Fail, fail, fail, fail, succeed

The Loss of Innocence

To state the obvious: You can never return to a state of innocence, no matter how badly you might wish. To think otherwise is a fool’s game.

Unfortunately, in life, you can’t un-know things.

Start Here

Always assume the worst case scenario and work backwards from there.”

This is how we (medicine and nursing) think in the ER. We come at it from slightly different angles but the end result is the same. Medicine uses the paradigm of the “differential diagnosis,” which is really just a process of elimination. The doc looks at the patient and, based on symptoms and presentation, will begin eliminating worst-case scenarios.

Nurses, on the other hand, are more concerned about the nuts and bolts of the situation. When people are critically ill and/or dying there isn’t a lot of time to dick around thinking about what to do next. You learn to think five steps ahead so that you’re ready when shit goes south – and oh my friend, make no mistake – it will go south.

But if you already assumed it was going south, you’re good. You know exactly how to respond because you’ve played out this scenario, or something very close, many times before – even if some of them were only in your mind.

Mind you, I’m not saying that this is a good way to live your life outside of a profession that demands it.

But it sure can come in handy if the situation requires it.

How do you Define Success? (Part 1)

The reason it’s so important to answer this question is this: You can’t say that you failed at something without having had a clearly defined vision of what success would have looked like.

I’ll go even further and say that success for any given endeavor may not necessarily be a stationary target – I would argue that your idea of what success looks like should organically evolve with the work.

But there is another adjacent but critical concept to always keep in mind. Even if you fail to achieve something you had a clearly defined outcome for, if you find yourself thinking “I am a failure,” you must immediately stop and recognize this as a cognitive distortion, a toxic script you are playing out in your mind that has no basis in reality.

You should instead be proud of your failures, because they are proof that you are growing and moving forward. Understand that this is what successful people do.

They fail. Over and over and over again, until they finally get it right. So if you’re failing, just remember this:

You’re getting closer to success.


Best case scenario? You learn something, make some connections, soak up ideas from fellow attendees, speakers, and vendors, and just generally get a little pumped up by the energy.

Depending on the size and the industry, they can be quite a production. I am at one now and it has been an interesting experience.

  • Learned something? Check.
  • Made some connections? Check.
  • Soaked up some ideas? Check.
  • Got a fresh perspective on my job? Definitely.
  • A little jacked? Yeah, I’d say so.

Expanded my perspective a bit? Affirmative.

The Corporatization of America

I don’t hate corporations per se, but I hate what they represent – and I loathe what they have done to culture and society. Let me be a little more specific..

At one time, there used to be family run restaurants all over America. Every town and neighborhood had its own selection, complete with whatever quirky dishes and recipes that were unique to that particular establishment. The concept of corporate fast food franchises didn’t really start to take off across America until the late sixties. Before that every small town had its own burger joint, run by someone locally.

What this meant was that, in order for a local restaurant to succeed, they had to provide something special that you couldn’t easily do at home. And because each restaurant was its own little world, it was unique – whatever they made had stood the test of time and proven itself. This, of course, was a great point of pride for the owners. They knew they had made something special, something you couldn’t get anywhere else, and their loyal customers were proof of that.

But corporations are the opposite of that – everything in corporate franchises is pre-measured and designed to be as blandly pleasing as possible. Recipes are designed in laboratories with maximum profit the end goal. Every last bit of individuality is ground out so as not to offend anyone, thus making it possible to reproduce each serving exactly the same bland fucking way at every goddamn location across the planet. There’s no humanity left – it’s all mediocre. It wasn’t even designed to be great, greatness never even entered into the equation.

And this my friend, is what we’ve done to countless industries in America. Let’s be clear: corporations are not people, regardless of what Mitt Romney believes. In fact, part of their appeal to the businessman is to remove him from liability. The corporation is liable, not him – an important distinction if you get sued for poisoning your customers or stiffing your vendors.

I hate making blanket statements, but here’s one: Any product made by committee sucks. Movies, food, cars – suck, suck, and suck. Great stuff is created by visionaries.

Oh, and BTW – in case you’re wondering – a band isn’t a committee.

It’s a wolf pack.


“America was created by true believers and passionate dreamers, by hucksters and their suckers—which over the course of four centuries has made us susceptible to fantasy, as epitomized by everything from Salem hunting witches to Joseph Smith creating Mormonism, from P. T. Barnum to Henry David Thoreau to speaking in tongues, from Hollywood to Scientology to conspiracy theories, from Walt Disney to Billy Graham to Ronald Reagan to Oprah Winfrey to Donald Trump. In other words: mix epic individualism with extreme religion; mix show business with everything else; let all that steep and simmer for a few centuries; run it through the anything-goes 1960s and the Internet age; the result is the America we inhabit today, where reality and fantasy are weirdly and dangerously blurred and commingled.“

– Kurt Anderson, from “Fantasyland: How America Went Haywire”

Novelty and Repetition

On a conceptual level, these are the fundamental building blocks of music composition. As humans we like to hear a theme, usually a melody (but it could also be a chord progression or rhythm) repeated enough to be pleasurable but not so much as to become irritating. It feels good so we want to hear it over and over.

This repitition must then be broken by something novel and unexpected – and it is this juxtaposition of the familiar and the unexpected that keeps us listening. These concepts hold true regardless of genre – classical, pop, jazz – all rely on this basic idea.

But for the sake of simplicity, pop music (jazz and classical are a bit more complicated) is filled with examples. Pretty much every successful pop tune has examples of this phenomenon, some more obvious than others. These concepts have been developed into a science with contemporary pop/rap.

Today, however, repetitive themes tend to be much simpler and novelty is introduced more from sound design than actual music – actually, sophisticated digital processing often provides both the themes and the novelty. I really don’t think this is a question of better or worse rather, however it bears the question:

Imagine what cool shit you could make by combining both ideas.

A Big Lesson From a Big Man

After his second fight with Mike Tyson was stopped on a disqualification, because Mike had bitten chunks out his ear not once, but twice, Evander Holyfield’s initial reaction was, of course, anger.

We know that today, 22 years later, Evander has been vocal about forgiving Tyson, which is pretty amazing by itself. But how long did it take?

In a recent interview, Holyfield answered that question without hesitation.

“By the time I got back in the locker room, I had forgiven him. My whole team was angry, but I just asked them, Whose ear did he bite? Mine, and I’m saying I forgive him.”

Why Bother?

Seriously – why bother doing anything? OK, I’m being a bit facetious here, but whenever I wonder why I’m spending my precious time doing something, I think “What exactly is the return here?” This blog is a good example – periodically I hit a wall and ask my self exactly this question.

If my goal is to generate income, then what we have here is an epic fail. Maybe it’s to build an audience of readers? If so, let’s call this epic fail #2. But maybe those aren’t the right reasons to write a daily blog…

Would I like people to read it and get something out of it? Sure! Do I do anything to promote it? No. So clearly that’s not my reason for doing it. But every time it gets hard and I think about stopping, there are a few things that come to mind that I’m not quite sure I want to give up.

I know I’ve said this before, but it bears repeating to myself whenever I get discouraged. I’m 62 years old, so the act of writing something everyday and making it public, whether anyone reads or not, forces me to be more engaged with the world. It makes me pay attention, and that just makes life more interesting.

So I guess the answer to “Why bother?” is to ask yourself yet another question.

What am I getting out of this?

There’s your answer.

Be Kind to Yourself (Part 3)

OK, let’s get this straight. You were trying to do the right thing, but it’s a treacherous world and your good intentions led you into murky water.

Nobody got hurt – let it go and perhaps be a little more cautious next time. Take a deep breath and don’t beat yourself up.

Be kind to yourself.


If you work in a large organization, particularly a hospital, there will be policies for almost everything. These policies are important – they help guide professional practice.

But professionals are paid to think, to use their sense of agency to guide their interpretation of policies. Sometimes you have to look at the greater good when making decisions.

Policies are not meant to absolve your ability to think and make decisions in order to find the best solution. Because there will be many times where there is no clear cut solution, yet you will have to come up with one nonetheless.

This is what leaders do. They’re not afraid to use their judgment to think through problems and lead.

They don’t refuse to help because “it’s not in the policy.”

This kind of thinking is especially egregious when people’s lives are at stake.

Lead or get the fuck out of the way.

Well Here’s a Thing

Ever heard of ASMR? It stands for autonomous sensory meridian response, and it’s apparently a very big thing. Let me state out front that I’ve never followed any YouTube stars – in fact, I don’t really understand the whole phenomenon. But I just found out about this thing (ASMR) in a New York Times article, and after watching a few minutes of two “ASMR stars” videos, I’m feeling very confused.

Before going any further, perhaps you might take a minute or two and check these out:

ASMR Comforting Boyfriend

ASMR Slow Tapping

In the first video, the “comforting boyfriend” is a 17 year old boy who has never had a girlfriend and lives with his parents. He makes “roll play” videos to help women fall asleep. I made it through about 3 minutes before my skin started to crawl. I’m sure he’s a fine young man, but I found him about as comforting as Joel Osteen (another phenomenon I don’t get). In other words, I immediately felt he was a sociopath. I feel Joel Osteen is a sociopathic grifter, but I digress.

OK, so my impression of the comforting boyfriend was that he was inducing relaxation so he could more easily murder women in their sleep, but hey – that’s just me. WTF do I know?

Let’s move on to item 2: “Slow tapping.” Everything about this video confuses me and sets off alarms. What is happening here? The whispering is really creeping me out, the way she keeps moving from one side to the other is suspicious, and the tapping? Dear god – the tapping, tapping, tapping on the cork candle – it’s like something out of an Edgar Allen Poe story.

What is wrong with me? This whole ASMR thing is supposed to relax you, to cause some kind of “braingasm,” but instead both of these people make me feel like they’re trying to steal my soul. Evil seems a bit strong, but Jesus – this is some of the most disturbing shit I’ve seen in a while.

And yet – millions of YouTube followers would clearly vehemently disagree. The thing is – I don’t think this is an age thing (as in “I’m an old guy who doesn’t get it). I think this a life thing.

As in “Where’s your fucking antenna for trouble, people?”

What is a Successful Life? (Part 1)

Let’s start this exercise with by flipping the question: What would it mean to be a failure in life?

I would say that a life where you contributed nothing of value would be a failure, but defining value seems a little slippery. More on that later…

Definitely a life where you neither loved or received love – that would definitely be a tragic failure.

This may also be a bit broad, but maybe that’s as it should be: A life where you helped no one else – that would unquestionably be an epic failure.

It’s important to sort this stuff out – you don’t want to get caught when the curtain comes down and realize you missed the boat.

Always Open (Part 2)

ER’s are like they the drain at the end of the health care pipeline – everything ultimately ends up there. It’s your last stop before your final disposition. There’s only three ways out – you’re either discharged home, admitted to a unit, or packed up in a body bag and sent to the morgue.

Anybody that either can’t or won’t be seen by a provider on short notice (e.g. general medicine, cardiology, orthopedics, oncology, pulmonology, neurology, urology, pediatrics, geriatrics, psych, OB/GYN, infectious disease, etc.) is simply told “go the ER.” No beds in the hospital? Send ‘em to the ER! ICU’s full? Keep ‘me in the ER! Just don’t want to deal with your patient? Send ‘em to the ER! Maybe you’re a practitioner and just want to cover your ass? Send ‘em to the ER!

We’re always open and we never turn anyone away. If you’re sick we’ll take care of you and if you’re dying you’ve found yourself in the right place.

And here’s the cherry on top – we like what we do and we’re good at it. There’s just one caveat: whoever’s in charge of staffing, for god’s sake make sure there’s enough of us working to treat these people safely.

It doesn’t seem like too much to ask.


Nada – cero – mi cerebro es vacío.

Vuelve mañana…

Asking the Right Questions

When faced with a problem, your starting point is almost always going to be the questions “What?” and “Why?

For example – say you’re witnessing some unfamiliar phenomenon. Your first thought is going to be “WTF is happening here?

Or perhaps you keep making the same mistake over and over even though you think you are doing things differently each time. With mounting frustration, you ask yourself “Why is this happening?

Welcome to the real world, where you’ll never find the right answer until you ask the right question. And knowing what the right question is isn’t always obvious…

This is why even very smart people get stuck, spinning their wheels and getting nowhere, over and over again. We are almost always blinded by what we don’t know, by our inability to reframe the question in a such a way as to give us the solution we desire.

First principles can help, but if you are stuck on something and can’t find the solution, step back and try to reframe the question from a completely different perspective.

It also helps to focus on the problem before going to bed, for as long as necessary. Let your brain work on it while you’re asleep – you might be surprised at the results.

But remember this: If you can’t crack a particular problem, you either don’t fully understand it or you’re just not asking the right question.

Holiday Jumpers

To wit: Those who commit suicide by jumping from heights on holidays.

Common enough that we have slang for it.

Thank you – That will be all.

There It Is…

Just when you think you’ve got a handle on things in the ER – system overload! Impending meltdown here boss! I love that feeling where you’re starting to drown, and then the charge nurse looks at you and says cardiac arrest, ETA 5 minutes!

From that point on, it’s all systems go baby. No rest for the weary, just hang on ‘cuz it’s going to be a bumpy ride…