What Good is a Stinkin’ iPad?

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My good friend SY wrote me yesterday asking basically, “what good is a stinkin’ iPad?”

Hi Mike!

How are you??
My husband and I bought an iPad for my dad, but he decided he didn’t really have use for it (i.e. he uses his laptop and his phone and can’t get Java to work on the iPad so he can’t play ba-dook on it).

So now we are deciding whether to take it back or keep it for us–How useful is it really? You can’t edit documents or talks on it can you? Is it good for taking notes at conferences? Isn’t the wireless plan expensive on it? I pretty much bring my Mac everywhere with me, but I’m not sure it’s more than an indulgent toy for us.

SYP

I wrote back.

Hi Sung Yun. I have been asked this same question many times and can answer in the affirmative that tablets are overall great for reading and looking at stuff on. For editing and taking notes, it depends on what you are used to. And for portability, tablets>laptops. Tablets in general get a lot done, and of the tablet choices that you have, the iPad is still, for now, the best tablet a lot of money can buy.

I went all in when the first iPad came out, buying not one but two iPads. It occurred to me from the start that the pain of lugging my 15 inch Macbook Pro was soon to be relieved by the magic iPad, but I was worried that I would not be able to multitask. I normally keep several desktops and multiple windows going at the same time on my laptop, and to get a similar functionality from tablets, I feel you have to have multiple tablets. I also figured two iPads were still more portable than a single Macbook Pro (2007 issue).

The first great use of the iPad was as a reader. I own several Kindles and while I love reading books on my Kindle Paper White 3G, I equally enjoy reading them on the larger screen of my iPad. The skeuomorphic iBooks with their faux page turns are fun, but the iPad Kindle App with an Amazon Prime Account is reading heaven. Toss in FreeBooks app that feature everything out of copyright, and you have a public library in portable form. Overdrive reader app lets you access your local public library -you can look up and check out eBooks from your library! If you read magazines, most magazines feature an iPad App. Harder to find magazines can be found in newsstands like Zinio, but the killer app for magazines is Next Issue which for a monthly 8 to 15 dollars features hundreds of magazines like Esquire, Time, and People. I can’t live without my New Yorker magazine, and now rather than a mess of magazines around the house, they are all in my iPad.

The next use of the iPad is as a portable widescreen TV. While iTunes lets you purchase and then download movies and TV shows from iCloud onto your Mac, AppleTV, or iOS device (iPad, iPod Touch, iPhone), the streaming app trio of Hulu, Netflix, and Amazon Prime gives you access to thousands of current and vintage movies and television shows. Hulu Plus, a monthly subscription, gives me access to every episode of South Park, the Daily Show, Colbert Report, Community, and The New Girl. It also features the Criterion Collection of critically acclaimed but difficult to find foreign films -I am in the midst of watching Riso Amaro (Bitter Rice), an Italian post war film of lust and crime in the Italian rice paddies. Movies-Riso_AmaroNetflix has a great selection of movies and TV shows as well, and the ability to have DVD’s mailed to you. Amazon Prime’s video player also features many recently released films for streaming, and beats iTunes by letting you stream rather than download then watch rental movies. Amazon also has every Ken Burns documentary, if that is your thing.

These two features are the core of how the adults in the house use the iPad. Jen enjoys watching Downton Abbey in the bed while I read the NY Times and listen to Paloma Faith on Spotify. The NPR app, by the way, lets you listen to all the NPR that you missed during your busy day. The boys love watching their shows anywhere, anytime. The funny thing is, because we watch shows on our terms, the TV goes the whole week without being turned on except for family movie night or when dad watches sports. During baseball season, by the way, I buy an MLB season ticket to watch major league baseball games -usually as a ten minute summary of outs and hits the next morning, but often I stream the live radio broadcast just to hear John Sterling howl, “Yaaaaaaankeeeees Winnn!”

The third feature is up to you to decide if you want in the house. The iPad is a great gaming platform. While not as immersive or complicated as an XBox, Wii, or Playstation, games on the iPad are no less fun or addictive. Words with Friends pops on a larger screen. Pinball is a great stress reducer. My boys play all manner of games -most of which are free or cost 99 cents which is a lot cheaper than the average XBox game.

The utility of tablets is that eliminating the keyboard frees you to interact with the computer in a far more natural way. Drawing and music creation are two ways I put mileage on the iPad. My favorite art app, Paper, was the App Store’s App of the Year last year, and I doodle constantly. The Brushes app is used by David Hockney and other artists to create serious art. I frequently use Adobe Ideas to sketch on top of CT scans for patient consultations.

For note taking, there are innumerable apps for taking freehand notes and the better ones allow you to record the presenter’s audio synced to your notes. My favorite second brain app is Evernote which lets me data dump important files, notes, and ideas for access across all my gadgets. If you type fast, you probably aren’t going to change note taking tasks but I have to mention that it’s less intrusive to write notes on iPad than click clack away on a keyboard.

This brings me to the last part -work. I composed this blog entry on an iPad using the Logitech Slim Keyboard Case, which I recently reviewed. It turns the iPad into basically what the Microsoft Surface wants to be, a post-laptop work device. While Office for iOS isn’t out in the wild yet and probably never will be, there are many options for writing and editing. Pages is a good word processor, but Word is more universal and more importantly has collaborative editing and version control that is superior to anything on iOS. That said, Pages is unmatched in its ability to layout documents. That’s how I use it -after composing the content in a simple text processor like iA Writer, I open up and prettify it in Pages and save it as a Word file for sending out.

For presentations, Keynote is how I make all my presentations. I can make them on the fly during and after cases to present complex operations to patients and their families. You can export into Powerpoint or PDF, but equally powerful is the ability to present directly off your iPad, either via a cable or wirelessly to an AppleTV (an unpromoted feature). The usual way I create presentations is I upload all the pictures and graphics to a Dropbox folder and then compose the presentation on my iPad after taking intraop photos with my iPod Touch or iPhone. I’ve uploaded a sample presentation SFA-POP-Tibioperoneal Trunk EndoRE that I created right after a case for explaining what I did for a patient’s family.

The wireless plan is pricey if you’re not needing it, but I find it indispensable because my iPad 3 with Verizon 4G has a hotspot function which will allow me to tether other devices like a Macbook Pro or iPod Touch at high speeds. The typical use scenario is on long car trips where the iPad is the hotspot for streaming video to the boy’s tablets and I listen to This American Life episodes (every episode ever is available on their app). In a pinch, the iPad can act as a ridiculously large phone via the Line 2 app, which gives me a phone number (in Manhattan no less) for non-work use.

Now here is the last tip -I suggest you trade in your iPad for an iPad Mini with Verizon Wireless. The big screen is great, but impossible to carry around the hospital in a white coat. The 8 inch size fits perfectly. I’m holding out for the retina display iPad Mini which hopefully is next. For now, my Android Tablets fulfill this in the pocket function, and match the iPad largely feature for feature except for speed (they are older single processor devices) and ease of use. I think if you are adventuresome, the Nexus 7 is probably hits the sweetspot of price (about 200 bucks) and size (fits white coat pocket), but for cheaper, you don’t get the cellular wireless or nifty form factor, and you have to geek out on Android.

Hope that helps.

Mike

Egg in a Basket -from V is for Vendetta movie

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Inspired by the egg dish in V is for Vendetta, it was called eggy in a basket. The circular toast that comes out of the center is fun for eating yourself or for toddlers. Want to know from my UK friends if this actually exists as a breakfast dish.

12 Used Things to Get For Your Favorite Surgeon

One of the most popular posts on this blog is a gift suggestion list I put together last year. Surprisingly, every item remains fresh –even the iPad and Macbook Air. Because of the terrible economy, I thought that “gently used” and “pre-owned” items deserved their time in the sun. Add to the list last year’s model which technically isn’t used, but still a great bargain. Here it goes.

1. Gently used Porsche –these were in fact easier to get in 2009 after the crash, but the lots are full especially in tony but transient locales like the Hamptons, Aspen, and Lake Taho. My particular favorites are the 911 turbos from the 80’s and 90’s. They have go cart like handling and are plenty fast without costing more than a new Hyundai.

2. Sony NEX-5, last year’s model. The lenses for the new one fit. The cameras have been updated, but there is no need to buy the latest and greatest here. Why even bother getting a SLR quality camera when your smartphone takes nice snaps? I agree, there is no reason to buy a point and shoot camera when the iPhone and others take excellent snapshots, but to take great macro shots in the OR or beautiful portraits and landscapes, a great camera and lens still wins. Ansel Adams could not have produced his masterworks with an iPhone.

3. iPad2 in a few months –they are plenty fast and because I have never used Siri, I don’t miss it yet. The iPad2 does everything that the original iPad does about 20-30% faster. The device is definitely thinner. Facetime is GREAT and brings the promise of videophone to life. The Android manufacturers don’t realize that not only are they competing with the to-be-announced Retina display, Siri equipped iPad 3 in April, they will be competing with the millions of iPad2’s that will be sold on eBay when current owners upgrade. The wonderful thing about Apple is that Apple updates the operating system unlike 95% of Android manufacturers, and that devices going back more than a year are supported in these upgrades, which means many years of usefulness for iPad2 and last year’s iPad.

4. Tiny Laptops –When released, tiny, pocketable laptops like the Sony Vaio P series were very pricy toys but now they are available used for a significant price reduction. I recommend getting a late generation model with the SSD hard drive. These fin in the coat pocket and will allow most physicians get onto their hospital information systems –something cumbersome to do on a tablet. The Windows 7 devices will also let you run iTunes letting it be a very nice media player. The only downside is the short battery life which can be augmented with an extra battery or one of those combo USB/laptop batteries –I use the Eveready branded ones as they allow you to simultaneously charge a smartphone, a laptop, and itself.

5. Old school iPods –the iPod 5th generation, also known as the video iPod, is readily available used on eBay cheap and come in 30 and 60gB sizes –usually more than enough for most music libraries. The only trouble with them is that the batteries are often run down –that’s usually not a problem as it costs about 20 dollars and fifteen minutes to swap one out. The older iPods work well with most automobile maker’s iPod docks which for some unfathomable reason are several years behind at the time of release. The original Bose Sound Docks and the Apple branded iPod speakers (very hard to find) are wonderful loudspeakers and work great with these older iPods. The older iPods are durable and won’t break the bank if you leave it behind in the OR, unlike an iPad or an iPod Touch. I recently acquired an iPod Mini from my dad who never really used it, and I not only changed the battery on it, but I swapped out the 4gB compact flash hard drive for a 32gB solid state hard drive –instructions are widely available on line.

6. High end automatic espresso machines. My recently acquired Saeco Incanto Sirius espresso machine will grind and brew perfect espresso and lattes. When purchased new, they are well over a thousand dollars, but you can find them used for a couple of hundred. The great thing about these is that there are resellers of these machines on line, and finding spare parts and repairing them yourself is pretty straight forward. Once you try coffee from these machines, you will never go back to Starbucks, or even remotely enjoy the swill from a Keurig.

7. Used Kindle 2 –Kindle 2’s, the black and white ones with the keyboard are trickling on to the market as the newest array of Kindles come onto market. If you can find one for under $50, you should snap it up because the secret about the Kindle 2 is this: the always on 3G connection and the “experimental” web browser. You never have to pay a subscription fee, and for reading text and email from the web, expecially if you set up a web news reader account well, you will be surfing away anywhere in over a hundred countries without paying wireless fees. Plus, you can read your books. In the sun. I was initially against ereaders, but being able to download and read hardcover books for 10 bucks or less, and carry several hundred around at a time trumps any antediluvian “I love how an old book smells” sentiment. That old book smell, by the way, is likely a potentially deadly mold.

8. Used Aquariums –The one thing about people moving around a lot is that aquariums don’t move well. People once excited by Nemo suddenly find the cost and time involved in taking care of fish to be a burden. The key is avoiding salt water set ups and focusing on self sustaining easily breeding fish like guppies that don’t need to be harvested from the tropics. The maintenance is minimal in fact if you go for a natural museum presentation with algae and freswater plants as well. The water from these tanks should never be thrown out –they are incredibly fertile natural plant food for the garden and potted plants. Best found on Craigslist and local barter sites, the sweet spot is 10 gallons and up.

9. Used Big Televisions –while flat screen televisions are cheap, the 60 inchers are considered the high end and still command a premium price. The increasingly obsolete DLP (digital light projection) televisions can be found used for sale and have excellent pictures particularly in the darkened home theater setting where being flat isn’t critical. The important thing is making sure the connectors are up to date –HDMI is a must. The other bonus is that these televisions are incredibly light –they’re mostly air.

10. High end stereo equipment from the 80’s and 90’s. Those ten thousand dollar stereos from twenty years ago are now considered junk because of iPods and iPod speakers have largely obsoleted CD players and standalone stereos. That said, the sound coming out of high end used speakers and a quality amplifier like the NAD amps which will accept the audio out from an iPod via RCA jacks is both loud, amazing, and cheap. Most kids don’t have the experience of listening to Pink Floyd at full volume through six foot tall speakers.

11. Used Golf Clubs –There is really no need to pay top dollar for the latest clubs, but most amateurs start and play with clubs that hurt their scores from overwhelming age or cheapness. There are certain clubs that will improve play which were amazing when they came out and still play better than the entry level kits from Walmart or Costco. Vintage Ping Irons –the Ping Eye2’s, are forgiving, durable, and very easy to find in your size. Perimeter weighted Maruma’s and Honma’s –basically hand carved Japanese irons that were several thousand dollars when new, can be found for a few hundred or less on eBay. Best person to ask –any long term golfer –ask them what were their dream clubs in the 1990’s. Most of these irons can be regrooved with tools from the internet –while illegal for tournament play, for the average golfer, these rejuvenate older clubs for use. All they need are new grips.

12. Projectors –8mm Projector and slide projectors –if you have old cans of 8mm movies or boxes of slides, you can have them digitized for a fee, but its much more fun to watch them through original equipment. The missing link is usually the projection equipment which was often fragile with now hard to replace parts. Fact is, these can be found functioning and make for incredible family activities around Thanksgiving or the holidays. Imagine screening wedding footage from the 60’s or 70’s or vacation slides from your parents childhood. The 8mm film and 35mm slide are the least accessible of the popular consumer medial technologies of their times, and being able to show these films and slides with the clickety clack of the projectors, the shuffle of the carousels, with live narration of the subjects (while they are still around) is worthy of filming with your smartphone.

Merry Christmas to all.

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Extreme Golf

I took tax day off and played a round during an ice storm. Good for building character, playing in inclement weather is useful in testing your game against many more variables than just the usual yardage, light wind, lie, elevation, incline, etc. Add to it slickness of grip, 35mph prevailing winds, stinging rain and sleet, and hypothermia and you have a sport -Extreme Golf.

A Year in Two Seasons



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 Flood

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.

Golf Passage of the Mysteries

A poem written driving from Detroit to Des Moines after we missed a connecting flight, we were returning from a spring golf trip to Hilton Head, myself and several most excellent golfing companions. As we pulled out of a convenience store lot, I had the vision of a wizened old man, a specter, hailing us with the following words…
Five and One man, on a journey!
Heading westwards, on into the night.
Burdens shared, and sleep neglected,
Y’all crossing the river, and arrive at first light.
Great joy you have found, and more do you seek
Onwards and onwards, for promises to keep,
Hammer on the right foot, no shoe on the left
Still many hours, before you shall sleep.
So go, I say go, and listen No More,
I am an illusion, but so is your labor,
That ball is not a ball, that hole is not a hole,
And that last hasty meal, you will not savor.
And when you are home, and you lay in your bed
Alive you will feel, alive with no dread
And in seeking all that golfin’ pleasure,
You realize the truth that the company is the treasure.

What does Bowie’s Major Tom mean?

The David Bowie song has taken a lifetime to decipher. When I first heard it, I though it was a groovy song tuned to the psychedelic times -this is the most common interpretation that I got on the internet. Here are the lyrics.

Ground Control to Major Tom
Ground Control to Major Tom
Take your protein pills and put your helmet on
Ground Control to Major Tom
Commencing countdown, engines on
Check ignition and may God’s love be with you
Ten, Nine, Eight, Seven, Six, Five,
Four, Three, Two, One, Liftoff
This is Ground Control to Major Tom
You’ve really made the grade
And the papers want to know whose shirts you wear
Now it’s time to leave the capsule if you dare
“This is Major Tom to Ground Control
I’m stepping through the door
And I’m floating in a most peculiar way
And the stars look very different today
For here
Am I sitting in a tin can
Far above the world
Planet Earth is blue
And there’s nothing I can do
Though I’m past one hundred thousand miles
I’m feeling very still
And I think my spaceship knows which way to go
Tell my wife I love her very much she knows”
Ground Control to Major Tom
Your circuit’s dead, there’s something wrong
Can you hear me, Major Tom?
Can you hear me, Major Tom?
Can you hear me, Major Tom?
Can you….
“Here am I floating round my tin can
Far above the Moon
Planet Earth is blue
And there’s nothing I can do.”

It’s after the passage of 42 years that I understand the true meaning of the song. The song has to do with transformation. The hero is an astronaut. In that era, astronauts were the straightest of straight arrows. Buzzcut illuminati of American manhood, these men were walking statues of virtue, and for Bowie, an easy group to symbolize as the American Everyman, who worked for a large corporation, drove an American car out to a suburb, with a pretty wife and cute children.

The disembodied voice of Houston is in fact the voice of society and her expectations. It is also the voice of authority. When Major Tom leaves his government-issued cocoon, he undergoes a transformation. He’s floating in a most peculiar way, and the stars look different today. It is the awakening of the man, and he understands he can’t go back to the way things were. This happens to some men after they reach the top of the hill and look back and then look forward. Some can’t help themselves and decide to go sideways. The middle-aged man is typically at the height of his powers, but is in essence impotent in the face of the inexorable passage of time, the enormity of the universe, and unbearable blueness of the Earth.