- iPad. I can’t say enough about this device. It’s changed the way I approach technology. I use it every day to check email, to browse the web, and to write blog entries such as this. Using the Citrix app, I can access my practices EMR in large format glory. I can remotely attend meetings and watch the slides on the GoToMeeting app. I snuggle in the easy chair with my son and watch movies on rainy weekend days off via my Netflix app, and he uses it to play a bazillion games -none of which cost more then ten dollars., most for a buck which is a substantial savings over Nintendo DS games. I can keep up with my favorite tv show, The Walking Dead, downloaded weekly directly to the iPad. I can watch every Yankees game this season on my MLB app, live and in high definition. What really makes this device rock is Keynote –I use it to create a presentation of preop imaging studies, particularly the stunning 3D reconstruction of CTA imaging, and add intraop photography to it using the iPad Camera Connection Kit. The whole process takes a few minutes, but makes a patient family discussion incredibly effective. I feel that we are only scratching the surface of this category of device. I purchased a 64GB iPad with wifi only because of the next reason. (www.apple.com)
- Mobile Wifi. This comes in many different forms and is offered by most carriers. It can be purchased as USB stick for a computer –I don’t recommend this as it is the most limiting form of mobile Wifi. The mobile Wifi hotspot can be purchased as a small cigarette boxed sized item (in how many years will that description become obsolete?), and allows for up to 5 devices to be on the network. While this is nice, it requires a separate contract, and doesn’t make sense if you already have a data plan for a smartphone. Most Android phones allow Wifi tethering and this is the most compelling reason to get an Android phone despite its inferiority to the iPhone in most other ways. I have a Droid 2 on Verizon, and despite its failings as a smartphone, it is a wonderful Wifi hotspot, allowing me to use my Macbook Air, iPad, and iPod Touch 4g. I’ve even used Skype on my iPod Touch 4g to make international calls which were clear as a bell and cost only pennies per minute. How nice is it? Going to our rural clinics, the 2 hour drive is made productive and bearable with Wifi in the car (with my assistant driving, of course).
- MacBook Air 11 inch. While I do most of the my work on my 2 year old Macbook Pro 15 inch, I was frustrated by the limited battery life in that laptop. It is only good for about 3 hours, and I had to carry an extra battery. Several days ago, I hurt my back carrying the laptop bag on my shoulder, and I decided to take the plunge. While the Macbook Air 13 inch does have the longer battery life, it is very close to having a 15 inch laptop which I already have. I wanted something substantially smaller. The best analogy would be someone with a 5 Series BMW wanting a sporty 2 seater for occasional use –that person would not get another 3 Series sedan. The MacBook Air does not fail to satisfy. I have owned two prior netbooks in an attempt to go ultraportable and while the battery life was excellent (using lumpy extended batteries), they were slow and the keyboards were miserable, but what really drove me away from netbooks were their trackpads. I had an Acer Aspire One and more recently a Dell Mini 10V which I hackintoshed. Even with OS X running on the Dell netbook –and it ran very well, the trackpads on both machines left me feeling wretched after short usage. The MacBook Air does not have this problem with a full-sized keyboard and a giant trackpad that takes multitouch commands. I am writing this article on the Air, and I have a shit-eating grin on my face right now. Why the Air, and not the iPad. I do have a bluetooth keyboard for the iPad –I found an old Palm bluetooth keyboard that works very well and is even more portable than the Apple Bluetooth keyboard. While text entry is okay at the desk, and even better with the iPad keyboard dock, both bluetooth keyboard and even keyboard dock fail to connect with the iPad. While I haven’t tried since the iOS 4.2.1 update, I found this to be bothersome trying to type on the iPad, and feel better for coming back to a laptop. That said, the 11 inch air is weighs about the same as the iPad. Apple, despite its addition of a limited subset of iWork apps for iPad, does not see it as a content creation device, and I agree. Ergonomically, the laptop still has its use. Most notably, iWeb and other web management applications run exclusively on the laptop for now. Also, despite my dislike of Microsoft Office on Windows, I am very pleased with Office for the Mac, and Word for Mac 2011 is the first piece of Microsoft software to leave me happy in a long time. (www.apple.com)
- iPod Touch 4th Generation –This is basically the iPhone 4G without the phone part. Because the telephone elements are gone, what is left is an insanely slim and light iPod Touch with a back and front facing camera and FaceTime capabilities. While I haven’t explicitly tried it yet, Facetime has incredible potential as a telemedicine platform. In a hospital with fast Wifi, it’s a no-brainer. The iPod Touch is my mini-iPad. Even better, the GV Mobile + app lets me dial out via my Google Voice number which is forwarded to my cell phone. One thing about the Droid 2, the latest and greatest from Motorola –it freezes or slows down tremendously when you look up contacts. My iPod Touch acts as a dialer for my phone and through Google Voice, all my voicemails get transcribed as emails. The Line2 app is even greater –it turns my iPod Touch into a VoIP (voice over internet) phone. It’s an important function because in the bowels of most hospitals and in my basement, cell reception is nonexistent but wifi is present, and because my answering service calls to my Google Voice number, it forwards to my Line2 number and I can get important calls in dead cell zones as long as there is wifi. And being a iPod Touch, you get access to all the wonderful games and media apps. Did I mention Retina display and the A4 processor? The display on the iPod Touch 4th Generation is a modern marvel. 4 point font is perfectly discernible and there are not jaggies or fuzzies in the text. Movies pop on this screen, and it is my front pocket computer and my in the bed computer –my wife is less bothered by my reading from the iPod Touch than from my iPad. My only complaint about the iPod Touch 4th Generation is battery life. Multitasking, particularly having the Line 2 app on to take incoming phone calls, kills the battery in about 8-10 hours –but remember, it was not meant to be a cell phone. (www.apple.com)
- USB recharging batteries –These are largish lithium ion batteries equipped with USB ports specifically for the recharging of gadgets that recharge via USB cables. There are many varieties and flavors, but I recommend the largest you can get for the price –you will never regret it. I found an Energizer branded cell that will recharge my iPad and still have half the power left. It is great not having to plug in at the airport. I can recharge with both battery and gadget in the carryon. One company even had a battery that would recharge the Macbook via repurposed charger cables, but Apple got a cease and desist and these batteries are no longer available. The reason why they should be large large capacity is because the charging adapters for them tend to be bulky and I leave mine home.
- Laptop Bag –These vary from bulky bags that go to the maximum limits of carry-on-ability to to slender sleeves. I own a range of very functional bags that allow for just enough capacity while not being bulky. The best of them is the Brenthaven backpack (link) which allows for bulletproof protection while having more than enough compartments for a laptop, a second laptop, an iPad, a digital camera, an iPod, headphones, memory cards, a smartphone, a backup battery, the cables and chargers, pen and paper. The most stylish bag (my wife calls it the man purse) is a Kenneth Cole laptop bag in black leather. While the Brenthaven bag says, “GEEK,” the Kenneth Cole bag reeks of style (link).
- Watch –Watches are indispensible tools for a physician. First and foremost, the date and time are required elements of a doctor’s note. A watch with a second hand is indispensible for checking heart rate. And a surgeon has to look presentable in scrubs, and the watch is one of the few personalizing items that I think a surgeons should choose with some thought. The problem with premium watches and surgeons is that the surgeon has to take them off while scrubbing for an operation. There must be at any given time some combination of Rolexes, Tag Heuers, and Omegas in hospital laundries across the country. I have become a big fan of the great looking, highly functional, cheap watch. The two best are the Timex T45951 Expedition series alarm watch which is a big chronograph with a handsome leather band –other colors are available, but the cream faced one with tan leather band is only 50-65 dollars and cheaper on sale at Amazon. It has the Indiglo feature, and a nice beeping alarm that wakes me without waking my wife. It is comfortable enough to wear to bed. The other watch is the Casio MDV102-1AV Sea Analog Illuminator Dual LED Dive Watch. This is a beautiful watch that could be mistaken for a Rolex Submariner or the James Bond Omega. Even better, the LED on it is so bright, I use it as a flashlight. Cost? Currently $42 on Amazon.
- Pens –The surgeon can never have enough pens. The problem with expensive pens is exactly the same as expensive watches –they are waiting to be lost in the hospital tucked into a chart or left in the laundry. The best pens leave a permanent record in the chart and has blue or black ink. They have to be roller ball if carbon paper duplicates are still used in the hospital. My favorite? A box of UniBall Onyx pens in fine point. I used to prefer Micro, but found the Micro points to be less durable. The ink flows smoothly and authoritatively from these pens which I don’t mind losing. The other pens are personalized pens to give away. The federal rules do not allow for drug companies to give away pens, but there is no such impediment to physicians giving away pens. There are many companies on the internet that will personalize bulks of very nice and usable pens.
- Moleskine notebooks –These handsome faux leather (no moles in moleskine)notebooks are the original PDA’s. I keep one handy for a case-log and another as a personal journal and writer’s notebook. I like the 3.5×5.5 inch sized journal because it is large enough to write comfortably in but not so much that it won’t fit in my pockets. I preferred lined pages, but unlined is nice for those who like to sketch. (http://www.moleskines.com/)
- CME on disk –The problem with CME conferences is that it’s hard to get the CME’s on short notice and air travel makes it fairly miserable to hike across country to get the 30-50 annual CME hours required by most state boards. There are many CME products available, but my favorite are SESAP for general surgery (link) and the UCLA update on Vascular Surgery (link). Both are available as print material and handy MP3 and video MP4 files, allowing you to take them on your iPod or in your car. And that is where your CME time is well used. I frankly enjoy the 30 minutes listening in the car.
- Chestnuts –I grew up with chestnuts. They were a wintertime treat. Roasted, they were a savory and sweet snack that went well with the frigid wintertime air. In New York, that great melting pot, chestnuts would be served roasted on the streets from carts by older Italian gentleman, but now you hardly ever see them. It’s hard to find a good batch of chestnuts because they don’t travel well, being prone to fungus because of the high sugar content. I came across a batch of locally grown chestnuts and pounced on them because they were fresh. That said, you can get a jar of shelled and cooked (by steaming) chestnuts from France at Williams-Sonoma. It’s seasonal and once you open the jar, you have to refrigerate them, but they are delicious plain or in a stuffing –anywhere sweet potato would go in a dish, the chestnut does better. (link)
- Legals Seafood Fish Chowder –There is no better chowder than fish chowder and arguably, Legals of Boston has, if not the best, at least the most convenient. You can go on their website (link) and order a gallon or a quart, and you’ll get it shipped chilled and ready to heat up and eat. If you can’t consume it all at once, you can split freeze it, or split the package into smaller portions and freeze. A bowl of fish chowder on a winter day after playing out in the snow is something special. You can try making it yourself, but you won’t get the correct combination of fish and flavor that was featured in the Bush (pre) inaugural.
There are two seasons in a year, winter and golf. This past golf season just came to a close as the Wakonda Club and Des Moines Golf and Country Club covered their greens this past Monday. The season opened for me with cold rainy rounds at the Legacy GC where snow banks could still be seen in the rough. It took a miraculous 2 weeks to go from three feet of snow to lush green fairways and greens at Wakonda as the past three years’ investment in turf paid off. Despite the spring rains, the grounds crew somehow managed to groom the course into playable condition day after day. As the weather stabilized, the course blossomed in mid summer and Wakonda became a destination as it hosted multiple outings and events. What impressed me was how the course recovered after heavy usage. I credit this to favorable weather, knowledgeable members, and the grounds crew under Mr. Temme.
The weather mostly favored us in the latter summer and fall, creating a bumper crop of turf. The deep root systems, now several years old, allow for nearly instantaneous recovery if properly repaired. This is where the membership came through. Despite the unrepaired ball marks and unfilled divots after bouts of heavy play, the majority of members took it upon themselves to repair all the defects they came across and not just their own. Personal observation of the #10 green showed after an outing, the green had multiple unrepaired ball marks, which after a few days of play by membership and grooming by the grounds staff was basically tournament quality within several days. This was not possible in the older greens where heavily trafficked areas were susceptible to permanent damage requiring direct returfing.
This did nothing good for my handicap because the greens rolled very fast all season. At the Broadmoor for example, they were in the process of a yearlong grooming for the Ladies’ US Open next year, and this resulted in slower greens that I could hammer at –I shot an 86 there on the high course with no 3 putts, playing with three strangers who became good friends at the end. Wakonda gave no such quarter this year.
My favorite away-course this season? DMGCC –after many years, I am beginning to appreciate some of the lumpy bumps, and more importantly the friends I have to play a round with over there. This year included discovery of a no longer used set of Maruman irons in my dad’s garage. They are very light but launch the ball very high and long. Along with these came vintage Taylormade steel hybrids with the Raylor sole plate in 15 and 19 degrees. I have hit the 15 degree as far as my three wood on occasions but can land it with sore feet on long par threes. There really is no need to buy the latest and greatest but rather stick to what works. That said, my happiest moment came with my new set of Taylormade Burner irons, a birthday gift from my wife. I was 216 yards out on Wakonda #4 after fluffing the drive. After considering my choices, I had a great feeling about my 4 iron –I was on a slight downslope and there was wind at my back. I aimed left and set up for a smidge of fade. The pin was mid green to the left. I landed on the flat on the left of the fairway and the ball rolled on and came to a stop 2 feet from the cup. The shot of the year.
The grocery store turkey’s evolution from the wild turkey is an echo of our journey from our wilder, free-range origins. The wild turkey, whose intelligence caused Benjamin Franklin to recommend it for our national bird, is a far cousin of the overbred, overmedicated artifice that is the plastic wrapped bird that you plunk into your grocery cart. In the passage from our free-range origins to our over-cultivated existence, are we just overbred, overstuffed turkeys? Three things confirm this: the outsourcing of our basic food functions, the reduction of work into processes, and no reduction of stress from our surrender.
Outsourcing of Basic Food Functions
The wild turkey is known to be the most cunning of birds, requiring stealth and deceit to bring it close enough for a shot. I would assume the human in the original state of nature to be no different and no less intelligent. The urban legend is that the domesticated turkey is so stupid that they can’t be left out in the rain because they look up when hit on the head with raindrops, subsequently drowning. While this is untrue of domesticated turkeys, it may be true of domesticated humans, Homo sapiens sapiens familiaris.
We use to hunt for our food or gather it from the fields and forests. At a critical point, we domesticated the game and started farming the fruits and vegetables that sustained us, creating enough surplus calories to sustain larger populations that could then specialize in crafts, trades, and services, to where eventually the majority of the population could outsource food production to a minority of the people. If you’re lucky, you can buy a luscious apple out of season brought in by jet transport directly to your Costco from the Antipodes. This is not too much different from the turkey who willingly or unwillingly entered into the similar bargain with humans. In doing so, the turkey increased its population to an estimated 660 million turkeys currently in the world –technically a raging success on the chromosomal level. The outsourcing of the finding of food proved to be a Faustian bargain for the turkey whose life is rendered short and brutal. Depending on your outlook, the human bargain is no less Faustian because there are 6.8 billion humans, the majority of which now depend on this outsourced food production. If you are reading this on the internet, you are clearly benefiting from this arrangement. The recent economic downturn shows how easy it is to fall from the grace afforded by this system. If you can’t afford the fancy fruits, vegetables, and viands, you are stuck eating the processed corn and petroleum byproducts offered as stock feed for the masses.
Reduction of work into processes
Somewhere the idea of work, trade, and craft as virtuous activities became lost as the management professions became elevated. I remember having dinner right out of college with a bunch of young lawyers and consultants in Boston, none over the age of thirty. All were entrusted in some way with managing, valuing, judging, and giving advice on billions of dollars, thus affecting the lives of many people. None of these guys had really worked a day in their lives (including me except maybe stocking groceries throughout high school), but were clearly inside some kind of membrane that separated them from everyone else who did have to work for a wage and save a lifetime to afford a lifestyle that these young men were having straight out of college. One boasted that the yearly return on their fund outstripped the gross national product of whole countries, reaching for some kind of irony that I used to think was cool and now I think is depressing.
I have nothing against capitalism, and know second-hand through my parents and my wife’s parents the horrors of totalitarian communism, but there is a problem when theory trumps practice. Business management allows the reduction of any human activity into processes. The inputs and outputs of these processes can be tabulated, analyzed, and optimized. The logical end result is a human worker confinement pen like the factories in Shenzhen that make my gadgets –the workers live in dormitories adjacent to the factories allowing them to run 24/7. What we are witnessing is the ongoing triumph of totalitarian capitalism, and we’re going to either compete with China on their level or borrow furiously to maintain our relatively luxurious, free-range confinement pens. Neither is palatable to a country having just ended America’s Century in the dust cloud of falling towers.
No Reduction of Stress From Our Surrender
The majority of us don’t worry about food because it’s always there in the mega-mart, piled high and cheap. By surrendering our food production, we give up a load of stress but gain new ones. The ancestral stresses of hunger, climate, fear, and disease have been swapped for financial, social, and domestic stress. We outsourced our security functions to the local constabulary and our military, but rather than bask in security, we worry about terrorists at home and an endless war abroad. This stress is basically the same stress that the Thanksgiving turkey feels confined to a few square feet among thousands of other turkeys. That turkey fears not the fox, coyote, or bear, but it must feel something is terribly wrong with its world.
Taking It Back
The populist anti-elitism that elevated the dancing Palin against far more qualified, limber, and graceful competitors bears poorly for America’s continued excellence. The problem is not with the elites, but with the complicity of the turkeys in their continued confinement. Rather than cheap corn and petroleum based feed, they should demand the variety of diet that was available only two generations ago right out of small family farms and home vegetable gardens. Rather than dismiss food reform as the socialist dalliance of elitists, people should confront the source of their predicament.
The second half of this is the realization that the solution to outsourcing is In-Sourcing -which means work. It means that the service industry jobs that move quants and utils over the intertubes must be abandoned for work, trade, and craft. It means taking it down a notch as a society and lowering expectations while elevating living. It means a lot more people working in food production and repopulating small towns. It means reconnecting with community and family rather than moving every three years from Charlotte to Atlanta to Houston to Tampa to Denver. It means sweeping, hoeing, weeding, hunting, fishing, gathering.
Worse catastrophes have happened to people –go ask the Carthaginians when you’re in line in purgatory. People want a return to the past, to the golden age of the 50’s and early 60’s. What we’ll get is the 1920’s and 30’s. If you aren’t Howard Hughes, it’ll be a lot of work after work, with canning in the fall.
I have always wanted to directly access my Outlook schedule on my Macbook Pro, and found nothing that really satisfied except to go into Virtual Box, run Windows and launch Outlook. I purchased Office 2011 for Mac really just for the Outlook, but found to my disappointment, that it supports only Exchange Server 2007 or later. Our corporate server is Exchange Server 2003, and so I’ve had zero luck trying to get it to work.
I was on the cusp of returning the package to the Apple store when I launched Word just for the hell of it. Yes, there are some Microsoft related annoyances like the listed user on the splash screen is “Test User” rather than me, and I can’t figure out how to change that, but despite that, I have come to love Word 2011, even more than Pages.
I never really warmed to Pages despite its relatively straightforward and simplified scheme. It does create beautiful PDF documents and I think that that is how I will use Pages.
What I love about this Word is that it is Word, and for some reason, I don’t mind the business at the top -called the Ribbon. It’s remarkably easy to use.
My corporate experience with Word 2003 is not so great, but mostly tolerable, but 2011’s Word is just flat out wonderful. I haven’t even started using the cloud links. Fact is, I hated going to Google apps except to bang out snippets to paste into a later document. Same goes for using Pages on my iPad, which I have decided is not to be used with a keyboard unless absolutely necessary -the Bluetooth never really works and requires frequent re-linking, and even with the plug in keyboard stand (pictured partially under the Office 2011 box above), it never really works well.
Why is Word 2011 all of a sudden important to me?
First, my Macbook Pro is back. I basically stopped using it over the summer because of iPad, but I realize now that to make stuff, you still need the power of a laptop. I toyed with the idea of getting a Macbook Air, but the primary thing that I wanted was just battery life, and I could get it with extra batteries. When the warranty runs out, I plan on swapping the hard drive out for Flash based SSD’s.
The Macbook Pro, despite being 2 years old, is still lightning fast and eminently sufficient for what I need to do. Docked here to a 23 inch monitor, it basically functions as an iMac, but mobile, it is wonderful to sit down in a comfortable chair and compose.
Second, writing well is very important to me and I have always chosen the finest papers and writing instruments when I write manually (and lose a lot of those fine writing instruments, which is why I favor multipacks of Uniball Onyx pens). Word 2011 is like a top of the line IBM Selectric or a Mont Blanc pen. With 2011, you are writing in style. The spell checking, the formatting, the grammar checking all works well and intuitively. For example, I chose the quotation format, and then later changed the font. It asks you subsequently when you make another quotation, if you want to use the modified format, but does so in a way that doesn’t infuriate you like past Microsoft efforts.
Third, compatibility is still an issue. Despite the fact that I find quitting desktop based software for the cloud easy and natural, most people don’t. There will necessarily be a five year time lag before it ever happens and it may never really happen as people don’t want Google or Facebook (cloud apps are next for them) to know everything about you. The funny thing is, the default file format is .docx which is not backwards compatible!
Fourth -there is no Clippy. In fact, there is very little Windows anything. It feels like Mac software, which OpenOffice and StarOffice, the free office suites, do not. Pages feels more like a page layout software than a word processor, while the iPad version’s fixed appearance just drives me crazy -call me shallow but I think the fake wood top margin drives me insane, and I have gravitated to Quickoffice on iPad for exactly that reason.
Genesis 9:17 So God said to Noah, “This is the sign of the covenant I have established between me and all life on the earth.”
As the waters rise, as the scientists warn, as Greenland is growing its own lettuce for the first time, the response from many Americans is basically some variation of the above verse from Genesis, where God reassures Noah that, no, I will not fill the world with water and make every living creature live on a Neolithic barge. Again.
The Reverend Timothy Keller, PhD, pastor of Redeemer Presbyterian Church in NY, NY, wrote a wonderful essay on threading the needle between modern science and orthodox Christianity (link to essay http://www.biologos.org/uploads/projects/Keller_white_paper.pdf) where in a style which I learned to appreciate, he spells out the basic problems in a tripartite apologia –his preferred format for preaching to the yuppies. He writes:
Question #1: If God used evolution to create, then we can’t take Genesis 1 literally, and if we can’t do that, why take any other part of the Bible literally?
Answer: The way to respect the authority of the Biblical writers is to take them as they want to be taken. Sometimes they want to be taken literally, sometimes they don’t. We must listen to them, not impose our thinking and agenda on them.
Question#2: If biological evolution is true—does that mean that we are just animals driven by our genes, and everything about us can be explained by natural selection?
Answer: No. Belief in evolution as a biological process is not the same as belief in evolution as a world- view.
Question #3: If biological evolution is true and there was no historical Adam and Eve how can we know where sin and suffering came from?
Answer: Belief in evolution can be compatible with a belief in an historical fall and a literal Adam and Eve. There are many unanswered questions around this issue and so Christians who believe God used evolution must be open to one another’s views.
The response from the bench is predictable as this dispute between literalists and the interpreters predates Christianity. This dichotomy is likely a manifestation of human speech and all the neurologic wiring that entails. I can imagine this conversation between Erg and !Kerg, two chatty Australopithecines.
Erg: When the great Mother cried her tears and made the seas in ten days and she laid down to become the great Mother mountain yonder, that would mean that she would have had to cry about 1/10th of the volume of the world’s waters in a day… That’s a lot of water. Could this mean that a day in Her time was much longer than a day is now? Could this mean that she was much bigger once and made bigger tears and shrank to become the Mother mountain? Could…
!Kerg clubs Erg.
The commentary from the literalists on Dr. Keller’s essay ranges from, “…Professor Keller is trying to square the circle…[scripture quotes]…and therefore the day in Genesis is clearly 24 hours” to “club!” While I concede that many New Yorkers would welcome the opportunity to live in the belly of a whale, most thinking people scratch their heads and think that Hansel and Gretel’s cannibal witch is far more grounded in reality than a cetacean studio.
The fact and reality of science and modernity puts a great deal of pressure on an unchanging orthodoxy. Those most willing and capable of thoughtful change are never in the majority. The Malthusian concept could just as easily apply to this: the educated breed arithmetically while the orthodox breed geometrically.
Time and again, when learning and education flower, the bright lights of the world are drowned out by a flood of fear and ignorance. The execution of the Chinese scholars, the torching of the Alexandrine library, the sacking of Irish monastaries, Galileo, Darwin, and Rushdie –these are the normal patterns. When the creators of South Park have to stop their series mid-season to be censored by the orthodox of several religions in a country that places free speech before all other rights except the right not to have Congress establish a state religion, it confirms that before the great flood, there is an even greater flood of intolerance, narrow-mindedness, and incivility.
May God keep you and bless you, if you so tend to believe.