Sunday, December 24, 2017

Creston Park, Holladay Center, The Underground, The Waterfront, Lincoln High and Blue Garage

For the past three or four weeks I've been reading  a treasure trove of 90's skateboarding lore and 'where are they now?' type of things called the 'chrome ball incident.' Over the years I've perused this blog once in awhile over the years but I got caught up in it and have been working my way backwards. I'm reading interviews from 2011 right now. I've become fascinated by these interviews of people who were heavily involved in skateboarding during the same time periods I was. 

Bryce Kanights at the China Banks in 1986. Photo: Grant Brittain

In 1986 I had a passing fancy in skateboarding. Some kids at school were skateboarding, and they wore Vision Street Wear shoes, which I must admit I coveted with the desperation of a fourth grader who wanted to be cool, and liked. 

I wanted these shoes for so long, well, 2 years seems like a really long time in grade school. 

The kid also wore this Def Leppard shirt that I thought was the coolest thing I'd ever seen. 

Def Leppard had graphics and logos that simply enthralled me. The album cover for Hysteria seemed so cool; I remember the smell of the cassette tape inner leaflet, whatever that thing is called. Remember, the drummer from Def Leppard only has one arm and Hysteria was the first album for which this was true

Interestingly enough, this same kid would be one of the most talented dudes on a skateboard I would know. He never seemed to really like skateboarding. He was throwing 360 flips when I was a Freshman and struggling to learn to control my ollies. But I'm getting way ahead of myself here. 

Kobe Bryant had his jerseys retired last week and he, like many others before him, wrote a love letter to basketball. That, plus my recent obsession with Chrome Ball Incident have led me to think about labels, self-identity and appreciating the forces that have shaped me over the years. 

My ideal dream of skateboarding in the 80's

No surprise that I point to skateboarding to providing me with many of the ethos and general philosophies of life and problem solving that I still use today. I've spoken to this point in various manners with different perspectives. Here is yet another way that the love of skateboarding still bubbles up within me. 

I wanted to be a doctor because I thought it would impress the ladies. 

Vision skateboards. Yup. 

That was the first spark that allowed illumination of the path I'm still on. Of course that reason has been retired for many years and I've been able to find many better reasons to keep going. 

Powell Peralta trying to be cool like World Industries here. This is not the Powell Peralta that I grew up with; no skulls or even skateboards or skaters in this ad. 

Similarly I started skateboarding because the cool kids were doing it -- first, in the 80's when Vision and Powell Peralta and the Bones Brigade ruled the day and then later, with a very different style, the early 90 street skaters, with a bizarre look of huge pants and tiny wheels struck a chord with me.

Uniform circa 1991

 My first and main exposure to such styles actually came from friends and family from Edmonton, Alberta. The irony was lost on me at the time, that a kid in Portland Oregon, a place that had and has continued to have an exceptionally strong skateboarding culture and community was turned on to such a fascinating world by kids from the suburbs of Edmonton. Not actually a cousin of mine, but cousins with dozens of other cousins of mine was a kid who was a year or two older who was riding an Andrew Morrison New Deal board. 

Prolly the best skate video of all time, prolly

It was an everslick and the first board that I road that had the double kick -- a staple even now. I had no idea who Andrew Morrison was, nor the history of New Deal, or even what had happened in the industry which had left Powell powerless and Vision Street Wear nowhere to be found. 

I didn't even put together the fact that Blind Skateboards was started by skaters from Vision and that it meant something, but I did know what Video Days the video meant as far as where and how skateboarding would progress; and that is what I cared about. Not many images available of that vaunted New Deal board exist, the best one I can find is from a collectible website. 

My first real skateboard

I had spent the summer in Edmonton and when I came back home to Portland I was determined to become a skaterdude. Initially I bought an old Alva board from a friend and I learned to ollie in my garage and driveway. My birthday is in October and I made my desire to get a New Deal Andrew Morrison Everslick board with Venture 5.0 trucks for my birthday. Cal Skate, perhaps Portland's oldest skateshop was housed on the Eastside at that time in a small warehouse that had a wooden skatepark inside. For about month before my birthday, I would come home from school and call Cal Skate and ask them if they had this board in stock. I mean, they were making fun of me on the phone by the second week and thoroughly disgusted by the 3rd week. By the time my dad took my friends and I down there on a Friday afternoon, it was all they could do not to wring my neck. I was oblivious and was focused, with a singular mind that had this goal that must be achieved. 

Me. Baby blue airwalks. Tiny wheels. New Deal shirt. Alien Workshop hat. And, I'm pretty sure these are thrift store cut-off jeans. 

I remember trying to hatch money making schemes and brainstorm for odd-jobs in case I didn't get this skateboard for my birthday in 1992. They did have the board, I got my Venture trucks with the green bushings and was talked into a set of grey Channel One Sidewalk Surfers for my wheels. 

1992 saw TWS advertising articles that discuss how much skateboarders hate snowboarders (I remember when that was a thing) and of course, street style vs freestyle. Oh to be caught up in those things and care so much what I should think is cool, and what is not

Clearly I picked up a skateboard because I thought it looked fun and the people doing it were intriguing. That remains true, but turned into a real joy of riding the board and evolved into a alternative way of viewing the world. 

The holy mecca of skateboarding. RIP concrete formations. Right now there is the annual ice skating rink, not that it matters to skateboarding anymore

The cold and brutalist architecture that comprises many of our urban centers are turned into playlands with ledges to slide across, stairs to jump down and handrails to grind down. Objects serving a purpose completely unbeknownst and inconceivable to the architects and corporate needs that shaped the plazas and courtyards around the world. 

There is something about that, this concept of repurposing objects and procedures for alternative means -- Hip Hop took cuts from the jazz, funk and R&B from the generation prior and gave it now life in a way the composers, musicians and singers did not imagine, parallels exist in street skating. 

Two of my friends and me. I can tell you that I'm riding a New Deal Ron Knigge Everslick board. My friend to the right of me has a well worn Rob Dyrdek Alien Workshop board with Independent trucks and a New Deal shirt. The friend in the back had a Firm board at the time. This stuff meant so much at the time. 

Whether we are rich or poor in America we are surrounded by excess -- the difference being our direct access to those bounties. In this environment it seems like a healthy thing to take an artificial world built of concrete, bricks, marble and glass and use it as a canvas for the art and science of skateboarding.

The magazine scene had Transworld's monthly offerings reduced to thin stapled affairs. Thrasher wasn't much better. I still poured over every page, picking through the ads, feasting on the art and iconic logos that have and continue to function as a rootbed for popular culture at large, to varying cyclical degrees. 

Lean and mean alright. I used to be, too. 

Now I live in a world with much less "EMB" and more "EBM" -- Evidence Based Medicine, that is. we do things for reasons, reasons that are based in research. But this drive to see things in a way that is often perpendicular to the way it was "meant" to be viewed still exists. And yes, I do look at the parking lot's curbs, curb cuts, ledges, ground and gaps -- but that isn't what I'm getting at here. I fully embrace the EBM way of conducting the science of medicine, but the art of medicine is much less science, or evidence based, for that matter. I know I keep writing about this, and well, I think I'm still trying to wrap my own head around how to get best outcomes for patients. And for me. For the most part, my best outcome, so to speak is tied directly to the patient's outcome, allowing that there is just some processes doctors and modern medicine cannot affect, or change -- I get that, it doesn't take long for a physician to see this. But a doctor's best outcome is more than just tied to the patient's clinical course, of course. That is what I'm still fleshing out and perhaps writing about it helps. Maybe I'll figure this out and have something more exciting to write about. Maybe these next three months, which truly will be the doldrums of intern year will allow for a clarity hitherto unknown. 

Here is what I do know: self identity is important and I'm actively fighting against what seems like is the common idea of what doctors like to identify as. In general, I'm thinking of older doctors but not always. I've spent my life being labelled a great many different things by outside entities. I've spent a good portion of my life identifying as a "wannabe doctor" and now that I've been here for awhile I see clearly that in order to be satisfied with the "doctor" label I will have to forge my own idea of what this means. Also a work in progress but through these posts, this is something that I am working on. 

On another note, I'm really enamored with trying to find a destination for a week vacation in early April. Just enough time to go someplace exciting and exotic, but short enough that New Zealand seems too far -- even Europe seems like a stretch. Anyone have any ideas for a week long getaway for early April? Taking a chance on having a ski resort to still have snow seems reckless, albeit something I may be willing to chance. Living in Southern California makes tropical destinations a little less intriguing. My life is not short on palm trees and beaches, it is short on snow and real forests. 

Friday, December 22, 2017

I prefer a tikka masala sauce that is creamier and unbroken

ACGME and people in graduate medical education send a lot of mixed signals when it comes to physician wellness for residents. Much of it is program and facility specific. Some places do better than others, but at some point during this year I've had this growing awareness of larger forces at play. Retreats and local, ground level provisions are necessary and appreciated; but our day to day experiences expose us to the worst that humanity has to offer, contrasted, with varying frequency, the best humanity can impart.

A strategy has to be built to deal with the desperation and apathy we are faced with. Frustration levels are high with everyone, most of us, and I mean everyone in the hospital -- from the patients, patient's loved ones to all that participate in the success of a hospital as workers; clinical and nonclinical. Every single one of us has a valid reason for our frustration. We fight for people in an inhumane, rigid yet whirling machine that forces us to feel like compassion is a luxury and five extra minutes with a patient infringes on our paperwork workflow. I'm still strategically strategizing my strategy.

The leaders of this nation have added to the existential dread that seems to have gotten so much worse as of late. I think a lot of good people kind of hoped that the system that capitalizes medicine and healthcare had just been a mistake and not actually an engineered sham. I find it interesting that most doctor lounges, even those in California are more likely to have Fox News on TV than anything else. Admittedly, the channel selection is skewed by the fact that younger doctors, and ones that have good work ethics don't spend time in the doctor's lounge watching TV. Regardless, not many people have much hope for the immediate future and most of us are kinda hunkering down for the onslaught of even more undiagnosed and untreated "run of the mill" pathologies. Unchecked infections delighting in the patient who has neither the time, money or access to a primary care physician will be rushed to the ED in septic shock, with their life in jeopardy. Of course, more resources and money are spent on this patient's acute care than 500 primary care visits would cost -- that doesn't seem like an exaggeration, depending on the hospital course.

It is in this setting that empathy becomes so incredibly valuable. Small talk with jokes or solemn recognition of a patient's suffering, or whatever else helps keep the lifeline of human relationship patent and flowing with good will. Some patients are manipulative, some nurses and doctors are too. Deal with people with respect and maintain proper boundaries and this stuff becomes secondary, and much less of an emotional suck.

Nights are tough -- call nights with no chance for rest take their toll. In some ways though, I really like the fact that it feels more like a normal work shift. I mean, day time is filled with rounding, discussing, teaching -- us being taught, and us teaching students. At night, you get the work done and if that means 10 Uptodate articles, so be it. I like it. I've missed feeling like I have a "normal" job more than I previously realized. Doesn't mean I'm not going to take advantage of having tonight off and not leaving the house the rest of the day and ordering delivery Indian food, though.

Tuesday, November 28, 2017

And I Love That Basketball. I Took That Basketball Everywhere I Went. You Know What? That Basketball Was Like A Basketball To Me

Went home for Thanksgiving. First time travelling away from the LA since residency started this summer. It was nice seeing family and friends. My mother had a birthday recently, so the idea was to take her to Powell's  bookstore with a mandate to find books we would then buy for her. Of course, it had been a long time since I had wandered around the store, too. I found a handful of books related to the book I'm writing, and also this one:

Golden: The Miraculous Rise of Steph Curry by Marcus Thomson II had been a book I've been meaning to read. I was in the Bay Area for six years. When I arrived the Warriors were not good, at all. And other than the 'We-Believe' team with the Baron Davis dunk and dismantling of the number one seed Mavericks, had last had real success around when last the Trail Blazers won a title -- the late 70's. Keith Smart was the coach, with Mark Jackson soon to come. Andris Biedrens was still on the roster. Sniffing the playoffs would have been considered successful with this team. The number seven pick of the 2009 draft had glass-like ankles, seemingly. I went to a handful of games at Oracle Arena where the Trail Blazers were the visiting team, until the last year, when we were priced out of the arena. While it is fun to sit even in the nose-bleeds, I confess I much prefer to sit closer (duh) and would rather not spend way too much money to sit at the top of the gym. Regardless, between live games and streaming games, watching the Warriors become the most unlikely juggernaut, two championships in three years with a 73/82 win season. They won 89% of their games that season, and besting Jordan's Bull's team that had previously won 72 games out of 82. History would tell us that an NBA team that wins 50 games in a season is successful, most likely makes the playoffs, and may even be good enough to get hot at the right time and see major victories in the playoffs. And even now, they harbor superior talent and are the favorites to win the chip.

I am kinda tempted to turn this into a Steph Curry kiss-ass prop-piece. I don't know a lot of people that I would even consider doing that for. It's tempting to extol his virtues, of which there are many. Some of you may not know much about basketball, nor care about it. I get it. I don't really like the NFL, or the other major sports, in terms of rabid fandom. And while, yeah, I consider myself a "fan" of the Trail Blazer team based in Portland, Oregon, I do enjoy watching basketball. In general, if one spends time a bunch of time engaged in a certain activity, watching the best do it is fun -- the memories of what it was like to be able to run and jump with abandon force us to live vicariously through the professional athlete. I've played a lot of round-ball in my life. But what Steph Curry brought to the world of the NBA transcends the game of basketball and shines in sharp contrast too many in our culture who boast loud bullhorns and shy not away from abusing their position. In short, Steph Curry has positioned himself to widely considered the best shooter in the history of the NBA, and for those who argue he has not had the longevity to warrant such a title, I can't really argue with you, but, there is no sign of slowing down and we shall see in the next ten years what happens. This cat has won two MVP awards, and the second one was unanimous -- the first time that had happened. He is 6'3" on a hot day and does not have the chiseled, imposing and intimidating physique that many NBA players have. Much has been made of his light skin tone. He doesn't overpower people by smashing into them, but he does bend men to his will.

I think one of the reasons I've become fascinated with The Chef, is, like so many of us, imagine that his public persona and modus operandi is representative of what we would do, best case scenario, if we were in his position. Obviously he isn't some infallible deity, and of course I'm speaking in generalities, but the consistency is there, from childhood, through prep school and into and through college into the professional ranks. He was raised by a family with means; his father, Dell Curry was a bonafide sniper from 3 point range, for his time, at least. And while NBA players in the 90's were not making the kind of coin they do in this era, in no way was the family struggling to make ends meet. Furthermore, Steph grew up around basketball and NBA players, nevertheless, this has seemingly worked against him in that he wasn't ranked as a prep player, in his state of North Carolina or in the nation. He was not recruited by any major collegiate basketball programs; Duke and North Carolina had no interest in him; he ended up at Davidson, in part due to their academic prowess. While there he led the nation in scoring and led this small, otherwise unknown (at least in the world of NCAA basketball) school to the elite 8 of the Final Four tournament. And while he was picked 7th in the NBA draft, he was the third point guard taken. Through all of this he has taken every slight, underestimation and write-off and internalized it, and from a distant, outsider's perspective, has used that for fueling a healthy response. He does not speak ill of other players or past associates. The only negative thing I can recall him espousing is a contradiction of Under Armor's CEO praising our Tweeter in Chief, which I count as a positive thing overall. Other players, past and present have piled on in subtle and heavy handed ways over the past few years. Members of successful teams from the past stating that Golden State would not stand a chance against them in a hypothetical head-to-head match up. Players from the 80's and 90's have long since criticized teams and players for being soft in this modern day hand check free game. While I risk losing every reader if I go down the tangential rabbit hole that is "get off my lawn" attitudes of older people who love to denounce younger people practicing in the same field as they used to. One would be forgiven to think that Larry Bird never missed a shot, that Magic had a triple double every game and that players worked harder, smarter and were more efficient back in the day -- oh, and this was all done while being mugged by the defense. This assumes that the great players of today wouldn't adapt. That they are not tough enough to deal with hand checking. That they don't have superior technology and an improved, deeper pool of resources. Could a 30 year old Michael Jordan dominate in today's league? Yeah, I think so. Could Stephen Curry go into 1989 right now and battle the Piston Bad Boys and be victorious? Hell yeah.

All of that is besides the point. The demeanor in which Steph Curry, a leader within his field, treats those around him is a strategy that has, is and should be employed in every professional field. Boasting, in general, does the exact opposite of the boaster's intentions. Tearing down others in efforts to shine brighter serves to illuminate deficiencies in character of the 'tearer,' not the other way around. In general I feel like helping others succeed, whether it be teaching, encouragement or simply (trying) to set an example, is how I can be the best me that I can be (I write this knowing how cheesy this probably sounds) and often this means that glamour, glory and accolades are showered on others. Perhaps being an introvert plays into this dynamic -- anecdotally it seems to favor this type of disposition; I don't wholly buy into this but certainly it easier for those who shun the spotlight to allow others to bask. In my opinion (as if someone else's opinion would show up here) the largest element that allows one to willingly, or even, enthusiastically, desire those around them to succeed is simply contingent on a solid perception of high self-worth.

The summer before last saw the Warriors lose in the final series of the NBA playoffs to Lebron James' Cavaliers. That was the season Golden State earned the highest win total, ever, in the history of the NBA. The contrast in being the best regular season team ever, with then losing the 'ship was, I presume, painful to the team and their fans. A few weeks after the playoffs ended, free-agency started and Kevin Durant, a previous league MVP decided to leave Oklahoma City (can't blame him -- I spent 3 weeks there last year) and join the Golden State Warriors. Much has been said and Durant has been much maligned for this decision, but that is not the issue at hand. What is impressive is that Curry welcomed another MVP to his team, a team that had won a championship two years prior and followed that up with a record breaking regular season. Undoubtedly Curry's light would be partially hidden under a bush even in the best of circumstances. Durant is a basketball machine, at nearly seven feet tall and slim with quickness usually reserved for men much less his stature, might even have a more complete game relative to Steph Curry. Last year the Warriors made it to the championship series for the third straight year (as did the Cav's) but this time around the Warriors rolled with relative ease. Durant was named the finals MVP -- and he deserved it. Curry showed no signs of jealousy, remorse for having Durant join and at times, take up most of the spotlights shine.

For you or I, this might not seem like much. But in the world of professional athletes, especially NBA players, this is unique. Not all of these things are unique to Curry alone, but the way he consistently responds to judgements and evaluations deeming him less than worthy of not only his potential, but also his past works, is unique, I think, in his world. He has continued to assert his dominance, to put on display his superiority in ability to put a ball through a metal ring from a long ways away and this gives him rights that he doesn't exercise. Maybe because he grew up with the bright lights of the arenas and cameras that he doesn't seem fazed by them, maybe it is why he seemingly feels so comfortable under the lights. Maybe he knows that life requires human beings to be multifaceted, to be dynamic in their behavior and that one size will never fit everyone. Perhaps his upbringing taught him that despite what the columnists say and what the talking head television pundits spout off on, it is never all about him. The joy that the Warriors bench celebrates on court awesomeness is indicative of Curry's overall attitude.

I'm old enough to remember Michael Jordan when he played, and not just for the Wizards. WGN would broadcast all the locally televised games out of Chicago, and whatever cable service we had at the time carried WGN. It was exciting to watch him play -- what crazy thing would he pull off in this game? There have been plenty of stars in the NBA who approached this level of intrigue. But since Curry has come into his own the past few years, it is the first time I've felt that excitement about a player. Kobe, Shaq, T-Mac and Vince Carter were all exciting, but they all played within a certain framework allowing for sensational acts, to a certain degree. Kobe scored 81 against Jalen Rose's Raptors -- pretty damn incredible. But nothing has compared to Curry and his ability to invert the basketball court and allow his outside shot to open up his inside game, it has always been the opposite. Inside game allows for the outside game to develop.

Anyway, here's to a Kerr/Popovich ticket for the 2020 Presidential Election!

Saturday, November 18, 2017

Lynch Park, Terry Porter and the Commute Encumbered by Civic Dispute Long Since Forgotten

Lynch Park was an elementary school in South East Portland, on 148th right between SE Division and SE Powell, otherwise known as State Highway 26. I am an alum of Lynch Park, (a Jaguar for life) having spent my years of kindergarten through third grade learning how to be the best Jaguar I could be. Our gym did multiple duties; cafeteria, assemblies, whatever. But I remember Terry Porter, #30 of the Portland Trail Blazers, who grew up in Milwaukee Wisconsin, and had an impressive NBA career by way of University of Wisconsin Stevens Point, standing on what was our half court line and draining jump shots as he chatted with our principal, or someone. That memory stuck with me, thinking that he was launching them from half court with ease, draining them. Some years later I happened to be in that building, but it was now a Montessori school but that half gym half cafeteria still had the hoops on either end and the mid court line. The line was closer to the rim than an NBA three point shot on goal. I had not enough experience, as a 3rd grader, to realize that the gym at school was but a fraction of the size of the court this man played on, while I watched him on television. A lesson exists here.

Back to the streets of Division and Powell, both of which originate close to the Willamette River, which is the delineating factor between East and West Portland. The Willamette is the 2nd largest northward flowing river in the entire world. The topmost being the River Nile. These two roads are not even a mile apart and they go eastward, through Gresham. Division eventually fades into another road that heads into the Oxbow area of the Sandy River. Powell continues as Highway 26 and goes through Sandy all the way up Mt Hood to Government Camp and then on into Eastern Oregon. There is a curious thing about these roads, though, in that Powell, all the way until just past SE 92nd, is a 4 or 6 lane major traffic arterial throughway, where it turns into a 2 lane road for many miles. Conversely, Division boasts neighborhoods along inner Southeast Portland, with some of the best Portland has to offer in terms of eating, drinking and shopping. But a major traffic conduit it is not. Two lanes as it passes by Mt Tabor, the extinct volcanic vent, and then all the way until just past SE 82nd avenue until it becomes a 4 to 6 lane major east west channel of traffic. Weird, huh? I think the City and the County had differing ideas of which one would best serve traffic needs. I'd be willing to bet that the reason for our discongrous east west traffic flow patterns in Southeast Portland and East Multnomah County is planners on either side simply could not compromise and just to spite each other, they purposefully left it like this. Maybe it was ODOT as Powell is a State Highway, after all. I don't know.

Back to Terry Porter. I remember a kid on the middle school football team -- now I was a proud Cougar at Centennial Middle School, his name escapes me. A little further east than Lynch Park, now I was pushing up against SE 182nd and we could see this road from the football field -- and we were still between Powell and Division. Regardless, this kid had branded himself with a large "TP" on one of his shoulders. It looked infected -- even middle school me could tell that. We all knew "TP" stood for "Tracy Packard," and yes the name is changed to protect the creeped out, but the initials are the same. He told us it stood for "Terry Porter." I remember all of us laughing until we were sick; he stuck to his story though. Maybe a tattoo covers that homage to Terry Porter, or maybe a shark took the arm. Barring something like that, undoubtedly the "TP" lives on.

This is Terry Porter. Do you see the two scars on his right upper arm? One lateral, wide scar roughly mid-bicep and the other at an angle on his anterior deltoid. I can't tell if the bicep one is actually a tattoo or not. Blazer games radio broadcast was on 1190 KEX, and after the post-game show there was a call in show called "The Fifth Quarter." Often home games were aired from a Tony Roma's rib place a couple of blocks from the Memorial Coliseum. I never called in. I always wanted to call in and ask about the origins of the scars. I never did.

I guess in some way all these things are connected in my mind, with swirling explanations of why and murky questions related to why we hold on to these moments. Of course if we are anything, as humans, we are at the bare minimum, with all dogma, philosophy and religion accounted for, a simple collection of experiences that  shape us and inform us, or, the 'id' -- if you will, meaning that all of us have moments along our journey that imprint on our brains and become a physical form, in our brain, there to stay until wormfood we become.

Sunday, November 12, 2017

Of Quartz It Is Hard Not To Take It For Granite

I've never been mistaken for a nurse. Even when I was in undergrad, working weekends in the emergency department, in a non-clinical capacity (granted, I did wear scrubs and carry a computer or clipboard) I was mistaken for a doctor more times than I can count. Not once did I enter the room and have a patient tell the other end of a telephone conversation that 'the nurse is here, I gotta go." But dozens of times in the span of a year or so, I had them say 'the doctor is here, I gotta go." These days i walk into a room, and they correctly assume I am a doctor. 

When I have patients refer to my colleagues, including medical students, as nurses -- it is always based on their gender. I've seen responses that are highly varied, and I respect them all. But now, I can't help but step in and politely point out the fact that this is actually doctor so and so, or medical student blah blah blah. If nothing else, the patient should be aware of who and in what capacity a caregiver fulfills. At best, they might be reminded that women are actual human beings, capable of operating at the absolute top of any given professional capacity. 

I've never been accused of being a frail, small and incapable man. Tallish at 6'1", big boned with plenty of musculature left over from the days when I would treat myself well enough to actually exercise on a regular basis. I've had very few patients try and physically intimidate me. Furthermore, I've been in a handful of sticky situations in my life, with real bodily harm being a succinct possibility and those were scary places to be. A situation in which a CHF exacerbation patient who can't walk to the bathroom without dyspnea who tries to stand up and intimidate my colleague, who, of course, is female by standing up and raising his voice and trying to tower over her, can be intense, but scary? No way. 

I feel very protective of the people I work with; I think we are all protective of each other. This current climate of men of power being called out for abusing their influence and stature for sexual gratification, exploitation and dominance seems like a healthy cultural purge. If anything, for me, it acts to highlight disparities and conveniences I am prone to take for granted.  I wish to give a shout out to the doctors who regularly do this job on hard mode. Simply for being a woman. 

Sunday, October 15, 2017

I See Crack

For the past few weeks I've been on a laborist service -- meaning I try to catch as many babies as I can. Here and there I see gynecological patients, as well. Saturdays I cross cover for general surgery, too. So far I've been in more cesarean section procedures than vaginal births. I enjoy C-sections; fast and horrific. It is one thing to remove an infected gallbladder or appendix, it is quite another to cut open a belly and pull a live, squirming person out.

Some people choose family medicine as it gives them opportunities with women's health and obstetrics in a way that no other specialty does. This is not me; and these components of medicine will most likely not play a large part in my eventual practice but nevertheless, it is important to consciously expend energy in areas where we feel less naturally motivated or competent.

This idea of focusing on weakness, as unpleasant as it can be, has been on my mind recently. Kind of one of those things where personal experience and the lessons thereof seem pertinent to society at large. This also ties into why I feel so dismayed and deeply disturbed with the current administration and the agenda that is put forth. A barrage of deceit, while composed of individually easily debunked lies, have an effect on a population -- which is first and foremost -- an attempt to normalize dishonesty. Does anyone actually believe the nonsense the 'commander-in-tweets' spews? Well, some people do, I would guess. Some people think the world is flat, too.  But for the rest of us who are rational, thoughtful citizens, it seems we've gone from amusement, to outrage and now have settled into a sense of acceptance that the constant barrage of propaganda and self-aggrandizement is just how our life is now.

And don't get me wrong, it is not as if we've had a government which has been completely forthcoming and honest in its communication before all of this. This is different though.

Furthermore, I am coming to the point where I am starting to believe that this is may be how the modern American Evangelical Christian sells its soul, as a whole, for lip service from the highest man in the land. It mirrors our society's march to come to value aesthetics, or "optics" over substance, or real tangible, proven value.

Grab 'em by the Pussy? We don't care as long as he makes it harder for women to receive health care.

Multiple divorces, affairs and marrying women much younger than he? We don't care as long as the 'gays' cannot get married.

Bankruptcy and a repeated history of financial fraud? We don't care as long as he cuts taxes for the rich and eliminates health services for the poor.

Referring to white supremacists as "fine people" and black NFL players as "sons of bitches?" We don't care as long as  blind patriotism and indiscriminate support for military spending is encouraged.

Private email servers used in this current administration? We don't care! Lock! Her! UP!

Frequent golf trips to his own properties and self-enrichment? We don't care -- as long as he doesn't look like Obama!

Attacking the 1st amendment? We don't care as long as he lets churches be active in politics and keep their non-taxable status.

Ensure environmental calamity in order to become further dependent on fossil fuels? Sure, as long as my price to 'fill-up' stays the same.

I sense that this ongoing and worsening dichotomy of hypocrisy and blatant power grabbing will push America, in the near-ish future, far from the weird form of American Evangelical Christianity that has taken hold during my lifetime. In many ways I mourn the death of an ideal, while simultaneously celebrating the hard truths that have surfaced. I recently read a long thought out post on Reddit about how Hollywood and the Harvey Weinstein situation is similar to how sexual abuse in the Catholic Church was so pervasive, for so long. I feel a similar analogy can be drawn to mainstream Evangelical Christianity in the United States.

Before I go further, I do feel compelled, even though I think it is obvious, that this is less an indictment on American Christians as a whole -- and more focused on those involved with politics, and those who seek power and money via Christianity. But there is something to be said about those who are complicit and who stay quiet. A few days ago, 45 said that "we are stopping cold the attack on Judeo-Christian values." In a vacuum, with no context, this must sound great to a Christian who lives in America. Unfortunately, I believe that we will be held accountable for knowing the source of such words, and what has been sacrificed in order to hear these words from our dear leader.

For those of you who say 'God can use evil men for good' I ask you how you approached this platitude during the previous administration. I fully believe some of you (us) do not, or at least, try not, to think in absolutes and realize people are dynamic and multifaceted. I try to remind myself of this in the current political climate.

A part of me that thinks we are being trolled on a level never seen before in modern history. Perhaps all of history. Is all of this an effort to dismantle the GOP and their ability to push emotional buttons to ensure that voters consistently vote against their own self-interest? That may be the best outcome from this whole circus show. Unfortunately, I can't say that I much like what is being pushed as a replacement -- fascists, white supremacists, misogynists, conspiracy wackos (and I say that  while at the same time acknowledging that some conspiracies do and have existed) and those who seek to divide on old, tired but powerful tropes. Can this deluge of ridiculous, flimsy propaganda from this administration be carefully crafted to shed light on the swarmy corners of Fox news and Fox news-like propaganda? I mean, it has become harder to believe as time goes, especially when calls to revoke licenses of critical media mouthpieces ratchet up in intensity. But then again, maybe I just don't have the same vision to see exactly how far we need to be pushed in order to be birthed from the womb of complacency.

All of this to give a word of encouragement to all of us, whether you agree with me or not. I implore you to be as self-critical as possible. To not ignore the plank in your own eye, as I am wont to do about the plank that dwells in my own eye. I say to you that unplugging from the television news (fake or not) is a healthy place to start. To venture out of your own comfortable space with aims to build bridges with those unlike you is invigorating and provides perspectives, thoughtfulness and helps in efforts to be slow to anger. I recognize the difficulty that modern culture presents to those who feel their heritage, or family values are being threatened. However, what is built on sand and not solid rock will not stand, and I believe that hypocrisy lives in the spaces between the shifting pieces of sand and acts to pull apart foundations, and can go as far as making ruins out of the most solid looking, stone solid foundations. I see the cracks.

Monday, October 9, 2017

Baby Even The Losers Get Lucky Sometimes

I pay very little attention to celebrity and the going-ons thereof -- I don't really understand the obsession. When a celebrity dies, and people have dramatic emotional reactions, I just don't identify in that they've not played a role in my life, with some exceptions, of course. A week ago Tom Petty died; that day was also the day after the terrorist attack in Las Vegas. I work in LA and many people here have connections to Las Vegas. Numerous people at the hospital had loved ones or friends at the event. Perhaps that is why when I heard the news on Monday afternoon I felt like it was a bigger blow than it might have been otherwise. Today, while driving around completing errands, I had the Tom Petty channel on Spotify playing. It got me thinking, Tom Petty has been a part of many different memories and pivotal points in my life. I'm sure you want to hear about some of them. Here we go.

I kinda think of Tom Petty, Rush and U2 as occupying the same area in my musical catalog, in that when I was a teenager, I loved these bands but it was not cool to be found listening to these bands. NOFX, Pennywise, Minor Threat and Black Flag were the cool bands that I "should" be listening to. I explicitly remember studying in the library in high school with my discman and some of the only other skaters in the school wanted to know what I was listening to and when I reluctantly told them I was listening to Tom Petty's Wildflowers I was looked at with scorn. I got over it, though. Even back then, while much more sensitive to what others thought of me, as is the understandable perils of being a teenager, I had a lot of individuality, for better and worse.

Back to Tom Petty and (sometimes) the Heartbreakers. I am old enough that as a child I was able to witness the MTV when they played music videos. My parents had cable and I remember MTV was channel 25, and in order to not get in trouble for watching MTV, I had to make sure when I turned the television off it was on a different channel, as to not alert them to my watching MTV. Sorry mom and dad -- what can I say, I want(ed) my MTV! 

Real quick side track here: I saw this video having kids listen to Led Zeppelin and reacting to it.  As a child I remember hearing songs that immediately struck me and had some kind of magic to them. Free Falling off of Full Moon Fever was one of them. Baba O'reilly by the Who is another.

This video was in heavy rotation in 1989. I was 10 years old and just getting to the point where skateboarding was becoming I was very fascinated with. The skateboarding in the above video is kind of a last hurrah for that classic 80's fashion, board shape and skateobarding sensibilities. Soon, neon and spandex would be replaced with ultra big pants and unimaginably tiny wheels. Vision Street Wear and Airwalk were out and World Industries, SMA and 101 were in. 

Around this time I remember an afternoon where I was at my friend Adam's house and he had a neighborhood friend a few doors down from him, I believe his name was Billy. Weird and random memory but for some reason this has always stuck with me -- we were at Billy's house, playing, whatever, and he had a CD of Full Moon Fever in his room. I remember looking at it and was just transfixed with the cover. 

In my early teen years, my week revolved around Tuesday night free skate night at SkateChurch, and every year they would have a sleep-over -- basically, from 6 at night to 6 in the morning, or something like that, the kids were locked in the basement where all the ramps, funboxes and such were and we skated until the wee hours of the morning. My mom picked me up going home and I distinctly remember lying on my bed trying to go to sleep but the excitement of the previous night, and all the tricks we learned and saw others pull off ringing in my head and on the radio was Last Dance With MaryJane. It was 1993.

This song was released as a new song on a Greatest Hits album. I listened the shit out of that album, or, is it, I listened to the shit out of that album? Either way, I also remember driving with my friend David and his older brother Josh as we left what was the called the "Youth Rally" and was held in the mountains of Idaho every year at the end of summer. We would start the 10 hour drive home on Labor Day morning and I remember settling into the drive with this album in the CD player -- it may have been a cassette player, I don't know.

This song was released in 1994, on the Wildflowers Album, which, like Full Moon Fever, was a Tom Petty solo album.

And while I probably appreciated this song when it came out, as I definitely had this album on CD (I miss those rainy afternoons dedicated to perusing the local music shops -- Music Millennium, Everyday Music and 2nd Avenue Records -- I mean I still could go to music stores, but I haven't used a CD in over 10 years!) but it was in my early 20's when I found it and felt the sappiness and melodramatic nature appropriate to help me move on from a certain woman. This song, along with Neil Young's After The Gold Rush, and any post-breakup sentimental fool can really start to feel sorry for themselves with earnest.

I have my favorites for long drives, when I feel like I could fall asleep and I need some "sing-along" music and Tom Petty is always a favorite. I also think that some of his videos are truly works of art -- and reviewing some of them while writing this further reinforces that. Some of my favorites are below.
The end of this song is so brilliant. Slog through a few minutes of heavy synthesizer, drum machine and weird vocalizations pay off with the ending which holds my favorite Petty moment, where he goes, "EHHH eeehhh EEEH HEEEH e EHHHE." Unfortunately on the video above the last part of the song fades out and you can hardly hear the 'Ehh Ehhe' thing, but, yeah, I love that last part of that song. 

"Runn'n Down a Dream" has an animated Tom Petty in another weird but impressive video.

"Learning To Fly" is still an interesting video, and one that I don't really remember from my clandestine MTV watching days. The song, however, is one of my favorites -- simple, and cautiously optimistic -- kind of like me, I guess.

"Learning To Fly"

Well I started out down a dirty road
Started out all alone
And the sun went down as I crossed the hill
And the town lit up, and the world got still

I'm learning to fly, but I ain't got wings
Coming down is the hardest thing

Well the good ol' days may not return
And the rocks might melt and the sea may burn

Well some say life will beat your down
Break your heart, and steal your crown
So I've started out for God knows where
I guess I'll know when I get there

RIP in Tom Petty -- you're death actually touched me and this time around, it is an appropriate emotional response, in that your music played a such a longstanding role in my life. Earlier this week I pronounced a patient dead and within that hour was pulling a baby into the world, screaming and squirming, as if it knew what life was about and wanted to go back to the safety of the womb. The cycle of life continues and getting old is not for the young, but once in awhile we have to pause and recognize the innate frailty of being human and that none of us get out of this life alive.

Sunday, September 24, 2017

This is the Water, and this is the Well. Drink full, and Descend. The Horse is the White of the Eyes and Dark Within

I didn't watch Twin Peaks when it was initially on broadcast television. But for the last, oh, maybe 20 years I've been waiting to see Laura Palmer again. And true to her, and by extension, David Lynch's word, she came back. As did Agent Cooper with many of the old characters and plenty of enjoyable new ones. Plenty has been written about Twin Peaks and never so much as now, with (what seems like) the conclusion to the series finished and available for consumption. 

And I stand not as a Twin Peaks authority; I am relatively a neophyte compared to many of those who count themselves as David Lynch aficionados. Similarly to how I feel about music, in that I've never tried to make it, is cinematography and filmmaking. Skateboarding inherently has video cameras involved, but a Sony DCR-VX1000 and some skater friends do not a cinematographer make. So, there is one small aspect I wish to focus on. The scene which takes us into the heart of the first nuclear detonation at White Sands, Nevada in 1945. This is a well thought out blog by someone who describes the "most Lynchian scenes" in the newer episodes -- scroll down to read about the nuclear explosion scene. 

This transfixing yet strangely disturbing journey towards and into the heart of the explosion is really something. Truly, the idea of pulling asunder the very building blocks of matter, of the Universe as we know it, is an act which even in the minds of modern rational humans engenders and promotes the wonder of the unknown. A feeling that, just maybe, what we are doing is wrong. This scene implies that the BOB, one of the evil characters in the movie is born, or perhaps he gains access through this window created by the tearing apart of the atom. After a few minutes of the string section of some strong fingered musicians, we enter what we presume is the middle, or heart of the explosion, or perhaps what is serves as a glimpse to another place, dimension, time, existence, whatever. 

This episode is the only one that goes back in time, as a flashback. Most of the episode is in 1945. It feels important in the grand scheme of the Twin Peaks Universe, and while much of David Lynch is being weird for weird's sake, his art persists and has relevance because of a grand vision, or message that comes through. Of course we've seen nuclear accidents, or radiation exposure play prominent roles in much of pop culture. Spiderman, Radioactive Man, and of course, Godzilla are good examples. He serves to add to this by incorporating it into this world of Laura Palmer's. 

J Robert Oppenheimer, the scientific lead of the Manhattan Project had this to say about how he, and the crowd reacted to seeing the Trinity test come to a successful explosion in White Sands, New Mexico in 1945:

The men who knew most about what scale of destructive potential exists in this technology were vocal against using it against other human beings. Men of war who witnessed the explosion thought very much the same words as Oppenheimer uttered, yet I imagine they had an evil gleam in their eye and a sinister grin on their face. 

I grew up in a relatively isolated culture that, at times, verged into celebratory apocalyptic teachings. I remember the first Gulf War, I was in 8th grade. I remember a preacher, a fiery and entertaining (again, this is all relative and "fiery and entertaining" for our church meant he might wave his arms or tell an interesting anecdote from the pulpit) guy who proclaimed that Jesus was coming back within the year, and that we were witnessing, via Cable Television, the unfolding of Armageddon as Evangelical Christians of the Hal Lindsey (The Late Great Planet Earth book was everywhere when I was growing up and made me really sad) and "Left Behind" theology understand it. I remember that Sunday morning -- I was in the balcony of the church on Mitchell Street, in Southeast Portland. My Dad ran the sound system -- a Sun sound board that had a ton of cool knobs, switches and lights I wasn't  allowed to touch. The preacher told me that life was going to end before my teenage years had really started. Before I kissed a girl, drove a car or dunked a basketball (still waiting for that one -- I dunked a volleyball on a 10' rim oh so many years ago) it was going to be all over. I took that to heart. Maybe some other people in the congregation took it with a grain of salt, maybe some were ready for the pain and rigors of their well lived lives to be over. Maybe some others took it like I did -- there was little time to have fun, to experience what life had to offer and living for the now and preparing for a healthy, well balanced long-lived life was no longer an option. I still fight this. 

This, mixed with the constant background baseline anxiety secondary to being "left behind" provided for some unhealthy formative years.  Sure, I was saved, and I was told that I would now be a part of the lucky few to be zapped out of this existence right into heaven, and into my new body. But what if I forgot to ask forgiveness that night prior? What if my Mom and Dad and all my cousins were zapped without me? I would be left to navigate a world bent on not only torturing me in this life, but ensuring my eternal damnation to boot! This was a problem for me in 1990. I was 12 years old. 

And what if the Ruskies dropped a nuclear bomb on my head while I was sleeping and I had forgotten to ask forgiveness for a particular transgression the day prior? That is like getting zapped right to hell. The instantaneous nature of the rapture and nuclear annihilation, in my young mind, lent credibility to both. In 4th grade I remember a play we watched as a class about Hiroshima, and I remember envisioning what that must have been like, to be reduced to ash blown in the wind in the briefest of imaginable moments-- the only tangible reminder being the shadow you left on the side of the building when the bomb went off. 

Now, we have a world stage that looks like a sinister blackface Vaudevillian act has merged with an avant garde puppet show rendition of Othello and it seems like nuclear destruction as a real problem for people on this planet is back on the menu! Last night there was a rocket with a confidential payload that took off from Vandenburg military base and went roughly due west out over the ocean. Well, I didn't see it but browsing reddit before I fell asleep there were many posts asking what that was. Before I read the answer (with a very small but nevertheless real sense of relief) you can't help but wonder if we shot down a missile, or if we're sending a Cruise Missile at a ship, or submarine, or who knows what. Maybe a return ICBM for an attack somewhere else in the nation. I'm not sure if that would have been my first thought 3 or 4 years ago. This speaks for itself. 

As kind of an aside, I thought it would be fun to see this clip from the 44th President's first year. Just, just -- I can only say that I get a twinge of PTSD listening to this. For those who don't watch embedded videos (me included but it seems so fun and dynamic while writing a post) you can learn how we will all be microchipped by 2017, how Obama is clearly fitting all the requirements of being the antichrist, and how a move to dictatorial rule was underway. All backed up by multiple scripture citations every other sentence.  

Anyway, somebody smarter than I said something along the lines of: art is more important than ever, as it evokes emotion and strikes at what it means to be human in an increasingly inhumane and mechanistic, practical world being carved for consumption by the bleeding edge of the razor sharp bottom line. We hear the countdown at the beginning of the clip from 1946 in New Mexico. The camera accelerates towards the burgeoning explosion that came from the 30 foot tall steel platform not far from the McDonald Farm in New Mexico, and from which was suspended "The Gadget." We enter the hot gas cloud still accompanied by the high pitched shrill of the music. It feels intense. It is designed for anxiousness. It succeeds. I felt like I was back in the pew that Sunday morning, a Sunday morning that is roughly 1458 weeks ago, yet still stands as a pivotal moment in my life. And for that I thank you David Lynch. 

Wednesday, September 20, 2017

A Resident Should Get Student Discounts, Right?

A lot of emphasis is put on the team aspects of modern medicine and in some circles, this is viewed as a negative aspect, or more precisely, an encroachment on the (often) paternal and blanket authoritarian rule of law. Different environments have varying degrees of teamwork and each individual physician, in any given clinical scenario has a sizeable impact on the "temperature" of the room. Over time, with relationships built, and with a trust between people, people who work well with people will enjoy a healthy workplace community, in general.

As a medical student, there is not enough time to let time naturally build relationships and trust, and the astute and emotionally competent ones set out to get to know the people they will rely on to do their 'job' which is being a physician-in-training. Of course, by the time the support staff knows your name, it is time to go to the next rotation.

In politics, and popular culture at large one often hears about 'the movement of the goal posts,' which in this slickly packaged reference to our now non-intentional post-modern society of fluid truth and it  stands as the short-sighted idol to the evil of a progressive and self-critical society. In reference to the life of a medical student in their clinical years, it is much simpler with, usually, a more myopic gestalt, at least in day to day operation. Each physician I've worked with over the years has certain things they uniquely incorporate into their daily practice -- which stems from the interpretation and utilization of the collective experience, this is how training works. Sometimes it may be just a different way of questioning, or perhaps idiosyncrasies in bedside manner and communication, and of course all this when incorporated with the art of clinical practice it can be summarized as the exclusive approach to the art of medicine. Each hospital has their own culture, and within that setting the residents, attendings and of course, each Graduate Medical Education office has their own requirements and needs, too.

Medical students are often seeing things that we've seen many times over, for the first time. Knowledge is compartmentalized and a big-picture perspective is yet to grow. However, the third year students, who are all fresh off of taking the first round of board exams, have the largest working knowledge of esoteric and abstract facts and mechanisms. Stuff that I used to obsess over while studying for step/level I now seems like a fuzzy memory. It is good to remember the foundations of pathophysiology and I appreciate the students for this.

If life has taught me anything, and as a dedicated life-long learner, I enjoy trying to soak up lessons and experiences that are, at times, uncomfortable -- I can boil it down to two maxims, which are generally true some of the time, it is this:
  1.  NO GOOD DEED GOES UNPUNISHED When doing the right thing, or when doing something nice or considerate for others, expect to pay a price. You can make a clear choice when acknowledging this as general law of the Universe
  1. BETTER TO REMAIN SILENT AND THOUGHT A FOOL, THAN TO SPEAK UP AND REMOVE ALL DOUBT This is definitely true in medicine. In front of patients, support staff and colleagues, it is imperative that one chooses their words carefully and thoughtfully. In some ways it could be described as 'defensive speaking,' akin to 'defensive driving.'
Obviously I did not come up with these well-used cliches, but I do recognize their utility. And, as far as being a med student is concerned, the second one should rule one's conduct throughout the clinical training years. Knowing when to ask questions and perhaps, more importantly, the difference between asking a question versus having a question and making a note to look something up, or asking later is a skill that can make or break a rotation. 

I've not been in the military and nor do I have a lot of first, or even second hand knowledge of what being in the armed forces is like. However, medicine has a defined hierarchy and properly navigating the power structure demands adaptive behavior. Of course, when you are moving from one distinct environment to another on a regular basis just as med students do, it can take a toll on those who cannot adapt and who are not adept at "reading the room." Like all professional relationships, success doesn't necessarily come with all parties understanding the expectations of their role but I assure you that if even one party has an issue with understanding or failing to live up to the expectations set forth, failure is forthcoming. And that is the key -- expectations set forth. Often the most important expectations of a role are the ones that go unsaid. How unfair! Not only are the goal posts in motion, but you can't even see the goal posts! Once again, when humans are involved, communication is key.

So, as the interview season heats up for residency and the match process, I tip my hat to those catching the red-eye that they booked on their other credit card, the one that's not maxed out, just to get back to their rotation and catch hell for taking a couple of days off. Just know that you won't be wearing the Ice Cream Man coat forever.

Saturday, September 9, 2017

The Laws of Nature Abides No California Stops

A patient the other day asked me at the end of her visit what I liked best about being a doctor. The question caught me off guard, mostly because we were talking about mother-in-law dynamics and how she was glad to have a good relationship with her daughter's husband. I said something about a mandate for life-long learning and building relationships, whatever. Yeah, that is all true. But I've been slowly grinding on that question for a few days and on a day off may have identified, specifically what I like best.

Last week I went to a drug rep dinner (maybe the best one I've been to, with a charismatic speaker and valuable information no less) but, no, while as a resident these dinners are appreciated, they are not my favorite aspect of being a doctor.

The trust that people have in me, is something that I never take lightly and while I couldn't be a physician without this dynamic I couldn't do that as well without the doing this -- Active Self-Criticism.

I'm not criticising myself to make myself feel bad (sometimes it feels bad) but to change my behavior and grow my "toolbox" in order to be a better physician -- with increasing ability to develop my judgement and efficiency in managing interventions, medications, evaluations, and communication with patients -- with an emphasis on effective two way communication.

This is a difficult thing to do, it is tiring. In medicine we are taught, in class and ultimately by taking care of patients, that "anchoring" is dangerou and needs to be actively guarded against. Very simply, anchoring is latching onto an initial diagnosis or impression despite new or changing data that indicates otherwise. On a complete side-note, I go back and forth on my feelings of using italics, or (God forbid) all caps to emphasize any point I try to make. I rarely send text messages with more than one exclamation point or question mark in a row -- if more equates to stronger sentiments, where does it end?

Just as Bobby Digital, amongst many other luminaries are fond of saying, I try to adhere to the "word is bond, yo" philosophy, and as such, why should an italicized word mean more than the letters of increased verticality? But, then I must contemplate and meditate on the fact that my speech is not of all the same quality and that by the mere way I say words can add to, if not completely supplant the words and the meanings they traditionally hold. A life of conscious duality isn't too bad.

Back to anchoring -- this isn't unique to medicine, this is obvious. The essence of anchoring is choosing the path of least resistance even if the path is a dead end. It is lazy and mandates instant gratification or satisfaction over truth and ultimately, experiencing the best outcome of any given setting, situation or problem. We do this in our lives in so many ways; perhaps our self-image hasn't kept up with the actual shape our bodies are in. Maybe a relationship that has been neglected is still viewed through the lens of years ago. See, we hold on to old data because it helps us build a reality that is emotionally pampering versus the truth, that reality will not allow for what would have been the best outcome.

I saw the clip of Rush Limbaugh saying that Irma, and hurricanes in general were welcomed and capitalized upon by the liberal democrats who desired to advance an agenda based on climate change and the repercussions thereof. But, no -- wait, he did not say the 'repercussions thereof' -- he just left it at "agenda of climate change." This of course is so completely disingenuous -- and I hope all of you can see this. BUT, why not extend this fallacy to see how it holds up. What if climate change is a hoax? An evil agenda to -- to, uh, reduce the power of the oil industry which is nearly indistinguishable from the industrial-military complex? An evil agenda to decrease risk to a fundamental vulnerability to live, produce or defend ourselves in the setting of even a minor production wane? An evil agenda to transfer jobs from coal mines, which destroy lives and mountains to jobs manufacturing windmills and solar power products? An evil agenda to clean up the air and reduce particulate pollution in the city so my wife can breath without an inhaler? An evil agenda to have roofs made of solar panels that can store energy in batteries in the garage and sell power to the grid when the need is high. The people who want these things, these hippy, libtard, overeducated, safespace-needing, common-sense lacking cucks are taking us to a dark world indeed. Anyway, Rush ended up evacuating after all.

While Mr Limbaugh may not necessarily actually believe the things he says, especially knowing that drama and controversy brings listeners. But on some level he is being dishonest with himself. If he does believe the things he says, he definitely is lacking in active self-criticism. If he does not, he is using deception to advance a political agenda and this is profitable for him. It is one or the other. He has the luxury of sitting back and not being held accountable for lies, or misinformation that may harm individuals or the country as a whole. He is immune in that capacity, legally speaking,  however if you believe in a God or higher power, or whatever, this kind of individual is asking for trouble when it comes to accounting for their actions and life's work. But most of us, to some degree or another, do not have this luxury. That is, we are held accountable for what we say and do at work and in our lives, in general. A shitty carpet installer won't have a job for long. A careless doctor may find themselves in deep doodoo. A doctor that intentionally deceives people may go to prison.

This dynamic of professional development can, if one desires, spill over into other aspects of life. Especially as doctors advance in their profession and the fundamental foundation of competently managing their patient population, we can obsess over other professional endeavors and, of course, hobbies can become all consuming, as well. I write all this at the risk of sounding like a self-righteous self-help peddler of propaganda. But this lesson is something that can be applied in every one of our lives. Whatever you are doing during the day, endeavor to do it well. Maybe all you are going to do is lay in bed and watch Rick and Morty, old Simpsons seasons and maybe a Ken Burns documentary with the most active aspect of the day being doing laundry. Do the laundry well. Get. Those. Stains. Out. Make sure the dryer vent isn't clogged. Remember to check the lint filter.

And it is this component -- that I must always evaluate my performance and prepare to improve forever and ever amen, that I most like about being a doctor.

Monday, August 21, 2017

Why Yo-La-Tengo Should Be Your Favorite Band

I've written about this before, how music has played a large part in my life (not a unique scenario, to be sure) and how I've always been on the receiving end of a speaker's offerings; always the listener and appreciator never the strummer, key tickler, axe-man or skin-beater. Teenage years, when individuals are trying to be as individual as possible by assimilating to a subsect of culture they wish to identify with, is often when a particular genre of music becomes a part of their persona, too. Thankfully, I've spent time with many different sub-cultures -- as is often the case with skateboarding there exists an umbrella under which all types of people are welcomed and through a shared love of wooden toys with wheels, new aspects of a hitherto unknown culture is known. And as I've grown older, pieces from various times, activities, friendships and workplaces, I keep the music from those times, almost as a vehicle for revisiting and getting in touch with old friends. Some of the music I take for myself, making it less of a nostalgic piece, and instead it transcends, building upon the foundation of which I first heard it and becoming something that means much more than a reminder of good times with (good, or sometimes, not so good) people. I don't really listen to much Skinny Puppy these days, but oh boy, when I do, I think of that one guy when I was fifteen, who listened to Skinny Puppy and Ministry, only, as a strict rule. And I love this aspect of music, it's ability to transport us in time, to re-introduce us to old friends.

Yo La Tengo is a band formed in 1984 in Hoboken, New Jersey. They have been making music for a long time. Ira Kaplan and Georgia Hubley have been the two mainstay members, with various bass players and producers over the years. I was introduced to their music in a tumultuous time in my early twenties and, at first, it was because of who and how I was introduced to them, that I became infatuated with the band. As the years have gone by this band has transcended way beyond anything that has to do with the initial impetus that drew me close to Yo La Tengo.

But first, let us take a step back and look more at the fascinating world of creating sounds, especially in a world before computers. What first got me thinking of writing about all of this, is an article about 'gated reverb' that I came across the other day which is quite informative (especially for those of us who have never spent a minute in the audio engineer's seat) concerning one of the most recognizable sounds that is often associated with music from the 1980's, and now, music that sounds like it is from the 1980's. Gated Reverb, in this instance was a way to change how the drum sound was recorded, and, subsequently heard on the recording. Phil Collins and Prince made much use of this sound and once you hear it, it is something you will always be able to pick out.

Another interesting article about various sounds that came to be associated with famous songs (Pixies, Beatles and Joy Division songs are discussed if that means anything to you) which, as the article notes, the sounds are often sampled due to their unique but recognizable nature. I'm surprised the article didn't tackle the most famous (that I know of) sound from modern music: John Bonham's drum intro from "When the Levee Breaks:"

While I'm sure "Rhymin and Stealin" by the Beastie Boys wasn't the first place I heard this drum sequence, I can safely speak for myself, as a child of the 80's that this is where this was seared into my brain as an iconic musical moment. Kind of a shame, but -- in the controversial (used to be) world of samples, if nothing else, hip-hop music and the ubiquitous sampling has opened my eyes to music of yesteryear that is worth paying attention to. A quick Google search of "john bonham's drum sounds" brings up many articles and videos of people trying to replicate how he initially gained his impressive sounds.

Getting back to Yo La Tengo. Below is one of my favorite songs from them. It is from 2013, so relatively new compared to most of their library but it harkens back to the Shoegazing sounds that initially had me fall in love with them.

This sound, on exhibition in the above song, so exquisitely embodies what first drew me towards Yo La Tengo. The noise. The feedback. The harmony that springs out of seething chaos. A song that sounds urgent in its character but tells us to sit down, and just enjoy the process, exposing the competing and disparate ideologies and needs of the band members is exactly what I love. A female vocalist. A male vocalist. Acoustic. Electric. Keyboards. Orchestral accompaniments. Feedback. Distortion. I'm

Yo La Tengo is nothing if not versatile and unafraid to explore new aspects of music. This one, which may be on the other side of the YLT spectrum is one that really got me hooked way back in 2000 when it was released. Tears Are In Your Eyes:

YLT is also known for their covers of a wide variety of music. While I do enjoy most of their covers, it is their original music that brings me back over and over again. I don't really know much about the members of the band -- I don't spend time reading about them in gossip columns (probably doesn't exist, anyway) or following them on tour as if I were a 'dead-head' version for YLT but songwriting that spans the decades, as theirs does, allows us to grow up with the band. Songs from the early 90's that express the heartache and pain of heroin addiction and powderkeg breakups that are most often found in the early, formative years are prevalent. So often, a band's mojo dissipates after life becomes more stable -- inspiration formed in the pits of despair that mar the landscape of a twenty-something often wanes when marriage, then a family, then the morose mid-life crisis force us to look backwards, often leading us to grasp at the last vestiges of youth with a sickening desperation.

I trust that when (assuming I haven't already!) I look into the gaping maw of mid-life-ness and see the road fade into the distance that is known (death, yes, I'm talking about dying) I will not lean on exterior facets to secure my fleeting youth, but instead put on some headphones and sink into my really nice lounge chair (the one I got instead of the sports car) and travel back in time to when I listened to Skinny Puppy, and all the other bands that function as placeholders in my life. Yo La Tengo hasn't been there the whole time, but I'm thankful for them and what they have done for me.

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