The Agony and the Ecstasy

The Agony and the Ecstasy was my favorite dish at a stylish Japanese restaurant on the Upper West Side during the ‘90’s and has stayed with me since that time as a short hand description for living. As a dish, it was tarted up with wasabi and overpriced Tokyo style curry poured onto rice, but as a metaphor, is aptly descriptive of my life as a constant outsider. What curry and wasabi agony that was offered by the dish was paired well with the moderately ecstatic Asian sweet potato humming nicely with some carrots, interposed by the mediating beef, its fat and broth filling out the dish. It was a particularly nasty looking green which gave it the look of Star Trek food, the kind that would give Scotty and McCoy fits when offered by alien dignitaries.

One of the habits that I have is that if I like a particular dish at a restaurant, I get stuck on it and will only order that same dish over and over again. The corollary to this rule is that after about two years, I stop going. Two years is about when I get tired of it. As I had mentioned in prior posts, the half life of human desire is about six months. In two years, whatever passion I had for the dish drops by four half lives or over 90%. Without a meaningful change in the dish, the natural refractoriness of my dopamine receptors kicks in –refractoriness refers to a nerves inability to give off the same intensity of signals if used again and again. The dish, once ambrosia becomes sawdust.

I am ecstatic when reveling in the new. I like the new car smell on the latest gadgets as they come out of their box, and figuring out the essence of a new surgical procedure has that same allure. New people, new surroundings, new foods –this is what gets me going. Of course, life wouldn’t be what it is without the agonies, and I engage these with the conviction that no matter how overwhelming the circumstances, brain chemistry dictates that the intensity of feelings on the agony side of things will wane too. All bleeding stops eventually, we say in the OR. So it is that life change takes about two years to settle into a steady state. A new job, a new relationship, fresh grief – any life change takes about 2 years to reach a digestible state. It took Tiger Woods two years to win again after all.

Which makes you think about marriages and how they survive romantic love. The old coffee machine that we got on our wedding day lived with us for the past 17 years. It was a Krups combination drip brew and cappuccino maker. My wife, Jennifer, says it was a metaphor for our marriage. At the start, we kept a variety of beans to grind fresh for every pot, occasionally making espresso and cappuccino, but eventually, we settled on cans of Melita Classic, which we found to be a superior ready to brew grind. At about year 7, I broke the pot, but Jen found a replacement. Two years ago, the heating element broke, but Jen managed to find a source for spare parts and she performed the necessary surgery on it to repair it. It was this year she realized that our coffee was not as good as it used to be after she tried the coffee that came out of our friends very expensive European coffee maker, and it was it some sadness we are saying goodbye to the old machine –the new one arrived from Amazon. It’s letting go of the past, accepting change, and anticipating the new that is both agonizing yet full of hope. Marriages, by definition, are rife with moments of agony and ecstasy, but when faced together with your partner, they become surmountable.

If I am to escape the fate of the old coffee maker, I have to actively engage, fearlessly renew, and aggressively freshen. Sophomore slumps are the result of passivity and laziness of the mind. Looking back on seventeen years of marriage, I can see that at some point, I was a drip coffee maker, once shiny and new, but now I am a fully automatic, self cleaning espresso machine, slightly used, but perfectly serviceable. Ciao.

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Injeolmi -a kind of manna from childhood

My favorite food blogger, Maangchi, posted her recipe for injeolmi, a rice cake. Traditionally made from steamed rice which is pounded into an elastic paste with a forty pound hammer, shaped and cut unto lady finger sized pieces and rolled in toasted soybean powder, it would take half a day to make a batch usually suitable for a feast. Maangchi’s method (http://www.maangchi.com/recipe/injeolmi ) makes single serving in about fifteen minutes. It is brilliant and perfect! I did substitute yoolmoo cha as the soybean powder was unavailable. Nom nom nom. And yes Maangchi, I did pound it more than fifty times.

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Father’s Day Golf

Father’s Day passed with several fun things happening. First, I got to play guilt free golf in the morning, and I shot  an 84. Given the goal of playing par or better by Halloween 2012, I feel good about my progress. The secret sauce can be seen in the statistics from my Golfplan app.

In May, I was suffering from inconsistent play, and despite daily practice, was unable to make progress. Then I realized that trying to fix your own golf swing is a bit like removing your own gallbladder -something theoretically possible, but highly unlikely in practice. I sought professional help, and at Wakonda Club, we are fortunate to have Aaron Krueger who is a gifted instructor. Over two sessions, he was able to provide one critical principal that has changed my game. It is no surprise that it boils down to grip and stance, alignment and tempo.

It has been a revelation. This round occurred without my usual blow up holes, and I was surprised by the score at the end. And this has been no fluke -I have repeated it this past week and today, on a casual nine, I shot 46 despite a pair of double bogeys and a triple bogey. There is no question that professional instruction is the fastest way to improve.

That wonderful round on Father’s day was followed by swimming with the family and then a barbecue at home of L.A. Galbi, a Korean-American dish that I’ve always had in restaurants but never at home until I came across a recipe on Maangchi’s web site (link). It was clearly one of the best father’s day’s I’ve ever had.

Spam and Clam Chowder

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With the recent blizzard, and G getting a snow day, I thought a chowder would work well in warming us up. Chowder developed in the kitchens of inns and fishing homes of New England and Maritime Canada, and represents a kind of kibbles and bits stew. In that tradition, along with the clams (canned US origin) I added some leftover mashed potato from Alba (a local muy excellent restaurant) and minced Spam in place of bacon. The result was all very comfortable, angioplasty optional.

12 Gifts for the Surgeon to Get for Him/Herself.

  1. 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)
  2. 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).
  3. 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)
  4. 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)
  5. 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.
  6. 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).
  7. 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.
  8. 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.
  9. 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/)
  10. 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.
  11. 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)
  12. 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.

Woogujiguk -best cheap eats at Incheon International Airport

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After the long car ride from Miami to Orlando, we dropped in on a Korean restaurant where I ordered Woogujiguk. It is a mildly spicy cabbage and beef stew which is comforting and filling. There is a restaurant on the second level at Incheon International Airport where this dish is featured. It’s cheap (about 8 bucks) and delicious and served within minutes of ordering. The cabbage is soft and the beef is tender from hours of boiling. Its usually the last thing I eat on leaving Korea and for whatever reason, something I only eat on the road. Tasting it brings to mind journeying and cold weather.

Wakonda Club Number 9

The hole is 178 yards long from the blues, slightly downhill and depending on the prevailing winds needs anything from a 7 iron to 3 hybrid. It’s an easy 3 if you just let the clubs do their work, but try to muscle this hole, a 5 or worse awaits.