The recent focus on Kim Jong Il’s lifestyle brought gasps of astonishment -he sent his sushi chef on a private jet to Japan to shop for rice cakes while his country was starving. Fact is, among the wealthy, there are the über wealthy, and among the über wealthy are the super duper wealthy whose daily budget would feed maybe a thousand families. While we do not begrudge anyone success -as this is the cornerstone of America, even the most callous person has to admit there is some injustice in North Korean society. It does not come from a lack of guns -the noncoms always outnumber the officers, and the fact that people can bribe border guards to escape means that some independent thinking occurs. The fact is that a religion, a cult of personality, sustains the vast inequality of North Korean society. Religions demand faith over logic. Directing the resources of a nation to the sustenance of a few humans at the top defies logic. It is a religious-type faith and fear of retribution, fear of apostasy and heresy, and fear of change that causes this gangrene to linger. What are the idols that drive injustice here at home? It is the belief that success comes from being favored by God and that lack of success comes from sin. It is the belief in absolutes that define religion. This idea afflicts our politics as much as the cult of personality afflicts North Korea.
The subordination of logic to dogma and its use in organizing societies is a old tradition. It gets people across desserts, oceans, and helps individuals process grief and the unfathomable concept of infinity. It is a human trait as ingrained as circling three times before bedding in a dog. Yet this kind of thinking is also used to demonize the poor, write off the sick, and rationalize the unemployed. It is extended into contempt for anything for the public good that comes from taxes -clean water, safe roads, national rail, public health, education and safety. It sanctifies success defined as wealth and therefore denigrates anything that might take away from that wealth.
In our still free society, one’s success is the result of not only hard work, but favorable circumstances, good health, and the support of people who were midwives to the success -the family and community that nurtured the individual and the society that provided the fertile ground for success. It’s the good plumbing that provided fresh water for excellent development. It’s the public safety provided community police and fire departments. It is the critical mass of excellent citizens that allow for success and justice. I think that is the message of the OWS protesters, that the people who get tasty morsels flown in for them not get protections at the cost of the people making it possible.
I wish for the new year the restoration of reason and clear thinking guided not by desire for retribution or a return to a past that never really was. I want an America where everyone has available all the opportunities while being good citizens and supporting the community, state, and country that allowed that to happen.
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.
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.
Genesis 9:17So 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…
!Kergclubs 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.
If you are a citizen and you are of voting age, then it is your duty to vote. You have no basis for complaint if you do not vote. Many people around the world risk their lives to vote. Many people risked and given up their lives and are giving up their lives as we speak so that you can vote even from the comfort of your home.
There is no longer any excuse not to vote with early and absentee voting. God bless America.
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.
It’s a blessed day when your wife says “go play golf.” You shouldn’t hesitate, dither, or prevaricate but high to the course. I’m using a used set given to me by my dad, a set of forged Japanese irons by Maruman which are featherlight but remarkably accurate. I call this set, Yellow Peril.
I have seen sparks fly from my golf shots. Typically, you have to be in low light. The most vivid example of this was when I played Van Cortlandt in the Bronx at 5:30 in the morning many years ago. The ball was dusted in flinty sand found there -the glaciers ground the bedrock which is composed of granite, flint, and some chalk. The impact of the metal driver on this rock caused sparks which were really cool.
Unfortunately, in the instance of the golfer above (link), the spark landed on the tinder of dry California scrub land, and started a 20+acre wild fire. Typical of golfers, they reported what happened, but even more silly is the fact that authorities have to protect this golfer’s identity from a lynch mob.
And this is it -our brains are not wired to accept circumstances of nature as they are but demand an explanation rooted in personal values, usually interpreted as good and evil, sometimes confusingly both. There is the inability to accept a stochastic interpretation of events as series of causes that arise from probabilities. Without this overlay of moralistic interpretation, the self dissolves a little.
That’s just it -in acquiring self awareness, we also get the baggage of self importance. Free will is the other lie that we tell ourselves to assure ourselves of our critical place in nature, because most people freely shackles themselves in the strait jacket of religion, tribal/racial/identity politics or just narrow mindedness.
My daily bread for this week is challah bread. Specifically, it is Chernowitzer Challah bread from my current favorite iPhone app, Epicurious. I have always felt the pull of Judaica since I was a child in the shtetl of Jacksonville, Florida. Now, I can partake of a little bit of manna.
This bread took about 6 hours to make -my kitchen is a bit cooler than that called for leavening dough. The bread out of the oven looked great but was “biscuit-y” according to my wife. The difference was that I used bread flour rather than plain enriched white flour -perhaps the enriched flour is more gluten-rich?
I will try when it has cooled -perhaps the structure will set in as it cools giving the inner texture that one associates with the best challahs. That may be it or the Chernowitzers just prefer cakey challah.
Golfism -life is a metaphor for golf 