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Monthly Archives: April 2019


If you are an ER nurse, few things are more gratifying than giving TPA to an active stroke patient. One minute they’re aphasic – the next minute they’re not. Today I had the pleasure of taking care of an active stroke patient and seeing the therapeutic effects of this medication in real time – very gratifying.

The thing with strokes is: every minute they don’t get TPA (assuming it’s appropriate), the patient is potentially losing brain cells that they will never get back. So the whole function of the ER nurse in this situation is to give the medication (once ordered) ASAP.

I try very hard to be as aggressively fast as possible with this – in my previous job I worked with stroke patients exclusively. The damage they incur ripples out not just through the rest of their lives, but also through the lives of everyone who knew and cared for them.

So it was a good day in the ER.

The Right Moment

This quote was one of the things that helped motivate me to start this blog. Seth is big on self-expression as a way to give of oneself in order to contribute something unique to the world. I’m not sure I’m really doing that, but he at least inspired me to try.

It’s worth re-reading whenever you are having trouble getting started with something.

You might be waiting for things to settle down. For the kids to be old enough, for work to calm down, for the economy to recover, for the weather to cooperate, for your bad back to let up just a little…
The thing is, people who make a difference never wait for just the right time. They know that it will never arrive.
Instead, they make their ruckus when they are short of sleep, out of money, hungry, in the middle of a domestic mess and during a blizzard. Whenever.
As long as whenever is now

Seth Godin

Human Connection

The moments where we allow ourselves the freedom to achieve this helps us define and give meaning to our lives. It costs nothing yet is priceless – these transactions quite literally can’t be bought, they can only be freely given. But in order for them to happen we must drop our guard and allow ourselves to be vulnerable. That’s the hard part.

However, make no mistake: These connections are what we will remember at the end of our lives, and those whose lives we touched with some kind of human connection will form our legacy. It’s the part of us that will live on after we’ve long left this mortal coil.

So minimize these human connections at your own peril. Each opportunity is a portal that opens once, then closes. There will always be others – just don’t waste the treasure that’s right in front of you.

Duly noted.

Tribalism As A Form Immunity

Here’s a novel idea I just came across in William Von Hipple’s excellent book “The Social Leap.”

Hipple is an evolutionary psychologist with some provocative ideas – one being he postulates that xenophobia probably evolved as a form of disease prevention for the tribe. In other words, we became suspicious and fearful of other tribes because we didn’t share their immunity – we would literally get sick around them.

So from an evolutionary perspective, it made sense to fear “the other,” i. e. those who were unknown and different from “our tribe.” Our immune systems were different from theirs, thus making us vulnerable.

Evolutionary science is interesting to study – often it reveals biological imperatives for behaviors we might think are simply poor choices, or even somehow morally wrong. In reality, they developed as a way to protect and propagate the species.

It’s easier to change negative cultural norms if you understand why they got started in the first place.

Less Than Zero

All apologies to Bret Easton Ellis, but this is all I’ve got folks.

Fucking ER sucked all the life out of me.

Here’s a Thought (Part 4)

If you’re wondering whether something you wrote is any good, here’s a simple metric.

When you ask someone to read it, do they actually read the whole thing? Because if they do, then it’s good.

See, reading is an active experience, unlike watching TV or film, which is passive. You have to work to read something – it’s an investment of time and energy. You’re just not going to do it if you’re not getting anything out of it.

So the simple fact that someone actually read it in its entirety means it must be good, at least to that person.

If it wasn’t they wouldn’t waste their time.

Writing (Part 2)

Wherever this writing thing takes me, I just want to make a couple of notes here for future reference. At this point I’m halfway through my fourth short story.

First of all – I’m actually having fun doing this. I don’t really know what’s happening here, e.g. “Why am I doing this?” and “What do I expect to happen with this?” I’m just getting ideas for stories that seem provocative and interesting to me and then seeing if I can put them in a cohesive and hopefully compelling narrative.

Then I just sit down and do it. I’m not really consciously constructing anything, instead I’m thinking about the story and letting it tell me where it wants to go. Sometimes I know where I’m going to end up but I have no idea how I’m going to get there – but in the process of writing it reveals itself to me.

Sometimes characters just appear – complete with names. I have no idea where they came from, all of a sudden they’re just there. And the name thing is weird – as soon as they have a name, I just listen to them tell me who they are. It’s like they’re alive and I’m just paying attention and taking notes. I’m not kidding.

So when I sit down to write I don’t really have any plan, I just pick up wherever I left off and let the story tell me where it wants to go next. It’s interesting and mysterious. I have no fucking idea what I’m doing but when I go back and read it it sure sounds like I do.

More later…

Uncomfortable Epiphanies

I saw my shrink today and she casually made an observation that instantly crystallized something that I was struggling to understand before our conversation.

I’m at an age where people I know are starting to retire, and without exception they’re all really happy about the whole thing. I, however, have a problem with this – the idea of retirement scares the fucking hell out of me – and I never really understood why.

You need the strokes she said, to which I replied What do you mean?

What she meant was that I need the the acknowledgment of my usefulness from my peers and patients, because it makes me feel like I am contributing something meaningful to society. If I am left to my own devices, my mind and sense of self worth tends to get real dark, real fast. It’s not good. I begin to doubt myself and my worth to others.

Because here’s the thing: as humans, we have evolved to be social creatures. Our need to be a useful part of society is hard-wired into our DNA.

People with strong foundations that were nurtured by loving parents in their childhood tend to have an innate sense of self worth. They don’t spend a lot of time questioning their usefulness to others. On the other hand, those who were raised in chaotic, abusive environments almost always have a low sense of self esteem, even if they are sociopaths. Their default is to understand that they are not useful to anyone, because that’s what they were taught in childhood.

Looks in mirror with pained expression...”

It’s Sonny Chiba Motherfuckers!

Oh man, I’m late to the party – somehow I missed Sonny Chiba, the king of Japanese martial arts exploitation movies in the 1970’s. Oh sure, I’d heard about him, but nothing could quite prepare me for the sheer surreal brilliance of “Wolf Guy” from 1975. I watched it last night, slack-jawed and dumbfounded, feeling like I was looking in a portal to another reality while a latent acid trip slowly saturated my brain. It made absolutely no sense in the best way possible!

I mean, when you have a movie like this you simply have to suspend your idea of reality and just submit to the experience. I had the same transcendent experience I felt when I saw José Mojica Marin’s Brazilian masterpiece from 1969 “This Night I’ll Possess Your Corpse.” Nothing, and I mean nothing, can prepare you for the weirdness you are about to see.

Anyway, I think I’ve found a new obscure exploitation obsession and it’s name is Sonny Chiba.

Dig it!

Best Improvised Home Wound Dressing

And the prize goes to: The humble maxi pad!

It soaks up plenty of blood and wicks it away from the wound, keeping it clean and fresh – while at the same time it’s moisture barrier keeps the blood from leaking out.


Let’s Go Help Some People

I have a great job – I get paid to help people. Not only that, I get paid to help people when they are critically ill and dying – in other words, when they are the most vulnerable and in desperate need of help.

WTF!? Does it really get any better than that?

Mind you, it’s a ridiculously hard job – sometimes mentally and physically brutal – but at the end of the day, although it may seem like you’ve been beaten with a stick, you actually feel like you did something.

So no matter how tired I am, I have this thing I tell myself in order to get in the right frame of mind for work.

Let’s go help some people.

After this mental adjustment, I’m good to go.

What is a Game Changer?

Elon Musk is a game changer – but so is the emergency room tech who takes it upon herself to create a comprehensive program that will improve patient care – for no other reason than because she just wants to make things better.

I guess that just might be the fundamental spark that starts the fire of change.

The desire to make things better.

Disruption as a Catalyst for Change

One good way to understand a complex system is to disturb it and then see what happens.”

How our lives interact with the world constitutes a very complex system – changes to either will give results that can be very hard to predict.

The thing is, if we want to change and grow, we have no choice but to stir things up and see what happens.

Don’t live your life operating from a position of fear.

Fortune favors the brave.

Letting the Idea Drive

Dave Chappelle, talking to Jerry Seinfeld on “Comedians in Cars Getting Coffee.”

CHAPPELLE: Sometimes the offering drives. If I have an idea, it should drive. It’s like the idea says, “Get in the car.” And I’m like, “Where am I going?” And the idea says, “Don’t worry, I’m driving.” And then you just get there.

SEINFELD: The idea’s driving.

CHAPPELLE: Sometime’s I’m shotgun. Sometimes I’m in the fucking trunk. The idea takes you where it wants to go.

SEINFELD: That’s great.

CHAPPELLE: And then other times, there’s me, and it’s my ego, like, “I should do something!”

SEINFELD: “I should be driving!”


SEINFELD: That’s not good.

CHAPPELLE: No, ‘cause there’s no idea in the car. It’s just me. That formula doesn’t work.

SEINFELD: If the idea is in the car honking, going, “Let’s go…” It pulls up in front of your house.

CHAPPELLE: That’s exactly right.

SEINFELD: “You’re in your pajamas. Get dressed!”

CHAPPELLE: “I’m not ready!” “You can go like this.” “Where are we going? What are we doing?” “Don’t worry about it. You’ll see.”

Jacobs Ladder

“If you’re frightened of dying and you’re holding on, you’ll see devils tearing your life away.

If you’ve made your peace, then the devils are really angels freeing you from the earth.”

Danny Aiello, speaking to Tim Robbins in “Jacobs Ladder”

This is a wonderfully executed, sad and moving film on dying from director Adrian Lyne released in 1990, starring a very young Tim Robbins with Elizabeth Peña, both of whom give incredibly natural performances. It’s always cool to see directors try something challenging after a huge success (his previous film was “Fatal Attraction”).

The script is well written and superbly directed, which is no small feat for a story with this many layers. It’s one of those movies that didn’t really do that well at the box office, probably because of the intensity of the subject matter and a resolution that is both satisfying and complex, but one you really have to think about in order to arrive at your own interpretation. I love difficult art – art that draws you in while being opaque and mysterious at the same time.

I found watching this film very moving on a deeply personal level, yet I’m not entirely sure why. What happens when you are dying, particularly if you are not ready to go? What goes through your mind? There is something profoundly sad about all this, yet how many of us are really prepared for it?

I know people who say they are comfortable with the idea of their death, but I’m not sure that I really believe them. I was one of those people, until I was suddenly faced with the very real possibility of my own early death. Then I found out I wasn’t really ready at all – in fact, that single brush with my own impending demise changed my life forever. Fortunately for me it was a positive change, but it took several years to get to that point.

One of the profound personal realizations as a result of that experience is a theme that comes up over and over again in this blog.

I came away from it with this: Try to live with an awareness that this existence is a temporary state. Use this understanding to give meaning to every moment of your life, not in a morbid way, but rather to maximize your gratitude for each moment.

This ride might be over sooner than you think.

Observations on Aging (Part 1)

Everything that has to do with the physical functionality of the organism – i.e. your body – will decline with age. You can work hard and do your best to maximize its function as you grow older, but let’s be clear, it will decline no matter what. So there’s that.

The brain, however, is different. Our brains don’t really work on speed – compared to hardware, they are pathetically slow (obviously some are slower than others). Where they shine, indeed, what separates us from traditional hardware networks today, is that human computation is massively parallel.

What does this have to do with aging? Just this: if you have maintained your cognitive capacity, and you had a decent amount to start with, any minor slowdown in information retrieval is more than offset by a lifetime of pattern recognition and sophisticated cognitive mapping.

Your understanding of the world around you and how it works just continues to become richer and more nuanced. Your ability to recognize patterns in human behavior and the environment helps guide your decisions of how best to spend your remaining time, while also allowing you to see weaknesses in your previous thought patterns more easily.

Somehow, paradoxically, life actually gets better.

Cultural Change is Messy

We live in such an interesting time. Here in the U.S., the dynamics of our social culture is currently undergoing a period of intense change, and the way it is unfolding is awkward, messy, and often dangerously clumsy, with innocent people sometimes caught in the crossfire. In other words, it is happening exactly as might be expected if you look at cultural change through the lens of history.

Whenever an oppressed minority actively begins to fight for an equal place at the table, the leaders of the movement are, by necessity, abrasive and impossible to ignore – their job is be disruptive. They act as a social irritant, focusing all eyes on the injustice. The surrounding culture slowly begins to shift, often violently, and the conservative faction of the population will predictably resist the change. This is, after all, the definition of conservative thought – to maintain “traditional values.”

After this initial period of disruption in the social fabric, things begin to die down and may even seem to regress to “the way things used to be.” But to the trained observer, this seemingly dormant period is simply the precursor to the real show – the one where society suddenly begins to shift in an inexorable and unstoppable manner, integrating and recognizing the rights of the oppressed as if it were the most natural thing in the world.

Because, of course, it is.