Fail, fail, fail, fail, succeed

HIPAA And Blogging

HIPAA (Health Insurance Portability and Accountability Act) was enacted in 1996 to legislate the control of health related information for business and tax purposes as well as to provide a legal framework to protect patient information. It is a very broad and complex piece of legislation, but for the purposes of this post, I am only concerned with one specific facet: the protection of privacy with regard to patient health information.

Anyone who acts in a capacity as a health care provider must hold paramount the responsibility of ensuring the privacy of patients medical records.

This is sacrosanct and must be fully understood by anyone administering health care. It is not a difficult concept to understand and would seem to be self-evident – that being said, I fully understand the necessity of enacting this fundamental right into law, and I fully support upholding it. Protecting peoples privacy is a very big deal – I get that, and I take my commitment to honoring that privacy very seriously.

I am an ER nurse, a musician, and an artist. I make things by processing the world around me. I try to constantly learn in order to grow and better understand the world I live in. I do this so I can hopefully contribute something meaningful to this world to the best of my ability.

My interactions as a nurse in a busy inner-city ER provide a rich environment for personal growth, and I am constantly learning from my interactions with both my patients and my colleagues. I do my best to protect the identity of any specific person or event that makes me think deeply about what it means to be a compassionate human, but to not write about these experiences in a general and non-identifiable way would represent a failure of my mission as a human being.

We all move forward collectively, and to communicate lessons learned it is necessary to talk about what it means to be human in an honest, compassionate manner. The specific interactions and examples of human connection that led to an insight must be examined in a thoughtful way so that we may all learn.

It is only through thinking, talking and writing about our experiences that we are able to gain greater insight into what it means to be a fully realized human. Protecting patient information is important, but let’s exercise our judgement and use critical thinking about what exactly this means. 

Let’s not throw the baby out with the bathwater.

Defensive Practice

As a nurse, I’ve always had a problem with the idea of practicing “defensively.” I feel this is a trap that many doctors and nurses fall into – one that degrades care and ultimately robs the practitioner of exercising his or her agency in administering the best humanistic care possible.

For those outside of the healthcare professions, what I am talking about is the concept of practicing in such a way that you are more focused on protecting yourself – either from getting fired or being sued – than you are on the patient’s needs. I see this all the time, often from smart, good people. Here’s what is wrong with this picture, and what rubs me the wrong way.

Defensive medicine, by definition, means that you are acting from a position of fear. This is not the right mindset from which to care for sick people. It implies that the practitioner lacks confidence in both themselves and healthcare itself. It represents a profound breakdown of the system.

When caring for others in need, the emphasis should always start with a question: What can I do to help this person? If you are a doctor, you administer medical care to the best of your ability, and if you are a nurse you apply nursing science the same. The truth of the matter is that medicine and nursing are two sides of the same coin – they are symbiotically related. One doesn’t function without the other. When they are aligned, they become a potent force to solve problems in service of helping the patient. Often the solutions require a fair amount of creative thinking and maneuvering to get the patient the resources they need.

If one is constantly afraid of “breaking the rules” and is unable or unwilling to exercise their professional agency, they have failed the patient, their profession, and themselves. They may have gone into their field with the best of intentions, but they ultimately lacked the confidence and bravery necessary to do their job well. These professions are not for the weak-willed or the faint of heart.

The best rise to the top precisely because they are able to apply their intellect and grit for the greater good of those in need. They do not operate from a position of fear, and although they do not break the rules cavalierly, they most definitely break them as needed.

They are compelled to do so by their desire to contribute something meaningful to the lives of their fellow humans. They have dedicated themselves to their cause, and they fully intend to honor that commitment.

When you need them, they are there.

Never Did This Before

For the first time ever, with 667 consecutive posts, I’ve pulled one after publishing it. 

It was a thoughtful meditation on human connection, spurred by a specific interaction that may or may not have stepped over the HIPAA line.  

I will undoubtedly be writing more about this, but my feelings on this subject are complex and will take some time to sort out.

More later…

Whose Rules?

Organized sports have rules. So does language, physics, mathematics, and chemistry. Religion would like to impose rules, but it only works if you play along.

Some rules are hardwired into our understanding of the physical world. Others we make up for various reasons – fair play, social etiquette, or just to get along.

In order to have a functioning society, we make up rules that govern behavior and call them laws. Breaking these rules carries a stiff penalty, one that removes you from the community at large and puts you in a time out in another place that has its own rules – prison.

As humans we become accustomed to living by rules, so it can come as a bit of a shock when we encounter someone who doesn’t play by them.

The thing is, these are often the people who move things forward, forcing society to change in a way that is better for everyone.

But boy is there a stiff price to pay. Until everyone else catches up to the rule breaker and realizes that the new way is better, the one breaking the rules is an asshole troublemaker who draws the ire of everyone around them.

No wonder so few people do it.

Becoming Comfortable With Radical Uncertainty

Buckle up folks because technological changes are starting to pick up steam, and how this all plays out is anyone’s guess – and that’s the perspective from the experts. It’s hard to wrap your brain around the concept of exponential growth, but that is exactly how things are playing out.

See, it is perfectly understandable that most humans think in terms of linear growth, because that’s intuitive and seemed to be how civilization was progressing. The problem is, that’s not was happening at all. It’s just that the initial growth curve seemed linear because it was, by definition, happening slowly for the first few hundred thousand years or so of human history. Well, it’s not happening slowly anymore – we are about to hit the knee of the slope where things will begin to change faster and faster. It will seem a little confusing (it already is) at first, but because we are incredibly adaptive creatures, we will attempt to adjust or we will simply be washed along with the unrelenting tide of technological changes until we know longer understand what’s happening.

Whatever is coming is inevitable. We are either about to rapidly evolve into something completely new, or we will become just another failed species.

It’s going to be quite a show.


When you’re living on the street, you get up when the sun rises. It sucks, but you have no choice in the matter. You’re not sleeping in when this goddamn ball of nuclear fusion is burning through your eyes into your fucking brain and the whole world seems to be waking up. Trust me, the world makes a lot of noise when it wakes up.

I’d been sleeping in a field and staggered up, not quite knowing what to do. I was hungry and lucky if I had a couple of bucks – but it was so early nothing was even open yet. There was a gas station nearby, so I headed there for a coffee. At least I had a pack of cigarettes – the breakfast of champions. If you’re a smoker, you know the first cigarette of the day is really special – maybe your best smoke of the day. Well, one of them anyway. So off I go.

One of the things I remember about living on the street was this sense that there was an unlimited amount of time – almost too much time, really. You didn’t know how to fill up your day. And all of this time seemed to be spent on the most basic shit: where your next meal was coming from, trying to stay unobtrusive so the cops wouldn’t bother you, somehow getting some money to eat and get high, and the eternal question of where you were going to sleep that night.

If you’re a young man, you can imagine the potential for trouble. In fact, there would seem to be no way that this was going to turn out well at all. And yet somehow I managed to come out of this disaster in one piece. Why? I’m not sure I can fully answer that. I’d like to say it was because other people reached out and helped me, but that’s not entirely true. I had an almost feral mistrust of others that prevented anyone from getting too close. 

It was really music that did it – playing in bands gave me a sense of community and belonging, and immersing myself in the subculture of music helped anchor my identity.

It provided my first hint that I could rise out of what seemed like a hopelessly epic clusterfuck of a childhood and be somebody. It was all I needed to get started…

The Purpose Of Art

Is to elicit a visceral emotional or intellectual response, to make one see the world in a different way, to spur an internal narrative, to question the limits of what you thought was possible, to elicit wonder, to upset the status quo, TO PROVOKE.

Art should be shocking and mystifying, breathtaking and disturbing – it should engage you. If it upsets you or makes you angry then IT IS DOING ITS JOB. Art is a reflection of life, and everything in life isn’t beautiful. Let’s be clear: You don’t need to be shielded from art with ridiculous trigger warnings as if you could somehow be damaged by exposure to it, and anyone or any institution that attempts to do so is hindering your ability to grow into a fully realized human being. They are trying to control your mind, whether their intentions are good or not.

You do not need to be protected from art. You need to question everything and be exposed to EVERYTHING. It’s a big, bad, beautiful world out there, and it doesn’t give a fuck about your feelings. In order to grow up you’re going to have to take it all in and let go of your fear.

Even though it can be painful and disorienting, doing so allows you to participate meaningfully in life – and hopefully contribute something useful to the world in the process.



He’s a maker..”

I just heard this term in a discussion among writers in reference to one of their peers. There seemed to be a tacit acknowledgement that this put him on another level, that possessing this quality somehow separated this person from others.

They were right. To be a maker is something special. It implies a lot beyond just being creative.

It implies that this person is a finisher. This alone is a very big deal. Notice I didn’t say anything about whether the thing that was made was “successful” financially – ultimately, for the purpose of our discussion, that’s not important.

What is important is that the thing is unique – it didn’t exist before this person made it. Whether it’s good or not is a subjective judgment that also means nothing in this context. It is good to the person who made it. 

See, here’s the thing: Once something is finished and exists, it becomes undeniable. Before it’s finished, it’s just an idea. Ideas are cool and important, but to turn an idea into something finished requires a whole different skill set.

To accomplish that one must be driven, tenacious, indefatigable, tough, and undeterred by obstacles and criticism. They must be able to look into the abyss of their soul and confront their fears and weaknesses. They must be willing to expose this part of themselves to others. 

Most people are too afraid to be that brave.

Lush Life: On Being Black, Gifted, And Gay In Mid-Twentieth Century America

I am, of course, referring to the inimitable Billy Strayhorn, composer of one of the greatest songs of the twentieth century, “Lush Life.” To hear this music once is to never forget it.

He started writing it in his teens and finished the piece at 21. This seems impossible, but that’s how genius works – mysterious and unknowable. Other than my capacity for empathy and innate understanding of art seen through the lens of human experience, I have no way to know what it was like to be gifted, black, and gay in the mid-twentieth Century. I just know that the first time I heard this piece my whole world suddenly seemed to expand. I couldn’t really understand it and yet somehow I did – this was part of the genius of Billy Strayhorn.

This song has been recorded by many artists, but for me, the definitive version is the one recorded in 1963 by Johnny Hartman with the the John Coltrane Quartet.

The wistful sadness of glimpsing a life that would never be his is heartbreakingly poignant. To express it like this in art as a teenager seems impossible – it is both a tragic meditation on existential loneliness and a celebration of the pain of life at the same time.

Twelve o’clocktails indeed.

Front Row Seats

Here they come – some confused, some angry, some violent. Conscious, unconscious, altered, dead. Generally speaking, no one is happy to see you.

Who are they? Well son, that’s your job to find out. You’re the triage nurse, the portal of entry to the ER. It’s your job to sort this mess out. Oh, BTW, some of them are going to die. Out of a sea of humanity, most with relatively trivial complaints, your job is to pick out the ones who are really sick.

It’s harder than it sounds. Because here’s the thing about the ER – the only thing you can trust are your instincts built on years of hard won experience. And on the way to getting those years of experience you are going to make some mistakes. Painful mistakes. It’s just the only way to become an expert. You learn everything you can in school and then it’s time to hit the real world. Suddenly nothing is as it seems – everything is gray, and everything seems to transpire to confuse the situation, to make the process as difficult as possible.

For example, say EMS drops off a combative, wildly agitated older woman attempting to physically assault everyone who comes close. You have to somehow figure out what’s going on. Intoxicated? If so, with what? Brain bleed? Dementia? Psychotic break with reality? Anoxia? Cancer? Just plain old crazy?

You look at the docs note from her last visit and it starts with “Pt. Screams I hope your mother rots in hell.” This is good news – now you’ve got a baseline. Further digging reveals she drinks. A lot. Every day. More good news – now a picture is starting to form. You’ve still got to get security to help restrain her while you do your exam, but you’ve now got a few guideposts to put you on (hopefully) the right track.

It’s like you have a front row seat to every fucking thing that can go wrong with humans.

It’s just the thing for adrenaline junkies with a very low threshold for boredom.

Unlocking Your Genetic Potential

So the question is: How might we accomplish this?

I believe it’s by adding stress to the body and mind.

Think about it – we don’t really know what our genetic potential is. How would we? We must first be thrown into situations where we have to adapt to find out – and of course this adaptation implies growth.

On a physical level, lifting weights provides a great concrete example. Stress the body by lifting a heavier and heavier load and it adapts by literally  growing physically – it changes our morphology. There is only one way to find out what your genetic potential for muscular growth is and that is by stressing it with progressively increasing load resistance and watching what happens.

The same is true for our mind – but this idea can also be extrapolated to an infinite number of adaptations: the ability to integrate socially, to lead, to fight, to protect, to nurture, to educate, to create, to innovate, etc.

We don’t know to what extent we might excel at any of these things until we are stressed by being forced to adapt to the needs of any given situation. This kind of self actualization is born out of living an active life, but it requires you to actively seek out opportunities for growth.

This is why the easy way out will never show us what we are capable of.

Wait Until Dark

Do I like films from the 1960s because they’re really that good or just because I saw them at an incredibly impressionable age? To wit: Bullit, Rosemary’s Baby, Bonnie and Clyde, Alfie, The Pawnbroker, Easy Rider, 2001: A Space Odyssey, Night of the Living Dead, Cool Hand Luke, The Good, The Bad and the Ugly, Planet of the Apes, Repulsion, Psycho, The Birds, and a film I rewatched last night: Wait Until Dark. Seems like a pretty impressive list of 20th Century cinema to me.

Wait Until Dark is adapted from a play, and there are plot points that are definitely somewhat contrived… but boy does the whole thing work. Audrey Hepburn gives a stunningly moving performance that’s quite a trick: she not only plays a blind woman, she plays a character that has only been blind for a year, adding a layer of complexity to what might have been a more generic performance. She inhabits this character to the degree that you actually believe she is newly blind and is bravely trying to find her way in a world without sight. Her performance alone makes the movie worth watching.

But it just works on a lot of different levels: the soundtrack is subtly creepy, each character is fully realized by each of the five main actors, and the set and Greenwich Village location become integral to the story – but at the end of the day it’s just a beautifully realized performance by Audrey Hepburn that carries the film. Her strength and vulnerability are both inspiring and heartbreaking at the same time.

Definitely a piece of it’s time, but isn’t that part of the magic of film? It has the visceral ability to transport you to another world to the point where you actually feel the culture that helped shape the movie.

Good stuff.

Is It Possible To Become Smarter?

It’s an interesting question that is probably impossible to really answer because intelligence is too complex to accurately quantifyBut in general terms, I think the answer is unquestionably yes. 

I just came across this provocative statement which certainly resonates with my experience (which of course doesn’t mean it’s right). But if you’re paying attention life experience can often be a pretty good teacher. The writer is discussing a psychological study on this idea and states:

The key finding is that getting smarter entails doing things that feel uncomfortably hard. Once you’re a crossword champion, by all means carry on doing crosswords for fun. But if you want to get smarter, do something you’re not good at.”

There are so many ways to articulate this profoundly simple idea – this blog is unintentionally littered with them. “It’s important to suck at something,” “Failure is good,” “Get out of your comfort zone,” etc.

Uncomfortably hard.”

That sounds about right.

Remember This (Part 2)

We can’t control whatever shit storm life throws at us – influence it; possibly, mitigate it; maybe – control it; NO.

But here’s the thing – and this bears repeating on a regular basis:

We CAN control how we react to and interpret these events. In fact, this is pretty much the only thing that is completely under our control.

Understanding this goes a long way toward making life more pleasant. Once you learn how to refocus your energy and pull back from what is out of your control you get the added bonus of increasing your sense of self efficacy. You stop feeling like you are at the mercy of whatever’s happening to you and more like you are in control.

You start to become more confident in your ability to navigate difficult situations and come out on top.

An Obstacle Is An Invitation

Something standing in your way? Well my friend, what you have here is an invitation to show your true colors. The way I see it, there are really only two options.

Roll over and give up.


Show what you’re made of and figure this mess out.

Brian Eno, Part 2

I found this transcription of a lecture Brian Eno gave in 1979 that is just full of provocative ideas. He is such a thoughtful, intelligent artist – even though this is almost 40 years old, he was so ahead of his time that these concepts are still relevant. Of course, great artists, like great art, are always relevant. Art is not constrained by style.

The Studio as a Compositional Tool.”

If anything, his observations and musings about the possibilities of multitrack recordings – specifically the idea of using the studio as a compositional tool – articulated the groundwork for the sampling revolution to come.

But more importantly (to me), he was one of the first undeniable artists who used technology as their instrument, all the while pointing out how little he knew about any of this.

That’s the thing about artists – they just make art. They don’t care whether they are “qualified” to do it, they don’t ask anyone’s permission to do it – they just have ideas and execute them with whatever tools they have.


No, I’m not talking about pi – I’m talking about pie. As in “Who doesn’t like pie?”  You know: fresh baked pie!

Let’s say you are having a shitty day. Have some pie and presto – things start looking up. It’s even better when it was made by someone with love. I just had some – chocolate pecan pie, to be precise. And suddenly, at least for a moment, life just got a little better.

It’s the little things that make life worth living.

Don’t minimize that.

This Is How Humans Are

First, we either ignore or argue about mounting scientific evidence of some man-made looming catastrophe. This can go on for decades, a century even. When the disaster finally begins to wreak its inevitable damage on a global scale, we will still politicize and deny it as long as possible. No one wants to lose face and admit that they were wrong.

And then, after all is said and nothing done, the cataclysm begins – lives are lost on a grand, ever increasing scale and the earth becomes scorched.

Now what do we do?

Instead of coming together, facing our existential threat and trying to mitigate the damage, we simply acquiesce and submit to our now obvious reality. As if it was inevitable all along.

And we somehow have the hubris to think that we are the masters of our world.

Hi ho.

Your Dreams Are Just A Higher Form Of Yourself

I guess the real question here is: What do you do with your dreams?

Do they remain just that – existing only in your mind? BTW, that’s a perfectly valid place to keep them – that way, they’re always close at hand.

Or do you actually attempt to make them a reality?

If so, do you go all in and make their pursuit the focus of your life? Or do you make a more “casual” effort, stopping whenever things start to get uncomfortable?

They represent a window into a potential possible future, if only we have the courage to choose …