Iowa, Nice

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This video has gone viral and is a reaction to all the negative coverage about Iowa. I have always said that Iowa plays a critical role as America’s great filter. I believe this because Iowa has the highest percentage of educated and reasonable people in the US. In fact, it is Iowa’s number one export.

When I was in New York and we had to have any kind of group interaction, the ability of the group to function predicated on a minimal number of stable, reasonable people. The reasonable persons index is basically the number of reasonable people divided by all the people in the group. A midtown modification of this is all the reasonable people and their entourage divided by the people in the room and their intended audience, but I digress.

The minimal index for a group to function in my experience is 0.20, meaning one in five of any group has to be a reasonable individual. The average New York City subway car has an index of 0.05. The average city council meeting, 0.15. The average fully loaded cab headed to three different stops on a rainy day, 0.00, my apartment, 0.50. What I noticed in various committee meetings that was part of my job back in New York was that the reasonable people were either Jamaican or from the Midwest, and of those from the Midwest, the least insane were from Iowa.

When I moved to Iowa, for obvious reasons, I realized the impact of the high reasonability index when I visited the motor vehicle department for my Iowa Driver’s license. It was packed, and there was a sign asking me to please take a number and wait for it to be called. My wife was pushing my son, then a toddler, in a stroller, and was immediately offered a seat by several reasonable Iowans, including some who needed the chair far more than my wife. As we sat, the numbers were called and the people moved up to the desk with a beautiful dignity –none of the expected sighing, looking up to the sky, and loudly complaining into the cell phone that would have been expected behavior back in New York. When our turn came, the clerk noticed I hadn’t filled out a section properly and patiently waited while I filled out the missing parts. My wife who is the typical non-patient type A New Yorker was smiling Mona Lisa-like through the whole experience –a surreal, psychedelic ethereal moment of serendipity.

The average Iowa is college educated and well read. I have a patient who is a farmer. He holds a dual masters in agricultural sciences and business. While he sits in his air-conditioned combine feeding the planet, he is trading commodity futures on his Blackberry. We had a nice discussion about the writing program at University of Iowa where his sister, a budding novelist attends. He’s skeptical of climate change, but only so far as he is skeptical of anything on the Huffington Post, but has noticed the wetter summers and is adjusting his farming accordingly. He has an investment strategy based on climate projections and economic growth data –in a name Brazil, and he has prospered. He has never visited Manhattan and sees no need to, being very comfortable in his maxed out Ford F-150 which has all the appointments of the coziest leather chair in a quiet corner of an exclusive midtown club. He doesn’t see what the fuss is about gay marriage, but is very upset about our wars abroad. He wishes the Republicans would field a more reasonable candidate, basically an Iowan like him, and is on the fence.

When candidates crash and burn on the Iowa Caucus stage, it’s usually because the Iowan reasonableness burns through the spin. Howard Dean, fun guy, would have been a terrible president and scared Iowans to death with his primal scream. And people focus on the GOP caucus which is the one place where the reasonability index falls below 0.50. You should look at the people Iowa rejected and understand what is going on. Howard Dean, John Edwards, Hilary Clinton (narrowly), Gingrich, Bachmann, Paul, Perry, Mitt Romney ‘08 and I would argue ‘12. The more I listen to Governor Huckabee, who won in ‘08, the more I respect him for his reasonableness on many issues, even though I disagree with him on some very important ones –and that is why he won in Iowa.

The caucuses are Iowa’s Exposition of American Democracy. If you show up, you vote physically by moving around the room and gathering (caucusing) for your favorite candidate. That candidate may even show up or prior to that, at your favorite lunch counter, bistro, or living room. In the hyperconnected, hypercaffeinated media world, the Iowa Caucuses are a time warp to the 19th century of mustachioed men orating on soap boxes. Given the audience that the candidates face, it is no wonder that the least reasonable just wilt. It wasn’t the internet spawned image of Bachmann fellating a corn dog at the Iowa State Fair that lost her. She lost by failing to convince Iowan’s that she deserves to lead the country. Got that? Not money, though it helps, but on fitness to lead. Isn’t that the whole point?

So as we move our attention to New Hampshire (state reasonability index of 0.02, both of them from Iowa), and South Carolina (-0.35, negative when person so unreasonable that they negate the positive of those around them, like some in-laws), I think we should all celebrate and be grateful for Iowa, America’s pith.

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.

I F$#@ing Hate the Social Network, That’s Why You Have to Watch It

I fucking hate The Social Network. Not because it’s a bad movie -it’s very good and you should see it. The reason I hate it is it’s too good. During the entire first half hour, I felt like I was in one of my recurring stress dreams where I’m back at Harvard. In this dream, I am walking into Memorial Hall and sitting down with a stack of empty blue books, and I have three hours to answer questions that I know nothing about in a language that I cannot understand. < shudder >

Most of the first act was shot at Harvard, and the House dorms looked about the same as they did over twenty years ago.  What was more ingenious was the portrayal of undergraduate life there which was spot on. With those pictures rushed back the anxiety over social status, ethnicity, money, and the general envy and dismay towards all the Winklevosses who were there and above all of us. Hooray for Mark Zuckerberg and Eduardo Saverin. They have changed the world.

Everyone who agrees, just poke me.

The new iPhone Netflix app end of TV

The iPad had the Netflix app first, and it was amazing, but expected on the iPad with its large gorgeous screen. The appearance of the Netlix app (and Hulu+ app) on my two year old iPhone 3G is worthy of comment. First, aside from iPhone, no other piece of portable technology has weathered aging as well. It is currently updated to iOS 4.0 which makes it slow, but the incredible thing about it now is I have access to thousands of movies and TV shows. It works best with a good Wifi connection, and makes cable or satellite TV irrelevant. The only time I watch broadcast TV is to watch live sports -and this usually on network TV over rabbit ears. I tried to cancel DirectTV a while back and they halved my bill after begging me to stay. Despite this, the writing is on the wall. TV is over. It’s dead. So are movies in theaters.

The Rock Star

Okay. So I’m off key -I was suppose to sing Proud Mary which is my song, but the crowd at Universal Studios responded.

Yale Is Burning

This made the rounds a few weeks ago, including a nice article on The New Yorker. Watching it, I had to smile. As a Harvard Alum, I can tell you there is no amount of glee at 86 Brattle Street that can match this gleeful video. You either get it or you don’t. They want to select for an even creamier crème de la crème. This goes beyond being able to understand and appreciate pink polo shirts, munching on pistachios, grapes, and brie with a Gewurztraminer, or liking to sing show tunes in the shower while being completely heterosexual.

If you don’t get it, you will snigger at this video and apply to Princeton. If you really don’t get it, you’ll stop watching when the singing starts and you’ll apply to a Big Ten School. If you get it, but don’t get in, you’ll be perfectly happy at Amherst. And so on.

This inspires me to hark back to college, to the time when I hijacked the microphone at Naples Pizza in New Haven and proclaimed, “Yale Sucks!” And now, we have proof.

Dawn of the Dead -is all about us.

I recently watched the remake of Dawn of the Dead on Hulu while on call. In general, I find the horror genre either to be a thinly veiled subcategory of Chick Lit or generally too scary to watch. The first category, the horror Chick Lit or Chick Flick, are all the romantic vampire stories and beauty with beast fables. They are dreck even when an auteur like Joss Whedon labors to make them watchable. Something dark lies in the feminine psyche for fantasies about blood sucking, pasty faced, pretty boy immortals sells. The latter, the truly scary horror, deals in the supernatural. In the heart of all rational people, there is a primitive spot that wonders if there is good and evil and not just cause and effect. When a film taps this, and reveals the frightening voids and yawning chasms presented by contemplation and imagining of evil, even this fairly rational and educated surgeon can get a twee scared watching The Grudge in the dark (she looks like an ex-girlfriend).

But zombie movies? Not so! For some reason, I love them because I’m a doctor. The slow zombie era of Cesar Romero came to an end with the fast zombies of 28 Days Later (and its sequel, 28 Weeks Later). Zombie movies appeal to my inner infectious disease expert. In some way, I deal with the necrosis and suppuration every week, and seeing hordes of diseased people doesn’t seem too scary. It then boils down to how the undiseased people react in these circumstances which entertains me: by denying, by panicking, by getting armed, by having sex (more denial), and by getting oddly rational. When HIV began killing people in the late 80′s, the response was not unlike the plot of a zombie movie. There was fatal ignorance and denial, followed by panic, then calls for concentration camps, followed a neurotic mix of hedonism, consumerism, prudishness, and rampant heterosexualism. The collective sigh of relief was the announcement by Dr. Ho of multidrug therapy, as conceptualized by the not-gay and not down-low Magic Johnson just staying alive.

The most recent remake of Dawn of the Dead makes great fun with these concepts. The survivors of the plague hole up in a shopping mall, and all the zombies congregate there and mill about outside the locked entrances. And its the same now in the time of the economic plague that I see hordes milling about at our local mall. Despite the recession, the place is always full. I think people go there because going to the mall and shopping is a talisman of normalcy. After the horrible events of 9/11, President Bush told everyone to go shopping. Shopping! And that is what I see going on, the continued shopping for a little slice of happiness, is not unlike the zombies congregating at the mall in Dawn of the Dead. “I think its some retained memory they have that brings them here,” says one of the characters.

As a medical student, I was assigned patients and was their intern, responsible for their health. Never mind that most of them had HIV and were crack abusers, making them somewhat unstable. I learned to have a conversation with them, those who in another era would have been called possessed and unclean. I took the lessons of the plaque dedicated to the twenty medical students who died in the influenza pandemic of 1918, and understood implicitly the bargain I had to make. To be a good physician, I would have to take good care of all people. I performed central lines and spinal taps in poorly lit rooms on patients whose viral titres made them frankly toxic to be around with a needle, a scalpel, or broken glass (from lidocaine vials). I learned equanimity in the face of really horrible things like the gal who hid a roll of dollar bills in her abscess (pocket of pus) cavity on her lower abdomen. She’d pay for crack with those filthy bills and earned them by doing who knows what. If that trumps zombies, I don’t know what. I always wash my hands after touching money.

Eddie Murphy had a claymation animation sit-com in the 90′s called the PJ’s. It featured a crack addict who was spot on and completely true. Ironically, he was the straight man, and dished wisdom while eying the pigeons for a possible meal. The great tragedy in the AIDs/Crack epidemic of the 90′s was its victims who made to the hospital after living on the streets for years were incredible specimens. They had to be to survive for as long as they did. They were all tall, lean, and if you looked past the insanity, wear, tear, and grime, were usually good looking with good bone structure -think Na’Vi, twenty years after the aliens from Earth returns to Pandora, colonize them, and put them on reservations with their sensory pony tails cut and cauterized at the stump.

We forget that the heroes of the Zombie movies are in fact, the Zombies. Once infected and left to wander around for fresh brain, they are the perfect citizenry. Their behavior is predictable, and their intentions are true. They offer no political resistance by asking no questions, and their happiness lies in fresh brains. Substitute fresh brains for fresh fruit out of season, perfectly-red meat packed in styrofoam and plastic, and giant homes in the suburbs, and you have it. The real monsters in Zombie movies are the protagonists, they with their guns and fire, keeping the thronging mobs from their happiness and fulfillment.

So stop being a wet noodle! Go, run out and buy yourself some Zombie pickle and get happy! A good place to start: On January 27th, Apple will present their next great thing, by the way, you happy Zombie.

Escape from the Uncanny Valley -why Avatar is groundbreaking

The uncanny valley is the revulsion caused by robots and computer generated images that try to mimic human faces. It was coined in the 1970′s by Masahiro Mori (link) and is the reason why watching Polar Express makes me jump up and down like a rabid chimpanzee. CGI movies that maintain their cartoony-ness avoid this problem.

So it was with a bit of suspicion that I went to see Avatar, expecting to jump up and down like a rabid chimp as soon as those blue goat people got on screen. I was wrong. James Cameron understood this implicitly and created an image capture system that follows actors facial movements and maps it directly to the blue Navi’s. The actors are really acting and the computer generated animatronics are imbued with emotion that greatly exceeds that of the actual human actors.

Avatar is great in the way that Titanic was great. The main character in Titanic was the ship, and in Avatar, it’s the escape from uncanny valley. The script is a Disney princess movie on steroids, but the real reason you should see Avatar is this entirely new way of experiencing the world.

I have to add, I have always felt virtual reality won’t work until all five senses are involved and Cameron seems to understand it as well -to access the avatars, the characters lay down in an MRI machine -it is through electromagnetic manipulation of nerves that true telepresence will be achieved.

Elvis, by Wowee, straight from the Uncanny Valley

The Coda

the planOne of the greatest television shows ever created was Battlestar Galactica as reimagined by Ronald D. Moore.  The Mini-Series brought the core of the show, a story about a nuclear holocaust and the travails of the survivors, and brought it into the present with an examination of our culture at war without and within. It showed the best of humanity and its worst, and showed the Cylons to be far more complex than an army of Terminators. The whole show ended earlier this year with a very memorable and complex finale that capped an opus that stands up there with the best storytelling. So it was with a bit of trepidation that I downloaded and watched Battlestar Galactica: The Plan. Some people panned it as an editors’ cheap trick, a kind of über fan-film of the kind you watch and cringe at on Youtube.

I disagree. It filled several plot holes that never made sense in the original series, such as the appearance and disappearance of the Librarian Six, known as Shelley Godfrey. I enjoyed this because it fills these plot holes. But like the filler that is used to repair actual pot holes, the patch work is noticeable. The scenes visually jump around and older original footage runs into obviously freshly shot footage that tries very hard to look seemless but isn’t. They also left you with a final plot hole -the whereabouts of a dark haired 6.

That said, it is a fitting coda to a great series. They really should stop now. I only hope they don’t try to make a movie. There is a spinoff, a prequel, called Caprica that looks at the origins of Cylons, but it rates only about 6 out of 10 where the original miniseries was an 11.

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