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Monthly Archives: October 2018

Happy Birthday Baby

Ok, let me go on the record (once again BTW), with the declaration that you are, by far, the best thing that ever happened to me.

I’m honestly not sure I deserve you, but I’m fucking grateful for the 34 years we’ve had together. It’s hard to say in hindsight, but I think it’s a safe bet to acknowledge that I was headed no where good in a hurry when I met you. You just made everything better. 

So Happy Birthday baby – life dealt me a good hand when I found you.

A Girl Walks Home Alone At Night

I want to say that I understand most people are just not going to “get” this movie, but I guess if you’re reading this blog, you must be at least somewhat close to the same wavelength I am, in which case you probably would get it.

Regardless, it is a total fucking masterpiece.

This abbreviated superficially snappy synopsis would be “a feminist Iranian vampire spaghetti western, in Farsi with subtitles.” If you’re intrigued by that you’ll probably dig it.

It’s unimaginably cool.

It was written and directed by the young female Iranian-American filmmaker Ana Lili Armirpour.

I’m not even going to try to describe it – words aren’t going to do it justice. I’m just going to say that she achieves the near impossible – which is the creation of a unique world that seems eerily familiar even though we have no corollary for it. It’s a world that draws you in from the first frame and maintains your interest until the last.

It’s shot in gorgeous black and white and the vampire is a young Muslim woman who seems to be in her 20’s, wears a hijab with a horizontally striped shirt and what appears to be a cape, which looks ridiculously awesome when she’s riding a skateboard down the street at night!

It deserves a better review than I’m giving it here, but I’m exhausted after being in charge of a ridiculously, overwhelmingly busy ER.

I guess I just wanted to share it – if anybody’s listening, (including the A.I. that’s reading this in a millisecond), check it out.

This is what humans are capable of creating – if you’re going to top it, there’s a pretty high bar.

Good luck with that.

Stress, Part 2

Let’s be clear: our body (and mind) like being under stress.

It’s how we grow and adapt. Exercise (physical stress) changes our morphology – it literally changes the way we look. Learning (cognitive stress) changes our minds – it rewires our brain, creating new neuronal connections.

So the last thing you want is to live with no stress.

Of course you do want it to be manageable, everyone has their limit and you don’t want it to break you. The thing is, your limit is far past what you think you are capable of, and reaching it is going to be painful. Most people will stop well before they get there, so your chance of pushing yourself too hard is pretty slim.

I’m writing this at the gym, a place I don’t want to be. I am painfully pushing myself, something I don’t want to do. But I do it for the payoff and because I know there are no shortcuts. I have done this for 35 years and it never gets easier, but the rewards are undeniable.

Make no mistake, without stress we can never fully realize our potential. So the next time you think something is too hard, understand that’s the whole point.

No stress = no pain = no growth.


In life we are always in one of two states.

We are either moving forward or falling behind.

As we get older, it unfortunately becomes easier to fall behind than to move forward.

Therefore we must push through our torpor and remain in motion.

Move or die.

Remember that the next time you don’t feel like doing something that you promised yourself you would.

Note To Self, Part 1

Whenever you are having a shitty day, try doing something nice for someone else, as an alternative to being led by your reactive emotions and behaving like an asshole.

The day might remain shitty, but your outlook will immediately improve.

And your largesse will have made someone else feel better as well.

Easy win win.

David Lynch, Part 1

I have a tremendous fascination with David Lynch and his art – I saw his first film “Eraserhead” at a midnight movie screening somewhere around 1979 in Boston and was seriously disturbed. I don’t mean like “ha ha, that’s disturbing.” I mean disturbing as in I couldn’t stop thinking about it. Disturbing as in I would literally have nightmares after I saw it. I can still hear the mewling cries of the “baby,” and almost 40 years later and it still creeps me out.

He doesn’t give many interviews, so when I found one recently written by Rory Carroll, I was eager to read it. Here are some thought provoking excerpts:

He (Lynch) is at his most animated when discussing ideas. “They’re like fish. If you get an idea that’s thrilling to you, put your attention on it and these other fish will swim into it. It’s like a bait. They’ll hook on to it and you’ll get more ideas. And you just pull them in.”

“Sometimes I get ideas, and I don’t know exactly what they mean. So I think about it, and try to figure it out, so I have an answer for myself.”

“A film or a painting – each thing is its own sort of language and it’s not right to try to say the same thing in words. The words are not there. The language of film, cinema, is the language it was put into, and the English language – it’s not going to translate. It’s going to lose.”

“I like to have some people around. If I was totally alone I think I’d get funny, and not in a humorous way.”

As a father and husband he has often been absent, he concedes. “You gotta be selfish. And it’s a terrible thing. I never really wanted to get married, never really wanted to have children. One thing leads to another and there it is.”

That sounds like regret, until he elaborates. “I did what I had to do. There could have been more work done. There are always so many interruptions.”

Sometimes, (although not always), in the process of making art, someone is going to get hurt.

“I Stopped Being Ashamed”

In light of a theme that seems to run through a few of my recent posts, I was struck today when reading this quote from page 204 of J.D. Vance’s excellent book “Hillbilly Elegy.” It’s relevance is clearly universal, but here it is used as a singular realization he had while attending Yale law school.

He was referring to the lies he told the other students about his upbringing, inventing them to hide the shame of his background of poverty and “hillbilly culture.” I’m thinking also of my close friend who was raised in an orphanage, yet didn’t actually tell me that for almost ten years, sticking instead to fabricated family he had made up to hide the “shame” of being an orphan. I use quotation marks because, of course, there was no shame at all in his circumstance, beyond that which he had imposed on himself.

Shame is crippling, yet it is largely something we impose on ourselves. It begs the question: What would happen if we were able to live and function without it?

Which immediately brings to mind another book I am reading, “Kitchen Confidential” by Anthony Bourdain. This book, which was written 18 years ago while Anthony was still working as a chef, is so nakedly unashamed it is breathtaking. He had no idea at the time of publication what effect it might have on his career, indeed, in the forward he wonders if he will still be able to work after it’s publication.

In it he chronicles in great detail his character flaws, weaknesses, shortcomings, and limitations as a professional chef. He is quite open about his wasted decades of substance abuse, all of the people he let down, and his general failings as a human being. His honesty is so raw you can’t help but be impressed by his humanity.

And what effect did this utter lack of shame have?

It led to to the most acclaimed and universally admired success he had ever experienced. His brutal nakedness and lack of shame led directly to achievement beyond which he could ever have imagined.

Food for thought.

May As Well Enjoy The Trip

If “the best way to avoid dying is to not live,” and yet we insist on living, then there only seems to be one reasonable conclusion.

Stop wasting time and enjoy the trip!

The Psychology of Insults

Part 1: “No I’m not – you are!”

The classic example here is what sadly passes for modern political “discourse.” Here, one party accuses the other of engaging in the same nefarious behavior that they themselves are knee deep in. For example, one individual shouts “you’re lying” to their opponent whenever they are caught in a lie. This can go on ad nauseum, indeed, it has become the standard operating procedure for talking heads in the media. As if no one could possibly see through this bullshit.

Part 2: “I’m about to be revealed!”

Ok, time to use some objectionable epithets for the purpose of illustration. Men, BTW, are the worst at this. Let’s say one swaggering simpleton, in a fit of blustering machismo, yells at another “Faggot.” What this really means is that the accuser is petrified of his own preoccupation with homosexual behavior. Unfortunately, this can lead to some real violence, as one closeted dimwit attempts to beat his own “gayness” out of the other one. Like I said, men can be fucking idiots. News flash – real men could care less about another mans sexual preference. They are more concerned with character.

Part 3: “Ouch – that hurts!”

This is best described with the following scenario. Say someone refers to you as a “loser.” It only hurts if you think you might actually be a loser, otherwise it’s just some asshole spouting off. In other words, the only epithets that hurt are the ones that ring true – in which case you should probably pay attention when something upsets you. It might give you a clue as to how you think about yourself.

All three of these examples are powered by a fear of vulnerability, as if there was shame in owning who you are, weaknesses and failures included.

Welcome to being a flawed human – the sooner you can let go of your shame the quicker you can get on with self-actualization.


I used to be the kind of person who strictly compartmentalized my life, probably to an unhealthy degree. I think it was a misguided attempt to protect myself, or maybe it was a way to carefully create an image of who I wanted to project myself to be at any given time (which I guess was also a way to protect myself). Whatever it was – it was total bullshit, based out of fear like most bullshit is.

Fear of rejection and failure, from a person who very much felt like a failure – or rather someone who thought they were inevitably doomed to fail. Again, this was utter bullshit – but in my defense, I really didn’t know any better. I was trying to create something out of what I thought was nothing, and struggling mightily to do so.

Although I now know what nonsense this is, I still wrestle with remnants of this kind of dysfunctional thinking. It’s funny how long it can take to change. Sometimes it takes a lifetime.

I find as I get older the walls of these boxes begin to break down, and I realize they never meant anything in the first place. They were a trap I had built for myself, what I thought would somehow protect me ended up hurting me instead. What I thought needed to be kept a secret really meant nothing at all.

So now I am trying to unify parts of my life I always kept separate. I guess this blog was a tentative step in that direction.

So far, the sky hasn’t fallen and the sun continues to rise.

Let’s see where this goes.

By Any Means Necessary, Part 3

If you have the right mind for it, the ER is such an interesting place to work.

Federal EMTALA laws (which are just and necessary) mandates that there is no limit to the number of people that are admitted to the ER at any given time. Unlike any other area of the hospital, there is no point at which you can say “it’s now becoming unsafe and we aren’t accepting any more patients.” No matter how many show up, you have to find some way to deal with them. As you might imagine, this can create a very unstable environment. So how do we do it?

By any means necessary. 

Not enough staff?

Don’t have the right equipment?

No space left?

No problem.

Patient is found on the street, unconscious, with no pulse and no ID? We love this shit! We live to figure out impossible situations and try to help.

We never say no – it’s not an option. But if this stuff makes you crazy, we understand. There are plenty of other jobs that don’t have this kind of stress.

On the other hand, if you thrive in chaos and you’re not afraid of taking an active part in life and death situations, you’re going to like it here.

We always find a way.

By any means necessary.

Thinking About Artificial Intelligence, Part 3

It turns out that things are a bit further along than I thought. I knew we were on the cusp of some paradigm shifting developments, but I wasn’t fully aware of the real world applications that are already here.

Let me be clear – the development of general AI is already well underway, and it will either be our greatest human achievement, elevating every aspect of our existence, or we will have created our own existential threat.

The big question is: When it arrives, what will this unstoppable god-like super intelligence decide to do with us? Up until the point at which AI surpasses us, we will have ruled our world simply because we were the smartest occupants. What happens when we aren’t?

I don’t know how I missed this astonishing article “The Great AI Awakening” written by Gideon Lewis-Kraus and published in the New York Times on December 14th, 2016. It reads like a science fiction thriller, except it’s a true account of something that is very much real. And it’s two years old…

It’s the story of neural nets and how Google used them to improve Google translate, and if you think that sounds boring you would be very, very mistaken. One doesn’t have to even be that bright to extrapolate the implications. They are both truly frightening and blindingly exciting, and they’re all around us. It’s already happening and we don’t even see it.

Lewis-Kraus reports on the Google Brain project:

“First a human mind learns to recognize a ball and rests easily with the accomplishment for a moment, but sooner or later, it wants to ask for the ball. And then it wades into language…

…The first step in that direction was the cat paper, which made Brain famous.

What the cat paper demonstrated was that a neural network with more than a billion “synaptic” connections — a hundred times larger than any publicized neural network to that point, yet still many orders of magnitude smaller than our brains — could observe raw, unlabeled data and pick out for itself a high-order human concept. The Brain researchers had shown the network millions of still frames from YouTube videos, and out of the welter of the pure sensorium the network had isolated a stable pattern any toddler or chipmunk would recognize without a moment’s hesitation as the face of a cat. The machine had not been programmed with the foreknowledge of a cat; it reached directly into the world and seized the idea for itself. (The researchers discovered this with the neural-network equivalent of something like an M.R.I., which showed them that a ghostly cat face caused the artificial neurons to “vote” with the greatest collective enthusiasm.) Most machine learning to that point had been limited by the quantities of labeled data. The cat paper showed that machines could also deal with raw unlabeled data, perhaps even data of which humans had no established foreknowledge. This seemed like a major advance not only in cat-recognition studies but also in overall artificial intelligence.”

If you think life will always just keep rolling along, you are in for some very rude shocks. It’s possible that biological intelligence was just a loading program for the next step in evolution.

You know, the one where biology is no longer necessary.

Don’t Overcomplicate Things

If you really want to do something, just do it.

If you say you want to do something but you’re not doing it, then you probably didn’t really want to.

Is it really that hard to understand?


I think we all know what our instinct is when we encounter noise – we want to turn it the fuck off!

Well, noise exists in other domains besides sound. Washington for instance. Just like too much auditory noise at a high level over a prolonged period of time will damage your ears, I would argue that too much political noise will do the same to your mind and sense of humanity.

Anytime I see someone standing in front of an American flag I’ve already tuned out. Done. Show’s over.

But let me be perfectly clear: I am neither proud of this nor would I recommend it to others. If everyone felt like this, nothing would ever change.

But, for me, it’s the right thing to do. I’m a 62 year old who survived what might easily have been a lethal brush with cancer. I recognize that I have a limited amount of time left and I am choosing not to waste it on things I can’t change.

I will always vote, but that’s where my involvement with politics ends. What this country wants doesn’t align with my personal code of ethics, and since I can’t change that, I’m bowing out.

I’m leaving this mess for the young people of this country (and anyone else who cares enough and has the time to get involved) to figure out. I’m just going to try and treat the people around me with respect and compassion and get on with my life.

I’ve turned this noise off, and it feels good.

The Difference Maker

Showing up when you don’t want to.

Suffering in the short term for long term gain.

Making yourself do the work when you would rather play.

Not quitting when things get rough.

Keeping promises you made to yourself.

Anytime you do one of these things take a moment to feel good about yourself.

It’s the difference between those who do and those who don’t.

Dog Training As A Metaphor For Life

Ten days ago I got dog number eight in my life. Number seven died six months ago and, like all those before him, broke my fucking heart.

Number eight is the first adult I’ve adopted (she’s approximately one year), and she’s only the second female. This one is a shelter rescue from the south, so very little is known about her previous life.

I’m in the very beginning stages of introducing and acclimating her to her new home and people, and while walking her today I had a bit of an epiphany.

There is no such thing as “dog” training, rather, it’s all training. Every moment you are with the animal you are training it to be the dog you want.

See, with each dog, if you’re paying attention and trying, you learn more about their needs and what makes them tick. You begin to understand what makes them happy and balanced. Of course, unsurprisingly, you often learn by making mistakes – but fortunately dogs can be very forgiving.

This one seems exceptionally bright and she watches my every move, you can almost see her trying to figure out what I want her to do. I’ve learned that training a dog is not so much about setting aside time for learning commands, it’s about leadership skills and consistency.

In other words, it’s about how you live your life and who you are all of the time.

Isn’t this how life works with other people as well?

Notes From the Frontline: When Death Becomes Routine, Part 1

Today’s post was written for the online Journal “Synapsis,” and may also be read there.

What is Synapsis? From their website:

Synapsis: A Health Humanities Journal was founded in 2017 by Arden Hegele, a literary scholar, and Rishi Goyal, a physician. Our mission is to develop conversations among diverse people thinking about medical and humanistic ways of knowing, and we see ourselves as a “Department Without Walls” that connects scholars and thinkers from different spheres. We are grateful for the support of the Institute for Comparative Literature and Society at Columbia University.

This post is a bit longer than normal, I was trying to explore a topic I find very interesting. The full text is reprinted below…

I wasn’t prepared for so much death.

Before I became an emergency room nurse, I worked on a neuro unit with stroke patients. I loved that job and learned a tremendous amount clinically from my colleagues, and even more about what it means to be a human faced with impossible tragedy from my patients and their families.

Strokes are, by definition, traumatic brain injuries. As such, the damage they inflict cuts to the very core of who we are as humans. The sequalae of these events is far-ranging, and will ripple out not only through the rest of the patients’ life but also through the lives of everyone who loved or was touched by this person – including their caregivers. My work with these patients left me with an indelible impression of just how fragile our lives can be.

Occasionally a patient would go into cardiac arrest, and being a very curious nurse who wanted to learn as much as possible, I would always rush to the scene. I was struck by how chaotic it all seemed, with multiple doctors shouting out separate orders, and nurses scrambling to get the right equipment, meds, and establish IV access. An air of heightened anxiety was palpable – someone was dying, quickly, and everyone who responded wanted to save this person, but the whole experience was clearly outside the realm of their daily practice.

I remember thinking “I want to work in an ER and learn exactly how to intervene when someone is in cardiac arrest.”

Well, I got my wish, and I love my job and am grateful to be working with a team of highly dedicated professionals who have taught me so much. I’ll never forget the first arrest I watched as a new ER nurse: there was very little verbal communication and no one seemed excited, much less panicked. There was no “leader” assigning roles, instead everyone just coalesced into a team like a well-oiled machine, effortlessly sliding into whatever role needed to be filled. All necessary equipment was fetched and put in place by nursing, anticipating what medicine would need before it was even requested. I don’t remember the outcome, I just remember being amazed at how smoothly the whole thing went.

But very early on, I began to realize that most people in cardiac arrest don’t survive. This had a pretty obvious implication, since cardiac arrest is one of the most common “life and death” emergencies treated on a daily basis in virtually all ERs.

It means that you are very quickly going to take an active part in someone’s death – and you are going to do it on a regular basis. Some shifts there might be none, others might have two or three. Suddenly you go from death being a rather isolated experience to death becoming a routine part of your job. And this isn’t death from a distance, no, this is death up close and personal. Death as in one minute this human is alive and your hands are on them trying to keep them that way, and the next minute they are gone. Forever.

As part of the team attempting to resuscitate the patient, you innately understand that your job is not to become emotionally involved with what is happening. Sometimes there are spouses, life partners, loved ones, or family in the room while the team works to save the patient. At that moment, they don’t need to see your emotional involvement, they need to see a group of highly skilled professionals doing everything they can to save their loved one. And they will never forget what they see.

I often think of the ER as the last stop for those in dire need of medical care. In a true emergency, it’s the final destination before their ultimate medical disposition. There are only three ways the patient will leave – they are either discharged back to wherever they came from, they are admitted to the hospital, or they are wrapped in a body bag and transported to the morgue.

Although your best chance of surviving a cardiac arrest is in the ER, the reality is that the overwhelming majority don’t survive. So this leaves the ER nurse (or doc) with a bit of a dilemma: How do you handle so much death? Unsurprisingly, there is no simple answer to this question, and in most ERs, it is left to the individual to figure this out on their own. How they do so is a measure of their humanity. Of course, some people are going to be better at this than others, yet for the most part, it’s a topic that’s not discussed.

But ultimately, it takes a toll on everyone, whether they admit it to themselves or not.

In order to deal with this tragedy on a daily basis without burning out, one is faced with two adaptive strategies: either become tough or become hard. Here’s my distinction:

Tough means you can handle the worst that life has to offer and not lose your humanity.

Hard means you can handle the worst that life has to offer, but the process of learning how to do so took your humanity with it.

Obviously, we want to keep our humanity.

When I started working in the ER, I didn’t fully understand the powerfully intimate human connection that happens between two people when one is in such a desperate state of vulnerable need and the other one is professionally trained to care for and alleviate suffering. I didn’t understand what it would mean to take an active part in so much death.

With the exception of hospice nurses (where death is the expected outcome), I’m not sure there are many other professions where death becomes such a routine part of your job. It’s a great privilege to be part of a highly skilled team trained to save someone’s life – but it feels strangely unnatural for another human to die while your hands are still on them, working to keep them alive. And when they’re gone, you are expected to simply move on to your other patients, as if this is the most normal thing in the world.

But it’s not normal.

I always try to take a moment after the team agrees to stop the code and call “a time of death,” to quietly honor the life of this stranger in my mind. I have no idea who they were or what kind of person they had been. I just try to honor them as a human being who had lived a life and now their time was up.

How Do I Get To The ER? Part 1

Go to your local gym to “buy a membership,” but take off all of your clothes first. Bathing is optional.

When EMS shows up they will be happy to take you there.

We’ll be waiting!