A Utah Man, sir!

On the Sharing of Talents

2011-08-06T15:26:00.004-04:00

There is something simple and beautiful about this group walking down the street sharing their music with the world. Doesn't it make you a little jealous of their ability to bring a bit of joy into peoples' lives as they wander down the street?

I like my profession, usually. I like how I can sometimes diagnose the right disease, and occasionally fix their complaint. Not the "occasional" and "sometime" aspect, but that is just how medicine works, unfortunately. I don't really enjoy some of the insights my training gives me as I walk down the street, and I definitely don't like that I can't stroll down the street like the band Beirut spreading that happiness. But I'm awfully glad that others can.

My First Lady Is Cooler than Your First Lady, or, Why Did This Make Me Smile?

2011-05-09T09:07:00.001-04:00

On Life Without Call, or, On Mistakes, or, I Miss You Guys

2011-03-06T23:55:00.007-05:00

Left Coast, 3/2010

I have not been on call for almost a week now, and it has been amazing. I have been to four concerts in the last week with some awesome people. I have read most of an absolutely incredible novel. And I have rediscovered how much I miss my cycling team. Also, do you know how important chamois cream is when cycling? I knew this once; I know it again now. Unfortunately, I did not on Friday. The fifty-miler is not sitting so well.* While riding solo is still fun, I really miss my R4 buddies and our sweet, custom-chalked routes. Even the ones from Roshan and Jess out of Dateland. Oops.

Right Coast, 5/2010

*Pun so intended. Who doesn't use chamois cream? Seriously, how stupid can I be?

Book Review of the Time Period

2011-03-04T01:26:00.001-05:00

The Heroes is the latest in a series of fantasy novels by English author Joe Abercrombie. Now, I realize this vile and juvenile genre has turned up the majority of noses in the literary world. This book probably would, too, but not because of the fantasy elements, which are nowhere near the most interesting part of the story. This dark novel, so gritty you can nearly feel a tooth cracking as you chew through it, is filled with a commentary on the abject waste of war and a discussion on what it is to be more than a man, to be a hero.

The author takes the reader through the story from at least a dozen different points of view, on both sides of the conflict. From the generals down to the newest recruits, he shows us what his vision of a world consumed by war is like, and apparently it's one with a lot of graves. And vomit. We get introduced to one character as he abandons his widowed mother in order to join the draft, then watch as he comes to terms with the insanity that battle brings. Finally, we see him take his earnings and rise up to the challenge of protecting his family by being a farmer, leaving the world of heroes behind.

The counter-point, a veteran who single-handedly turns the tide of two battles through his skill and force of will, has his epiphany as the love-of-his-life, and wife of another man, points out what he has accomplished, and who he has helped. "Nothing and no one." . . . "So you love war." She said. But that wasn't her most damning accusation. "I used to think you were a decent man. . . But [now] I see . . . you're a hero." (The Heroes, Just Deserts). We are left with the unmistakable impression that the world would be better of without such heroes, and with a few more men.

The series has been enjoyable, but the last three books have been particularly impressive.The Last Argument of Kings discussed loyalty, and then The Blade Itself approached revenge in a style that would have made Alexander Dumas quite proud.

However, this book is certainly not for everyone. Coarse language pervades, and it's frank description of the brutality of men, made all the more macabre when done face to face with sharp pieces of metal. Still, I found this book to be not only a fun and interesting read, but also a thought-provoking piece discussing far more than a wizard and some medieval soldiers.

On Medicine, or, News from (too close to) home, or, The Circle of Life?

2011-02-19T14:39:00.003-05:00

Sandwiched between REL (90) and JRB (75) on the obituary page is Mr. Patient (29 - MP). His youthful face smiling clearly stands out on this page. Young and handsome, his picture forms a sharp foil to the older, more dated and worn faces he is now surrounded by. MP was a patient I took care of after his twenty-day ICU stay. He was a patient that I discharged home on hospital day #42. He was a patient that I had managed through home nurses for weeks, trying to get him to come in to the clinic. And then, through a PICC line that I had ordered placed – and with medicines I prescribed – he killed himself. And now all that remains is a half-dozen paragraphs glossing over his life.

He was only a few months older than I am.

R.I.P.

Highlights of 2010, or, Almost On Time

2011-01-31T00:43:00.004-05:00

2010 was, as Dicken's put it, the best of times and the worst of times. As I put it, 2010 was also the mediocorist* of times.

Best Books of 2010 - This category really gets a mediocrity score of 6. I have definitely had better.

1. David O McKay and the Rise of Modern Mormonism, by Prince & Wright. This will only be an interesting book to a small portion of the world, but it provides a really fascinating view into the workings of the President and Prophet of the Mormon Church. Thanks to detailed notes kept by McKay's secretary, Clare Middlemiss, we now have this insider's view into an otherwise mysterious position.

2. Cecil’s Essentials of Medicine - Also only interesting to a small group of people, but this is also a great, appropriately detailed book that does not try and beat the reader senseless like Harrison's, while also giving enough background to help you remember, well, the essentials. I only wish I could say I'd read it all, or remembered half of what I've read.

3. All Things Brandon Sanderson - I've been reading this one dang series for far too long, and now we only have one book left. That alone would be enough to make Towers of Midnight a book-of-the-year in my lists, but this book was also sweet. Then Sanderson published two other great novels this year, too. The dude is really cruising.

4.Slaughterhouse Five, Kurt Vonnegut - I agree with my buddy Mark. I liked Cat's Cradle more, but that does not make this less of a great novel in its own right.

5. The Road, Cormac McArthy - easier to understand than No Country for Old Men, and deserving of the Pulitzer.

Movies of the Year, or rather, The Shows Bryce Really Liked - Mediocrity score of zero. This was a solid year for films.

1. Scott Pilgrim vs. The World - This show was so incredible. At least that's how I remember it. I saw it after being up all night at work, basically half-drunk with sleep-deprivation. This show hit all the right notes for my slap-happy self, and though it has a silly portrayal, the theme of tackling life as an adult and the unforgettable line, "I lesbians you," make my totally-awake-self agree with my definitely-impaired-self: this show rocked.

2. The Kids Are All Right - This was another winner (speaking of lesbians . . . ). I saw this show post-call as well, but I have no hesitation in this placement. My friend Crystal summed it well afterward by saying, "I can't remember a movie where I have been so interested in every single character." A really touching film. And funny. And with lesbians.

3. Exit Through The Gift Shop - Banksy is awesome.

4. The Social Network - Man this show had smart, snappy dialogue.

5. True Grit - The Coen Brothers are also awesome.

6. Toy Story 3 - I don't understand how Pixar is making films this good.

Best Albums - 2010 was an exceptional year. Mediocrity score of -5.

The New Pornographers - Together

The National - High Violet

Jonsi - Go

Sufjan Stevens - The Age of Adz

Sleigh Bells - Treats

Mumford & Sons - Sigh No More

Florence + The Machine - Lungs

Josh Ritter - So Runs the World Away

Metric - Fantasies

Vampire Weekend - Contra

Best Concerts of 2010- Mediocrity score of -10. Really. (Salt Lake has really shown up in this circuit. Mediocrity score: -3)

Best free shows: The Twilight Concert Series is just amazing. Beirut and The New Pornographers were absolutely incredible. I still can't believe I passed up Girl Talk for a bad Mediterranean dinner. The Utah Arts Festival had some great (basically) free shows, too, especially with Cadillac Sky.

Best Venue: The State Room, where I saw Punch Brothers. You know them as Chris Thile's band, and you know Chris Thile as the Mandoliner* from Nicklecreek. Man can he play.

Best ever: Jonsi. The only thing that was not absolutely incredible about this concert was the venue. This is undoubtedly the show that all others will be judged against for the rest of my life. Or the foreseeable future, at least. Runner up: Sufjan Stevens.

Most memorable: Freelance Whales, at Kilby Court. Most memorable for a great show, some great music, and just a great night.

Best in Columbus: Temper Trap. $5. Such a sweet disposition.

I am still bitter, though, that I missed the incredible lineup at the end of medical school, when Vampire Weekend, Teagan & Sarah, Passion Pit, and Band of Skulls were all playing in a three day span. But who wouldn't rather spend 36 hours driving 2000 miles from Columbus to San Diego? And then I missed Vampire Weekend again in Salt Lake because of call. Just like I missed Tchaikovsky's Violin Concerto (quite possibly the most perfect piece of music - ever) again. But given the incredible concerts I did see this year, even I don't feel bad for me. And 2011 is looking even better.

*It is a word. Google it. Even if it's only on my blog.

Hope For A Brighter Future, or, Waxing Philosophical

2011-01-18T23:04:00.004-05:00

It being Civil Rights Day, I read MLK's Letter from a Birmingham Jail today. Here are a few thoughts from a 21st Century, worn-out, Mormon (eek), male(gasp) mind. Maybe we as Utahns, Americans, and people, can be a little better at attempts at dialogue and proving contraries. Then we can pay attention to what actually matters.* I think Mr. King would be happy about that.

From NYT article A Tale of Two Moralities, Paul Krugman (Nobel Laureate):

One side of American politics considers the modern welfare state — a private-enterprise economy, but one in which society’s winners are taxed to pay for a social safety net — morally superior to the capitalism red in tooth and claw we had before the New Deal. It’s only right, this side believes, for the affluent to help the less fortunate.

The other side believes that people have a right to keep what they earn, and that taxing them to support others, no matter how needy, amounts to theft. That’s what lies behind the modern right’s fondness for violent rhetoric: many activists on the right really do see taxes and regulation as tyrannical impositions on their liberty.

There’s no middle ground between these views. One side saw health reform, with its subsidized extension of coverage to the uninsured, as fulfilling a moral imperative: wealthy nations, it believed, have an obligation to provide all their citizens with essential care. The other side saw the same reform as a moral outrage, an assault on the right of Americans to spend their money as they choose.

This deep divide in American political morality — for that’s what it amounts to — is a relatively recent development. Commentators who pine for the days of civility and bipartisanship are, whether they realize it or not, pining for the days when the Republican Party accepted the legitimacy of the welfare state, and was even willing to contemplate expanding it. As many analysts have noted, the Obama health reform — whose passage was met with vandalism and death threats against members of Congress — was modeled on Republican plans from the 1990s.

And from MLK Jr.'s Letter from a Birmingham Jail,

Just as Socrates felt that it was necessary to create a tension in the mind so that individuals could rise from the bondage of myths and half truths to the unfettered realm of creative analysis and objective appraisal, so must we see the need for nonviolent gadflies to create the kind of tension in society that will help men rise from the dark depths of prejudice and racism to the majestic heights of understanding and brotherhood...

RIP Mr. King. Hopefully.

*People, if you're a Democrat, and money, if you're a Republican.

OVERHEARD LINES; or, Attention: DCFS

2010-12-20T00:08:00.002-05:00

3 year old: Grandma, can we play with matches again?

Grandma: Sure.

On Learning Another Lesson, or, To Every Thing There Is A Season

2010-10-20T01:25:00.007-04:00

"I've got one for you."

The most ominous words that you hear as an intern are actually just that benign. Not because of the words themselves, but because of what comes next. And this time it came rapid fire.

"Mr. RM* is an 83 year old man who became unresponsive at home several hours prior to presentation, and he vomited three times. He's got a history of seizures, has a sodium of 128, a potassium of 5.7 but his troponins and CK and MB are negative. His chest film was pretty normal, and his brain scan was negative. We're checking his tegretol level, and admitting him for all of these problems, and also for the ones we haven't figured out yet. Don't really know why he isn't responsive." **

This all came out in one breath. Like an M-16 on full-automatic. I had stuck my head out of my foxhole by answering the phone with my usual, "Hello, this is Bryce." And I had been hit.

Needless to say, two weeks into my actual internship, I was feeling overwhelmed. As in, Polish-cavalry-facing-Nazi-Panzer-divisions overwhelmed.

Unfortunately, that was pretty much exactly what happened. But let's not get ahead of ourselves.

I went down to the Emergency Department, and turning to the electronic record, I did the “chart biopsy,” where I looked up what I could on this patient. He has a history of seizures, well controlled on tegretol. He was in the hospital most of last month after a stroke, and while there he also had ischemic colitis. Ischemic colitis means not enough blood flows to feed the intestines, so a portion of them die. He also had two pituitary surgeries in years past for a slowly growing benign growth. These surgeries can often affect the brain itself. He has high blood pressure, high cholesterol, low thyroid, and a funny heart rhythm. Walking into the little patient bay in the emergency department, I see he is also still not responsive.

His wife is sitting by the bedside. She confirms most of the history, adding a detail there, creating holes elsewhere, and usually not being able to confirm or deny my questions.

"Why is he on fludrocortisone? How long has he been taking that medication?"

"Has anyone ever told your husband to be careful about how much water he drinks?"

She has no idea about these, but she is able to tell me that she thinks her husband would want to be a “full code” where we try everything we can to save him in the event of his heart stopping. I dutifully note that down on his admission papers.

Continuing through my admission interview, I am nearing the end when the attending suddenly appears at my side, deus ex machina. I update him on what I had gleaned, he asks a couple questions, and then we excuse ourselves to talk about the plan. What did I think? Was this a seizure? Was it a new stroke that the CT did not pick up? Since we can't get an MRI because of his hip, what should be our next step?

"Well, it's straightforward, you see," said the young and smart and dashing young attending, quickly. "You need to figure out if this was a seizure or a stroke or his heart, or maybe it could be his lungs. So, here's what you do. Order an EEG tonight, get a neurology consult for the morning, and with no MRI available (because of his fake hip), recheck a CT of his brain in 24 hours. Keep checking his cardiac enzymes and EKG's for signs of myocardial infarction, and watch him overnight on the heart monitor. It very well may be his lungs, since he could have gotten some of that vomit down the wrong tube. So just check his chest film again in the morning. There is going to be a blossoming pneumonia there. Dollars to donuts, Bryce, there'll be a pneumonia. But he might have a big clot in his lungs, and since we can't get a CT scan for that because of his kidneys, we'll check his legs for clots, since that's where those would have come from, and then we can get a V/Q scan sometime tonight. OK? So I'm going to take off now, but why don't you go get him tucked in tonight and write these orders. I'll see you in the morning."

And just like that, my deus ex machina went right back to wherever it was he had come from. I do not know where backstage is at the hospital, but I am desperately trying to find it. I was left there, center stage, to walk this patient upstairs. Once we were on the medical floor I noticed that Mr. RM seemed to be breathing pretty heavily. Thinking on my own, I asked the respiratory therapist to come down and get a blood gas, and to get ready to start him on BiPAP while I kept working on his admission paperwork.

His new nurse, on the other hand, was more concerned. "He looks pretty sick,” she said. “Don't you think he needs to go to the ICU?"

“No. He was just seen by the attending a few minutes ago. He said the patient should come up here. Let’s get the gas and BiPap him.”

(I should interject here that my training situation is likely different than any you may have heard of elsewhere. It is nothing like TV, and it is almost certainly not like your hospital. At my residency, there is no team with intern, senior resident, and fellow in a hierarchy before reaching the attending. There is the intern. Then there is the attending. I do not have a senior resident that I report to before either of us discuss the case with the attending. Any patient you admit on call is yours and yours alone. You call whichever attending normally sees that patient as an outpatient (or the hospitalist on the case) to staff the patient each day. There are no table rounds. There are no herd rounds. Again, it is just you, sitting alone on your horse, holding your shiny-new-MD-diploma-of-a-sabre, staring across the battlefield as diseases launch their Blitzkrieg).

As I continued working on his orders, the respiratory therapist came and told me she could not get the blood gas. Poking my head in the room, I reassess the breathing. The patient now seems to be having Cheyne-Stokes respirations, where they breathe quickly for a period and then slow down, almost stopping, then start breathing quickly again. I tell her to go ahead and start the BiPAP now and then get the gas. I do not, however, return to my paperwork.

Watching the patient makes me more and more nervous. After waiting only two minutes for the respiratory therapist to grab the BiPAP machine, I begin thinking the nurse was right all along.

“How do I get a tube in a patient on the floor?” I ask.

“That has to be a doc-to-doc. Call one of the intensivists.”

“Well, why don’t we do that. Would you call one for me?”

A few minutes later I am on the phone with Dr. H, updating her on the situation with this patient. She would be happy to come down and help me out.

And that was when everything started to fall apart.

Since I am new to this process, I do not try and intubate myself. Shortly after Dr. H intubates, however, she asks me if we should call a code blue. Feeling for a pulse, we discover the patient had entered the realm of pulseless electrical activity, where the monitor looks fine but the heart is either not beating or only beating so poorly no blood is actually being pumped. We roll the patient up, put a backboard under him, and I start to give chest compressions.

It is difficult to describe, but when you feel an octagenarian’s ribcage crumple like a box of Kleenex under your hands as you start CPR, you can almost feel your own chest collapse. At least that is how you feel when you’re the admitting intern. As people continued to pile into the room, responding to the code, I feel myself stop thinking. Brain dazed, I keep thinking that the attending just saw him, not 30 minutes ago. What did I do? How did I let this patient get to this point?

I have been in codes before this. I have given CPR. I have seen patients die. I have been there after codes for those discussions with family afterwards. I have pronounced patients dead before who had died in front of families. This time, however, was different. Very different. This was my patient. I could not escape the feeling of horror as I watched, almost in third person, as we struggled to save his life.

After fifteen minutes, I walked down the hallway to talk with the wife, who was sitting with the social worker in a consultation room. Her face mirrored the emotions I felt surging within me: confusion, horror, and fear. I found myself having a discussion I barely understood.

“Mrs. RM, I’m sorry to have to come and discuss this with you. We are not sure why, but your husband’s heart is not beating effectively, and as you are aware, he was not breathing well by himself. Right now we are breathing for him and keeping him alive with chest compressions. We are still trying to figure out the different reasons why his heart is doing this. I know this is difficult, and we talked about this already downstairs, but should we keep doing this? Do you think your husband would want us to be giving him these chest compressions?”

As she said yes, I could see the fear and horror crowding her eyes. After walking down the hallway to his room, we kept going. Fifteen minutes later, I walked the reverse course, back to the consultation room.

“We are still looking for a reason, but the treatments we’ve tried have not been successful yet. We will keep trying.”

After another quarter of an hour, however, we had exhausted all of our ideas. We had checked the labs we could, given the drugs that might have helped. There was nothing left to do. Despite everything we had tried since he got to the hospital, some things had not changed. Mr. RM was still unresponsive. But now it was much worse. And much more permanent.

While the code team dispersed, a few people staying to help clean up the body, I slowly made the walk back towards the wife’s room. While I have had classes that covered how to deliver bad news, I have never felt as unprepared as I did at that moment.

“Mrs. RM, as we talked about, your husband’s condition was very serious. We have tried everything we could, but the other doctors and I agree, there was nothing more we could do. I’m very sorry to tell you that your husband has passed away.”

And just like that, I realized I was in way, way over my head.

*(actually not really his real initials, because even though I've worked with HIPAA rules my entire career, I have no idea what they really mean).

**I’ve taken the liberty of rearranging the order of this ED doc’s presentation, because he practically gives it backwards. Literally the last thing he told me was the patient’s age. I knew about his negative CT before I knew he was unresponsive.

Allow me to offer one additional thought, which I don’t mean to sound pretentious. I am not trying to pretend here that physician's have the hardest/best/most anything job on the planet, so please don't take that from this thought. Everyone I talk to about my training gasps about the hours. “You’re working 80-90 hours a week? That’s horrible.” Well, nearly everyone. The old-guard physicians think we're pansies for not spending 120 hours in the hospital a week like they did. Regardless, the hours can be tough, for sure. 30 hours straight of being awake is difficult. There is a very good reason no one stays awake all night after they graduate from high school – because it’s not actually any fun. But the hours are not what makes residency difficult. A 30 hour shift is actually pretty manageable. What makes residency hard, such a challenge, so draining, is the weight. The weight that comes with the decisions you make is what makes this different. It’s not about putting in hours. It’s not about “surviving” three to seven years of residency so that you can live the good-life of an attending, golfing to your heart's content. Residency is about a lot of things, sure. Learning how to remove an inflamed appendix or how to best manage diabetes are important, sure. But so far I think it is more about learning to deal with the weight. And I’m not sure that weight will ever go away. Because Mr. RM isn’t ever coming back. And that has some weight.

(As an aside to those of you close to me. I know this sounds depressing. It was. It happened in August. I’m doing alright.)

Quote of the time-period

2010-10-17T23:34:00.001-04:00

Voltaire:

Le mieux est l'ennemi du bien,

or,

The perfect is the enemy of the good.

2010-09-14T19:08:00.003-04:00

Evidently this is my 100th post. Woohoo me. Now, to pat myself on the back (since having a blog about myself isn't enough self-adulation), I'm just going to post something I wrote a year ago.

My brother-in-law is applying for residency, and I had the chance to help with his personal statement. This reminded me of the misery of applying and writing my own personal statement. Here it is. And half the reason I'm posting this is because I have the next chapter of the statement almost finished, the one where I learn the next lesson mentioned below. And that lesson was not fun or happy. Anyway, here is me in 569 words.

Toy Cars, Hospital Hallways, and Modern Medicine

BKP

Before entering my assigned ward on the first day of clerkships, I paused, intimidated. Thick fire doors guard each entrance to the hospital hallway. The walls are scuffed and marred, the tile on the floors dull, and the smell of disinfectant hangs pungent in the air. A cacophony of beeping alarms, loud pages, shouts and sobs crash through the silence. But despite the noise and the chemicals and the drabness of this hall, I have found warmth and caring and human commitment.

BM, a 3 year old boy, besides providing a chuckle over his unfortunate initials, formed a cornerstone that much of my pediatric education has been built upon. He initially presented with a history of decreased oral intake, decreased energy, and a unilateral swollen tonsil. The emergency department performed a CT of the neck which demonstrated a likely phlegmon developing. He, along with his twenty or so toy cars, came to our floor and received several days of antibiotics for the suspected retropharyngeal abscess. He taught me a lot about that disease while in that hospital hallway. Except he never did have the typical fever. After failing to improve to the antibiotics, he was taken to the OR. While under the knife the infection suddenly morphed into something worse; something far more sinister. That was when BM stopped being the kid with the infected throat and became BM the kid with Burkitt's lymphoma. He left our service, and all of his cars went with him.

A week later I left the Infectious Disease floor to go to the Hematology/Oncology wing. Who else was there but Mr. Toy Cars himself? I quickly snatched him up as my patient. Even though he was now a cancer patient, we still played with the same cars while he received his chemo, and he taught me about induction therapy. He left, only to return to our hallway a week later having developed a fever. Since his immune system was so weakened due to the poison that had been pouring in through his central line, this "simple cold" was now a medical emergency. BM was providing me another lesson, this time while deathly ill. Thankfully, he improved to be able to play cars again, and avoided teaching me a final lesson, one that I hope to delay learning as long as possible. And until I learn that last lesson, and hopefully afterwards, too, there will be plenty of cars to play with.

Because of these (and other) experiences, hospital hallways no longer remind me of a noisy warehouse. I walk these corridors with a new perspective, and I now know that more than just my passion for medical science drives me to be a part of this bustle. Real people, with genuine, human needs are found here - people who touch me at least as much as I touch them. They walk through different hallways at times, requiring different levels of medical care, but they carry the same toys, the same human needs whatever the hallway they are currently in. Presently, I walk these halls as a medical student, providing the care I am currently able. Someday soon I will walk the hallway as a physician. And I look forward to providing the same care and compassion that I have seen provided so far, with the special opportunity as a family physician to help guide my patients through the different hallways they will need during their medical care.

The Guiness Book of World Records, or, Welcome to Utah

2010-07-10T10:25:00.000-04:00

Two words. Actually only one, if you consider this particular phrase as a single compound word. Two words is all it took for a certain Labor & Deliver nurse to decide I needed to go on a date with someone she knew. Two words. Those two words acted as introduction, point, counter-point, and conclusion to her. I, on the other hand, still do not know this particular nurse's name; come to think of it, I am not sure she knows mine. Those details were not part of the conversation. A conversation went like this:

Bryce, walking down the hallway, discussing with fellow intern the intricacies of the housing market: I know, unbelievable, right?

Fellow Intern: Ridiculous. I can't belie-

L&D nurse, to other nurses in hallway: I can find out.
L&D nurse, interrupting Fellow Intern: How old are you?

Bryce, uncertainly: Twenty-nine.

L&D nurse: I have someone I want to set you up with.

And, scene.

I'm still a little confused myself.

On Shaving Legs

2010-05-12T21:40:00.007-04:00

I would like to take this opportunity to discuss some issues about cyclists. First, they are extremely sensitive about their name – cyclist – as opposed to biker. This likely stems from the latter’s preference for leather instead of lycra. Which brings up another issue: spandex. Cyclists wear this for several reasons, such as aerodynamics, reduction of that annoying flapping while doing some awesome descent, and also the opportunity to show off the physique attained while doing some hideous climbing. Which brings up another, larger point. One that almost everyone asks a male setting out on a cycling trip. The shaven leg. Below is a brief discussion of the pros and cons of shaving the lower extremity, which we discussed on our short trip from Buckeye to Phoenix, before our presentation to the University of Arizona Medical School about global health. Fourth year medical education at its finest, right here. But enough about medicine; back to the legs.

Reasons Cyclists Shave Their Legs

1. Road rash – this is allegedly the real reason people shave their legs when cycling. The shaven leg is much easier to debride, or scrub gravel out of forcefully with a stiff plastic brush, than the hairy leg. Thankfully we have not had a crash resulting in road rash yet, but Katie Kidwell did have an excellent dismount from her bike at a stop light that day in Phoenix. She didn't even remove her feet from her bike as she lighted on the ground - all those years of gymnastics paid off!

2. Improved aerodynamics – lets be honest, this is pure B.S. The cyclist may feel they are faster without leg hair, but there is no way that cyclists, especially at our level, will have a gain in performance due to a lack of hair; if anything, you may miss the feel of wind in the leg hair making you aware of your pace, and paradoxically feel slower due to the newly naked skin.

3. Solidarity – this is a very important reason. Several of the male riders had already shaved their legs for aesthetic or other reasons, and the shaven ranks swelled by a few in the first few days, as Tim Mitchell joined in with his razor. The sense of brotherhood and team is an important part of why people shave their legs for cycling.

4. All the girls were doing it – past tense. The less said about this the better.

5. Sunblock – since we are riding for several hours each day, sunblock is an important part of your morning ritual, unless your name is Maggie Rosen. Leg hair, especially thick leg hair, can greatly complicate and lengthen this maneuver. A shaven leg is much easier to apply sunblock to than a hairy one.

6. Insect Rights – believe it or not, every day after a ride I have to dig at least three bugs out of my leg hair. This is somehow more disgusting to me than the bugs swallowed while riding or the bugs that you wipe off your face. Without leg hair, the bug would slide right over the leg, continuing to live. At least until it met an unshaven leg. Or a windshield.

7. The calves – you know you want to see them. A shaven leg just puts them on display that much better.

Reasons Cyclists Should Not Shave Legs

1. Time – from a base state of hairiness, it takes about 45 minutes to shave a leg. One. Singular. This is a serious time commitment.

2. Razorburn. Ouch.

3. Folliculitis/ingrown hairs -> necrotizing fasciitis -> sepsis/amputations -> death. No one wants to be a case report.

4. Razorburn. Hurts even worse the second day.

5. Sunburn - according to Travis Grace, M.D* hair acts as a natural sunblock: “I mean, your scalp doesn’t burn unless you shave your head.” Sounds scientific to me.

6. Awkwardness – the positioning required to shave, say, the popliteal space behind your knee or the back of the thigh properly requires a PhD in yoga. And may make you feel like you need to have a confession.

7. The itching – it does not stop.

What, then, is the reasonable cyclist to do, given these facts? The answer seems clear enough to me. Shave one leg, and let the other go.

*pending satisfactory completion of the Ride For World Health

My Life Recently, or, The Ride For World Health

2010-05-03T22:31:00.011-04:00

As some of you may already know, I am currently riding my bicycle across the country with a group called Ride For World Health. We are a group of mostly medical students who are riding our bicycles across the country to try and raise money and awareness for some global health issues. And I have been lax in my reporting thus far; we have completed about 55% of our ride now. I’ll try to briefly catch you all up to date on our adventures. Imagine some Doogie Howser, M.D.ish music playing as I’ll try to sum up the one or two items I learned that day of the ride.

3/27 - Do you know how long it takes to drive from Columbus to San Diego? I do. And it might be reducible to 36 hours, but it is a very, very, very long time. (Columbus, OH to San Diego, CA)

4/1 - 56 miles the first day, with 6600 feet of climbing thrown in for fun. Not my idea of fun, and I don’t think most peoples, either, but allegedly a person exists somewhere who finds that fun. (San Diego to Lake Morena, CA)

4/2 - Riding down a 6% grade could be fun – heck, it should be fun. But it is not when on I-8. (Lake Morena to El Centro, CA).

4/3 - Even if you fastidiously apply sunscreen twice a day over all of your skin, your lips will still sunburn. And blister. Also, flocks of red-winged blackbirds outside dairy farms create memories that last lifetimes. (El Centro, CA to Yuma, AZ). Oh, and those neat stateline “Welcome to Our State” are actually really difficult to find.

4/4 – Riding in groups is fun. (Yuma to Dateland AZ).

our pace line in the AZ desert

4/5 – The Ohio State University is going to take over the world. The town was named by proud alums back in the day – true story! (Dateland to Buckeye, AZ)

4/6 – Short, fun ride that led into our first Global Health Day. (Buckeye to Phoenix)

4/7- And if you ride to DQ after a long ride, you will hit your first “century” ride, where you cover more than 100 miles on your bike in one day. (Phoenix to Picacho Peak State Park, AZ).

Me after my first century ride.

Picacho Peak is pretty awesome

4/8 - Waking up early to hike a peak makes even a short 43 mile ride pretty long. Especially when there is a stiff headwind. Still worth it, though. (Picacho Peak to Tucson, AZ)

4/9 – Having a day off, even if it starts out with ornery custodians, is glorious. (Tucson AZ)

4/10 – New rootbeers in the middle of the day make any day better! (Tucson to Wilcox AZ)

Captain Eli's Rootbeer - really good, fully flavored and fairly sweet - 8/10

4/11 – Lordsburg is a horrible, horrible place. Also, I have a very different scale as to what is spicy, according to one Katie Kidwell. (Tucson to Lordsburg, NM)

4/12 – It’s a good thing there are signs to mark where the continental divide lies out in the desert. (Lordsburg to Deming, NM)

The continental divide

4/13 – I really love small-town America. (Deming to Las Cruces, NM)

4/14 - The whole group rode together for much of the day. And I finally found a state border sign! (Las Cruces, NM to El Paso,TX)

4/15 –White Sands National Monument is the prettiest bombing range I have ever seen in my life. (El Paso, TX)

4/16 – 4/21 – If you wake up 15 minutes before your flight leaves to Cancun, you can get there earlier than scheduled. I'll have a different post about this some other time. Maybe. (Cancun, Mexico for AMSSM conference

4/22 – Did you know Methodist churches have roller skating rinks in them? And bowling alleys?(Abilene, TX to Ranger, TX)

4/23 –The first 50 miles of this 107 mile day were some of the most beautiful I’ve ever seen. We had a nice wind, and the Texas wildflower bloom is really something everyone should see sometime in their life. (Ranger to Ft Worth TX)

4/24 – Ft Worth is a really fun town when spent with 20 of your friends.

4/25 – Horrible headwinds for the first thirty miles are totally redeemed by tailwinds for the next fifty, when you can average 30mph and end it with a dip in a private lake. (Ft Worth to Greenville, TX)

4/26 – The church ladies in Greenville and Paris are amazing. Really amazing. (Greenville to Paris, TX)

Some people struggle with directions

That's it for now. I'll try to be better in the future with reporting on the ride. It has been a really, really ridiculous amount of fun. I doubt I will ever have a better trip in my life, honestly, but it has also been a ton of work.

Also, if you want to follow some more faithful chroniclers of the ride, here are some of my friends' blogs:

The official blog is written by a different rider each day: http://www.rideforworldhealth.org/blog/

Tim Mitchell - tmr4wh.blogspot.com

Maggie Rosen - Maggier4wh.blogspot.com

Libby Huffman - http://libbyr4wh.blogspot.com/

Justin Harper - http://www.justinsride.blogspot.com/

Chris D'Ardenne - http://buttbutter.wordpress.com/

Adam Koon - http://adamshead.tumblr.com/

Andy Nyberg - Cdrifter.wordpress.com

Soo Last Week, or, I Matched!

2010-03-25T19:36:00.004-04:00

I was on the news. Or my class was on the news. You might not know, but we're kind of a big deal.

http://www.abc6onyourside.com/shared/newsroom/top_stories/videos/wsyx_vid_3171.shtml

I wish I could embed the video on that page, but I'm not that savvy. The main reason is that I would like to ask one question: who in the world writes for these TV newscasters? They should all be fired. I mean, take the opening line of that story: "It's called medicine's own March Madness." Really? Who calls it that? Not only is that not factual, it's not even catchy.

In other news, I'm headed *gasp* back to Utah. I will spend the next three years as a Family Medicine resident at McKay-Dee hospital in Ogden, though I do plan to live in the SLC.

In other, other news, I leave to start my bike ride in less than 36 hours. Not that I'm stressed. Wish me luck.

My Boring Life, or, For Google's Eyes Only

2010-03-21T17:56:00.004-04:00

I recently presented this paper at a History of Medicine conference in KY. I enjoyed writing the paper. Sort of. I enjoyed the conference. Sort of. It made me very glad I am not a Ph.D historian, because, while I enjoyed talking with them, I asked one what his emphasis was on. "Empathy," was his reply. Anything related to that word, which was only first introduced in the 20th century, believe it or not.

That is my way of saying that you, my average reader, will probably not enjoy this post whatsoever. I'd be delighted if you prove me wrong, but this is something of an esoteric, dry paper on medical philosophy.

So, only because Google is good about indexing everything, and this doesn't stand a chance of being published elsewhere, I thought I would post this article so someone, somewhere, sometime, might read this and get a little help on his or her research paper. Just remember that I didn't talk about Ibn al-Nafis in my introduction of Harvey. If you are doing a more exhaustive work on Harvey himself, you should read about him as he did present a logical discussion of the heart and continuous circulation in the 13th C and Harvey may or may not have read al-Nafis's writings. But the history of Harvey wasn't really the point of my paper.

The <> markings are where the slide was advanced.

William Harvey, “The Book of Nature,” and Modern Medical Thought

Bryce K. Peterson

Wm Harvey, Baldness & Ulcers

Briefly, my talk will have an introduction, then we’ll talk about the history preceding Harvey, then Harvey himself, then we will talk about two other medical discoveries.

Introduction

<> This is a picture of Frog Basin in Northern Idaho, one of the more beautiful places on Earth. If you were to hike over this ridge, you would be met, not by a view of the ocean, the city, or any other prize signifying the end of the journey. Instead, you would be met, <> with a new view of more beauty, but one that differs in the details. New vistas can emerge as we are raised by the vision of those who have gone before. Giant’s shoulders are required to stand upon to climb to new heights. <>Einstein required Newton; Martin Luther King, Jr. needed Gandhi. As thorough readings of history reveal, few ideas are completely original, or outstandingly revolutionary. So it was with the introduction by William Harvey in the 17th century of the circulation of the blood. Built upon a long, solid history of medicine, and on the backs of others mining for new knowledge <>, Harvey was then able to unearth the stone, which, according to the Kenneth Franklin edition of De motu cordis, is “the most important work in the history of medicine” (Franklin, flap).

<> Occasionally, however, these new discoveries lead to conclusions that are not correct, such as with the 17th C advent of telescopes leading to the 19th C (erroneous) discovery of canals on Mars, quite the engineering feat of the intelligent Martians; similar such blunders have occurred in medicine, whether in topics as superficial as baldness or as serious as peptic ulcer disease. While the work of men and women in times past is essential for forward progress, healthy skepticism must remain for new discoveries.

While striking the balance between acceptance and skepticism when approaching new scientific findings can clearly be difficult, it is of vital importance in our approach to not only the patient, but the world. Although this is a topic being approached from a historical perspective, this talk is not intended to be a rigorous historical treatment; it is, rather, meant to be a thought piece that provokes conversation about the consideration a clinician must use when examining new information from any source, as well as remembering the human filter through which that information flows, affecting our own view of ideas, both old and new.

Ancient Medicine

<> To better understand the view that William Harvey had of medicine and the world, it is important to first briefly recall the historical context in which Harvey lived. <> As an obvious medical phenomenon the blood itself was given attention by the earliest ancestors of medical scientists. Many theories were given, but predominant in the Middle Ages was the view of Galen from the 2nd century A.D. I might recall to you that these theories relied on the Platonic ideas of physiology, where pneuma (air) was modified by different organs for the various requirements within the body. <> The liver combined air with digested food and produced the ingredients for growth and nutrition to be distributed by the venous system, while the heart utilized the arterial system to distribute heat as along with pneuma to envivify the body. The brain produced the necessities required for sensation and movement, distributed throughout the body by the nerves. <> Relying upon ingenious experimentation, Galen rejected the ancient idea that arteries contained only gaseous material. Instead, Galen held that upon diastole the arteries drew air in through pores on the skin, mixing it with blood drawn in from the veins. After being used in the body, the spent air or “sooty vapor” was then passed through the septum of the heart into the left ventricle, carried to the lungs, to be there expunged. (Magner, 90-93). Galen’s remained the principal theories for the next 13 centuries, and gained such respect that they were revered as nearly Holy Writ.

Harvey’s Predecessors

<>The Medical Renaissance of the 15th Century brought “admiration for all things Greek” (Porter,Greatest, 169). The original Greek texts were sought, clean of Arabic or Latin interpretation. 1525 brought a Galenic codex published in Greek, paving the way, along with other Greek works, for physicians and researchers of the modern natural philosophy to question the conflicts between these two.

One such critic came in the mid 16th Century; Vesalius, trained by a conservative Galenic advocate, studied anatomy and dissection. “Vesalius grew . . . critical. {His} Familiarity with human anatomy drove him to the unsettling conclusion that Galen had dissected only animals . . . no substitute for human [cadavers]. He now began to challenge the master [Galen] on points of detail” (Porter, Greatest, 179). Vesalius, in Book VI of Fabrica, explicitly denies the permeability of the heart’s septum to allow for the transfer of the sooty vapors as described in the Galenic model, thus clearly weakening the Galenic model of physiology. This work was continued by Vesalius’s successor, Realdo Colombo, in a similar fashion.

<> Colombo, a respected surgeon, took Vesalius’ post as Professor of Anatomy and Surgery at the University of Padua. He continued in the work of Vesalius in presenting questions regarding the Galenic models, but he made a very large, and very public, break with Vesalius, until their relationship became quite tainted. By pointing out Vesalius’ shortcomings, Colombo sought to bolster his own reputation. Colombo’s major work, published in 1559 was an anatomical text wherein he argued against the Galenic idea of blood and pneuma mixing in the right ventricle, his reasoning based on a logical analysis of the size of the components, namely the lungs, right ventricle, and the pulmonary artery. Instead, he presented what we now recognize as the pulmonary circulation, where the blood flows from the right side of the heart, through the pulmonary artery into the lungs and through the pulmonary vein into the left side of the heart (Magner, 190; Porter, Illustrated, 158).

<>Hieronymus Fabricius, Harvey’s mentor at the University of Padua, also made notable progress in anatomy, notably in embryology and the discovery of venous valves, which he published in 1603. He assumed that the valves’ physiological function was to retard the flow of blood so that distribution would be symmetric throughout the body, thus regulating volume instead of direction. (Porter, Greatest, 192-193).

Wm. Harvey

<> This milieu of ideas was present as William Harvey was receiving his education and training. Starting his training in medicine at Gonville & Caius College, Cambridge, Harvey received an Aristotelian education, considered quite archaic and outdated by the rest of the contemporary medical community (French, 51). He then left Cambridge for Padua, “the natural choice for an able and ambitious medical student. A Paduan degree was recognised . . .[as] it was the most famous medical school in Europe” (French, 59-60). Thus, from his Cambridge education steeped in natural philosophy and his cutting-edge medical training in Padua, Harvey was a hybrid from two different worlds. Whitteridge quotes Ent’s early translation of Harvey, where Harvey notes that his world view was clearly framed by the work of those giant’s whose shoulders he was climbing onto:

“. . . know I tread but the steps of other men who have lighted me the way, and (so farre as is fit) I make use of their notions. But in chief, of all the Ancients, I follow Aristotle; and of the later Writers, Hieronymus Fabricius ab Aquapendente, Him as my General, and this as my Guide.”

<> One of the steps that “lighted the way” for Harvey, according to Robert Boyle, was the discovery of the venous valves by his predecessor. This acted as a spark that turned him towards the search for an acceptable physiological answer to a picture murky with ancient ideas (Whitteridge,Movement, 27). He wrote:

“I do not profess either to learn or to teach anatomy from books or from the maxims of philosophers but from dissections and from the fabric of nature” (38).

As the above mentioned discoveries were presented in the medical world, Harvey, true to this statement, evidently repeated the experiments himself, using the “body” as his educator and authority, rather than relying on books written elsewhere. Though Harvey found the same experimental results with the venous valves, he came to very different conclusions. Harvey argued against the explanation of venous valves acting to prevent pooling of blood in the legs and feet, pointing out that the jugular veins’ valves are oriented in the opposite way. Harvey began to reason that the purpose might not be to “retard flow” but to create a unidirectional flow. Later experimentation was to prove his ideas correct (30).

I might recall to you that Harvey’s experimental research that led to the introduction of his theory of general circulation in 1618 was extensive and spanned nearly twenty years. <> He realized, by a logical argument he presents in chapter 9 of De motu cordis, that the heart pumps, by his conservative calculations, three and a half pounds of blood in one half of an hour, while the whole body only contains, upon inspection, four pounds (Franklin, 62). Many other experiments were conducted. <> Harvey proved the unidirectional nature of the venous valves with his famous ligature experiments by manually pushing the blood out of the vein and demonstrating that it could not be forced past a venous valve in a direction distal to the heart. <> He beautifully detailed these findings. <> He surmised a connection between the arterial and venous systems by noting a pulse remained and the veins grew when a tourniquet was placed upon an arm. By turning to “the Book of Nature” and performing his many vivisections and dissections, inspecting anatomy and noting the movement of the heart and blood vessels, Harvey came to conclusions which contradicted the Galenic model. Harvey was then able to utilize the rich array of ideas and observations that had been provided, <> offering up his own theory of general circulation which he published as De Motu Cordis, the writing served the “same purpose as modern scientific article[s]” where the world is informed of new findings and invited to test the theory (Movement, 13). His formal treatise arranges the argument into an exhaustive description of his observed data, presentation of the hypothesis in chapter eight, followed by proof by demonstration, logical arguments, and arguments e consequentia (predictions) and a posteriori (explanations of previous findings) (39).

<> However, though Harvey did present the idea of the general circulation of the blood, it is important to note that the current modern model differs in many key points from that put forward by Harvey in the 17th Century. The physiology behind Harvey’s model is quite similar to that of Aristotle: the distribution of heat throughout the body. The purpose of the heart, while including that of the actual movement of the blood throughout the body, was principally to envivify the blood, bestowing it with some essential quality which it would distribute to the tissues. In the extremities the blood would “coagulate,” and cool, requiring a return to the heart to repeat the cycle. The cause of the heart’s beat was mystical, as well, ultimately springing from the soul. (The modern model, of course, is one of distributing nutrients and other essentials to the tissues of the body and removing the wastes of the processes of life, with a chemo-electric cycle causing the beating of the heart). Harvey’s early education at Caius College is important to remember; Aristotle’s ideas were embedded deep within Harvey, and he held with the idea of the spiritual driving force within the heart and blood being the essential component of the blood and the point for its circulation, with the idea of the blood moving, “as it were, in a circle” featuring prominently as well. Hence, although Harvey put forward the modern idea of continuous circulation, it is also important to note the mystical, Aristotelian physiology he associated with it.

<> What effects did Harvey’s research have upon the world of medicine? His own practice was to suffer, as patients were frightened of new ideas then as well; but of the bigger picture the view becomes murky. Harvey’s scientific approach smacks of the new scientific method that was soon to become a driving force, but in Harvey’s case the roots are more ancient Aristotlean and Galenic in origin than a foreshadowing of “new science.” There were plenty of reactionary writings, both opponents and proponents, so we can certainly say Harvey’s work stirred scientific discussion. <> Ultimately, however, the influence of Harvey was in the attack upon Galenic physiology, not in his contribution to medical knowledge of cardiology (Conrad et. al, 338-9).

Modern Medicine’s Myopia

<> Harvey’s proposal of continuous circulation of the blood forms a fine example of scientific progress; he used the findings of those before him, examined them and, discarding those he found unworthy, kept only those he found accurate. Occasionally, the opposite can happen, and an article from the Journal of the American Medical Association in 1903 is illustrative of this point. <> Allow me to briefly digress in my introduction of this topic to discuss two interesting words. First, phalacrophiba – somewhat irrational as it is, <> the word describes the fear (known primarily by men in their twenties) of becoming bald. The second word, peladophobia, seems to describe a more logical fear,<> as it describes the fear of bald people themselves. Returning to the 1903 JAMA article entitled “Prophylaxis of baldness,” the introduction follows: <>

“If anyone had insisted 25 years ago that tuberculosis was only slightly hereditary, but distinctly communicable, they would have been laughed at. The germ theory has now become a doctrine of ever-widening scope, and we realize that many affections are directly communicable and only a few hereditary. At the present moment it seems that even for so old-fashioned an affection as baldness a complete change of opinion as regards etiology is taking place. As with tuberculosis, so it has long been noted that baldness is likely to run in families.”

<> The author goes on to cite findings that premature baldness is “practically always associated with the presence of certain bacteria” and then suggests a causative relationship, further hypothesizing that “undoubtedly the ordinary conditions of scalp hygiene among men are favorable to the development of these germs” and that the relative ischemia caused by hatbands may play a role as well, possibly by decreasing the ability to combat the microbes mentioned above.

<> As an exemplary clinician, the author’s principal concern appears to be for his patients. He counsels:

“Greater care should be taken with regard to brushes and combs, especially in families in which early baldness is the rule. The hair brush should be dipped in an antiseptic solution several times a week. Combs should be boiled regularly and frequently, and under no circumstances should members of precociously bald families use other combs or brushes than their own, or allow them to be used on them, in barber shops, unless they are assured of their sterilization beforehand. These precautions may seem a high price to pay for the prophylaxis of premature baldness, and many will prefer to take the chance of becoming bald, but some have such a horror of the affliction that they will willingly put themselves to much trouble to prevent it.”

While we are able to now, with the support of more than 100 years of scientific progress, find this line of reasoning and counsel humorous, it does offer an important point. New findings are being interpreted by people living in a world steeped with ideas, opinions, and “facts.” This is why progress must be met with skepticism. Not all of the “facts” are actually factual; certainly not all that is written is true. Personal observation of, as Harvey put it, “The Book of Nature,” should not so easily be replaced by new discoveries.

To turn to a more modern (and more medical) example, the history behind the approach to peptic ulcers is illuminating. <> First described by William Brinton in 1857, the lesion was accurately detailed along with its accompanying symptoms of pain, vomiting, and occasionally hemorrhage. Brinton’s conjectures as to etiology were quite varied and had an impressive scope, including “old age, privation fatigue mental anxiety, and intemperance” (Grob, 551). <> As time passed the consensus became an excess of acid as the primary factor, but this merely displaced the search for a cause to what was causing the acidification. Grob notes that “the absence of evidence that could relate causes to disease processes did not prove a deterrent. Physicians instead drew upon prevailing medical paradigms and external social and ideological belief systems to develop what appeared to be defensible etiological explanations” (Grob, 557). Such explanations included focal infection, leading to many extractions, appendectomies, colectomies and colostomies, although this explanation fell out of favor in the 1930s as no causative organism could be isolated; <> stress and psychic factors also featured prominently, with “shell shock” and the increasing demands of the industrialized world pointed to as evidence; racial factors were also considered, as one physician noted a relative dearth of ulcer disease in the African-American population, writing that it was due to the “slow-moving” and “easy-going [nature] . . . untouched by aspiration for culture.” (560)

Of course, our current understanding of peptic ulcer disease is not perfect; while the etiology is now attributed to infection with H. pylori or NSAID use, only a fraction of patients with these risk factors develop symptoms. <> Grob, however, points out that “medical explanations and therapies . . . do not always follow from rational scientific discovery, and conflicts between medical specialties, prevailing medical and scientific paradigms, ideological beliefs, and personal allegiances affect the manner in which diseases are interpreted and treated. . . To point this out is not in any way to denigrate biomedical science . . . it is merely to remind practitioners that it would be wise to recognize the contingent nature of etiological explanations and therapies.” (564). Although we strive to live a higher law, we must remember that physicians and scientists are, after all, human as well and subject to all of the interpretation flaws that history has shown us. By recognizing these flaws, we can be watchful for them and thus be able to provide better care for our patients.

Conclusion

<> With the benefit of three hundred years of scientific progress, the significance of Harvey’s discovery could be either exaggerated or minimized. His courage in tackling the Galenic fortress, though it had been softened by those before him, was immense; critics, on the other hand, could cite his inability to dispense with the mystical ideas of Aristotle as his downfall. Regardless, Harvey has influenced medicine by breaking the foundation of Galenic physiology as noted in his writing, “I do not profess to learn or to teach anatomy from books or from the maxims of philosophers butfrom dissections and from the fabric of nature.” As long as we, as clinicians, can also remember to interpret new ideas with a sense of transference and counter-transference towards the new research, we can look at Harvey’s great contribution as providing yet another, greater height whose new vista will beckon to the generations to come as they go forth on their own quests for truth.

Bibliography

Conrad, Lawrence, Michael Neve, Vivian Nutton, et. al. The Western Medical Tradition. Cambridge, England, Cambridge University Press, 1995.

French, Roger. William Harvey's Natural Philosophy. Cambridge, England, Cambridge University Press, 1994.

Grob, Gerald. The Rise of peptic ulcer, 1900-1950. Perspectives in Biology And Medicine2003;46(4):550-66.

Harvey, William, Gweneth Whitteridge, ed., De Motv Locali Animalivm. Cambridge, England, Cambridge University Press, 1959.

Harvey, William, Gweneth Whitteridge, ed., The Movement of the Heart & Blood. Blackwell Scientific Publications, Oxford, England, 1976.

Harvey, William, Kenneth Franklin, ed. The Circulation of the Blood and Other Writings. J.M. Dent & Sons, Ltd., London, England, 1979.

JAMA 1903;40:249 as quoted in JAMA 2003;289(4):494

Magner, Lois. A History of Medicine. New York City, New York, Marcel Dekker, Inc., 1992.

Porter, Roy. Cambridge Illustrated History of Medicine. Cambridge University Press, Cambridge, England, 2001.

Porter, Roy. The Greatest Benefit of Mankind. Harper Collins Publishers, Ltd., NYC, USA, 1997.

Whitteridge, Gweneth. William Harvey and the Circulation of the Blood. MacDonald, London, England, 1971.

On Honesty and Dating, or, This Mormon Life

2010-03-14T22:23:00.002-04:00

My friend Chris had the idea to try and create a Mormon analogue for the amazing radioshow, This American Life. To that end, he created a group blog that explores a single topic each week. The topic is dealt with by a variety of individuals, all of whom hopefully approach it in a different and creative way. Last month was a discussion of honesty and dating, particularly in the Mormon sphere. While the discussion takes place with that narrow scope, I think most of the principles are applicable whatever your personal creed. Anyway, since I haven't posted anything substantial for some time, here is my bit from last month. If you do have comments, which I would love to hear, I would ask that you please post them over at the website where the original article was posted. I think you might enjoy the blog.

On Honesty & Love in Dating

David Sedaris has a lot of stories about hitch-hiking. He said it started out as an easy way to get to the other side of town, then became a cheap way to get to the next city, and then became a way to enjoy the thrill of being able to recreate himself. With every new driver he got the chance to fashion a new identity, an opportunity to become someone more interesting; someone more exciting; someone more, well, new.

One of the places that it is easiest to become someone new is, of course, the internet. Take, for example, the first girl I ever chatted with over a modem. Back in the days of BBS’s and direct computer-to-computer connections, we met and chatted about various things. Eventually she sent me a picture of herself, really without prompting.

While everyone on the internet is obviously not a liar or sexual predator, it does become very easy to misrepresent yourself and be dishonest. I was recently at a coffee shop with my friend Linezolid.¹ She, along with about fifteen other friends, has been telling me I should look into the world of online dating. The implications of this on my personal life are best saved for another day. This did, however, lead to a very interesting conversation about dating. She told me of an older man she came across on one of these sites. His profile was different because, well, it candidly disclosed the fact that he had a sexually transmitted infection. One of the permanent kinds. I did not ask if it was as serious as HIV or as (relatively) benign as genital warts, but that is really beside the point. What was interesting was that he was so candid, so up-front and open about it. Almost in-your-face about it. While his staunch rejection of the easy opportunity to be dishonest is laudable, was this stark honesty the right approach? Sooner or later, the woman he ends up in a relationship with will find out, anyway. Hopefully from him, and not from her physician. If the disease was going to be a deal-breaker in itself, we figured he was probably just trying to weed those people out early. Really early. Before even meeting.

But what if it was not going to be a deal breaker? How many people would this early disclosure, this preemptive strike, drive away too early? How many that, after knowing him better (or at all) would have otherwise still accepted him, warts and all?² After all, none of us are perfect. Such blunt honesty is not only awkward, it is almost dishonest in itself. Are there others on this online dating site whose profiles include “anger issues” or “horrible with directions?” “Compulsively late” or “commitment issues?” Before knowing someones shining points, how can you really judge their weakest ones? If there is such a thing as too much honesty, I think this is it.

But isn’t that basically the point of dating? I mean, dating seems like some sort of complicated dance where we slowly reveal portions of ourselves to each other as we become more and more intimate. And I do not mean intimate in a necessarily sexual way, but rather the real intimacy. The intimacy only reached by sharing time together, talking, learning each others’ secrets, and holding those secrets close. Becoming aware of how the other person thinks, feels, and lives – that is intimacy. In that way, I believe that Internet-Guy-With-An-STD was on the right track, but jumped the gun. He was trying to be completely honest, but a bit too soon. At least of this sort. While he has probably had good reason to do so, likely by being hurt in the past because of late disclosure, he is skipping steps in the dating process, revealing too much, too quickly. And those steps are there for a reason. Maybe presenting your best face, which some may call lying, is not only appropriate but often necessary in dating. Dating etiquette requires phased honesty.

In unrelated conversations with a few other friends, the issue of honesty and dating was repeatedly brought up with specific regards to faithfulness within Mormonism. As many of you know, there are, in fact, varying degrees of Mormons within our community. There are Iron-Rods and Liahonas, there are the EQPs and FEQPs.³There are Peter Priesthoods, Molly Mormons, and Jack Mormons. There are True Blue Mormons and Cafeteria Mormons.⁴ It is with some of these last type, friends who are quiet (and active) cafeteria Mormons, that this idea of honesty and dating has come up frequently. And the conversation usually gets pretty heavy, pretty quickly. I mean, what would you say if someone asked you, “Do I need to tell her that I don’t believe in revelation?” or, “How early should I tell my boyfriend/girlfriend that I can’t support the Church’s policy on Proposition 8 [or the stance on the role of women, or whatever]?” or “I may go to church every Sunday, but I don’t believe in God the same way everyone there does. When should I tell him that?” Is there a right answer to those types of questions? I didn’t think so either.

Another friend, Ember¹ thought these dilemmas of faith (or lack of faith) an absolutely essential subject for discussion, at least as relating to relationships and Mormonism. Bishops, home teachers, or anyone else besides a boyfriend/girlfriend, are another matter. To her it was simply a matter of timing, not an option of whether or not to have the discussion at all. How early, though,one should “drop the bomb” was a little less clear. Should this timing relate to kissing? To dating exclusively? To discussion of marriage? The conclusion was that you should tell them as soon as you (or the significant other) starts to think seriously about the relationship.⁵

It seems, to me at least, that uber-bluntness is not quite the right approach. But neither is persistent deceit, whether by creating a new persona or hiding your true one. I think they both fail in relationships because they prevent that intimacy, that closeness, from forming. David Sedaris has a lot of stories about hitch-hiking. He said many of the stories involve lying through his teeth. He said that the feel of the cold gunmetal against his head felt exactly like he thought it would. He said that after the second time he had a gun pulled on him, he gave up hitch-hiking all together. Maybe he should have just tried being more honest while hitching. Then maybe he wouldn’t have had people lying to him, too. He might have even found someone who would drive him around for eternity.

Name changed to protect identity or somesuch.
Sorry. Horrible, I know. I couldn’t resist.
Elders’ Quorum Presidents and Future EQPs.
A cafeteria Mormon is one who chooses which teachings to believe, a la carte style. Not my term.
In Ohio terms, I believe this is also known as “the first date.”

Way cooler than the Fonz

2010-03-03T13:36:00.002-05:00

Seriously, is there a band cooler than OK Go!? I'm not necessarily talking about their music. I'm willing to bet everyone has seen some of their music videos (which they direct, by the way), and many have read the NYTimes OpEd piece by them about the music industry, but their latest video is really amazing. I was laughing and smiling through almost the whole thing - I felt like Charley getting his first glimpse of the Chocolate Factory.

For those of you who have missed their older ones, here are a couple. I haven't really watched the remixes of the WTF video - anyone have favorites?

OK Go - This Too Shall Pass from OK Go on Vimeo.

Becoming Part of History, or, Pastings from my Journal

2010-02-07T07:53:00.002-05:00

2/3/2010 – Wednesday

Yesterday was a very packed day. We glanced through the local brochures – there was lots that looked fun around Plettenburg Bay, South Africa. Ziplines around a river with a bunch of waterfalls; a bungee jump from a bridge over 200m high (world's highest bungee base); a private game reserve just outside of town; ocean kayaking near dolphins; a large nature and marine reserve on a peninsula just down the beach. So much to do, so little time!

We planned out the day to do the furthest activity first, then work our way back towards Plettenberg. So we drove out first to the Tsitsikamma Adventure Tours, which is in Tsitsikamma National Park and we did the zip-lines around this river, near some waterfalls. It was pretty fun – especially since our two tour guides – Heinrich and Henry – were pretty funny. Henry had all of the English phrases down, and kept repeating things like “brother from another mother” during our tour. The river we kept crossing was a dark, cola-brown color. Evidently this is from the tanins seeping out of the trees into the water. Safe to drink, according to our guides. Just unsettling to look at, and will give you stomach cancer and tan leather, I suppose, at least that is what LGRichards told me. Then we saw a two-tailed lizard Just your average day, so far.

Our next stop was the Bloukrans River Bridge, where this bungee jump is located. Guiness Book of World Records Certified. Maybe not as memorable from 5th grade as those fat twin brothers on their motorcycles, but still in the book. We spent a little while looking at the bridge and watching some of the jumpers. I knew I wanted to do it, as I knew I'd never have this chance again and have never been bungee jumping. Chris wanted no part of it whatsoever, but was content to watch and take pictures. Although it was about $90, I thought it worth it. So they got me in a harness and then walked out to the bridge. I started getting more and more nervous as I saw how high the bridge actually is, likely accentuated by the fact that the walkway we used to get out to the middle of the bridge was bolted to the side of the roadbridge. It had a metal-mesh flooring that not only allowed one to see the horrible height that was growing under us, but was also only spot-welded to the metal frame, and had an uncomfortable give to each step. I was quickly becoming more and more nervous.

Arriving at the middle of the bridge, they had house-music blaring, and several other jumpers were having their harnesses removed and gave me some of the strangest looks – pity mingled with awe and fear in equal parts. The crew started wrapping my legs up, and claimed to attach a bungee rope in two ways to my feet, but both caribeaners attached to the same spot, and I could not see the connection between the stuff wrapped around my feet and the harness. My anxiety continued to grow as they stood me up.

Hopping with the aid of the staff to the edge, they kept hold of me until my toes were just over the edge. Looking down was a mistake, but a mistake that I had just paid $90 to make. Counting down from five, the crew did not give me a chance to back out. So I bent my legs and jumped out, away from the bridge and towards - nothing. For the next ten seconds, the only thought in my mind was, “This was the worst decision I've ever made in my life.” It was a very long ten seconds.

Then came the rush of blood to the head. It wasn't anywhere close to a neat experience, like Coldplay may have led you to believe. As I felt my head nearly explode from either the worst valsalva maneuver I've ever performed while upside-down or the change in inertia at the bottom of the rope, I had another clear thought that reconfirmed what a geek I am. I didn't think, “Whoa, what a rush,” or, “Awesome!” No, I thought, “Well, I guess I don't have a berry aneurysm because I'm sure this would've popped that sucker.”

I continued to bounce up and down 4 or 5 more times. Those ones were just fun. No lame thoughts or fear at that point. Just the fun experience and an incredible rush of adrenaline. Once I got back up to the bridge I remember feeling a little really jittery from the adrenaline. I also had a clear thought at this point. “I'm going to enjoy having done this a lot more in the future.”

It's the future, now. I'm not sure if I was right or not yet.

Chris is a Flight Genius, or, On Saving 69 cents.

2010-01-31T13:38:00.002-05:00

For those of you who didn't know, I'm in Africa. And I'm pissed, because Toto has had me so excited for years about the Africa. There haven't been any rains here. What a waste of a trip. Anyway, I'll try to post some updates of what we've actually done while here, but the only time I've had to actually write was while on the plane over here a week ago. And without further ado:

Far and away this has been the most difficult trip I've ever been on. It started out with my roommate not having a single item in his suitcase 15 minutes before we had planned to leave for the airport. Well, I suppose it really started for him when it took me 10 minutes to buy my plane ticket, and since I'd just bought a ticket it increased the price for his flight – which he was not able to change after more than an hour on the phone. (The fare came back down later that day). At the airport, it continued with the plane taking us to DC having a mechanical failure. After waiting in the long line, we spoke with the gate agent who rebooked us. Now we were to be routed through London and would not arrive until more than 12 hours after planned in Cape Town. At this point I was fairly content to sit and read my novel, but Chris whipped out his trusty iTouch and, exploring options on Travelocity.com, found what he thought to be a superior option. The gate agent told him that particular flight was not available. Chris, however, was not to be so easily deterred. After finding another flight, through Chicago and Amsterdam, he thought it worth another shot – but I had to go bug the agent this time. Knowing I had to spend the next 6 weeks in pretty close quarters with Chris, I thought it best to humor him, though I had little hope.

To my chagrin, it worked. Chris approached the counter, looked at me and said, “I am a flight genius.” I was forced to agree. If the whole psychiatry gig doesn't work out, he should totally just work expedia.com for people. The connections worked, and we were booked for Amsterdam to get to Capetown at about our original destination. This was great, because the hostel we'd arranged for that night (from the airport – late, admittedly, but still) had required a 10% deposit. It came to USD 1.38. Split between us, that is 69 cents each.

While we did have to see the gate agent in Chicago because Chris didn't get all the right papers from the Columbus agent, we had a nice little flight to Amsterdam. Our connection time was short, and so we quickly printed out our boarding passes for the Cape Town flight from a self-serve kiosk. Since I'm a good person, and karma is real, mine printed without a hitch. Chris's, on the other hand, said that he had to see a gate agent. You can draw your own karmic conclusions. Now we had a new problem, though. Finding an agent. It took us at least 10 minutes to find where the gate agents were. Probably because they were not at the gate, like you might expect. There wasn't even an agent in the same terminal. Turns out that since they wear such nice periwinkle uniforms, they like to cluster the gate agents together. Gives them more of an effect, I suppose.

After watching the agent work on a computer with two different phones glued to her ears for at least 15 minutes, it became clear we were not going to make our flight. Since we don't have phones or any real plans in S. Africa yet, we elected to stay together and started discussing what two things we could do in our 24 hour layover in Amsterdam. (Incidentally, do vacation rules apply in Amsterdam? Or do their lack of rules negate the traveling rule of acceptable rule-breaking?) After our original boarding time had passed, the agent suddenly printed out two boarding passes and said, “Run to your gate.” Obedient young men that we are, we double-timed it across two terminals only to be asked by the security guard, “Why are you so late? Everyone is waiting for you two!”

Not everyone appreciates what a flight genius Chris is, evidently.

Folgers and the Sacrament Cup Redux, or, What I Did Last Saturday, or, Omphaloskepsis

2010-01-21T19:33:00.003-05:00

Last Saturday was our ward talent show. This is what I did. You may remember it from here.

Depressing Realization of the Time Period, or, Why I Hate William Harvey

2010-01-18T17:16:00.004-05:00

Some people dream of awesome things, like flying or interacting with beautiful people. Some dream about crazy things, like teeth falling out. Some dream about high-school puppy love but wake-up screaming curses (my sister is awesome).

Not me. I'm old and boring.

I dreamed last night about preparing my presentation and powerpoint slides for a conference six weeks away. The dream was detailed - I remember typing out the bullets. In an outline format. I even remember what those bullet points were.

My life is average.

Best TV Intros of the Time Period, or, I Have Too Much Time On My Hands

2010-01-18T00:29:00.002-05:00

First impressions and introductions are funny things. We judge people by them, and ignore later contrary evidence. Of course, this isn't just with people. We judge albums by their cover-art. I remember not buying the first book in a series for several years because the cover was too dorky looking. It later turned out to be my favorite book saga to date.

TV is no different really. Some shows have awesome intros, some have crappy ones. Think of that happy, care-free tune during the intro to The Office. You can hear it now, and if you’re like me, you are starting to laugh a little. I think I have been classically conditioned to expect funniness is coming when I hear that ditty. (We won’t speak of the past season or two).

Other intros channel awe, or wonder. Think of the LOST intro. That ethereal sound as the word spins across the screen combined with the narrow depth of field giving a blurry focus to it and the lack of anything else just seems to add to the questions surrounding the show.

Or there’s this intro, for Dexter, a show about your everyday-average-likeable-serial-killer-next-door. Somehow this just hits the spot between creepy and relatable.

My personal favorite introduction comes from a show that I actually do not enjoy all that much anymore, Rescue Me. But the music, the lighting, and the speed just work so well that it becomes, well, incredible.

However, the award for Best TV Show Intro has got to go to David Lynch’s Twin Peaks. The beautiful pastoral scene with its accompanying relaxing and melodious music makes one think of a hypnotist at work, and forms a stark contrast to the insanity of the show’s characters.

Of course, I have neglected many other great TV intros. What are some of your favorites?

Best of the Year (Part Whatever), or Books of 2009

2010-01-13T22:38:00.009-05:00

Unlike last year, which was filled with tons of great new books, this year was a mediocre one for reading. At least for reading for enjoyment. I read about half as many books this year, too. However, there are a few that I read that were quite notable:

1. The Gathering Storm, Robert Jordan/Brandon Sanderson.

This was a relief. This is the 12^th book in a series I started in 4^th grade. The author died of a type of blood cancer a few years ago, and fans despaired of ever seeing the end. Brandon Sanderson was brought on board, and then the worry became how he could ever take over the reins of such a massive project. Well, he not only took the reins, he whipped the horses into a gallop. It was a great book, and made me very excited for the next two volumes.

2. The Perfect Mile, Neal Bascomb. A prize-winning book, this told the story of not only Bannister’s 4-min mile, but also of the other athletes at the time who were chasing the records and the amazing show-down race that occurred between them shortly thereafter. Tightly written and fun, unlike many history books, this book also captured the excitement of track racing quite well.

3. Born to Run, Chris McDougall.

As many of you know, I have started doing a fair amount of my running barefoot. I came across this book late in my research on unshod running, but it is a very fun and interesting read that does a good job of not only telling the important anthropologic story of the Tara Humara Native Americans, it also presents some of the research that has been done on footwear.

4. Cat’s Cradle, Vonnegut.

My friend Mark recommended this to me, but warned me that everything Vonnegut wrote related to how messed up living through the firebombing of Dresden had made him. The book was fantastic, but definitely endorsed a bleak/nihilistic outlook on life. It is told with the frame of a made-up, ultimately pointless religion called Bokononism. Below is a quote from the last chapter.

“’Maturity, the way I understand it,’ he told me, ‘is knowing what your limitations are.’ / He wasn’t far from Bokonon in defining maturity. Maturity,’ Bokonon tells us, ‘is a bitter disappointment for which no remedy exists, unless laughter can be said to remedy anything.’”

5. The Alchemist, Coelho

This was an interesting little metaphysical piece that explores the idea of growth through adversity. It endorses a type of foreordination that seems popular – if you are determined to accomplish something, all of the universe will bend to try and help you accomplish it. I read it immediately after reading Cat’s Cradle, and to say it was jarring is an understatement.

6. Pride & Prejudice, Austen

Although I’ve been through her home/museum, this was my first introduction to Austen. I found it intriguing, and disappointing. Let me first say this. Elizabeth Bennet kicks some serious ass. I was so impressed with this novel from a feminist perspective. Written in the early 19^th C, this strong female protagonist with very clear individualistic ideas and actions was interesting. I was, however, very disappointed in Mr. Darcy and the “romance” that developed. He seemed a flat character, and I was confused as to the passion that developed between these two characters. But maybe I’m just bitter.

7. When You Are Engulfed in Flames, David Sedaris

Actually, I did the right thing and let David Sedaris read this book to me. He is hilarious. I do, however, take some serious issue with the Sedaris family point-of-view on the bowtie.

8. Best Served Cold, Joe Abercrombie

Abercrombie really loves dark, flawed characters. The development he takes them through somewhat reminds me of Ludlum’s Jason Borne (the book is far better than the excellent movie, by the way).

9. Once A Runner, John L Parker, Jr

If only I could run two miles, every day. Every day. And grow a beard. Or read an hour a day.

I read a handful of others, but these were the best. As you can see, it’s mostly a list of running books and fantasy novels, but I promise I like to read other things too. If you have any comments or recommendations, I would love to hear them.

Bad Omens, or, Screwed by Genetics

2010-01-10T18:13:00.001-05:00

My brother is not only far better looking than I am, he's also a much better person. And look what happened to his boys.

Christmas Eve, 2009

I think this is a sign that I should either not have children myself, or never, ever, ever, under any circumstance, allow him to interact with my children at all.

Movies of the Year, or, Look, A Bandwagon!

2010-01-09T13:19:00.000-05:00

I guess I’ll jump on the bandwagon and do a “Movies of the Year” post. Having not seen as many films this year, though, compared to previous years, this is going to be a weak list.

Favorite Films of the Year:
Fantastic Mr. Fox – Holy smokes. Wes Anderson is a slugger.
Zombieland – Woody Harrelson was born to play this role. And the cameo at the end is genius.
Avatar – I don’t care that it’s the same as Pocahontas or Dances With Wolves.
Up – Pixar did it again. Not as awesome as Ratatouille, but definitely in their top 3.
Dear Zachary, - The most raw and emotional film I can imagine. And it’s a true story.
I Love You, Man - Anwar Sudat will never be just a Nobel Peace Prize winner again.

Somehow missed, and plan to repent:
District 9
The Watchmen
The Informant!
The Princess and the Frog
The Road
Sin Nombre
Up In The Air
Where the Wild Things Are

Cloudy With A Chance of Meatballs
Brothers
Crazy Heart
In The Loop
An Education
I can’t decide if Inglorious Basterds belongs on this list.

Movies Redeemed by Outside Forces:
Terminator: Salvation (Turn off your phone!)

Recovery From Bitterness, or, Liberal Memes

2010-01-08T13:08:00.001-05:00

When people actually choose to work together, the results can be amazing.

Music of the Year, 2009 ed., or, I'm Still Cool, I think. I hope. Maybe?

2009-12-31T12:18:00.007-05:00

I went to another sing-in of Handel’s Messiah this year. It was very pleasant, and very amateur, but it reminded me of how much I really do love that oratorio. That, in turn, made me think about all of the other amazing music I’ve listened to this year. Which, in turn, made me think that I needed to blog about said music. So, without further delay, here are some of my favorite albums of 2009.

1. Arcade Fire, Neon Bible. Oh. My. Gosh.

2. Vampire Weekend, Vampire Weekend. Weak, I know. This is a 2008 album. I don’t care, because this album hit me with a vengeance this year. I mean, this entire album just rocks. I’ve witnessed it make a 23 yo female have a near-epileptic attack from the compulsion to dance and I’ve also seen it keep a car full of three typically-noisy kids quietly occupied for a 20 minute car ride to the fish store. Unbelievable. And not to mention the sweet tunes. I really can’t wait for Contra, the sophomore album to come out on 01/11/10.

3. Phoenix, Wolfgang Amadeus Phoneix. I heard about this band first on NPR’s All Songs Considered. A French band that sings only in English, hearing their interview I was very unenthused. Then they started playing, and I stopped caring that they were Frogs. These guys rock. I saw them live this month, too. Really, just great, fun sounds. Listen close to their drummer. And that vibrating tone at the end of “Rome” was honestly the coolest noise I’ve ever heard at a live show.

They opened with “Lisztomania” in the C-bus, too.

4. The National, Boxer. Wait, this one is a 2007 album. See #2. Except I hadn’t heard of them at all until this year. I freaking love this guy’s baritone. I mean, really, really, love his voice. And yes, since you asked, I would marry it.
.

5. Animal Collective, Merriwether Post Pavillion. This feels like a cop-out to me, to choose Animal Collective as one of my year’s best. Everyone else is doing it. But they’re doing it for a reason. This album was not an instant winner – I had to listen to it a couple of times before it grew on me – but then it was like cancer, except the fun kind that led to more and more enjoyment, not the other sad depressing kind. By the way, what is it about writing about music that makes people use horrible imagery? I mean, that wasn't the worst thing I've ever written, but it's up there.

6. Various, Dark Was The Night. This is another total cop-out. But an awesome one. Besides being such a great title, this is a 2-disc compilation put together as an AIDS benefit. That should be enough reason in some of your heads - with my liberal bleeding-heart, how could I not put something like that in my “Best of 2009” list? You’re right, I had to.

7. Brad Paisley, American Saturday Night. Some silly lyrics. Great guitar work. It works. Americana through and through.

8. We Are Scientists, Brain Trust Mastery. Yes, made famous by the Nick & Norah show, but this is a great album in its own right.

9. Oren Lavie, The Opposite Side of the Sea. I don’t usually like music videos, and I don’t usually consider them art. This video is definitely the exception to the rule. I link to the youtube videos just because I’m lazy and don’t want to hassle with uploading mp3 files and then linking just them. This video of Her Morning Elegance, co-directed by Lavie, is definitely the exception, and you should watch it for sure.

10. Blind Pilot, 3 Rounds and A Sound. I heard about these guys while driving to church at 6:45 one morning. I was so excited about them I had to pull out my phone, call myself, and leave the band name on my voicemail so I would remember the name. And then I missed their show in Salt Lake the weekend after Thanksgiving because I had to give a stupid talk on stupid Sunday about keeping the stupid Sabbath day holy. Stupid Karma.

Honorable Mentions:

a. The Sounds, Crossing the Rubicon. Unashamed pop.

b. Yeah Yeah Yeah’s, It’s Blitz. One of my friend’s favorite bands, I missed out on their show this year because of a stupid rotation. Super-pop at its best. While I didn’t listen to it enough for it to qualify as one of my favorites, it really is a great album.

c. The Mountain Goats, The Life of the World to Come. Probably one of the most interesting albums, as each song is based off a biblical passage. I think this didn’t make my favorites list simply because I had such high expectations after last year’s Heretic Pride. Still, though, this is a great album, and it’s all Biblically based. Sunday approved!

d. Built to Spill, There is no Enemy. I have liked this band for a while, but they had fallen off my radar until this year. I went up to Boise, ID for an interview for work. My flight got in early, and I didn’t know anyone in town. So I looked up concerts in Boise. Built to Spill was playing for $10 later that night. I hitched a ride over there, bought a ticket, walked to Beto’s, and then listened to the weirdest set of opening bands ever. A Hank Williams solo act followed by a speed metal band followed by an indie-rock band and finally the band I wanted to see. I quickly remembered why I’d liked them so much. The album is solid, but I particularly like the song “Hindsight.”

e. Dirty Projectors, Bitte Orca. Similar enough to Animal Collective that they got bumped down here, but still a very good record.

So, there’s my (latest) attempts at being a hipster; too bad I'm not more comfortable in skinny jeans. This is some of the stuff I loved in 2009. What about you?

(Hopefully) The Last Time That Will Happen, or, On Temples, or, Training for Life

2009-12-27T17:00:00.017-05:00

I have not lived in Bountiful for over five years. Count them. Today I gave my fourth talk in my parents' church in that time. Count that. Can I take this opportunity to whine? I mean, isn't part of the benefit of moving out the fact that you do not "have the opportunity" to give a talk or hold a calling in the old ward anymore? And four times? I mean, I'm supposed to be on vacation! Am I the only one this seems ridiculous to?

Although I do not want to turn this blog into a religious rant site, I am posting my church talk below again. As I mentioned before, talks are, I think, a particular challenge for me to write. Again, by way of warning, although I have written the talk out word-for-word, please remember that this was intended to be spoken, not read.

On Temples, or, Training for Life

Today I would like to ostensibly talk about Temples, but specifically I want to talk about the strength that comes into one’s life by living correct principles; but first, a bit about me. I competed in several triathlons this year. I use the word “competed” here in the loosest possible sense. Obviously crossing the finish line and the thrill associated with the finish was a great feeling. However, the reason I engaged in these races was not to finish fastest. I did not race to win; I did not race to beat the other competitors. The race served as a goal for me to fix my eyes on as I prepared for the tasks required. A prize that I could visualize as I trained and tried to drag myself to a gym last winter. A boring gym. In a boring winter.

I would like to suggest that the race is similar to the Temple – and that training for the race is analogous to preparing ourselves to enter the Temple. All analogies are flawed, and my point is not to suggest that the ordinances we receive in the temple setting are unimportant. But by training, by preparing ourselves, by becoming worthy to enter the House of the Lord, and then by maintaining that high level of performance, that high level of worthiness, that high level of Christian living – doing those things required to enter the Temple are what I see as the real payoff of being a temple attending individual. Obviously, if you so believe, there are also the small payoffs and prizes of salvation and exaltation associated with the ordinances as well.

Turning to a talk from General Conference. Brigham Young, in the April 1861 conference, lends some support to this idea that the preparatory process associated with temple worship is a vital portion of the temple experience. In a talk about why Jesus had not yet returned, he discussed how every job requires the proper tool. For fishing, poles, boats, and nets are all requisite. To save the people, he says, a Temple is required. Listen to his words: “If we are to be saved in an Ark as Noah and his family were, it will be because we build it.” The Lord commanded Noah to build his Ark. Brigham continues with his reasoning, “If we build a Temple here, it will be because we need one. And if we really need one, we are going to go to work and build it. Will we count the cost? No!” If salvation is our goal, what import is a worldly cost to us? “I care not what it will cost, so long as we are occupied in a good work, it keeps us out of mischief and unrighteousness. . . If you wish this Temple built, go to work and do all you can this season. Some say, ‘I do not like to do it, for we never began to build a Temple without the bells of hell beginning to Ring.’ I want to hear them ring again. All the tribes of hell will be on the move if we uncover the walls of this temple, but what will it amount to?”

For some of our younger friends in the audience, let me first briefly describe the temple. The temple is a place we go to engage in sacred ceremonies and make covenants with God. The ceremonies are a formal way prepared to teach some of the same material taught in the scriptures, namely, that we are children of God, we have sinned and fallen out of his presence, and that Jesus Christ was sent to redeem us. These doctrines are presented in a slightly different way, but there is nothing new or particularly earth-shattering in the doctrine presented. Which is to say, there is nothing surprising or crazy that goes on there. The covenants we make in the temple are also straightforward. The temple covenants are natural extensions of the covenant we just renewed by taking the Sacrament of the Lord’s Supper, where we covenanted to be willing to take upon us the name of Christ. In the temple, we make further covenants that are in accordance with taking upon us His name; we covenant to obey the commandments, we covenant to sacrifice for the Lord, we covenant to live the gospel, and we covenant obey the law of chastity.

Let me illustrate with a historical example how these covenants affect our lives. Previously, as the Saints were fleeing the United States in 1846, there was much hardship. Many left too late in the season. Many of us have ancestors that were in these parties. We know these stories well, where westbound groups met many different hardships. Mud, snow, Indians, marauders, disease, hunger. When word reached the leaders, relief parties were rallied, almost instantly. Listen again to President Young after hearing about one of the struggling groups of West-bound Saints. He says, “Now is the time for labor. Let the fire of the covenant which you made in the House of the Lord, burn in your hearts, like flame unquenchable.” The wagons, unsurprisingly, soon rolled East to rescue the stranded Saints.

“What was it that gave those early Saints such strength, such drive, and such determination to face the great challenges of the work of the Lord?” Elder Bednar asked in a recent conference. It was the fire of the covenant that burned in their hearts, a covenant made clear in the temple. It was their commitment to worship and honorably hold a name and stand. It was their commitment to live worthy to bear such a name as “Christian.” It was their commitment to live worthy to enter the Temple. It was their commitment to prepare. We have all committed to be willing to take upon ourselves the name of Christ. Will we, brothers and sisters, live up to these covenants and stand in the Lord’s house, prepared, as he has asked?

The most nourishing doctrine of our Church is perhaps the Eternal nature of families. It would simply not be “heaven” to us as Mormons if we were not to be united with our parents, our grandmas and grandpas, our eternal companions (knock on wood) and our posterity. This union, this cementing of family ties, comes through the sealing power used in the sacred ordinances of the temple.

The most satisfying doctrine, to me, is that of universal ordinance work. By vicariously performing ordinances for all for the sons and daughters of Adam and Eve, God effectively removes the ordinance variable from the equation of exaltation. By making it a universal common denominator, God effectively “cancels out” these necessary ordinances, thereby providing these blessings to all of his children, regardless of their situation in life. What more satisfying, glorious principle can exist?

As we attend the Temple, we not only foster a greater sense of community by seeing each other working to prepare to meet God, but when we attend the Temple we are also constantly reminded of the potential that our fellow human beings have. From our close ward friends to those other ward members we don’t get along with so well, from our neighbors to strangers; when we attend the temple we are reminded of THEIR divine potential. We realize THEIR great worth. Although he never attended the Mormon temple, CS Lewis had great insight into this principle and saw the powerful blessings associated with community worship. From his sermon, “The Weight of Glory,” he says,“ It is a serious thing to live in a society of possible gods and goddesses. To remember that the dullest and most uninteresting person you may talk to may one day be a creature which, if you saw it now, you would be strongly tempted to worship, or else a horror and corruption such as you now meet – if at all – only in a nightmare.

“All day long we are in some degree helping each other to one or the other of these destinations. It is in light of these overwhelming possibilities, it is with awe and the circumspection proper to them, that we should conduct all our dealings with one another. All friendships. All loves. All play. All politics.

“**There are no ordinary mortal. You have never talked to a mere mortal. . . but it is immortals whom we joke with, work with, marry, snub, and exploit. . . next to the blessed sacrament itself, your neighbor is the holiest object presented to your senses. If he is your Christian neighbor, he is holy in almost the same way, for in him also Christ vere latitat, the glorifier and the glorified, Glory Himself, is truly hidden.” In him, our neighbor, is God.

As we prepare to enter the Temple we are constantly reminded of our neighbors worth. Of the eternal and glorious destiny of all of our Father in Heaven’s children. This, the true Spirit of Elijah, the recognizing that all who now live, all who have lived, and those yet to come, are part of our heavenly family. They all deserve our love, respect and service. Everyone. The Petersons. The Clarks. The Marstons. The Mormons. The Catholics. The Muslims. The Jews. The Atheists. They all deserve our love, respect and service. This, the Spirit of Elijah, is one of the central themes taught in the Temple. That everyone is deserving of our love, respect and service is one of the basic tenets of leading a good life.

The Temple is a wonderful place; the Temple functions as a place of focus, a reminder of how to live our lives, a prize to remind us how to train for the race of life. The Temple acts as a place to remind ourselves of our relationship with God, a place to remind us of the potential worth of our fellow man, and a place to help us understand the eternal nature of families. But the Temple also acts as a goal, a reminder, a glittering prize that we can focus on as we strive to live our lives in a better way. May we all bring ourselves in line with the teachings of Christ and thus enjoy a richer life, enjoying the blessings associated with being prepared, is my prayer, in the name of Jesus Christ, amen.

Strokes of Genius, or, You're Sitting On A Goldmine

2009-12-18T13:45:00.003-05:00

I mean, seriously?

OVERHEARD LINES; or, Mormons are Amish, too, or, On the Relationship Status, or, It's Complicated (x12)

2009-12-15T01:07:00.005-05:00

Chick: Does your religion believe in Facebook?

Nerd Stuff of the [Time Period], or, Science is Awesome

2009-12-05T13:00:00.000-05:00

Click here for an explanation, if you don't get it. And if you thought that was funny, watch this video below. Otherwise, you should probably skip it.

Can you believe it has been 10 years since The Matrix came out? The movie is still incredible. But this tribute may be even more incredible than the original:

I thought this was just fun. But remember, Carl Sagan said, "The beauty of a living thing is not the atoms that go into it, but the way those atoms are put together."

Speaking of atoms, please, please click over here and play with the slide bar along the bottom of the frame. It is one of the best examples of orders of magnitude I have ever seen. And just friggin' sweet.

Mom, stop reading here. You too, Aunt Janet.

Click here to see a picture of the ultimate owning in online chatting. Really, really awesome. Nerds are already taking over the world. One chat room at a time. Even the dirty ones.

Best Movie of the [Time Period], or, The Fantastic Mr Fox

2009-12-03T23:52:00.005-05:00

Exceptional. Just plain exceptional. Best use of my night, for sure.

The animation, the story, the dialogue, the characters riddled with depth and believability despite their, well, obvious problem of being-drawn-images-of-animals-dressed-in-human-clothing, combine to make The Fantastic Mr Fox one of the best films I've seen this year.

Perhaps my favorite scene in the film included this bit of dialogue.

Mr. Fox: I'm trying to tell you the truth about myself.

Mrs. Fox: I don't care about the truth about yourself.

And if you see the movie the fact that this is my favorite line does not make it seem like I'm a bitter, crotchety bachelor with misogynistic views of the problems in relationships. Or just stupid. Or just a hopeless romantic. If you see the movie (which you should), you will simply be forced to agree with me that these lines are a really beautiful and clever use of words, and are but one great moment in an exceptional film.

Just plain exceptional.

OVERHEARD LINES: Welcome To Church, or, Kleptomaniacs Anonymous

2009-12-01T08:00:00.000-05:00

In the foyer at Church:

Guy: I heard the woven cable bike locks are the hardest to get through.

Dude: Eh - they're not so tough.

Last Time That Will Happen, or, Keeping The Sabbath Day Holy, or, Why I Hate Sunday, or, My Sacrament Talk

2009-11-29T14:08:00.008-05:00

Clearly I haven't been writing much lately. This past month I was all over interviewing for residency, but I just got back home. I have had a few ideas for upcoming posts, including The Adventures of a Mormon Sommelier, and the Best TV Opening Credits Ever. But, most recently I wrote a talk for my church services, where the homilies or sermons are typically given by a couple members of the congregation. I was the concluding speaker and went until the normal time, but the Bishop stood and took about 7 minutes after me. I am not sure whether I am proud of this or embarrassed -- or maybe it was completely unrelated. While he did not clearly recant any of my words for me, he may have been trying to. It was difficult for me to write this talk, so I thought I would share it here. By way of preface, please remember this was written to be spoken, not read, and intended it to be humorous frequently. ~~Some~~ Most of those jokes fell flat. Surprise, surprise.

Why I Hated Sundays

Brothers and Sisters, I hate Sundays. Or at least, I used to hate them. Now I just don’t look forward to them very much. Why? Well, first and foremost, background. The Sabbath, by Hebrew definition, means “day of rest.” When the Lord gave the command to Moses to “Remember the Sabbath day and keep it holy” he also added, “Six days you shall labor and do all your work.” Josephus, the First Century historian, wrote that the Sabbath day was “set apart from labor and dedicated to learning our customs and laws.” This teaching nicely dovetails with D&C 59:10 where the Lord instructs that the “Sabbath Day is appointed unto you to rest from your labors and to pay thy devotions unto the Most High.” (Incidentally, we have the Jewish labor unions of the 19^th century to thank for the 5 day workweek and 2 day weekend. Since a large portion of workers were Jewish and wanted Saturday off to worship the labor bosses capitulated. But since an even greater portion of workers wanted Sunday, “the Lord’s Day” to worship, we got both days off, and road trips became possible.) And what do we do as Mormons do with that two day weekend? I believe it is summarized well in the 14^th Article of Faith:

We believe in meetings, all that have been scheduled, all that are now scheduled, and we believe that there will yet be many great and important meetings scheduled. We have endured many meetings and hope to be able to endure all meetings. Indeed, we may say that if there is a meeting or anything that resembles a meeting or anything that we may possibly turn into a meeting, we seek after these things. (Robert Kirby, SL Tribune)

On a more serious note, part of the reason I have not always looked forward to Sundays is epitomized in an experience I had in Elder’s Quorum last week. Before the Bishop or President Moody have conniptions, this experience was in my parents’ ward in Utah. Priesthood opening exercises were good – great even. A boldly sung hymn. Warm welcomes. Elder’s quorum started out with the usual announcements and invitations to do service in the middle of the workday. With about 30 minutes left of the block, a teacher came to the front of the room and an iPod was turned on. For the remainder of the time, Elder Holland’s talk from this past session of conference was played. En toto. That was the lesson. Approximately 3 minutes of comments were made at the end of the lesson. Then we dismissed. While Elder Holland’s is a good talk – some may even say an instant classic – I will confess I took little from the class other than a sense of bewilderment that I had to listen to the same material a second time, and that the opportunity to discuss and explore these inspired words in a more personal setting was being completely ignored.

But remember, I don’t hate Sundays anymore, even though this stellar EQ lesson was just last week. Why don’t I hate them anymore? Let me turn to one of my favorite passages from the Epistles: Paul wrote: (1Cor13:11 NRSV)

“When I was a child, I spoke like a child, I thought like a child, I reasoned like a child; when I became a man, I put an end to childish ways.”

When I was a little younger, I expected to come to church and be, served plugged in and recharged. I expected to come and have others take care of my spiritual needs. I came to church expecting not only to be fed, but to be spoon-fed.

Brothers and sisters, this is obviously the wrong attitude. Church is not here to let us sit back and become better people. Now please do not misunderstand me. I am not trying to say that I have "put away all my childish ways" and am now a "man" in all gospel-senses. I am only trying to say that I think I have moved past this one childish thought. Let me use another favorite scripture. Moroni, near the end of his life, wrote (Mormon 9:27) “. . . hearken unto the words of the Lord, and ask the Father in the name of Jesus for what things soever ye shall stand in need. Doubt not, but be believing, . . . and come unto the Lord . . . and work out your own salvation with fear and trembling before him.” Moroni here tells us that the purpose of the gospel, including the Sabbath day, is to learn. He also says that it is our responsibility to learn it. We need to figure it out individually. Sometimes that means 9 hours of meetings on Sunday. It almost always means that the Sabbath is not a day of rest anymore, like I wanted it to be as a child. The Sabbath may not be the most restful day anymore, but that is okay. To quote Eugene England, “If we constantly approach the Church as consumers, we will never partake of its sweet and filling fruit. Only if we can lose our lives [in church service] will we find ourselves.” “If we only ask ‘What has the Church done for me?’ we will not think to ask the much more important question, ‘What am I doing with the opportunities for service and self-challenge with which the Church provides me?’” (England, Why the Church is as True as the Gospel.)

No church talk about keeping the Sabbath Day Holy would be complete without a discussion of “do’s and don’ts.” Guidelines certainly exist for keeping the Sabbath day holy, but they are inadequate. The only appropriate set of guidelines that I have found for appropriate Sabbath day activity is this: you should be doing things on Sunday to help yourself and others become better people. For a professional cyclist, he or she may not feel it appropriate to go for a bike ride on Sunday. For the rest of us who do not get to ride bikes much, Sunday may be a wonderful day to take that opportunity to enjoy God’s Green Earth from a bike saddle. Indulge me for a moment on this topic; while preparing for this talk, I came across a blog that had a posting regarding Sabbath day activity lists, asking for commenters to add their own insights into what they, and their typically young families did or did not do on Sundays. It seemed to quickly devolve into something of keeping-up-with-the-Joneses. One commenter would say they didn’t watch team sports on Sundays. The next would say they only watched Discovery Channel, and that as a family. The next said that they never watched TV on Sundays. The next said that they sold their TVs and were forging ahead with a plan to feed the world. Not only did these comments not seem helpful, they started creating a sense of anxiety in me. I watch TV. I have not been working for world peace enough, and so on. Am I not doing what is right? I want to share a word of caution that my grandfather once gave to my sweet mother, who was an accomplished violinist. When mom was about 14, she was asked to perform a piece in church. She practiced and practiced, but she choked when the time came and did not do so well. She of course was devastated. But Grandpa Kirton came to the rescue, taking her into the front room, sitting her down, and saying, “My sweet Collie, you are good enough.” He went on to say that by comparing herself to others, she was setting herself up to either be puffed up in pride or racked with self-doubt and feelings of inadequacy. Comparing yourself to others is a good way of setting yourself up to fail, because you will always come up short in some aspect. So it is with Sabbath Day observance. I hope we can remember that, while there are basic guidelines, each individual and each family’s path, is, ultimately, their own path. Do not let anyone tell you otherwise. Your best is good enough.

Allow me to discuss another reason why attending church and keeping the Sabbath day holy are important. Martin Luther wrote that “Marriage is the school of love.” Note that he did not say that marriage is the product or result or home or goal of love. Marriage is the school. Marriage is what teaches someone how to love. I think part of the reasoning behind this is because at times, I have heard, you want to murder your companion. But marriage does not just teach you how to not kill your companion; rather, marriage teaches you how to deal with and love and cherish your companion. Church, similarly, is the school of godliness. At least half of you, if you had the choice, would choose to never associate with me. At least half. Yet here you are. Forced to associate with me. Typically, we see each other at least once a week. And by that forced association, you are made better people. Not by associating with me, necessarily (though that is often the case – eg Chris Sorensen). But in learning to deal with and work alongside and worship together with people that you would otherwise choose to avoid. By doing this we all become a little more, well, Godlike. Is there anything more Godlike than learning to care for and take responsibility “for the personal and marital, the physical and spiritual welfare of people we may not already love [or] (may even heartily dislike)[?], and thus we learn to love them. It stretches and challenges us, even when we are disappointed and exasperated in ways we would not otherwise choose to be stretched and challenged. . . [church] gives us a chance to be made better than we may have chosen to be – but ultimately want to be.” (E. England, Why the Church is as True as the Gospel –edited with brackets). Is it any wonder that attending church meetings is such an important part of keeping the Sabbath day holy?

Let me close with the words of President Spencer W. Kimball, “We do not go to Sabbath meetings to be entertained or even solely to be instructed. We go to worship the Lord. It is an individual responsibility, and regardless of what is said from the pulpit, if one wishes to worship the Lord in spirit and truth, he may do so by attending his meetings, partaking of the sacrament, and contemplating the beauties of the gospel. If the service is a failure to you, you have failed. No one can worship for you. (Ensign, Jan 1978, p4-5, emphasis mine).

What beautiful opportunities the Sabbath presents us with. A chance to mingle and serve people we do not always want to be around, a chance to actively pursue our spiritual needs, and a chance, as Josephus said, to take a day “set apart from labor and dedicated to learning our customs and laws” and finally, the Sabbath presents us with a chance, to practice true religion which James, the brother of Jesus, wrote that (James 1:27) “Religion (and I might add Sabbath observance) that is pure and undefiled before God, the Father, is this: to care for orphans and widows in their distress, and to keep oneself unstained by the world.” That is the only “do’s and don’t’s” list I will give. And that is why I don’t hate Sundays anymore.

So What If It Was On A Treadmill?

2009-11-13T19:04:00.001-05:00

5 miles. Barefoot. Felt great.

OVERHEARD LINES; or, Relaxed Fruits, or, Enlightened Culinary Styles

2009-09-30T21:04:00.004-04:00

Dude, to dude: "Hey, I left my banana hammock in your kitchen. Can you bring that to the restaurant?"

Looney Tunes Lied To Me!, or, Midnight Snacks

2009-09-16T22:56:00.002-04:00

Have you ever had a fundamental, foundational portion of your world-view removed, suddenly? Right before you crawl into bed? Well, I did, just now.

I turned out my light, began crossing the room, and stepped squarely on a banana. Not only did I not slip, the banana still tasted great. Footy, but great. Turns out having your cornerstones removed isn't such a big deal after all.

Poem-ish type writing of the time period

2009-09-14T22:32:00.002-04:00

Dark and cold we may be, but this
Is no winter now. The frozen misery
Of centuries breaks, cracks, begins to move,
The thunder is the thunder of the floes,
The thaw, the flood, the upstart Spring
Thank God our time is now when wrong
Comes up to face us everwhere
Never to leave us till we take
The longest stride of soul men ever took.
-Christopher Fry

Supreme Snark, or, People Eating Tasty Animals

2009-07-28T21:04:00.003-04:00

A lot of stuff comes into my Google Reader. Lots of lame stuff. Some not lame stuff. Medical blogs, photography blogs, friends' blogs, sports blogs. Well, you get the picture. One of my favorite posts, that I have kept "unread" for a month so I can laugh at it every time I open up Google Reader, is simply the below Bulletin Board WIN.

Modern Medicine At Its Finest, or, Good Thing Dad Does Not Wear Hats

2009-07-24T18:09:00.002-04:00

I recently came across this article, from the Journal of the American Medical Association. I found it interesting. I think you will too.

PROPHYLAXIS OF BALDNESS.

If anyone had insisted 25 years ago that tuberculosis was only slightly hereditary, but distinctly communicable, they would have been laughed at. The germ theory has now become a doctrine of ever-widening scope, and we realize that many affections are directly communicable and only a few hereditary. At the present moment it seems that even for so old-fashioned an affection as baldness a complete change of opinion as regards etiology is taking place. As with tuberculosis, so it has long been noted that baldness is likely to run in families. The sons of bald fathers are all the more likely to become bald young, and it is not the rule to find a single bald brother where there are a number in a family. On the other hand, daughters seldom become bald, but then the women folk rarely use the combs and brushes of the male members of the family, while boys not only use such articles in common, but often exchange hats, have their hair cut frequently at barbers, and in general are not rarely in circumstances in which they are likely to contract the disease, if it is communicable.

It is nearly ten years now since Sabouraud at the Pasteur Institute pointed out that premature baldness is practically always associated with the presence of certain bacteria. The seborrheic condition causing what is known as dandruff, on which early baldness probably often depends, he demonstrated to be a very probable result of the presence of these micro-organisms. Bacteriologic investigations made since have tended to confirm this opinion, and while they have failed to show the existence of any specific germs, they have made it appear probable that microbes play an important roˆ le in causing the increased desquamation of the epithelium which chokes up hair bulbs and finally leads to their obliteration. Undoubtedly the ordinary conditions of scalp hygiene among men are favorable to the development of these germs. The circulation to the scalp all comes from the vessels of the neck and finds its way over the bony skull to be distributed to the hair bulbs. It is especially likely to be interfered with by the pressure of the hat band, and that this is an important factor in the etiology of alopecia can be seen from the fact that baldness always begins just above the occipital prominence at the back or above the frontal bosses anteriorly, that is, just where the pressure of the hat band on the blood vessels is most likely to be occlusive. This interference with the circulation lowers the resistive vitality of these parts of the scalp and consequently provides opportunities for the growth of micro-organisms. It must not be forgotten, moreover, that these three points mentioned are especially liable to infection. The comb and brush are used particularly in arranging the whorl of hair in the occipital region and in parting the hair and brushing it back over the frontal bosses anteriorly. If infection plays an important role, then, in the production of baldness, these are just the parts that, theoretically, should be first affected, and from which infection should spread to the other parts of the head. As a matter of fact this is what occurs in practice.

Greater care should be taken with regard to brushes and combs, especially in families in which early baldness is the rule. The hair brush should be dipped in an antiseptic solution several times a week. Combs should be boiled regularly and frequently, and under no circumstances should

members of precociously bald families use other combs or brushes than their own, or allow them to be used on them, in barber shops, unless they are assured of their sterilization beforehand. These precautions may seem a high price to pay for the prophylaxis of premature baldness, and many will prefer to take the chance of becoming bald, but some have such a horror of the affliction that they will willingly put themselves to much trouble to prevent it.

JANUARY 14, 1903

JAMA. 1903;40:249 as quoted in JAMA. 2003;289(4):494 (doi:10.1001/jama.289.4.494)

This all just begs the question, why were bald men using combs 100 years ago?

Skip to 1:17 in the clip. Worth it.

The Difficult Truth, or, Health Care Reform

2009-07-23T12:19:00.004-04:00

After President Obama's address last night, this seems like a good time to talk health-care reform. Two large issues come to mind when I think about the need for reform.

1. The elimination of "just to be sure" medicine. Defensive driving is a very good thing. Defensive medicine is sometimes a good thing, but it is almost always a very expensive thing.

2. The second is an issue about the need to apply cost-benefit ideas to medical care, is covered better in an article posted below. I realize this a horrible idea, but the world is a horrible place. I'm not ecstatic about this, believe me, but please, read the article. I know it's long. (Click on the title for the link to the original article).

July 19, 2009

Why We Must Ration Health Care

By PETER SINGER

You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?

If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed.

In the current U.S. debate over health care reform, “rationing” has become a dirty word. Meeting last month with five governors, President Obama urged them to avoid using the term, apparently for fear of evoking the hostile response that sank the Clintons’ attempt to achieve reform. In a Wall Street Journal op-ed published at the end of last year with the headline “Obama Will Ration Your Health Care,” Sally Pipes, C.E.O. of the conservative Pacific Research Institute, described how in Britain the national health service does not pay for drugs that are regarded as not offering good value for money, and added, “Americans will not put up with such limits, nor will our elected representatives.” And the Democratic chair of the Senate Finance Committee, Senator Max Baucus, told CNSNews in April, “There is no rationing of health care at all” in the proposed reform.

Remember the joke about the man who asks a woman if she would have sex with him for a million dollars? She reflects for a few moments and then answers that she would. “So,” he says, “would you have sex with me for $50?” Indignantly, she exclaims, “What kind of a woman do you think I am?” He replies: “We’ve already established that. Now we’re just haggling about the price.” The man’s response implies that if a woman will sell herself at any price, she is a prostitute. The way we regard rationing in health care seems to rest on a similar assumption, that it’s immoral to apply monetary considerations to saving lives — but is that stance tenable?

Health care is a scarce resource, and all scarce resources are rationed in one way or another. In the United States, most health care is privately financed, and so most rationing is by price: you get what you, or your employer, can afford to insure you for. But our current system of employer-financed health insurance exists only because the federal government encouraged it by making the premiums tax deductible. That is, in effect, a more than $200 billion government subsidy for health care. In the public sector, primarily Medicare, Medicaid and hospital emergency rooms, health care is rationed by long waits, high patient copayment requirements, low payments to doctors that discourage some from serving public patients and limits on payments to hospitals.

The case for explicit health care rationing in the United States starts with the difficulty of thinking of any other way in which we can continue to provide adequate health care to people on Medicaid and Medicare, let alone extend coverage to those who do not now have it. Health-insurance premiums have more than doubled in a decade, rising four times faster than wages. In May, Medicare’s trustees warned that the program’s biggest fund is heading for insolvency in just eight years. Health care now absorbs about one dollar in every six the nation spends, a figure that far exceeds the share spent by any other nation. According to the Congressional Budget Office, it is on track to double by 2035.

President Obama has said plainly that America’s health care system is broken. It is, he has said, by far the most significant driver of America’s long-term debt and deficits. It is hard to see how the nation as a whole can remain competitive if in 26 years we are spending nearly a third of what we earn on health care, while other industrialized nations are spending far less but achieving health outcomes as good as, or better than, ours.

Rationing health care means getting value for the billions we are spending by setting limits on which treatments should be paid for from the public purse. If we ration we won’t be writing blank checks to pharmaceutical companies for their patented drugs, nor paying for whatever procedures doctors choose to recommend. When public funds subsidize health care or provide it directly, it is crazy not to try to get value for money. The debate over health care reform in the United States should start from the premise that some form of health care rationing is both inescapable and desirable. Then we can ask, What is the best way to do it?

Last year Britain’s National Institute for Health and Clinical Excellence gave a preliminary recommendation that the National Health Service should not offer Sutent for advanced kidney cancer. The institute, generally known as NICE, is a government-financed but independently run organization set up to provide national guidance on promoting good health and treating illness. The decision on Sutent did not, at first glance, appear difficult. NICE had set a general limit of £30,000, or about $49,000, on the cost of extending life for a year. Sutent, when used for advanced kidney cancer, cost more than that, and research suggested it offered only about six months extra life. But the British media leapt on the theme of penny-pinching bureaucrats sentencing sick people to death. The issue was then picked up by the U.S. news media and by those lobbying against health care reform in the United States. An article in The New York Times last December featured Bruce Hardy, a kidney-cancer patient whose wife, Joy, said, “It’s hard to know that there is something out there that could help but they’re saying you can’t have it because of cost.” Then she asked the classic question: “What price is life?”

Last November, Bloomberg News focused on Jack Rosser, who was 57 at the time and whose doctor had told him that with Sutent he might live long enough to see his 1-year-old daughter, Emma, enter primary school. Rosser’s wife, Jenny, is quoted as saying: “It’s immoral. They are sentencing him to die.” In the conservative monthly The American Spectator, David Catron, a health care consultant, describes Rosser as “one of NICE’s many victims” and writes that NICE “regularly hands down death sentences to gravely ill patients.” Linking the British system with Democratic proposals for reforming health care in the United States, Catron asked whether we really deserve a health care system in which “soulless bureaucrats arbitrarily put a dollar value on our lives.” (In March, NICE issued a final ruling on Sutent. Because of how few patients need the drug and because of special end-of-life considerations, it recommended that the drug be provided by the National Health Service to patients with advanced kidney cancer.)

There’s no doubt that it’s tough — politically, emotionally and ethically — to make a decision that means that someone will die sooner than they would have if the decision had gone the other way. But if the stories of Bruce Hardy and Jack Rosser lead us to think badly of the British system of rationing health care, we should remind ourselves that the U.S. system also results in people going without life-saving treatment — it just does so less visibly. Pharmaceutical manufacturers often charge much more for drugs in the United States than they charge for the same drugs in Britain, where they know that a higher price would put the drug outside the cost-effectiveness limits set by NICE. American patients, even if they are covered by Medicare or Medicaid, often cannot afford the copayments for drugs. That’s rationing too, by ability to pay.

Dr. Art Kellermann, associate dean for public policy at Emory School of Medicine in Atlanta, recently wrote of a woman who came into his emergency room in critical condition because a blood vessel had burst in her brain. She was uninsured and had chosen to buy food for her children instead of spending money on her blood-pressure medicine. In the emergency room, she received excellent high-tech medical care, but by the time she got there, it was too late to save her.

A New York Times report on the high costs of some drugs illustrates the problem. Chuck Stauffer, an Oregon farmer, found that his prescription-drug insurance left him to pay $5,500 for his first 42 days of Temodar, a drug used to treat brain tumors, and $1,700 a month after that. For Medicare patients drug costs can be even higher, because Medicare can require a copayment of 25 percent of the cost of the drug. For Gleevec, a drug that is effective against some forms of leukemia and some gastrointestinal tumors, that one-quarter of the cost can run to $40,000 a year.

In Britain, everyone has health insurance. In the U.S., some 45 million do not, and nor are they entitled to any health care at all, unless they can get themselves to an emergency room. Hospitals are prohibited from turning away anyone who will be endangered by being refused treatment. But even in emergency rooms, people without health insurance may receive less health care than those with insurance. Joseph Doyle, a professor of economics at the Sloan School of Management at M.I.T., studied the records of people in Wisconsin who were injured in severe automobile accidents and had no choice but to go to the hospital. He estimated that those who had no health insurance received 20 percent less care and had a death rate 37 percent higher than those with health insurance. This difference held up even when those without health insurance were compared with those without automobile insurance, and with those on Medicaid — groups with whom they share some characteristics that might affect treatment. The lack of insurance seems to be what caused the greater number of deaths.

When the media feature someone like Bruce Hardy or Jack Rosser, we readily relate to individuals who are harmed by a government agency’s decision to limit the cost of health care. But we tend not to hear about — and thus don’t identify with — the particular individuals who die in emergency rooms because they have no health insurance. This “identifiable victim” effect, well documented by psychologists, creates a dangerous bias in our thinking. Doyle’s figures suggest that if those Wisconsin accident victims without health insurance had received equivalent care to those with it, the additional health care would have cost about $220,000 for each life saved. Those who died were on average around 30 years old and could have been expected to live for at least another 40 years; this means that had they survived their accidents, the cost per extra year of life would have been no more than $5,500 — a small fraction of the $49,000 that NICE recommends the British National Health Service should be ready to pay to give a patient an extra year of life. If the U.S. system spent less on expensive treatments for those who, with or without the drugs, have at most a few months to live, it would be better able to save the lives of more people who, if they get the treatment they need, might live for several decades.

Estimates of the number of U.S. deaths caused annually by the absence of universal health insurance go as high as 20,000. One study concluded that in the age group 55 to 64 alone, more than 13,000 extra deaths a year may be attributed to the lack of insurance coverage. But the estimates vary because Americans without health insurance are more likely, for example, to smoke than Americans with health insurance, and sorting out the role that the lack of insurance plays is difficult. Richard Kronick, a professor at the School of Medicine at theUniversity of California, San Diego, cautiously concludes from his own study that there is little evidence to suggest that extending health insurance to all Americans would have a large effect on the number of deaths in the United States. That doesn’t mean that it wouldn’t; we simply don’t know if it would.

In any case, it isn’t only uninsured Americans who can’t afford treatment. President Obama has spoken about his mother, who died from ovarian cancer in 1995. The president said that in the last weeks of her life, his mother “was spending too much time worrying about whether her health insurance would cover her bills” — an experience, the president went on to say, that his mother shared with millions of other Americans. It is also an experience more common in the United States than in other developed countries. A recent Commonwealth Fund study led by Cathy Schoen and Robin Osborn surveyed adults with chronic illness in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom and the United States. Far more Americans reported forgoing health care because of cost. More than half (54 percent) reported not filling a prescription, not visiting a doctor when sick or not getting recommended care. In comparison, in the United Kingdom the figure was 13 percent, and in the Netherlands, only 7 percent. Even among Americans with insurance, 43 percent reported that cost was a problem that had limited the treatment they received. According to a 2007 study led by David Himmelstein, more than 60 percent of all bankruptcies are related to illness, with many of these specifically caused by medical bills, even among those who have health insurance. In Canada the incidence of bankruptcy related to illness is much lower.

When a Washington Post journalist asked Daniel Zemel, a Washington rabbi, what he thought about federal agencies putting a dollar value on human life, the rabbi cited a Jewish teaching explaining that if you put one human life on one side of a scale, and you put the rest of the world on the other side, the scale is balanced equally. Perhaps that is how those who resist health care rationing think. But we already put a dollar value on human life. If the Department of Transportation, for example, followed rabbinical teachings it would exhaust its entire budget on road safety. Fortunately the department sets a limit on how much it is willing to pay to save one human life. In 2008 that limit was $5.8 million. Other government agencies do the same. Last year the Consumer Product Safety Commission considered a proposal to make mattresses less likely to catch fire. Information from the industry suggested that the new standard would cost $343 million to implement, but the Consumer Product Safety Commission calculated that it would save 270 lives a year — and since it valued a human life at around $5 million, that made the new standard a good value. If we are going to have consumer-safety regulation at all, we need some idea of how much safety is worth buying. Like health care bureaucrats, consumer-safety bureaucrats sometimes decide that saving a human life is not worth the expense. Twenty years ago, the National Research Council, an arm of the National Academy of Sciences, examined a proposal for installing seat belts in all school buses. It estimated that doing so would save, on average, one life per year, at a cost of $40 million. After that, support for the proposal faded away. So why is it that those who accept that we put a price on life when it comes to consumer safety refuse to accept it when it comes to health care?

Of course, it’s one thing to accept that there’s a limit to how much we should spend to save a human life, and another to set that limit. The dollar value that bureaucrats place on a generic human life is intended to reflect social values, as revealed in our behavior. It is the answer to the question “How much are you willing to pay to save your life?” — except that, of course, if you asked that question of people who were facing death, they would be prepared to pay almost anything to save their lives. So instead, economists note how much people are prepared to pay to reduce the risk that they will die. How much will people pay for air bags in a car, for instance? Once you know how much they will pay for a specified reduction in risk, you multiply the amount that people are willing to pay by how much the risk has been reduced, and then you know, or so the theory goes, what value people place on their lives. Suppose that there is a 1 in 100,000 chance that an air bag in my car will save my life, and that I would pay $50 — but no more than that — for an air bag. Then it looks as if I value my life at $50 x 100,000, or $5 million.

The theory sounds good, but in practice it has problems. We are not good at taking account of differences between very small risks, so if we are asked how much we would pay to reduce a risk of dying from 1 in 1,000,000 to 1 in 10,000,000, we may give the same answer as we would if asked how much we would pay to reduce the risk from 1 in 500,000 to 1 in 10,000,000. Hence multiplying what we would pay to reduce the risk of death by the reduction in risk lends an apparent mathematical precision to the outcome of the calculation — the supposed value of a human life — that our intuitive responses to the questions cannot support. Nevertheless this approach to setting a value on a human life is at least closer to what we really believe — and to what we should believe — than dramatic pronouncements about the infinite value of every human life, or the suggestion that we cannot distinguish between the value of a single human life and the value of a million human lives, or even of the rest of the world. Though such feel-good claims may have some symbolic value in particular circumstances, to take them seriously and apply them — for instance, by leaving it to chance whether we save one life or a billion — would be deeply unethical.

Governments implicitly place a dollar value on a human life when they decide how much is to be spent on health care programs and how much on other public goods that are not directed toward saving lives. The task of health care bureaucrats is then to get the best value for the resources they have been allocated. It is the familiar comparative exercise of getting the most bang for your buck. Sometimes that can be relatively easy to decide. If two drugs offer the same benefits and have similar risks of side effects, but one is much more expensive than the other, only the cheaper one should be provided by the public health care program. That the benefits and the risks of side effects are similar is a scientific matter for experts to decide after calling for submissions and examining them. That is the bread-and-butter work of units like NICE. But the benefits may vary in ways that defy straightforward comparison. We need a common unit for measuring the goods achieved by health care. Since we are talking about comparing different goods, the choice of unit is not merely a scientific or economic question but an ethical one.

As a first take, we might say that the good achieved by health care is the number of lives saved. But that is too crude. The death of a teenager is a greater tragedy than the death of an 85-year-old, and this should be reflected in our priorities. We can accommodate that difference by calculating the number of life-years saved, rather than simply the number of lives saved. If a teenager can be expected to live another 70 years, saving her life counts as a gain of 70 life-years, whereas if a person of 85 can be expected to live another 5 years, then saving the 85-year-old will count as a gain of only 5 life-years. That suggests that saving one teenager is equivalent to saving 14 85-year-olds. These are, of course, generic teenagers and generic 85-year-olds. It’s easy to say, “What if the teenager is a violent criminal and the 85-year-old is still working productively?” But just as emergency rooms should leave criminal justice to the courts and treat assailants and victims alike, so decisions about the allocation of health care resources should be kept separate from judgments about the moral character or social value of individuals.

Health care does more than save lives: it also reduces pain and suffering. How can we compare saving a person’s life with, say, making it possible for someone who was confined to bed to return to an active life? We can elicit people’s values on that too. One common method is to describe medical conditions to people — let’s say being a quadriplegic — and tell them that they can choose between 10 years in that condition or some smaller number of years without it. If most would prefer, say, 10 years as a quadriplegic to 4 years of nondisabled life, but would choose 6 years of nondisabled life over 10 with quadriplegia, but have difficulty deciding between 5 years of nondisabled life or 10 years with quadriplegia, then they are, in effect, assessing life with quadriplegia as half as good as nondisabled life. (These are hypothetical figures, chosen to keep the math simple, and not based on any actual surveys.) If that judgment represents a rough average across the population, we might conclude that restoring to nondisabled life two people who would otherwise be quadriplegics is equivalent in value to saving the life of one person, provided the life expectancies of all involved are similar.

This is the basis of the quality-adjusted life-year, or QALY, a unit designed to enable us to compare the benefits achieved by different forms of health care. The QALY has been used by economists working in health care for more than 30 years to compare the cost-effectiveness of a wide variety of medical procedures and, in some countries, as part of the process of deciding which medical treatments will be paid for with public money. If a reformed U.S. health care system explicitly accepted rationing, as I have argued it should, QALYs could play a similar role in the U.S.

Some will object that this discriminates against people with disabilities. If we return to the hypothetical assumption that a year with quadriplegia is valued at only half as much as a year without it, then a treatment that extends the lives of people without disabilities will be seen as providing twice the value of one that extends, for a similar period, the lives of quadriplegics. That clashes with the idea that all human lives are of equal value. The problem, however, does not lie with the concept of the quality-adjusted life-year, but with the judgment that, if faced with 10 years as a quadriplegic, one would prefer a shorter lifespan without a disability. Disability advocates might argue that such judgments, made by people without disabilities, merely reflect the ignorance and prejudice of people without disabilities when they think about people with disabilities. We should, they will very reasonably say, ask quadriplegics themselves to evaluate life with quadriplegia. If we do that, and we find that quadriplegics would not give up even one year of life as a quadriplegic in order to have their disability cured, then the QALY method does not justify giving preference to procedures that extend the lives of people without disabilities over procedures that extend the lives of people with disabilities.

This method of preserving our belief that everyone has an equal right to life is, however, a double-edged sword. If life with quadriplegia is as good as life without it, there is no health benefit to be gained by curing it. That implication, no doubt, would have been vigorously rejected by someone like Christopher Reeve, who, after being paralyzed in an accident, campaigned for more research into ways of overcoming spinal-cord injuries. Disability advocates, it seems, are forced to choose between insisting that extending their lives is just as important as extending the lives of people without disabilities, and seeking public support for research into a cure for their condition.

The QALY tells us to do what brings about the greatest health benefit, irrespective of where that benefit falls. Usually, for a given quantity of resources, we will do more good if we help those who are worst off, because they have the greatest unmet needs. But occasionally some conditions will be both very severe and very expensive to treat. A QALY approach may then lead us to give priority to helping others who are not so badly off and whose conditions are less expensive to treat. I don’t find it unfair to give the same weight to the interests of those who are well off as we give to those who are much worse off, but if there is a social consensus that we should give priority to those who are worse off, we can modify the QALY approach so that it gives greater weight to benefits that accrue to those who are, on the QALY scale, worse off than others.

The QALY approach does not even try to measure the benefits that health care brings in addition to the improvement in health itself. Emotionally, we feel that the fact that Jack Rosser is the father of a young child makes a difference to the importance of extending his life, but his parental status is irrelevant to a QALY assessment of the health care gains that Sutent would bring him. Whether decisions about allocating health care resources should take such personal circumstances into account isn’t easy to decide. Not to do so makes the standard inflexible, but taking personal factors into account increases the scope for subjective — and prejudiced — judgments.

The QALY is not a perfect measure of the good obtained by health care, but its defenders can support it in the same way that Winston Churchill defended democracy as a form of government: it is the worst method of allocating health care, except for all the others. If it isn’t possible to provide everyone with all beneficial treatments, what better way do we have of deciding what treatments people should get than by comparing the QALYs gained with the expense of the treatments?

Will Americans allow their government, either directly or through an independent agency like NICE, to decide which treatments are sufficiently cost-effective to be provided at public expense and which are not? They might, under two conditions: first, that the option of private health insurance remains available, and second, that they are able to see, in their own pocket, the full cost of not rationing health care.

Rationing public health care limits free choice if private health insurance is prohibited. But many countries combine free national health insurance with optional private insurance. Australia, where I’ve spent most of my life and raised a family, is one. The U.S. could do something similar. This would mean extending Medicare to the entire population, irrespective of age, but without Medicare’s current policy that allows doctors wide latitude in prescribing treatments for eligible patients. Instead, Medicare for All, as we might call it, should refuse to pay where the cost per QALY is extremely high. (On the other hand, Medicare for All would not require more than a token copayment for drugs that are cost-effective.) The extension of Medicare could be financed by a small income-tax levy, for those who pay income tax — in Australia the levy is 1.5 percent of taxable income. (There’s an extra 1 percent surcharge for those with high incomes and no private insurance. Those who earn too little to pay income tax would be carried at no cost to themselves.) Those who want to be sure of receiving every treatment that their own privately chosen physicians recommend, regardless of cost, would be free to opt out of Medicare for All as long as they can demonstrate that they have sufficient private health insurance to avoid becoming a burden on the community if they fall ill. Alternatively, they might remain in Medicare for All but take out supplementary insurance for health care that Medicare for All does not cover. Every American will have a right to a good standard of health care, but no one will have a right to unrationed health care. Those who opt for unrationed health care will know exactly how much it costs them.

One ﬁnal comment. It is common for opponents of health care rationing to point to Canada and Britain as examples of where we might end up if we get “socialized medicine.” On a blog on Fox News earlier this year, the conservative writer John Lott wrote, “Americans should ask Canadians and Brits — people who have long suffered from rationing — how happy they are with central government decisions on eliminating ‘unnecessary’ health care.” There is no particular reason that the United States should copy the British or Canadian forms of universal coverage, rather than one of the different arrangements that have developed in other industrialized nations, some of which may be better. But as it happens, last year the Gallup organization did ask Canadians and Brits, and people in many different countries, if they have confidence in “health care or medical systems” in their country. In Canada, 73 percent answered this question affirmatively. Coincidentally, an identical percentage of Britons gave the same answer. In the United States, despite spending much more, per person, on health care, the figure was only 56 percent.

Peter Singer is professor of bioethics at Princeton University. He is also laureate professor at the University of Melbourne, in Australia. His most recent book is “The Life You Can Save: Acting Now to End World Poverty.”

This article has been revised to reflect the following correction:

Correction: July 19, 2009
An article in The Times Magazine this weekend about the argument for rationing health care in the United States misstates the number of years it would take under the current system for the country to spend nearly a third of what it earns on health care. It is 26 years from now, or 2035, not 15 years.

Guided by teh Spirit, or, If Only

2009-07-22T20:22:00.005-04:00

On Awesmeness, or, (Possible) Best Music Ever

2009-07-19T23:34:00.003-04:00

This is an attempt to list what I consider the ultimate music in several different categories. Clearly, this is my opinion, and limited at that to the few categories below. As always, I'd be interested in your own lists, or the critiques you have of mine.

THE LIST:

Baroque: Bach’s Air on G String. I realize most would put Pachelbel’s Canon in D here, and it is a beautiful piece. I was torn and almost put Bach’s “Little” Fugue in G minor for Organ here instead, but the simple elegance of the wining piece made the difference.

Classical Piano: Beethoveen’s Waldestein Piano Sonata; this may be the greatest piece of solo music ever written. I will stand by that statement. I will even put it on my blog.

Romantic Orchestral: Tchaikovsky’s Violin Concerto with close second place tie Romeo and Juliet vs 1812 Overture. I do like most of the Russian composers. So angry and passionate.

Rock: Pearl Jam’s Better Man. My friends scoff at me for this. One asked, repeatedly, when I told her we were listening to this song if I meant Dave Mathews. She is not my friend anymore.

Alternative: The Decemberists The Crane Wife 3. Practically perfect.

Opening: Nirvana’s Smell’s Like Teen Spirit vs Guns ‘n’ Roses Sweet Child o’ Mine

Bluegrass: Nicklecreek Ode To A Butterfly

Country: Johnny Cash I Walk The Line – but his covers, notably on American IV & V albums, with such songs as the remake of NIN’s Hurt (absolutely unbelievable) and God’s Gunna Cut You Down, are some of the best songs I’ve ever heard. That’s right. Ever.

Punk-ish: The Get Up Kids Mass Pike

This band was my staple for about five or six years, until a few years after they broke up. I missed their show in SLC during their alleged last tour during college, and I still cry myself to sleep about it. The fungus growing in my pillow from the constant damp is really starting to cause problems, too. And they’re coming to town at the Newport 11/8 of this year. So tell all your friends, and come to the sweet show.

Hardcore: Taking Back Sunday There is no “I” in Team. This song just makes me want to explode. It’s awesome.

New Country: Toby Keith, Beer for my Horses. This surprised me. I don’t really like Toby Keith’s newer music, but since Willie Nelson sang in this song, too, it really mellowed Toby out. “New Country” is such a broad genre, too, that to pick a single artist that can represent Chris LeDoux and Alabama as well as Brad Paisley and The Dixie Chicks just does not seem possible. I think this song works well in that sense, a melding of the older, more traditional backbone of the genre with the newer, more popular style as well. Incidentally, the music video for this song is one of the most laughable things I have ever seen. Probably a close second to the Journey music videos I used as research for my mullet.

Bluegrass/Country: Alison Krauss & Union Station’s Forget About It. For some reason I really love the drum in this song. This song probably stands second only to the last song on my list, and not far behind.

The Beatles Blackbird. What is there to say? The song is perfect.

Clearly, this list is flawed as Neil Diamond, Journey, Led Zepplin, and the Greatful Dead are all absent, but, I suppose you could write your own list. And tell me your favorites.

Music of the Year (2008), or, Still On a Physician's Timetable

2009-07-15T12:32:00.008-04:00

Without much introduction, let's just talk the best music of last year.

7. Alison Krauss & Union Station – Live. This is #7 only b/c it is not new this year; it came out in 2002. However, it is deservedly on the list because I discovered it this year. Ms. Krauss & Co. have been on my many years, but I am embarrassed that I’d never listened to this album before. It is chock-full of awesome. Just listen to “Everytime You Say Goodbye,” even with the crappy Youtube sound, it’s still awesome.

6. Mates of State – Re-Arrange Us. I was turned on to this awesome group by the awesome radio program, This American Life, (which you should all be into). The band has a really fun up-beat sound in nearly all of their songs, but manage to not get repetitious. I think you will like them too.

5. Bishop Allen – Rain. Actually, if you want an album you can listen to start to finish, This Broken String is one of the best on this list. The songs cover the spectrum from just up-beat pop-fun in “Middle Management” to the more eclectic sound of “Like Castinets.”

4. Mike Doughty – Here's another one not discovered in 2008. Mike Doughty is the former singer of Soul Coughing. It's not often you get a real bass singer, and this guy pulls it off really well.

3. Band of Horses – Cease to Begin. This band has a great ephemeral sound to them, as well as some great harmony.

2. Ingrid Michaelson – You’ll all recogonize “Unbreakable,” and justly so. It’s a fun pop song. But the rest of this album is great too. The last half of “December Baby” for example, is great in its point, counter-point architecture.

1. The Mountain Goats –Heretic Pride. From start to finish, this album is ridiculous. I mean, who names their band after those shaggy animals? Have you ever seen one live? They are ridiculous looking. The band also has a ridiculous number of albums released. And they make ridiculously awesome remakes.

As for my favorites from this album, it’s difficult. The first song, Sax Rohmer #1 is really difficult to improve upon. The nasal vocals even work with everything else. Can you see it coming RIDICULOUS.

The title track is equally awesome. The simple piano background just pops out, the song grooves along, and you can’t help but love this song.

How to Embrace a Swamp Creature – besides an awesome title, this song also brings out a sweet piano theme in the bridge sections. The slow crescendo through the entire song is also great.

The quiet serenity of Marduk T-Shirt Men’s Room Incident is also great. There aren’t any videos with even marginal enough sound quality to post here. But I think you get the point. This album is awesome. Get it now.

And as a sneak peek of next year’s entry here is The National. Can you get a more plaintive, melancholy song than this?

As always, I’d love to hear your suggestions or thoughts on music. Is my list too pop-centric? Not enough feeling? However, if you point out any flaws, please bring a new/better song or artist to the table.

Medical Condescension of the Time Period , or, Primum Non Nocere, or, the Future of American Healthcare

2009-07-13T08:46:00.002-04:00

Bryce’s Best of 2008 (Part 1), or, On Physicians’ Timetables, or, Sorry I’m Running Late

2009-07-08T23:38:00.004-04:00

As my year drew to a close last week (one year of school left. Sort of.), I am reminded that I never put forward my Best of 2008 post. I had intended to write it, and even thought about it once or twice. However, doing “research” for the Best of 2009 article I plan to write always seemed more interesting. So, my selections for favorites that I discovered in 2008 are below. As always, I’m open to suggestions in all areas. Just make them good suggestions.

Without any further ado, here are my Best Reads of 2008.

Best Books of 2008

1. The Name of the Wind, by Patrick Rothfuss. This book ruled with incredible awesomeness. Undoubtedly one of the best fantasy books I have ever read, and it actually came out in 2008. It takes the very traditional, oft-repeated approach to fantasy novels of a young man, orphaned, who later turns out to kick ass. This one does it with some incredible flair, great prose, amazing puns (if you think I’m kidding, read the book and then tell me I’m wrong), and clever twists. This book definitely stands out, head and shoulders, as the single best book of the year.

2. The Backslider, by Levi Peterson. Long-hailed as one of the standard works of Mormon fiction, this was another very well-constructed story, with some powerful themes in it. I do not believe a comparison between the protagonist, Frank Windham and the main character of Catcher in the Rye , Holden Caulfield, is out of order. Clearly a “coming of age” type of story, told as Frank struggles to deal with his Mormonism, parents, neighbors, and love. It really is a great read, with tight plot lines. While the book does have a bit of an abrupt climax without much resolution, this is clearly intentional. The focus of the book is on Frank’s struggles, not on his life after the resolution of those struggles. While some of the story lines may seem bizarre to those familiar with Mormonism, I think they are fairly representative of Peterson’s experience with his religion as he was raised with it, and gives a fascinating peek into his experiences as a young man.

Incidentally, I took the opportunity to also read Canyons of Grace, a collection of short stories by the same author, and have come away very impressed with this English professor of Weber State University. I would definitely recommend this collection as well.

3. Dune, by Frank Herbert. I grew up consuming fantasy novels whole, to hear Mother tell it. How did I never read this book until this year? I played the video game on my 386 running DOS 6.0. I’m not totally sure where I got the game, but I do know it was from one of the pre-internet “BBS”s that I used. That game was fun, but it just didn’t make sense. It had these Stormtrooper knock-offs that were fun to play with though.

I made the unfortunate mistake of renting the movie Dune as a senior in high school. This should come as no shock to anyone who might be reading this, but Satruday nights, after 10PM, Top Hat Video would let any video still in the store be rented for $0.25. My dad had this sweet dual deck VCR ideal for copying videos, and I could squeeze three movies onto one blank cassette. Hence, logically, I would rent 10 movies for $2.50, copy them over the weekend, and watch them at my leisure. In this way I stumbled on Dune, the movie. And such things as Sting in a plastic ~~pair of pants~~ speedo.

But there is also some other actor in the film who looks just like him, and that really helped the plot make sense. Especially since I had no exposure to the story before the film. To sum my experience with Dune in my youth, I was always completely confused.

But I did pick up the book eventually. And the book was great. I was pretty disappointed when my roommate told me that all the subsequent entries in the series stink. And any book that can stand the test of time and desecration dressed in dark blue vinyl clearly deserves a spot on this list.

4. Honorable mention goes to Joe Abercrombie, for cranking out (quickly!) his trilogy that took the traditional Tolkien quest, told it exceptionally well, all while turning it on its head. The most believable characters – the most flawed characters – that I think I’ve ever read about.

5. Another Honorable Mention to Scott Lynch, whose first two books of the “Gentleman Bastard” series have been enjoyable, ~~believable~~, and completely different from each other.

Well, that is it. My Top 5 for 2008. If you have read any of them, I would like to hear your opinion; if you have your own list of Best Books of '08, I would also like to hear that. I promise I don't only read fantasy.

So far there has not been anything notable produced by my research for 2009, but I have hope for some promising releases later this year. Suggestions are always welcome.

3 Simple Rules, or, Medicial Theory, or, Eww

2009-06-21T11:00:00.000-04:00

1. Assume nothing. Every priest has syphilis until proven otherwise.
2. Believe nothing. Your patients will lie to you for who knows what reason.
3. Read like hell. And never stop.

These were passed along on rounds Friday afternoon. They rang true to me. But as someone with an insider's view of medicine, I'm curious, though, how are these perceived by the non-medical world?

As the same instructor pointed out, patients value their physician for, 1st, Availability, 2nd Affability, and a very distant 3rd, their Ability. Conversely, physicians judge other physicians in basically the reverse order. The ability to properly diagnose and then treat is far more important than friendliness in the care of a patient. While I agree bedside manner is important, I think I agree with my instructor here, too. Again, I ask the same question: which doctor would you want - the available, friendly one; or the smart one who figures out the disease and treats it properly?

On Synergy; or, Diversions

2009-06-11T19:52:00.004-04:00

I've played Rockband once. I think the Beatles are okay. Put them together, though, and you get pure unadulterated awesomeness.

http://www.thebeatlesrockband.com/cinematic.php

Recipes of the Time Period, or, Corn Chowder, or, Say it Frenchie!

2009-05-13T22:25:00.001-04:00

Corn Chowder
Makes 8 servings.

4 oz bacon, chopped into 1 inch squares
2 Tbs butter/olive oil
2 cups chopped onions
3 ribs celery, chopped
2 Tbs flour
2 cups chicken stock
2 cups milk
2 large red potatoes, diced
4 cups frozen corn kernels
2-3 Tbs sugar
1 Cup half-and-half
Salt/pepper to taste (read: tons and tons of pepper
2 bell peppers (red and green for color)
3 scallions, trimmed/chopped
1 Tbs fresh cilantro, chopped

1. In large stock pot, cook bacon ~5 min until almost crispy over med-high heat.
2. Reduce heat to medium-low. Add butter/oil, onions, and celery. Cook ~10 min. Stir occasionally.
3. Sprinkle with flour and cook ~3 minutes. Stir.
4. Add chicken stock, milk, and potatoes. Bring to simmer over medium-high heat. Reduce heat to medium low and cook until potatoes are just tender.
5. Stir in corn and sugar.
6. Remove 2 cups and puree. Add back to pot.
7. Stir in half-and-half. Salt and pepper to taste.
8. Bring back to simmer over medium heat. Add red pepper and scallions. Cook ~5 min.
9. Garnish with cilantro.

This seemed to be a major hit. I did use a bit more flour to thicken it some, and while I cooked the bacon in the pot, I didn't put any of the bacon in the soup until after serving it for my friends with vegetarianism, as bizarre disease if ever there was one. I also neglected the cilantro, mostly due to my poor ability to multi-task in the kitchen. I would be very sparing with it, though. It might work as a light accent.

Happy Mothers' Day! or, Happy Overworked-underappreciated Day!

2009-05-10T08:00:00.003-04:00

To my Mother, my three dear Sisters, and to the Lighter Half of the human race,

Please read these two articles and give yourselves a pat on the back. I realize the first is in specific reference to Christmas, but work with me. It's still a good article.

Merry and Martha, by Kristine, at bycommonconsent.com

There is one story from the scriptural account of Jesus’ life that haunts and troubles me, like a Zen koan–the story of Mary and Martha hosting Jesus. It is a good story and a useful corrective to (Mormon) women’s tendency to privilege the meeting of others’ physical needs (real or imagined) over the sating of their own spiritual hunger. And yet I find myself wanting to defend Martha from the Savior’s gentle rebuke. Particularly at Christmas, I’m inclined to assert the value of hustling and bustling and busy-ness.

If our church services hadn’t been snowed out Sunday, it’s likely there would have been talks decrying the commercialization of Christmas, urging more thought about the reason for the season, pleading for a return to the simplicity and wonder of Christmases past. “Keep Christ in Christmas,” pundits urge, fearing, perhaps, that God might be outmuscled by Santa Claus. To all of this well-intentioned sermonizing, I say bah! humbug.

At Christmastime, we long for the kind of simplicity Thoreau achieved at Walden Pond with his mother dropping in daily to bring him food and clean laundry (!) (!!) Those Norman Rockwell scenes of contented, well-scrubbed families at church or around the table–the pictures we invoke to remind us of the “real” meaning of Christmas–they require a great deal of behind-the-scenes work by someone! (Even the paintings of the stable where Jesus was born suggest that a great deal of cleaning had occurred before the poses were struck). My least favorite part of the season is the well-intentioned (often male) voices urging us to keep our celebration simple, to not “overdo”, to slow down. This message creates yet another impossible double bind for women, who now feel pressure to make a magic, wonder-filled holiday for their families AND make it look easy. It is not easy, and there’s no sense pretending that it could be. Ordinary housekeeping and cooking and childcare are plenty of work; the imperative of extra-special homey-ness and glitter for the holidays inevitably makes more work. But, as Kahlil Gibran says so perfectly, “work is love made visible.”

The spirit of Martha broods over the holidays, a troubled ghost yearning for Jesus as much as her contemplative sister, pouring her love into cookies and trinkets and overwrought centerpieces. Her work is unnecessary only when it is unappreciated, redeemed when it is received with the gratitude due all lovingly intended gifts. Work joyfully undertaken and happily received is among the deepest satisfactions of human existence. Loving those around us will, of necessity, entail being “careful and troubled” about some things, at least. Perhaps Jesus’ words to Martha were less rebuke than acknowledgment. Perhaps we would have seen, if we had been there when he spoke those words, his great love and tender gratitude for her fussy gifts, and his yearning to give her that which he had to give which could only be received after the hustle and bustle were through.

I would like to think it was so. Part of the wonder of the scene at the creche is the image of the baby patiently receiving the wise men’s ridiculous gifts. Surely they were no good to him, but they were good for the givers.

. . . [edited for length]

And second, Not-so-great-expectations by Judith Warner, New York Times 5/9/2007

The father of one of Emilie’s friends stopped by last Sunday morning to pick up his daughter from a sleepover.

His phone rang. He spoke for a moment, then hung up, looking peeved. His wife was mad at him, he said.

“What did you do?” I asked.

“Nothing!” He threw up his hands. “I offered her pancakes!”

“You must have done something else,” I said, settling eagerly into a chair. There is nothing more enjoyable than listening in on other people’s marital squabbles.

“I did not!” he protested. Then conceded: “I offered her pancakes, when she’s on a diet.”

“Ah,” I said, sympathetically.

I am on a diet, too. Every time I move the scale from the tiled bathroom floor to the rug in the hallway, I lose two pounds. The same two.

“At our age, it’s really hard to lose weight,” I said, peace-makingly.

“At our age,” he replied sharply, “maybe we just have to adjust our expectations.”

This was a very radical idea.

I mulled it over all week. I realized that this very same not-so-great expectations theme had also come up, not long before, in a conversation I’d had with my father-in-law.

We were talking about sleep. I was ruing the fact that I need it – nine hours’ worth sometimes.

I was telling him about a woman I know who gets up at 3:30 a.m. every day to do yoga. She’s on her computer at 4:30 and on a train to work at 7:30.

At 7:30 I am usually spilling my first cup of coffee down the front of my bathrobe and screaming at my children that if they don’t get out of bed they’ll never again eat anything sweet or watch any TV or have anything they want in the world for the rest of their lives.

“I wish I could get up early,” I said, explaining all the gracious, relaxed, self-improved Simply Being I would do, if I had an extra hour or two in the day.

I was saying I wished I needed to sleep only six hours a night. Or five, or four – like the really successful people you read about.

I would wake up my children, showered, teeth-brushed and smiling, the way the magazines tell you to do. I would exercise and garden and pay bills and reorganize the kitchen cabinets and make photo albums and …

My father-in-law looked at me with genuine befuddlement.

“Why,” he said, “would you want to do anything more than you already do?”

What a question! What a mind-bend! What a culture-clashing, anachronistic, out-of-this-world concept this had seemed: Know your limits. Acknowledge them. Deal with them. It had struck me as a revelation.

But upon reflection, I’ve come to think that perhaps this is what it’s all about. “It,” of course, being this experience of life-on-the-cusp-of-middle-age to which I keep returning, rather obsessively, week after week.

If one were to be highbrow about it, one could see the desire for self-surpassing – the refusal to accept, for example, a muffin top, or a greater need for sleep – as a refusal to accept mortality, which is of course the ultimate self-limit.

I never had any sense of my own mortality until I was pregnant with Emilie, my younger child, now nine. It was just a twinge then. But it accelerated when Emilie started school, and suddenly – as my waist thickened and hair thinned – it dawned on me that someday all too soon both my kids would be gone from home for good.

(“What is it like to have older kids?” a mom of toddlers I’d just met asked me outside a moon bounce, at a birthday party recently.

“You realize that your time with them is limited. That soon it’s all coming to an end,” I answered.

A moment later, as I stood there suddenly alone, I wondered why people always seem to run away from me at parties.)

The timor mortis explanation is really the only way to account for all the lowbrow concerns that have increasingly crowded out my higher thoughts as I advance in my forties. The weeds choking the garden. The hundreds of digital photos that no one has ever seen. The kid-art that hasn’t been hung. All these undone things, all these instances in which I Fail to Meet Expectations (according to the imaginary report card I update every day), derive their urgency for me from the sense that, if did meet performance standards, then I would be living my life to the fullest. If the photos could be put in albums, if I could sit down with the girls to look at them, then time would somehow slow down, perhaps even freeze, like the images on the page.

Every night, for as long as I can remember now, I’ve been swearing I’ll wake up early the next day.

Now, though, I am thinking of giving myself a reprieve.

For on another Sunday recently I had yet another important conversation, this time with the mother of one of my best friends. She was telling me about how her mother had kept all kinds of family memorabilia. It was wonderful, she said, to have bits of personal history going back for generations.

“I’ve been meaning for so long to make photo albums,” I said guiltily. “At least for five years.”

“Oh, that’s nothing,” she said, folding her hands. “I’ve been waiting 50 years.”

And then she laughed. She had her husband and children and grandchildren all around her.

“Nobody makes photo albums,” she said.

There are far more important things than photo albums - your sanity included. And roast beef for Sunday dinner. But maybe we can pull that off.

With a little help.

OVERHEARD LINES: Study group for the SAT, or, She really gets it!

2009-05-09T16:50:00.003-04:00

At a restaurant.
Him: The Lion King is to The Little Mermaid as . . .
Her: Doctors are to dentists.

OVERHEARD LINES: Taking Nicodemus Too Literally, or, Worst Hot Tub Ever

2009-04-13T16:10:00.002-04:00

Woman, after finishing Easter Breakfast: I just want to crawl back in a womb.

Why I Love My Friends, or, Puns are Awesome

2009-04-11T20:54:00.004-04:00

I was reminded tonight of how much I like some of my friends. I had the following conversation the other night. I bet you can't tell which one is me and which is my friend.

We're going to Fast & Furious tonight at 740.

You’re not serious.

I’m fast and serious.

Hope I’m wrong and it’s awesome. I just don’t see how that’s possible without Sam Jackson, snakes, and mother effing planes.

Dude, it’s the fourth movie of a series that should never have started. You know it’s gonna be awesomely bad. What have you got going tonight that could compete?

Anything.
Anything could compete.

Not true and deep down you know it.

But I’m living pretty superficially right now, so deep down doesn’t matter.

Here’s a chance for change

If I’ve learned one thing from the Republican party, it’s that Obama has shown that change is both impossible and dangerous.

Receipes of the Year, or, Vincent's Favorite

2009-02-22T14:30:00.005-05:00

I've been planning several "Year In Review" posts for two or three months now. Best Books of 2008. Best Movies of 2008. Best New Albums of 2008. Best "Your Mom" jokes of 2008. Best Moment of 2009 (which is undoubtedly going to be January 2nd at the Sugar Bowl). Anyway, you get the picture. Like I said, I've been planning these for a while now. Yet with the few free moments I have, writing blog posts just is not a priority. Best Night's Sleep of 2009 keeps getting priority. Sorry you two. I'm sure you've survived without a new update.

So, without further ado, here are a couple of the best recipes cooked in 2009. Tthe first two are new to me this year. Odd, I think, that all three are desserts. While all three of these qualify as my favorite dessert, a friend told me that this first one was his favorite bar-none. Restaurants included. I hope you like it too.

Ameree's Mtn. Dew Apple Turnovers

2 cans Crescent rolls
2 Granny apples, peeled and cut into eighths

2 sticks melted butter
1 1/2 Cup sugar
1 Tablespoon Vanilla

1 can Mtn. Dew

Wrap apple pieces in crescent roll pieces and lay in 9x13 pan.
In medium sauce pan, melt butter and stir in sugar until just mixed. Add vanilla. Pour over rolls. Pour most of a can of Mountain Dew all over into dish. (I do all but about two swallows. Otherwise they aren't quite flaky enough).
Bake 350 F for 40 minutes. Remove from oven.
Sprinkle with cinnamon.

These things are awesome, and they go really quickly, so be sure to get one early.

Jenny's Bread Pudding

Pudding
2 loaves white bread, cut off crusts, cut in cubes
1 1/2 Cup sugar
4 eggs, beaten
1 1/4 cup heavy whipping cream
1 1/2 cup milk
1 stick butter

Caramel Sauce
1/2 cup sugar
1/2 cup brown sugar
1 stick butter
1 cup corn syrup
1 1/3 cup heavy cream

Caramel Sauce: combine sugars, corn syrup & butter in sauce pan over medium heat. Remove from heat and add cream.

Mix all the pudding ingredients except bread. Fold in bread. Put in non-stick 9x13 pan. Pour 1/2 cup of caramel sauce on top. Bake 350 F for 30 minutes. Rotate pan 180 degrees in oven. Bake 30 minutes more until golden brown on top. Pour remainder of carmel sauce on top. Serve with whipped cream or vanilla ice cream.

This is really tasty but super-rich. People can't usually handle too large a piece, so this will feed more people than you'd expect.

Mom's Strawberry Cream Cheese Cake

1/2 white box cake mix, bake ~15 minutes.

Whip 1 pint cream, add 1/2 cup powdered sugar.
Whip 8 oz cream cheese with 1 cup powdered sugar.
Fold cream and cream cheese together. Spread over cake.
1 pkg danish junket with 1 1/2 cup water. Put as many strawberry slices as will fit on top of cream. Pour junket over top while still hot. Chill and serve.

This has been my personal favorite for the last 10 years. The apple turnovers might be edging it out currently, but I don't know if they can hold on to the lead once the novelty wears off.

Sacrament of the Damned, or, Folgers in the Sacrament Cup, or, Gone Fishing

2009-01-11T16:25:00.005-05:00

I was nine years old when I became a hardened sinner.

Grandpa wanted to teach me to fly fish, so we planned a weekend trip – just the two of us. I loved him, of course, but this particular grandparent was more intimidating than the mean-old-lady-substitute-Primary-teacher.

We rode up in Grandpa’s ancient diesel VW Vanagon – a vehicle never known for its stealth. Add to that the fact that, due to a childhood illness, Grandpa was deaf in his right ear, and it becomes clear why all our conversations sounded like a shouting match. But though these barriers to communication were high, they did not stop Grandpa from hollering a few jokes at me as we puttered north from Salt Lake. Jokes I would never repeat to my mother.

“What was the last thing to go through that bug’s brain?” he barked, pointing at a particularly large red-green splotch on his windshield.

“I don’t know,” I shouted. “What?”

“His anus.”

We got to the fishing hole before dark, time enough to pull in a few rainbows. Gramps did not have a pair of waders small enough for me. So I got to “cowboy up, kid.” Even in mid-summer, the water was icy, and numbed my skinny legs quickly. Grandpa had attached a billy club to his waders. He used it to crush the fish’s head as he pulled it out of the water. As for me, billy clubless, I was just supposed to break the fish’s back with my bare hands.

Fishing was rapidly losing its allure.

Finally, the sun sank below the horizon and I gratefully followed Grandpa to the van, shivering the whole way. We drove to a parking lot, warmed up a nice dinner of pork and beans, and retired for the night. I knew that a full day of fishing awaited us tomorrow. A day full of fire and brimstone, damnation and hellfire, because God had me in his scope, and was about to pull the trigger.

I woke as Gramps fried up some of the previous night’s catch. I still have no concept of his actual skill at cooking trout –I’ve never been able to bring myself to try one again. I picked at my fish for some time while he worked at the stove, fiddling with a strange, tall pot that had a transparent bubble on top. The clear bubble flashed brown occasionally, letting off strange gurgling noises, too. After a few minutes, Gramps finally poured me a mug of whatever it was. Pushing the mug across the breakfast table he muttered, “Here’s some sugar, if you want it.”

I was nine. Of course I wanted sugar! I wanted even more after I tried Grandpa’s new drink. Could he make nothing that tasted decent? A liberal dousing of sugar was the only thing that made the drink passable. I stopped pretending to eat the fish, and nursed this new breakfast drink instead. It soon became clear, however, that I had scrimped on the sugar. So I added more after every few sips and quickly found the point of diminishing returns: the sugar stopped helping. The drink became cold.

There I sat, longing for the pork and beans of the night before, picking at a mauled trout fillet, playing with a half-cup of brown swill swimming over a bed of undissolved sugar, when Grandpa’s harsh voice scolded me:

“What, you’re gunna be a damn Mormon brat and not drink your coffee, either?”

Suddenly the reality of Grandpa’s bitter brown liquid became horribly clear. I sat dumbstruck; my mouth suddenly glued shut. A flood of Primary lessons came rushing back to me. “The Lord has given us these bodies. They are holy temples. And cursed is he who defiles a Temple of the Lord,” I could hear Sister Purplehair declaring, “How would you feel if someone spray-painted graffiti all over the Salt Lake Temple? Well, that’s how Heavenly Father feels when we don’t respect our bodies!”

And here I was pouring filth straight into my temple!

My mind was racing. “Coffee! How could you be so blind, Bryce? Maybe you wanted to be blind. You wanted to be led away in sin. You wanted to walk close to the edge. Well, you’ve done it now. You’ve walked up to the edge and jumped right off. I sure hope Hell is nice this time of year. Hello, Brother Lucifer, long time no see.”

Plainly, I had become one of the vilest of sinners. But I did not want anyone else to know my shameful secret. The seriousness of my sin swirled in my mind as the water lapped around my legs that Saturday in the fishing hole. That my fallen, sinful, and horrifying state should be kept from my family, and especially my parents, was painfully clear to me. The first few years of my deception turned out to be easier than I had feared. I was not due for my next bishop’s interview until I was 12; and not having the priesthood meant no monthly PPI’s questioning my worthiness.

The Sacrament, however, was a challenge. My education in this area had been quite complete. You were NOT supposed to partake of the Sacrament if you were not worthy, unless you wanted to ensure your own damnation, of course. Woe unto him who eateth unworthily and what-not. I knew that I had already bought my ticket to the underworld, but I did not need any more flight insurance.

So I developed a strategy to hide my shameful status as a Sacrament non-partaker. When passed to me, I would pinch the bread between thumb and forefinger (right hand, of course!), bring it toward my mouth, and deftly palm the piece of bread. It could then be slipped inconspicuously into a pocket while a bit of artful misdirection on my part – pretending to chew and swallow – completed the illusion. That was the easy part. Smooth sailing to this point. I was a David Copperfield in training. I could make anything disappear. Until the next tray arrived.

Water. It was just an ounce or so, but it was a liquid ounce. I could not simply palm and pocket this. Nor could I merely pass the tray untouched. The whole ward would obviously see that. Neither could I just press the cup to my lips, as Pops would surely notice. I had no choice but to actually allow the water to enter into my mouth. Only then could I evade detection as the whited sepulcher that I had become. But once in my mouth, it was imperative that it not proceed down my throat to water the seed of damnation inside me.

I was a skinny, limber child and could easily double over on the pew. It seems only obvious that I would assume this reverent, contemplative pose after taking the water. Letting the water trickle out from my mouth onto my knee thus became child’s play. My father, who could detect whether or not water had been sipped from the small paper cup, would never notice the four inch wet spot on my knee. Or, if all else failed, I could wait until the Sacrament was over, go out into the foyer, run the drinking fountain, and place my lips into the stream of clean water . Only then would I allow the damning water to dribble out of my mouth and down the drain.

This continued for three years.

As I neared my twelfth birthday, I became aware of an upcoming event that could bring my house of cards crashing down around me: the required interview with the Bishop prior to my ordination to the Priesthood. I had the Articles of Faith down pat, but I had no idea what questions the Bishop would ask me or what the consequences would be for failing to answer one correctly. Public humiliation? Denial of the priesthood? I did not know, but my conscience was not completely seared by my wicked past. I resolved that I would not tell a lie to the Bishop. I knew I was already in deep enough.

The bulk of the interview passed without note—my worries were for naught—until that damning last question. The one designed to catch sinners like me.

Yes, there were things in my life that would keep me from receiving the Priesthood.

Lower-lip quivering, my mouth opened. And though the powers of hell conspired against me, making the walls close in around me, my throat dry up, and my stomach clench, I confessed.

I can still hear the Bishop laughing.

My Country, Tis of Thee, or, Go UTES!, or, Oh, Canada!

2009-01-05T19:43:00.008-05:00

In true American style, as a self-declared patriot, I declare that if the nation does not vote The University of Utah Utes the National Champions of the National Collegiate Athletic Association Football Bowl Subdivision, I am moving to Canada.

Word of the Time Period

2008-12-22T22:33:00.001-05:00

Koro.

Worth googling. I promise.

It's A Really Great Song, But I Wouldn't Like It, or, An Open Letter, or, Ways to Antagonize Your Audience

2008-12-17T22:26:00.007-05:00

Dear Sir or Madame Whose Blog I Occasion,

Why do you people think you have better taste in music than I do?

I've got news for you. You don't.

Believe it or not, I don't actually want to listen to your music while reading your blog. Not now. Not ever. I'd rather listen to a) the quiet whir of the heater under my desk, b) my own music, c) that "It's Delilah" crap 24-7, d) a dentist's drill, or e) basically ANYTHING other than your particular music. It's amazing how opposite our taste in music clearly is. I won't begrudge you treating yourself to that slop, but it's like you are making me pay a tax with my ears for the privilege of viewing your blog. Maybe it's just my fiscally conservative upbringing, but I just don't think the public will tolerate this particular type of taxation much longer. So, please, if you love our great country, get rid of those auto-play songs!

Now, as most reasonable people have discovered, providing people with music they can choose to listen to whilst perusing your blog is acceptable webehaviour. But removing my choice in the matter? Forcing me to listen to your music, which invariably stinks wore that tarry-black-red-brown gunk that comes out of someones nose 2 weeks after sinus surgery, while my browser is aimed at your blog? That sounds awfully similar to communism, and smells worse than the Tijuana dump. Hopefully people come to their senses quicker than Castro. Because communism kills, people. Communism kills.

Sincerely,

Peetie

Crack Cocaine, Marijuana, and Jazz Music, or, Family Practice = TV Time Out, or, People Are Crazy

2008-12-05T17:58:00.008-05:00

I'm at a Family Medicine clinic this month, which means my hours are, as my friend Matthew would put it, sweet. Which means I started a new TV show that someone recommended a long time ago. It's a little Canadian show called Corner Gas. I haven't seen enough to give it my own endorsement, but the opening was probably the best I've ever seen. Judge for yourself.

And they have a Wallflowers song during the title sequence.

Sweet. Except . . . I thought Canadians were supposed to be all nice and polite and stuff . . .

Also, I found a couple of new comic sites to add to my Google Reader. A Softer World is awesome. They are consistently hilarious, if you are a bad person. Another which is usually pretty funny is Married To The Sea. The other day their comic reminded me of some of our patients.

We've Never Lost a Fireside!, or, Going Bowling, or, GO UTES!

2008-11-25T20:20:00.004-05:00

Poor taste?

Add salt. Makes it better.

Things Worth Staying Up For, or, Go UTES!

2008-11-07T17:07:00.002-05:00

What's the best way to cap off a 14 hour day at school?

It didn't even feel that early the next morning.

When I Grow Up, or, My Thoughts Exactly

2008-11-01T12:06:00.005-04:00

People keep asking me what type of physician I want to be. I'm still not very sure, but that decision needs to be made in the next 6 months.

If I had to go back and do it again, I would, and I would want to become just like Robert Kirby. The guy is the most consistently awesome writer since, well, Dave Barry. Sortof. Agree or disagree with his content, he pulls this off masterfully.

http://www.sltrib.com/lds/ci_10809759

Robert Kirby, Salt Lake Tribune

A couple of years ago, I wrote a column in which I announced my official position on gay marriage. Basically, I don't care.

Not only do I not care if gays get married, it is none of my business. As a flaming heterosexual, it's a full-time job for me just to keep my thoughts clean in church. I don't have the energy to fret about somebody else's libido.

The column must have resurfaced on the Internet. I'm getting mail again telling me what a failure I am as a Mormon because I'm not solidly behind Proposition 8. As I understand it, the California ballot item would prevent the domestication of homosexuals. Or something like that.

Here are just a few of the attempts to get me to see reason.

"Are you a member or not? Do you want gays to get married in the temple? Please follow the brotheren's [sic] council [sic] on Proposition 8. This is a important gospel principal [sic]." G., e-mail.

"No unclean thing can enter the house of the Lord. Gays are unclean because of the Scriptures. You have to be hot or cold about it or the Lord will spat you out." T., e-mail.

"Were you listening in church when the letter was read from the First Presidency about supporting proposition eight?" R.Y., e-mail.

"Get with Prop 8 or your [sic] a homo." Anonymous, letter.

Hard as it is to counter such brilliant logic, my position hasn't changed. The only serious concern I have about gays getting married is that they'll register someplace pricey.

The church is serious about the sanctity of marriage. I get that. But aren't more potentially "dangerous" marriages already being performed out there?
For example, I hear in church all the time about marriage being ordained of God.
But I also hear about how the glory of God is intelligence.

Shouldn't it be against the law for stupid people to get married? What's more harmful to society - two well-dressed men getting married and settling down, or two idiots tying the knot and cranking out any number of additional idiots?

You should have to pass a harder test to get married than the one we currently have. Essentially, there are but two questions: "How old are you?" and "Is that your sister?" Hell, you could pass this test just by guessing.

There are drawbacks. Most people get married when hormones and youth make them about as dumb as they'll ever be. So, even a relatively easy test would by default raise the age limit to about 40.

With an increased marriage age limit, there would be fewer births. Genealogy would become easier to do. With fewer births, there would be fewer children born gay. Hey, isn't that what Heavenly Father would want?

OK, I was just kidding about that. But if you're really serious about putting a stop to gay sex, let them get married.

Sappy, Sentimental, and/or Sincere

2008-09-29T19:32:00.003-04:00

http://apod.nasa.gov/apod/ap080722.html

Worthwhile five minute study break.

Why It's Cool To Be Marginalized, or, Woe Unto the . . . Gullible?

2008-09-17T19:32:00.008-04:00

It becomes so easy to screw with people when you're part of a marginally acceptable group. For whatever reason, I was eating a donut during a meeting this morning. With a spoon. A friend of mine was next to me, and thought it awful strange.

I told him that Mormons believe that eating things with our hands makes the food dirty, allowing Satan to take control of our bodies.

Hook.

Line.

Sinker.

Of course this kind of thing is always followed with, "You know I'm joking, right?" I'm sure my friends are just trying to be polite to the religious nut-jobs, and I know it's not nice to take advantage of that, but it sure is a lot of fun screwing with people.

Going to Hell?, or, Dating, or, What are you up to this weekend?

2008-09-13T10:24:00.006-04:00

To quote a recent friend,

"Isn't it fun that we are at the point in our lives that everyone is scared for our eternal salvation so they try to hook us up with everyone they know! Cuz you know that when we hit thirty we are doomed, right? [. . .] But you, I'm afraid are a bit closer...you should work on that before you burn!"

Serious and slightly depressing, or, Life in general

2008-09-05T17:18:00.003-04:00

So, I have no idea how to handle a certain situation I have been facing weekly, if not daily. This morning's ride in the elevator up to my hospital floor illustrates perfectly, I believe.

Entering the elevator with only a few other people, I smile at the 50-60 yr old woman, holding two cups of coffee. Saying hello, I ask, "How are you?"

Turns out that trivialities like that, when wearing a white coat, are not taken as such. The woman replied, "Well, they're taking my grand-daughter off of everything today, and they're just going to let her go."

__________________________________

What do you do? I mean, what in the world is there to do?

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I said, "Oh, I'm so sorry." and I was.

I felt bad for her and her family.

I also felt bad that I'd asked the question, and I also felt bad that I was wearing the white coat.

Why the animosity towards the white coat? Not only because it is the fomite from hell, but because it made her want to share about the little baby, who was about to die.

And "they" were the ones doing it.

And "they" wear white coats too.

Just like me.

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On a related note, is there a good way to walk out of a dieing person's room and say, "Have a good day"?

I realize this is disjointed. I should rework this instead of posting it immediately. But I'd rather not dwell on this anymore than I already have. I'll attempt humor again in the next post.

OVERHEAD LINES: A New Fetish? A Truly Potent Potable?

2008-08-22T18:23:00.002-04:00

Guy, to guy: Dude, you doing the Elk Urine?

(The capitalization was audible).

10 more days; 10 DAYS MORE!

2008-08-20T13:51:00.002-04:00

OVERHEAD LINES: Umm, what?

2008-07-12T13:40:00.002-04:00

Woman to man: Can you saran-wrap her? I can't get to her right now.

Two recommended reads

2008-06-24T14:12:00.002-04:00

I came across two articles in the past couple of days that I really enjoyed. The first is by Robert Kirby, who is a great tongue-in-cheek writer for the SLTrib. For anyone not aware of the Trek phenomena that seem so popular among Mormon youth groups, be grateful.

Kirby: Crossing the plains was a pain
Robert Kirby
Tribune columnist
Article Launched: 06/21/2008 12:00:00 AM MDT

My great-great-grandfather Korihor Kirby trekked to Zion in 1855. He brought along my three grandmas, a regiment of children, two oxen, a dog, a sack of mustard seed and a banjo with a set of teeth marks in it.
The fact that they crossed the plains at all is the only resemblance my ancestors' experience has with the correlated version of what transpired. That we came at all is either a miracle or a misunderstanding.
The popular history of the great Mormon migration is one of vast hardship endured through faith and prayer. There were miracles aplenty along the way - food falling out of the sky, unseen Nephite spirits helping pull the wagons, and babies born in bison stampedes.
I concede that such things probably happened, but not that they were the rule. All sorts of Mormon personalities crossed the plains, including my family.
According to Grandpa Korihor's daily ledger titled Brethren That Owe Me Money, he wasn't exactly wild about coming to Utah. He liked Nauvoo. From his own pencil stub:
"Sun. May 20 (1855) - Church. Another discourse about gathering unto Zion. Am NOT going."
"Tues., June 5 - Dance. Pres. Pratt unduly attentive to Sister Grimm. Ministered unto him with banjo and fist."
"Wed., June 6 - Sold tavern. Leave for Deseret in morning. Anyone not in wagon gets left."
My grandmothers'journals contain mostly domestic observations about the overland trail, how hard it was to wash clothes, feed children, and keep the wagon clean during Family Wagon Evenings.
Grandma Meany occasionally took the time to pen her spiritual convictions, all of them heartfelt essays about how much God hated her husband.
"July ? - Delivered another child in the rain. It's what I get for marrying a Telestial spirit."
This isn't to say that my ancestors didn't receive divine help getting to Utah, just not the kind you'll read about in Ensign magazine. From Korihor's ledger:
"Aug. 1, Platte River - Mustard mush gone. Children clamorous about remaining distance. Went river pray for deliverance or drown self. Pelican hit by lightning. Dined on same. Beak and feet to bishop for tithing. Lord good but not overly generous."
My ancestors arrived in Salt Lake City Sept. 22, 1855, having taken nearly twice as long to cross the plains as the average Mormon.
Today, Mormon youth re-enact the pioneer trek as a way of understanding what it took to build Zion. Four grueling days of pushing a handcart across Wyoming teaches them something, I guess. Reading about it is enough for me.
It's not enough for my editor, though. She called me into her office today and told me to go buy a hat and a bucket of sunscreen because, "We're sending you to cover one of the LDS treks next month."
rkirby@sltrib.com

The second is by a blogger over at madhousewife.wordpress.com, and while the whole article was fine, it was two paragraphs that I really liked. Most of you know there are types of Mormons that drive me nuts. This woman hits the nail on the head with one of those types.

This is not a Mormon blog. It’s a blog written by a Mormon lady who occasionally goes all Mormony on you. I enjoy mocking my own culture sometimes–not to be all subversive and in your face, but because that’s just how I roll. I mock because I love. I love being a Mormon, and I love Mormondom in general. That doesn’t mean I’m blind to the church’s flaws and weaknesses, in its leadership and/or its membership. Some people wonder why, considering all my doubts and alleged square-peggishness, a sarcastic suckhead like me sticks with an institution that is designed for cookie-cutter sheep-type people with great teeth and awesome hair. Well, the fact is I am not that special, I don’t like my boat rocked, and my teeth and hair are pretty great, if not outstanding. But it comes down to this: the church is my home. Mormons are my family. We’ve got our skeletons and our crazy Aunt Myrtles. I can take good-natured jokes about this stuff because I’m willing to own the kooks and the skeletons. And in turn I can joke about it because I have such deep affection for the community–an affection I think is obvious to anyone who reads me without prejudice.

It is not obvious to a certain subset of Mormons, people who think being Mormon means never having to be ironic. I’m sorry that you people are irony-deficient. I wish there were a supplement you could take, because then you wouldn’t leave random comments on my site telling me that I’m bigoted and have no manners. This happens from time to time, and I usually shrug it off because, whatever, they don’t know me and they don’t care, why waste the emotion. When somebody leaves a comment like, “Your a little retard, Mormons are great,” I don’t even feel compelled to correct their spelling, or to point out that “retard” is not a euphemism that charming people use. I definitely don’t see the point in explaining that I myself think that Mormons are great, because if they didn’t want to understand the first time, they’re usually not motivated to get it the second time either.

OVERHEARD LINES: Creation of a Vegetarian

2008-06-14T20:15:00.000-04:00

Man: What did you do today?
Little girl (with excitement): I got to hold a baby chicken!
Man: Oh, that's nice, because that's exactly what we're eating tonight.

OVERHEARD LINES: Woman at Mexican Restaurant, with therapist?

2008-06-12T13:36:00.004-04:00

"I've had plenty of old people touch me at the supermarket."

Getting What You Pay For, or, Clint Clips the Competition, or, "Oh Boy"

2008-06-02T08:32:00.009-04:00

The problem with free stuff is that obviously you get what you pay for. Even if it's as simple as cleaning up the neckline. I hadn't realized how much hostility Clint had built up inside until after asking for a favor. Doesn't quite have the steadiest surgeon's hands, does he? At least his fees are affordable.

I'm done. DONE!

2008-05-29T18:17:00.002-04:00

If I hear the words "High" and "Yield" anywhere near each other - even in the same sentence - I'm going to have to punch someone in the throat.

USMLE Step 1 was my blyad! (hopefully)