the Clinton administration (oh the good old days when Christians and Republicans saw a clandestine blow-job as an impeachable offence -- oh, and the lying thing, too) and did not understand the looming storm that was to come in the wake of 9/11. Perhaps I think this because this was one of first nights out with what was to be a long-time girlfriend and group of friends I had many good years with. 

Back to Double-Dub. He had a callous on his forehead that lore said was due to him headbutting a line-up of fans after his show. And indeed, I stood in line and when it was my turn he said something and headbutted me. It was a night of significant revelry and celebratory partakings and I can't honestly say I remember what he said but it was kind of like a laying-on-of-the-hands, of sorts.

Early in the set we heard his ode to the Double Arches with this tune:

Later he followed this up with "I'm Sorry That I Got Fat," which is at the top of the post. Other insightful, popular songs include:

"Cut The Mullet"

"Suck a Camel's Poody Hole"

And of course, "My Mother Smokes Crack Rocks"

Out of all of these beloved classics, the one that continue to speak to me and help guide me is the confession of remorse concerning one's body habitus. And in my ongoing efforts to get "un-fat" this song is a component of my war chest that serves as my motivation ammunition. My initial commitment was 100 days to a strict way of eating. I set a ridiculous goal of losing 50lbs in 100 days. Aiming to burn one half of a pound of fat per day. That is, essentially, a 1750 caloric deficit, per day, as 1 lb of fat has 3500 calories. Well, I'm 38.4% of the way to that goal and this is the 44th day. That is correct, nearly 20 lbs down in just over 6 weeks.

I've found a successful way, a sustainable plan that has provided much more than just turning me into a fat burning blast furnace -- my mind continues to be functioning at a level that surprises me as I round the last corner of intern year. My sleep is higher quality, and I am naturally waking up before my alarm clock slaps me in the fact before 5 am. I occasionally have hunger pangs, but in general I can fast an entire day with very little hunger and even better, my energy is amazing on those days.

But I've already said too much. I've found that talking about accomplishments prematurely, even in the setting of good progress is unsettling; 55 days to go for my first preordained milestone. No more posts for the next 55 days concerning this topic. '

Saturday, April 28, 2018

Eastbound Powell Blvd at SE 92nd Stopped at Traffic Light in Lane #1

Must have been twelve years old, thirteen at most. It was before I started skateboarding.

The majority of my childhood had annual highlights, one of them being having my cousin and his family travel from Edmonton, Alberta -- The "Wild Rose" Province of Canada. Generally they would travel down for Christmas and then again in July, where our extended family had a beach outing. And this year was no different, my Canuck Cousin was staying with me and after an exciting night out on the town, with some older Cousins (I think) we stopped at McDonalds. I think it was McDonalds, we were being driven home. My cousin was in the driver's side back seat, I was in the passenger side backseat. Someone was in the middle. I don't remember who. For some reason I had picked up some nutritional pamphlets. For some reason, while in the backseat of the car, travelling due east on Powell Blvd (AKA State Highway 26) in the left land, somewhere between 60th and 92nd street, I was holding the pamphlets up to the window and pointing to them, trying to get the attention of a car in the right lane.

I got their attention. At the intersection of 92nd and Powell the light was red and our car, and the car of unknown people were stopped. We were next to each other. The driver exited his vehicle and came to my window -- he looked angry. My window was rolled all the way up; however, the window that my cousin controlled was rolled either partially or fully down. The angry man proceeded to the other side of the car and was yelling, with vulgarities. He may have requesting information as to why we (I) were holding papers up to the window and attempting to gain their attention. None of us had a good answer, including me, but especially the other passengers in the car who knew nothing of what had transpired for the previous 30 or so blocks. I'm not sure if my cousin responded to the inquiries or had much to say regarding the insults and such; but I do remember the angry man striking my cousin in the head. Was it open handed or closed fist? I'm not sure. It was a glancing blow, it did no permanent damage but it was scary.

This was before the days of cell phones and easily accessible cameras. My cousin took it all in stride; in general I think Canadians are a well adjusted, strong people. He is no exception.

We drove home with no other incidents.

At that time of my life, and as I see other young people, there is an element of "randomness equals funny" and, I think I had that going on. While occupying my "armchair psychologist" role, I see this as a mechanism of maturation, in that being "random" is a way to garner attention, and in some ways the person thinks it lends an air of mystery to themselves. In my childhood and even into my teen years I spent most of my time with people older than myself, some of this was because my parents were the Youth Group leaders at the church we grew up in, and I had an earlier introduction into that whole thing than I would have otherwise, part of it is that is just how the age ranges of my extended family shook out. Nevertheless, I often felt that I needed to get attention somehow, which often leads to negative aspects coming forth through behavior.

I thought it was "randomly" funny to hold nutritional pamphlets up to a car window and point to them while riding in a car.

I'm glad that incident ended with no, relative, harm done. No knfing. No GSW. Sorry old friend, I definitely felt bad after that happened.

What makes people react with such a quickness to anger? The dude who struck my cousin, if I remember correctly, was probably in his early 20's and I think he was white -- which is not a stretch in Portland. Sometimes I feel like I can sink into a reactive quagmire where my first, subconscious instinct is to feel anger -- that someone is imposing on me, or threatening to me, or is it a need to threaten them first? I think all those elements can get mixed in there, and, while I can only speak definitely for myself, I don't subscribe wholeheartedly to Solipsism as a framework for my reality and am willing to ascribe the previous ratios to other human beings. But I'm not usually like this, and when left to my own devices, with a relatively (and I say this with a big relative component here) low stress stretch, I feel like I am well adjusted with an ability to pause and process a situation before assuming the worst of everyone.

Another element comes to my mind while thinking this through; getting burned by patients and seeing how deceptive and manipulative some people are takes a toll. Often to feed a substance abuse problem, but also anxiety and true mental illness can force patients to lie about symptoms. This is not news to anyone, especially those in healthcare, but we, as providers, get better and while it is a headache and a time sink (taking away from patients who legitimately need medical attention, by the way) but this is not my point.

I wonder what that guy is up to now -- the one who took such offence to my nutritional pamphlets that he needed to strike one in our party. Does he remember that night? I would guess not -- someone that prone to physical violence probably has a lot of incidents over the years. I hope whatever pushed him into such an explosive reactionary mindset is resolved. Hopefully he isn't teaching his kids to respond in a manner as he did that night.

Friday, April 27, 2018

"Fascism is a Religion. The Twentieth Century will be Known in History as the Century of Fascism" Benito Mussolini

Good friend of mine introduced me to this podcast around a year ago while helping drive a moving truck down I-5. We made it almost all the way through a very intriguing episode called "The Prophets of Doom," an exploration of Martin Luther's reformation and the Anabaptists and the colorful and murderous exploits of one German City. Of particular fascination was the fact that the church I grew up in and that a large number of family and friends still attend hail from an Anabaptist heritage via Samuel Frohlich -- a trivial piece of information that, if you aren't familiar with, thankfully you will not find your edification compromised while listening to this.

A luxury of being so darn busy all the time is that consumption of media is lessened and when faced with some free time there is a pile of entertainment to pick from (a Stockholm Syndrome kind of thing to say, to be sure!) and the same stands for the available episodes on this podcast. However, I started listening to another incredible episode, concerning itself with the idea that ponders whether or not Human Beings are able to 'handle" the unimaginable destructive power of the nuclear weapon. Around a month ago I started and only today did I finally finish it.

I've written here, on this platform, and even before starting a blog, I have written short stories concerned with growing up under the threat of nuclear annihilation. In college, the best non-writing class I ever took was an elective all about the history of "the splitting of the atom" and was taught by a biochemist, who followed his passion of all things atomic and taught the class in a way that still has me pondering ideas -- political, scientific and really, the essence of the human experience. I like to think that I had the pleasure of growing up under the belief that armageddon was a heartbeat away, coupled with the threat of the rapture -- both happening in a blink of an eye -- from which a logical conclusion is arrived stating that this life, the only life we get on this planet, isn't worth much. Don't hope, plan or waste time thinking about the future because there is no future as you know it, or, as I knew it as a child. I'm off track again.

By the late 1800's the direct foundation for splitting the atom had been laid. Fundamental principles regarding electromagnetism and chemistry had been established; Newtonian Physics (which got us to the moon, by the way) had been a overwhelming success in terms of proving to be a true thing -- to be able to elucidate the unseen and hitherto unexplainable laws of the Universe.  140 years, or so, removed from when this science began to take hold we can look back and see the how this Earth has changed in ways never before seen. Truly, the wonders that we take for granted on a daily basis is astounding. We have devices that rely on technology developed by people who grasp certain fundamental rules of the natural Universe and even now, this technology is used by people who have efforted not to gain this understanding but espouse ideas that discount the efforts of those who sent us to the moon and even worse, those who deny the very basic geometry of residing on a sphere.

The idea of Generation "this" or Generation "that" seems, on its surface to be a irrelevant construct and who is to say who or what are in what groups, or demarcation lines arbitrarily drawn and the idea of what they mean, or why we think like this seems to be obscured, in general. In the terms of simple timelines and brackets of generations, the major defining events of recent history, worldwide, are easy ways to try and interpret the events as we see them in real time, today. World War I ended November 11th, 1918 -- almost 100 years ago. Anyone who played a role in the actual war is dead. I suppose a ten year old kid may have been in the war and is now 110 somewhere, smoking unfiltered Lucky Strikes and chasing it with a swig of Old Grandad, but nevertheless, no-one in our daily lives was a soldier in WWI; the same is going to happen to WWII veterans soon, too.

The people who remember what life was like when the shadow of nuclear annihilation first brought the shade to everything they did and knew are also in short supply. Dan Carlin makes an analogy of the threat of atomic warfare acting as a gun to the head of humanity. When life has been going along, while not perfect (and even less stellar for those digging out of the rubble of yet another world war) noticed the gun against their head and acted as such -- panic, fear, anger, progressive discussion and schemes of leverage, was everywhere. As the Cold War progressed and the Arms Race blossomed into a specter of death unlike the world has ever seen, people who grew up in this environment, and while they didn't remember life without the gun pointed at their head, they were raised by people who did. People who still felt the presence of the gun very much. We are removed enough at this point where very few people remember life before the gun to the head.

Within the past day it seems, at least on the surface, that the DoomsDay Clock has moved slightly backwards. North and South Korea lessening tensions, if sincerity exists on both sides, cannot be a negative thing. Remember the United States has pledged, through treaties to defend South Korea with nuclear arms, if necessary -- and for that matter, a few dozen or so other allies have this umbrella of protection with the United States -- for now. And what has the supposed problem been with North Korea? Their exploration in becoming a nuclear capable state -- while problematic, to be sure, it is that which pushes the foreign policy needle -- not torture, starvation and brainwashing of the people.

Amongst more than a few other reasons, a significant concern of our current national leadership lays in the little reason to trust or have confidence in responsible stewardship of our nation's strategic responsibility. A person like this, who currently holds the office of President, would not have been elected when people felt the gun to their head. People are easily whipped up into a frenzy over immigrants, the myth of Christian persecution (specifically in the US; not discounting oppressive totalitarian regimes and their religious militant dogmatism) and the trappings therein and the gun, which is still there, is nothing but another line item in the pantheon of complaints and murky conspiracy theories. We have moved into a day and age in this nation where real nazis and Ku Klux Klan members are walking around, with no shame. I fear that this is how the world has always worked, that the rise and fall of empires, nations and dynasties have always had the generation which eschewed the wisdom of the past, but only because of the corruption of the generation that raised them. Who complains about the "participation trophy" generation? The same f'ing generation that gave the trophies out!

And what does it take to bring a society together? A tragedy. A war.

Do you trust North Korea? Interesting to ponder what's up the sleeves of his Mao Suit.

Saturday, April 14, 2018

Concerning the Body and Internal Combustion Engines, Carbohydrates are to Fat as Gasoline is to Diesel

Post #113.

July 25th, 2011 was the date of the first post.

2450 days since first post.

An average of 1 post every 21.68 days.

Like our brains are wont to do, 7/25/11 in some ways feels like yesterday, and in some ways it seems like a different person typed out the words of the first post.

I remember one of the first lectures in medical school from one of the more insightful professors included a thoughtful discussion about the process we were about to undertake -- one that I'm still going through and in essence, will continue to have as long as I practice clinical medicine. Specifically he spoke of the propensity of this process to bring forth and manifest the vulnerabilities that each of us have. Not completely earth shattering in that people under pressure and stress show weakness where their biggest weakness lies -- of course they do! But this sticks with me, and I remember sitting in the lecture hall thinking about what my biggest weaknesses are. For me, there are plenty of aspects to pick from; my curiosity lay in wondering which particular one might show up.

Well, I can safely say that plenty of them did "show up" but one, with the help of age, history and perhaps familial propensity has had lasting ramifications. Weight gain.

I spent the year between graduating with a B.S. in biology and chemistry (don't forget my minor in creative writing!) and starting medical school, working and running. I ran a few half-marathons and worked at the same coffee roaster as I had been during my whole time in Denver, but back in a full-time capacity. Tossing around 160lb green coffee bean bags was no big deal. Running 30 or so miles every week; I was in great shape. I felt great. So hopeful for the future, for the doctor I was to be.

Abruptly going from that to lectures from 8 to 5, 5 days a week with a tragically large increase in cortisol due to stress left me rapidly piling on the pounds.

I've bounced around in various states of "fatness" since that time. Many months have been simply to busy to adequately exercise, and usually those months are stressful enough that adhering to a caloric deficit, or simply eating an overall healthy diet is difficult to maintain.

And here I am, roughly 6 and a half years from the last time I considered myself to be in "good shape." And here I am, approaching the end of intern year. An intern year that has had some of the most stressful days and nights of my life. And here I am, on the downside of the most demanding periods of training, with undoubtedly much left to learn, but also with the steepest learning curve behind me. In other words, as my youth continues to be ever more fleeting, now is the time to make moves -- to redirect the discipline and frankly, stubbornness, that has gotten me to this point in my career to another, more personal objective: weight loss and physical fitness.

I am a large human, relatively, in that my skeleton is taller and broader than most. Throughout my life, in various phases of intensity, I have worked to hang large muscles from my skeleton. The Body Mass Index does people like me a disservice (I could easily get distracted and go on and on about how BMI is severely flawed and that the creator of the equation never meant it to be used as it is today but perhaps another day, another post)  in that even at an appropriate body fat percentage, I will still be solidly "overweight," close to the numbers that equate obesity. Well that's okay -- at least I have that understanding.

So what am I doing to facilitate this change? I am hesitant to get into it -- to explain it, and as a physician I am even more reluctant in that I'm held (starting with me, I hold myself to a higher understanding of physiology) to a higher level of scrutiny when it comes to things like diet and lifestyle changes. This is because of the fervor and obnoxiousness that exists around American fitness, or lack thereof and efforts to counter the obesity and deconditioned nature of the people of this country.

Simply put, I'm facilitating the usage of stored energy (fat) instead of using new energy (food) to live and stay alive.

There are many ways to get to this state of metabolism. After all, our bodies in some ways are simple machines in their overall function and aims -- when excess energy is available it is stored, and the reason for storage, obviously, is to have it available for usage at a later date. Less energy pushed into the system, say, on a daily basis that is not sufficient for daily operations means the body will dip into the energy reserves. A caloric deficit is what this is. It is necessary as dictated by the 2nd law of thermodynamics in order to decrease mass of adipose tissue in each and every one of our bodies. Many people call this "Calories In; Calories Out" (CICO) and state that the argument over how best to lose weight ends here and it is this simple. And while yes, it is simple, it is an incomplete understanding of how best to optimize the usage of the energy reserves tied up in fat cells. Our body uses enzymes (which by definition lower the activation energy needed for a given chemical reaction; think of enzymes are able to get the ball rolling much easier and faster than it would on its own) hormones, and a complex feedback system to balance our energy usage and management of our reserves. Of course, perhaps the most important aspect is how we feel in that feeling hungry, having cravings equates to a conscious realization that our metabolic machinery prefer fast burning, efficient energy by way of eating food -- often in the form of the best bang-for-the-buck-compound our bodies can use -- carbohydrates. Gasoline is a carbohydrate (well, technically a hydrocarbon, as there is no oxygen atoms in the compound, but for this analogy, it works) and the power it unleashes when burned is obvious -- I took the fact that when I accelerated my automobile to get on the freeway this morning for granted; no appreciation at all for the controlled explosions occurring a meter or so in front of me, pushing me and a few thousand pounds of steel, glass and leather to a velocity unheard of for human travel for the overwhelmingly whole of our history. Regardless, a loose but workable analogy can be made here: gasoline is to diesel as carbohydrates are to stored fat. Shaquille O'neal, a man who makes me look petite had a nickname (among others) of "The Big Diesel" in that he was huge and slow, but steady and extremely powerful. Our bodies operate with an exaggerated difference; carbohydrates are fast burning, easy to metabolize and as such our senses are built to favor these compounds -- bread, sugar, pastries -- whatever, we naturally feel pleasure when consuming such things. A gratification that keeps us doing the things that our bodies need us to do.

Throughout our history, access to pure dietary glucose was minimal. Fruits. Honey. Grains. Natural syrups. That is all we had. Our bodies were exceptionally adept to take excess energy, in the way of a big influx of carbs, and store it. Our liver is able to take the sugars (carbohydrates = sugars for our purposes here) and turn it into something called glycogen, which is a stored form, and relatively easily accessible form of sugar. Our liver is a large storehouse of glycogen. Our skeletal muscles hold a lot of glycogen too. If our glycogen "tank" is full, well then, what happens to excess carbs that we eat? Our liver turns it into fat and it goes to the fat cells.

Modern humans overwhelmingly have less and less physical exertion as a component of daily living. I mean, the idea of paying to go to a place that has specialized machines to facilitate energy expenditure is a ludicrous idea for most of our history -- but here we are. 500 years ago, glycogen levels would be highly varied as that human, 500 years ago, depended on it for living. It takes a day or two to exhaust glycogen and if the glycogen was exhausted, that body would pull from the fat stores, as there was no other energy available, provided food was unavailable, or even if that person had a caloric deficit.

This speaks to what I'm trying to explicitly accomplish -- maintain depleted glycogen stores in my body so that the cellular machinery that keeps each and everyone of my 37.2 trillion cells (give or take a few billion) alive and functioning are burning fat, instead of carbohydrates for fuel. Simple, right?

Theoretically simple. Restrict carbohydrate ingestion to a degree where the body must pull from glycogen reserves. The body, at least at first,  dislikes this. Sugar is easy to burn. Energy required to burn it versus energy from burning it is good; it is efficient. We are built for efficiency, if nothing else. But then if carbohydrate ingestion is continued to be restricted, the body must acquiesce and use a much less efficient fuel -- you guessed it, the diesel of our diet and energy stores: fat.

As I said above, I hesitate to evangelize a certain diet above others, provided that there is evidence behind a given way of eating. For me, relying on endogenous "diesel" decreases the ups and downs of blood sugar and subsequently, feeling good and bad, with cravings and hunger a large component of daily life. Much of our "feelings" are driven by our insulin response; and perhaps more importantly, insulin dysregulation, whether it be at the factory (pancreas) or at the affected tissue (insulin resistance) leads to diabetes and other types of dangers associated with an excess of adipose tissue, including inflammation which, as we are learning, is highly correlated with atherosclerosis to a higher degree than simply over ingesting cholesterol or dietary fats.

Lastly, I think it is important as a physician to be very critical of the consensus guidelines that direct our clinical practice. For the past few decades, we leaned on the "fact" of a low fat diet and the evils therein. Study after study showed the correlation of high fat diet and cardiovascular disease, obesity and a myriad of other issues. It is now becoming clearer that at least some of this was pushed by the food industry in that cheap sugars needed to be sold as healthy. Eliminating fats, and having "fat-free" printed on a package was a panacea to the burgeoning obesity epidemic, so thought the American masses, and understandably so. Instead we were and to a lesser degree every year, depriving ourselves of essential fats and cholesterol that our body needs to function. Our body requires these things to function. Interestingly enough, our body does not require any carbohydrates to function. Now listen closely, I am not advocating everyone aim for a zero-carb diet, but just this realization is in direct conflict with the "common sense" of our age. Food for thought.

As a brief sidenote, consensus guidelines in medicine are controversial by the very fact they are consensus meaning that a group of scientists and doctors had a pow-wow and they all compromised to a certain degree to arrive at the decision of what to tell doctors to do in their clinical decision making. This means that the truth is not necessarily guiding the decisions, but the amalgamation of opinions. I didn't spend the last 8 years of school along with the years of clinical experience to simply abandon my own judgement and reasoning; and I, even now, can see evidence that guides me away from consensus guidelines in pursuit of providing truly the best care possible for a given patient. Again, I could go on and on...

I'm not even going to name this particular way of eating. Through my understanding of how the body works I am simply aiming to help my body use the energy reserves. And that is post #113.

Tuesday, March 27, 2018

Na Na Na Na Na Na Na Na LEADER!

Over the weekend I binge watched Wild Wild Country a documentary on Netflix about the Rashneeshi movement and their effort to build a city in Central Oregon, basically isolated by dozens of miles in either direction. I can't recommend it enough, of course I have a unique element allowing for, perhaps, extra exuberant enthrallment in that I remember this unfolding on the 5 o'clock news, as I grew up in Portland. It was edifying to see the fiasco from both sides; the "free-love, humanistic sannyasins" versus the "ultra-conservative, undereducated white normies" in the nearby town of Antelope, population of 40, at the time. The Rashneeshis were actually Sannysins, followers of Bogwan Shree Rashneesh. They, for most of their time in Oregon, wore all red clothing and were easily identifiable as such.

Cult of personality if there ever was one. Many of his followers spoke about his "presence" and less of his teachings.

This film inspired me to ponder the nature of leadership. Undoubtedly there are untold numbers of humans who have had good ideas, who have had the self-sacrificing nature and altruistic nature that we often say comprises a good leader. I would counter that many of our leaders, from unofficial "leaders" of a small group of friends, to middle-management in any corporate setting, anywhere USA to leaders of industry and those at the highest levels of elected governorship have many discernible attributes, but self-sacrifice and altruism are hardly elements that allows one to climb rank.

Not always is this the case, thankfully. From my perspective, however, I think our culture in the United States has shifted slowly over the decades to espouse and honor results at all costs, and many times, short term gains over long term losses. I could go on and on. I can point my finger at a few specific aspects of our financial system that not only reinforces, but under penalty of law, enforces this dynamic. Of course, if The Citizens United ruling actually made sense, corporations would be interested in their long term viability and not only immediate profits.

I digress.

"Doctor" in latin, translates as "to teach." Not all teachers are leaders, but I argue that most effective leaders, to some degree, are teachers. Perhaps not in an official capacity, but an effective leader needs to educate those in their service to a point where toil is performed with willful duty. You may forgive me for not immediately thinking of a martial structure, where rank and file do as they are told with no questions or concern. This system works when there is punitive action for disobeying orders. It is effective, this is why armed forces and totalitarian regimes adhere to this chain of command. However it is fragile pending loss of punitive measures. It is far better to have willful adherents to your etiology. Whether it be "cubicle troopers" who understand the need for TPS reports (may not like doing them, but they understand their utility and thusly dutifly complete them) or Sannyasins who would willingly die for a man named Bogwan Shree Rashneesh.

I never watched Nurse Jackie when it was airing on Showtime. I remember it was very popular when I was in undergrad. Last night I watched the first episode. Within the first few minutes we learn that doctors are idiots and that (at least Jackie) nurses are the only ones that care for patients well being, much less their medical outcomes. Makes for good TV, if you've never been a doctor, I guess. Not to demean the role nursing has in patient care (I always feel compelled to state that when talking about nurses) but the doctors, at least in the first episode are so careless and cavalier with their medicine, much less their demeanor with patients and other staff that they would not last a week in modern healthcare. At least not in the last century. And why do I bring this up? Because it flies in the face of everything I strive to be as a physician, and overwhelmingly everyone I've ever met in this process -- whether at the end of their career or an aspiring pre-medical student.

So what do I care about leadership? I worry that it stems from a place of ego -- from desiring power. I then remember that just having that worry, the fact that this is a concern of mine is a prognostic factor for a healthy leader. What capacity will this aspiration grow into? I don't know. Simply being a physician thrusts me into the role, like it or not. And there are days where I like it less than others.

Tuesday, March 20, 2018


I've been a basketball fan as long as I can remember. I would stay with the grandparents and we would watch Blazer over-the-air broadcasts. I remember going to my first Blazer game, I think I was in first grade and my neighbor Jason took me with his family. They played the Mavericks. I had a hoop on the garage, with a sloping driveway as a court.

Terry Porter came and gave talk at the elementary school (Lynch Park, now a Montessori School) and I remember watching him shoot hoops with my gym teacher. When Clyde, Terry, Buck and Jerome went to the finals (twice) my school was filled with signs and it was nearly a holiday of sorts as they kept winning through the playoffs. I've played and watched a lot of basketball in my years.

And I hate James Harden and Chris Paul as basketball players so much. They each embody the very things that I dislike about watching professional sports. But most of all, and this is the thing that really gets me -- they've both quit on their teams. Just gave up. Said, "nah -- I'm good. Just gonna take my paycheck and peace out." A lot of people do this with their jobs. I would argue that people who do this at their "normal" jobs deserve the ire I have for these professional, high-profile athletes. I sure do.

Perhaps it is due to hubris; maybe just wishful thinking, but I identify with basketball players who have ascended to the top of their game, who have shown that they have potential to be the best of the best. NBA basketball is a team sport,  yes, but all roles are not equal in responsibility, nor in compensation. Healthcare is a team sport, and of course roles are varied, with disparate compensation. Sometimes I think "wow, nurses work really hard! Why do doctors get paid more than them?" And of course nurses work hard, many days their hour to hour labor output is higher than a physicians. But when mistakes in care are had, or bad outcomes occur, the lawyers look for the doctor's name, not the nurses.

Chris was on the Family Feud though; surprised he didn't flop on the way to the buzzer thingy

A very loose analogy, and I hope this does not betray my sincere respect and (usual) love of nurse, but it kind of fits. Think of James Harden as someone who is obviously talented and to a certain extent, a student of his craft. He has obviously worked hard to get where he is, and this year he will probably win the MVP award.

Last year, in the playoffs, with his team being one of the best during the regular season, in an elimination game I watched him play with a urgent sense of apathy. He gave no shits. He went to the strip club after the game. He gave a big metaphorical middle finger to all those who had worked with him, next to him and for him all season long. He took the money and ran. No respect.

Of course his style of play, where gaining a whistle from the officials is foremost in importancy versus actually scoring, or assisting is an antithesis to all things I hold dear about the spirit of the game, but at least that is understandable. It is all for the aim of winning. Giving up? Miss me with that weak shit, Harden.

And Chris Paul. Used to play for the Clippers for the recent history until this year, teaming up with Harden and leaving LA for Houston. I don't think many tears were shed when he left LA. He is a difficult teammate to have. And while his blatant apathy is not as egregious as Harden's, he has a track record of potential unrealized.

He is criticized for not making it out of the 2nd round of the playoffs. This is not the root of my consternation as there is a lot of confounding issues, namely injuries which have been the primary reason. However -- and this is interesting -- a couple of years ago when the Clippers were playing the Rockets one of the best (in my mind) collapses happened to the Clippers. A franchise full of failure, throughout its history added to the legend of the perennial butt-of-jokes.

And the best part about this is that the Rockets did this without Harden, who was useless, again, in the playoffs. Bench players played with heart against a Clippers team that seemed to have all but mailed in their advancement notice to the league office -- perhaps 12 minutes of play early. Chris Paul looked like he just wanted it to end, and while his betrayal of all things honorable and right in this universe may be less impressive than Harden's, they are now on the same team. A team that has the best record in the league. A team that relies on Harden drawing the most cringe-worthy and bullshit foul calls in order to succeed. You see, it is not just the free throws that matter, it is much more a matter of disqualification of the defending players which alter an opponent's ability to fight appropriately.

Here comes the obvious comparison to doctors who would act in the same manner. Unfortunately, there are too many of us who do act like that. I deal with them, I'm sure you have, at some time dealt with someone like this. I could go on, but I just really want the Blazers to take out this very unlikable Rockets team tonight. 14 in a row.

But really -- how are the current Lakers so much more likable than the Rockets!? Especially now that D'angelo is gone. Huh. Who woulda thunk it.

And finally -- best wishes to Damian Lillard who is expecting a baby boy any day now. And very selfishly, thanks to the baby for not saying hello to the world until after the game tonight.

Sunday, March 18, 2018

I used to be with it, but then they changed what “it” was, and now what I’m with isn’t it. And what’s “it” seems weird and scary to me. -Grandpa Simpson

If I had to guess where my love of falling asleep to background noise, whether it be music, talk radio or television it comes from listening to Blazer games on the radio (1190 KEX) and waking up with some talk show blabbing on and on. It could be the fact that our household did have the television on more often than not and when I was really young I imagine falling asleep with the TV in the background was common and who doesn't love being carried to bed? Or staying up late with visiting cousins, watching late night TV before Grandma and Grandpa had cable. And then later skate videos over and over. Later in my teen years I would listen to the Art Bell show --  Coast to Coast AM -- a show that now seems to be lost to the "alt right" and new crop of the willingly ignorant. A distinct peculiarity of the modern age -- the ability to numb, or quiet our minds with background noise. Am I simply drowning out my own thoughts with incessant noise? Ehh -- whatever. A question for another day.

Regardless, this has turned into me having a 12 year run of using The Simpsons as background noise, a comforting chorus of voices and music; a presence that has been there for 3/4 of my life. First there was JTV.TV which was a casting website, where in the early and mid 00's people would stream NBA games. This is what drew me to web streaming channels. Eventually it would turn into what is now Twitch, where you can watch other people play video games -- I struggle to believe that this is actually a thing, but I digress. From that website's demise came another dude who has been streaming TV shows, including The Simpsons for approaching 10 years. If I'm studying I will often have this channel in the background. If I go to bed before my wife I often fall asleep with The Simpsons in the background. This particular channel has a season 1-13 option and one for season 13 and up. Overwhelmingly I watch the earlier season option.

All of the episodes for the first 13 seasons are known to me in a way that is overwhelmingly familiar and intimate. It will be difficult, but for each season, 1 -13 I will pick my favorite episode and break it down for y'all. Just what you've been waiting for -- a sitcom review for early 90's television! 

SEASON 1 --  12/17/89 - 5/13/90

Season 1 debuted December 17th, 1989. It was a Sunday. I think my family at this point was going to church on Sunday morning and evening and were in the habit of watching America's Funniest Videos with Bob Saget.  The first episode had the family adopting a dog that Homer bets on at the track, Santa's Little Helper. But the show that really gets me from that season is focused on Lisa. Moaning Lisa

While I was a year or two away from finding skateboarding and really having that world open up to me, but nevertheless I was at that age where the need for finding things outside of the familiar family experience really starts to grow. Normal growing up things, and knowing Lisa had the same kind of experiences was comforting, in a way that I'm sure I could not have articulated back then. 

SEASON 2 --  10/11/90 - 7/11/91

Danny Devito delivers, as always, in this episode. He plays a successful CEO of an automobile company, until, of course he learns he is a Simpson. Homer designs the car, it is a design disaster and puts Unky Herb out of business. I can remember my parents discussing the fact that this was loosely based on the Edsel, a Ford Company failure of a car, and it's design led to its failure. Interesting.

All in all, the second offering has a lot of solid episodes, where characters are really developed and without this foundation, the years upon years of static characters would not be possible, or at least, less successful and longevity would be compromised. And while many things have been compromised as the series has worn on and on, longevity is what they can hang their hat on, I guess. 

SEASON 3 --  9/19/91 - 8/27/92

Spinal tap. Failure-to-Launch dude in the attic. Classic rock concert riot. 

SEASON 4 --  8/24/92 - 5/13/93

As someone who had at least 4 church related activities per week growing up, I related to this episoded from the get go.

My all time favorite episode? Well, yeah. I think so. Phil Hartman as the Monorail salesman is just perfect. Leonard Nimoy. 

And how could we not include this gem:

And while this is pushing the envelope of undisciplined and indulgent episode inclusions, I don't really care and furthermore, here is more. I love the theory that in the fourth season, as we see in So It's come To This (A Simpsons Clip Show) that Homer is in a coma. The fourth season is where the writing becomes more whimsical and takes more liberties with twisting reality. I posit that this has allowed the series to survive and in some ways, the subtle style developed here directly lead to Family Guy and the cut scene architecture they use, all the time. Anyway, the theory posits that the rest of the series, since 1993 has been going on in Homer's head as he remains in a coma. Explanations for why celebrity appearances include family members, workers or a TV left on talks about celebrities and he incorporates these names into his dreams. I like it. I like thinking this is what happened.

The 4th season also gives the episode that has us fall in love with Ralph Wiggins, the "choo-choo-choose" me episode.

SEASON 5 --  9/30/93 - 5/19/93

The Last Temptation of Homer. Mindy and Homer. Need I say any more?

Another worthy moment from this season is the song the family sings with, and for Apu as he was fired from the Kwikee Mart, and in a heartbreaking admission at the end of the song, we learn that Apu does indeed need the Kwikee Mart. 

SEASON 6 --  9/4/94 - 5/21/95

I chose this one because it shows Ned in a light other than mockery -- and it its not as if they don't show Ned positively on a regular basis, I just could identify with the idea of the self sacrifice. It was discussed regularly growing up.

SEASON 7 --  9/17/95 - 5/19/96

King Size Homer has a mumu wearing Homer as he has decided to gain weight to get disability so he can work from home. The first time I heard the "any key" joke and where he orders a "Tab" by hitting the tab key. Classic.

SEASON 8 --  10/27/96 - 5/18/97

Homer's Enemy Frank Grimes.  A tragic and ultimately supremely understandable and knowable character. Frank Grimes is you, and me. It is what we would be tempted to do if thrust into the world of Springfield, depending on Homer and his role as Safety Supervisor at the nuclear power plant.

But also El Viaje Misterioso de Nuestra Jomer (The Mysterious Voyage of Homer) cannot be ignored. Marge trying to distract Homer from the Cook Off and then Homer smelling it and when he starts stomping up and down complaining that he is missing the Cook Off is just classic and really, in a way we feel sorry for him. Of course we want him to go to the Cook Off. Marge gets him to agree to not drink, and until he eats the insanity pepper he doesn't, of course, that is just when Marge shows up. And Homer ends up going on what, in my opinion, is some of the best television ever made with his psychedelic dealings with the coyote.

SEASON 9 --  9/21/97 - 5/17/98

Reality Bites. The final Phil Hartman performance. Celebrity deaths are not something I dwell on by any means, but the tragedy that is Hartman's murder by his wife and a uniquely loved career just makes all of his Simpsons visits that much more valuable and cherished. Homer driving Snake's car is always appreciated -- just a pure joy -- a man and his muscle car. Love it.

While I'm thinking about it here is a Phil Hartman dump. News Radio, a oft overlooked gem from the late nineties when the turn of century and the feverish worrying about the Y2K computer disaster really became a dull roar drowning out all other things. Everything but Prince's Party Like It's 1999, everyone heard that song over and over.

SEASON 10 --  8/23/98 - 5/16/99

Make Room For Lisa

Another Lisa-and-Homer-centric episode and  the deprivation chamber scene with Homer makes the episode, even with solid side stories. Homer wrecking the Bill of Rights with chocolate and then having the private cell phone company running the place just speaks to the fact that this era of writers really were so clever in their comments on society. 

SEASON 11 --  9/26/99 - 5/21/2000

Days of Wine and D'oh'ses

Barney goes dry. Perfect scene where Homer takes a six-pack for Barney as he is piloting a helicopter trying to rescue Bart and Lisa. 

SEASON 12 --  11/1/2000 - 5/20/2001

HOMR. Homer had a crayon in his brain, stuffed up there when he was a kid. They remove it and he is suddenly intellectually competent; able to relate to Lisa for the first time in the show on her level, less her making effort to understand him and his ways, as we've seen in earlier episodes with Homer and Lisa. Going through these I actually am surprised I have as many Homer-and-Lisa-centric episodes. Huh.

SEASON 13 --  11/6/2001 - 5/22/2002

The Sweetest Apu. Homer sees Apu with the squishee girl in the walk-in freezer. Scandalous!

I can hear it now -- the march of pitchfork bearing Simpson-philes who are asking me where are the Treee House of Horror episodes? For many of the above seasons I could probably make an argument for the Tree House episode being my favorite. I kind of hold them in a different category, in fact. I thought I'd just go through some of my favorite Tree House segments. These episodes are meant to be the Halloween episode, often airing a week or so off, depending on what is going on with the World Series, or whatever. There are three, separate segments of weird and whimsical, often set in alternate realities, or what have you.

No. No Sideshow Bob episodes. I don't like them. The one and only one that is tolerable is when he marries one of the sisters, and we really learn about the love of MacGyver.

But I do love Grandpa Simpson. How about a Grandpa collection? Okay!

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