evidently, jewish is the #1 word that people type after marc mezvinsky. a little spooky that it read my mind, a little annoying that I’m just like everyone else, and so awesome that google lets me know it.

Imagine you have a 3pm flight from Las Vegas to New York that arrives at midnight. You arrive early with a friend who has a 1pm flight that gets in at 9:30. That sounds soooooo much earlier. You approach the lady at the ticket counter and ask her if you can fly standby on the 1pm flight.

She says that there are six people in front of you on the standby list. Would you like to add your name? Sure you would. She says that there is a $50 fee to switch flights, but that if you aren’t accepted as a standby and end up on your originally scheduled flight, credit card is not charged. Is that okay?

What do you say? Reasonable deal?

All right now consider a different scenario. You approach the lady at the ticket counter and ask her if you can fly standby on the 1pm flight.

She says yes, but it will cost you $50 to change the flight.

Is it worth it?

Interesting, eh?

Amtrak cars seat two passengers on each side of the center aisle. Like everyone else traveling alone, I want to have a set of two seats to myself. There are some small number of solo travelers who would prefer to sit next to someone; these are of course the travelers to avoid being near at all costs.

If there are no sets of vacant seats, I must choose whom to sit next to. I must make this choice as I walk down the center aisle. There may be fellow travelers in front of me, making the same decision, on whose leftovers I must feed, and behind me, who will feed on my leftovers. The more people behind me, the less able I am to linger in one spot to consider my options, though veterans utilize carefully orchestrated stall tactics to buy an extra moment, such as switching a large piece of luggage from one hand to another or, in a related maneuver, accidentally having a wayward luggage strap get caught on an armrest. In general, however, I have about three seconds to assess each pair of passengers as they appear on either side before me: 1.5 seconds per person.

I must make this decision in 1.5 seconds, with a paucity of information. I see what each candidate looks like, hear what they’re saying if they happen to be saying anything, and occasionally catch a scent. No touching or tasting is allowed, and I cannot ask any questions. In 1.5 seconds I must decide based almost entirely on prejudice, preconception, and bias.

If I can’t sit alone, I want to avoid sitting next to someone who will try to talk to me. I want to avoid sitting next to someone who takes up too much space, someone who will eat, talk on the phone, pass gas, or steal my wallet. I want to avoid sitting next to someone who smells bad, or might start to perspire if the train stops, or will whip out a portable DVD player and start watching a movie, because I know that will distract me.

If I can’t sit alone, what I really want is to sit next to someone who will get off at the first stop, 30th Street Station, so that I can have the set of two seats to myself for the remainder of the trip. Coming to a decision based on these goals would be difficult enough in 1.5 seconds if it weren’t that my prejudices tell me that the kind of person I otherwise wouldn’t want to sit next to is also the kind of person who is likely to get off at 30th Street Station. So complicated, this world we live in.

Anyway, regarding the middle aged, stuttering, mildly dense guy, with what little of my attention wasn’t occupied by menu porn, I figured he was drunk or distracted. We sat down, and I was surrounded by people I didn’t know but was expected to talk to. An overly bubbly dominican girl started chatting with me, and I remember looking at her and being unable to focus on the conversation out of hunger: as she spoke, she turned into a steak, like in those bugs bunny cartoons when two castaways are stranded on a desert island.

Finally a very thin, mildly disheveled lady in her fifties approached and asked us if she could take our drink orders. I replied that I would like a shrimp quesadilla and a steak and cheese sandwich. Not a drink, for sure, but she looked at me as though I was speaking an exotic language. Now, with the hunger and all, I’m starting to get frustrated. As if I hadn’t said anything, she asks the table again if she can take our drink orders. Other people start ordering drinks, and she starts writing them down, but it’s taking her two and three tries for every order, I wonder if she’s reading lips or something and also wonder if I’m going perish before I get any food. Ultimately she serves the drinks and I ask her if I can order food, and it took a few moments but, yes I can. I again request a shrimp quesadilla and a steak and cheese sandwich, no tomato. She doesn’t get it. I look at Rodney, what on earth is going on. I point on the menu and raise my voice, she’s slowly beginning to comprehend but not fast enough for my appetite which now dominates all other emotion and reason. After what seemed like 45 minutes she gets my order down on her pad, and I’m incredibly annoyed, almost angry.

Rodney’s turn to order, and he’s straining to get the message across as well, what the fuck is wrong with this woman? Fortunately Rodney works with at-risk teenagers and is able to relate to her better, but still, his gorgeous locks of hair have lost their usual bounce – an early sign of patience being stretched. After she finishes with Rodney, she turns back to me, stares at me for a second, as if trying to remember something, and then asks me if she can take my order, and I am struck with a realization so thick and heavy that I might have just done a belly-flop off the high dive, the wind actually knocked out of me. This woman is mentally disabled, and so is the stuttering dude. This restaurant hires mentally disabled workers.

It took a few moments for the concept to sink in, but what happened next was even more remarkable: every thread of frustration evaporated. Instantly. In a matter of seconds I was living in an entirely different brain. Her incompetence didn’t bother me in the slightest; in fact her inadequacies as a server, which I was just enumerating in my head for a letter to the manager I was possibly going to a write, suddenly seemed like virtues. 20 minutes to process the word quesadilla? Fine. Not just fine, amazing. This disabled woman was doing a job that fully functional people find challenging. And the owner of the restaurant, who hires these people? God damn hero. I no longer cared when or if I got my food. In the end I left a generous tip.

I have encounters every day with people who frustrate me. For my work, I am charged with helping people deal with problems they often brought on themselves through vice and shortsightedness, and it is precisely these people who are the least grateful for my help and often frankly hostile, even when I’m trying hard to be nice. And sometimes it is really hard for me to be nice. Why can’t I harness the compassion switch that flipped in that restaurant? Take the compassion I felt for quesadilla lady and apply it to the world at large? Everyone’s disabled in their own way, right? Is this how jesus felt? Endless compassion? What a guy.

While our waitress was away working on our drink orders, Rodney, who lives in Montreal, flagged down the stuttering dude and pointed to soup du jour on the menu. What is the soup du jour, he asked. Stuttering dude looked at him and assumed a face that said, oh good, I can answer that question. In his most helpful voice, he replied, “It’s the soup of the day.”

1. When you can’t decide whether or not to pee before you go to the next venue, pee now.

2. When you’re at the store and you can’t decide whether or not to put your wallet down on the counter, don’t.

3. When you can’t decide whether or not to say something about someone else, don’t.

4. When you can’t decide whether or not to go for a run, go for a run.

5. When you can’t decide whether or not to make conversation around the name of a person you just met, don’t. That person has had that name their entire lives, and anything you have to say about that name has been heard by that person a thousand times. Ask about their job, talk about the weather, anything but their name. My favorite approach is to respond to the question “How are you?” with a random thought like “Good. Though on the way over here this guy on the subway ate an entire plate of nachos right next to me.”

6. When you can’t decide whether or not to capitalize a word, don’t.

7. When you can’t decide whether or not to make a comment about someone’s appearance, don’t.

8. When you can’t decide whether to handshake or hug, hug. When you can’t decide whether to hug or kiss, kiss.

9. When you can’t decide whether or not to shave, shave.

10. When you can’t decide whether or not to make a disclaimer, don’t.

I don’t want to be negative, but…

Disclaimers are an attempt to at the same time take responsibility and not take responsibility for what you’re about to say or do. You can’t have it both ways. If you don’t want to be negative, don’t be negative. You evidently DO want to be negative, you’re just hedging your negativity with this disclaimer. It’s a way of preemptively seeking forgiveness. But if you know you will need to ask forgiveness for something before you do it, you clearly don’t deserve to be forgiven. That said, I live by the maxim it’s easier to ask forgiveness than permission. But that’s different, that’s just taking your chances, has nothing to do with disclaimers. Fuck disclaimers.

I don’t usually do this on a first date.

11. When you can’t decide whether or not to use the word “obviously” or the phrase “of course,” don’t. If what you are about to say is truly obvious, it doesn’t need to be said. If not, you’re being insulting.

12. When you can’t decide whether or not to get out of bed, get up. Then reward yourself with a hot shower.

13. When you can’t decide whether or not to go to a wedding, don’t go. But when you can’t decide whether or not to go to a funeral, go.

14. When you can’t decide whether or not to water your plants, don’t. Everyone overwaters their plants.

15. When you can’t decide whether or not to broadcast a virtue, don’t. If you’re good at math, let them figure that out when it’s time to split up the bill. If you tell them you’re good at math before the bill comes, they’ll be at best unimpressed and at worst annoyed. Broadcasting is also the hallmark of inauthenticity: if you paint flowers in your spare time, that is something that should only be discovered by the stack of paintings in your closet found long after your death, not by the shitty paintings of flowers on your wall bearing your oversized signature.

16. When you can’t decide whether or not to use a superlative, don’t. Present your arguments with facts, and let the facts speak for themselves. Contrast

Ezekiel is the funniest comedian I’ve ever seen.

with

My sides hurt for three days after seeing Ezekiel perform last week.

17. When you can’t decide whether or not to use the phrase, “you should,” don’t. If you want someone to do something, sell it, don’t suggest it. A particularly despicable scenario is when “you should” is combined with a superlative.

That was the best book I’ve read in five years. You should read it.

What a conversation stopper. It’s not for you to tell me what I should do, and making frilly, superlative displays is for peacocks. Humans can explain.

Last month I read _The Giving Tree._ I started it on Sunday evening, and called in sick to work on Monday and Tuesday, finished it on Tuesday afternoon.

The most effective sale is accomplished by seduction, that is, the buyer doesn’t realize he’s been sold.

18. When you can’t decide whether or not to call your mother, call. Of course you should. Obviously.

The intersection of our routine and our priority structure generates a pattern of accomplishment in the following way: On a day-to-day basis, we move through our priorities, starting with the base and moving up, and at some point we run out of time. Because most of us have developed predictable (if implicit) priority structures, and because our routine tends to be, well, routine, there is a line in our priority structure below which the elements reliably get done, and above which elements reliably don’t get done–day after day, week after week. The irony is that activities that often fall just above the accomplishment line are A Tasks, which are most likely to result in long term improvements in our quality of life. Our challenge is to optimize our priority structure and to raise our accomplishment line.

I went camping this weekend, and joked that I prefer camping equipment to camping, and that I only go camping so I can use my camping equipment. This joke was in my favorite style of humor, which is stating a truth as plainly as possible, so that it’s perceived as a joke. This particular truth-joke, however, reveals an important strategy, which is that purchasing something cool inspires us to use it. Expensive camping equipment is lame, but camping is one of those things that I dread doing but always appreciate having done after it’s over, so if purchasing expensive camping equipment pushes camping below the accomplishment line, it’s an excellent use of money. This is gadget to action.

Gadget to action is why Mac users do so much more cool shit on their computers than PC users; Mac programs are fun and make you want to use them. I once designed a 3-year research project because it would have given me a reason to use a supercool Mac app.

I want to read more. Should I buy the Kindle?

In a larger sense, life is short, and among the most unsettling aspects of getting older is that as each moment passes, each moment represents a smaller fraction of our memorable lives, so that time passes more quickly as we age. A twelve year old’s summer is a sizable chunk of her life and seems to go on forever; the 42 year old feels on labor day that she just finished clearing the driveway of snow.

If time is precious, we benefit from a longer life, so it makes sense to do things like eat well and exercise. But all time is not equally valuable, in fact, time is only valuable insofar as we are happy during that time. We only want to maximize our number of happy minutes, so what to do if you hate eating well and exercising? It makes no sense to take steps to prolong your life if those steps diminish your happiness.

Further complicating the issue is the unfortunate tendency of happiness to actually destroy time. The happier we are during any given minute, the quicker that minute passes. What good is a lifetime of bliss that goes by so quickly we don’t notice it? Not much better than a lifetime of misery that never ends. We therefore want not only as many minutes as possible, but happy minutes, and not only happy minutes, but happy, slow minutes.

Most of us feel happiest when we’re busy, but busy doesn’t just use up time, it also destroys time in the way that happy destroys time. This is getting confusing.

One way we try to increase our enjoyment of any given minute is to consume cultural media. Music, books, magazines, newspapers, television, cinema, theater, the visual arts, and then the internet, which intersects and expands on all of these in all sorts of ways. We benefit from living in a time and place where we have access to an infinite reservoir of media that we would enjoy consuming, and our challenge, given the few minutes we have in the day and on earth, is to consume the media that makes for the (slowest) happiest minutes. Luckily, humanity has generated so much fantastic cultural media that it would take a lifetime just to consume the classics, and what a life that would be.

But we tend not to consume the classics. We buy and download the latest bestsellers, trendiest bands, blockbuster movies, and news of the day. This is illogical. Why would we spend our precious minutes consuming a new release when we could benefit from the sieve of time and generations of judgment to select for us the best media and consume that? Why is this week’s New Yorker so much more appealing than last week’s? Our consumption instincts encourage us to gulp down the fire hose of hot off the press, when we could be leisurely sipping from the media that has, through its demonstrated excellence, made its way downstream. The issue is not only that new doesn’t deserve the high status we are conditioned to give it; trying to drink from a fire hose is really busy, and busy destroys time. Furthermore, the current current widens as you try to swim in it–keeping up with one blog leads to two, newsfeeds lead to more newsfeeds–it’s not only never-ending, it’s viral. And exhausting. This is why so many report that they are much happier now that they’ve unplugged the internet from their homes.

During our unhappy minutes, we feel guilty for being unhappy, as we rich inhabitants of rich nations have nothing to complain about. We bathe ourselves in perspective checks when we’re down, and don’t hesitate to splash some on our complaining friends. Your boss won’t give you another week of vacation? That’s terrible. Have a look at this kid, his parents and siblings were just slaughtered before his eyes. And he has HIV.

Nobody would choose to wish for food, shelter and safety rather than an extra week’s vacation. But the assumption underlying perspective checks is that people wishing for food, shelter and safety are worse off than people wishing for another week’s vacation. It is certainly true that people who struggle to satisfy their basic needs try to move to a “better” station in life, but what if their instincts mislead them? Every station has its struggles, the question is whose happiness is more abridged by his struggles. Who is more unhappy: the cold, hungry homeless man or the lonely, directionless college grad?

I suspect that the higher we rise on Maslow’s hierarchy of needs, the more deeply our happiness is abridged by our struggles. Like all of you, I was born near the top of the hierarchy, so this conclusion seems convenient and self-serving. But my job not only puts me in contact with people from all over the hierarchy, but mandates that I assess their problems and their response to their problems. My conclusion is that though there are lots of unhappy homeless people, to reach the most horrible depths of misery, you have to be liberated from the need to find a place to sleep.

No doubt, however, that every cold, hungry homeless man would trade places with the lonely, directionless college grad and none of the college grads would prefer to walk in the homeless man’s shoes (if he has shoes). Perhaps it’s somehow better to be unhappy, higher on the hierarchy of needs than happy and lower on the hierarchy. Is it better to be an unhappy human or a happy pig? Maybe happier isn’t better after all. This is getting confusing.

Suggestions:

1. Every once in a while, sit and do nothing for a few hours. Stare and think. Or don’t even do that.
2. Stop trying to keep up with the latest of everything. Take a vacation from blogs and news–they’re not going anywhere. Don’t consume the newest stuff, consume the best stuff.
3. Keep perspective checks in perspective. You might be worse off than it seems.
4. Find religion. None of the above applies to the lucky ones who can fool themselves into believing in some sort of cosmic karma, afterlife, or reincarnation. For the rest of us, the prospect of dying is unsettling. Consider, however, the prospect of never dying. It’s a horrifying thought. Why get out of bed if today is just one in an eternal series of days? Life derives its value from its finiteness. Take comfort in your mortality.

When humanoids evolved the ability to reflect, their first conscious thoughts likely involved the feeling that they are at the mercy of the weather. Entire religions were constructed to address the impotence of man in the face of the elements. It is impossible to spend time in an extreme climate and not at least transiently be scared shitless of your utter helplessness at the hands of the environment. Edmund Hillary, who died this month, was the hero of a generation because he represented a victory of man over nature.

Suddenly, however, it is man who has become the aggressor. The perception that we are headed for a global warming Armageddon has become a political, media, and industrial circus. In the period of five years, the issue has moved from the scientific and activist fringe to affect everyone capable of having a conversation. We watch the reports of heat waves, declining crop yields, and drowning polar bears, and shake our heads, ashamed of ourselves.

I walked outside into 16 degree cold last week, and thought to myself, you go girl. For the first time in history, mother nature is the underdog.

Googlevoting came to me in a burst of inspiration when I was torn between humorous and humerus; I know one is funny and one is a bone in your arm, but can never remember which is which. Spellchecker counts them both as correct, but I know the funny one is used way more often than the in your arm one, so I plugged them both into google.

humerus: 776,000 results
humorous: 20,100,000 results

Funny bone, that humerus. But what about Jeff Kline/Klein? There are untold numbers of people with both spellings, and the winning vote will go to the Jeff Kline/Klein with the most recognition, which probably isn’t the guy who’s made a career of studying blood clots. No problem.

“jeff klein” “pulmonary embolism”: 9 results
“jeff kline” “pulmonary embolism”: 79 results

Other tough problems easily solved by Googlevoting include:

here, here! / hear, hear!
naval orange / navel orange
steel myself / steal myself
whoa, horsey / woe is me

But Gvoting isn’t just for homonyms; nor is it just for homos. Google makes quick work of strange proper names, also not correctable by spellcheckers, like my favorite band this week, Bigushkin. Or is it Begushkin? Just punch in Bigushkin and you get,

Did you mean: Begushkin

Why yes, yes I did.

“Don’t overfeed the dogs.”

Trying not to laugh and trying to respond to this without insulting his dogs, I asked him if the sign worked.

“No. I don’t see it.”

Incremental camouflage is the way something that is always in the same place becomes invisible over time. On my desk is a mousepad that looks like an Arabian rug that I use not as a mousepad but as decoration, and on it I put the things that I need to take with me when I leave the house: wallet, keys, watch, phone, handkerchief, hospital ID. I routinely, routinely leave something sitting on my little desk rug when I leave my apartment. I come back in and there it is, sitting there, plain as day. I didn’t see it.

We are frustrated by incremental camouflage when the LOSE WEIGHT sticker that we post on the fridge doesn’t prevent us from opening the fridge, but this phenomenon can be harnessed to our advantage. I keep the most-used cards in my wallet arranged in a particular order, so that when one of the cards is gone, the inside of the wallet looks all wrong and I notice it immediately.

My new job is performed almost entirely on a computer, in a chaotic environment with dozens of computer terminals around, where everyone uses the same computer application to do their charting. A frequently inconvenient and sometimes dangerous situation arises when Bob, charting patient Smith on one of these computers, gets called away to do something, and then Matt sits down and starts charting patient Jones on the computer that Bob was on, thinking that he’s logged in as Matt charting patient Jones, but in fact the application is still logged in under Bob. Twenty minutes later patient Smith receives a medication intended for patient Jones.

The way that many vendors deal with this problem is to log the user out after some brief period of inactivity, but this just pisses everyone off as they have to log in 50 times per shift. I suggest that we force each user to choose a picture from a palette of pictures, each user assigned to a unique picture. That picture, for example a blue bear or a mauve mushroom, appears in the toolbar at all times. After a few weeks, the mauve mushroom in Matt’s toolbar becomes invisible to Matt, but when he accidentally sits down at a computer logged in as Bob, Matt’s mauve mushroom is now Bob blue bear, and that difference will scream at him (though he may not know it) and he will immediately recognize he sat down in the wrong chair. Error reduction through fun pictures.

[names have been changed]

Sarah Goldstein was in my high school class and is now a year in front of me here [in med school]. She recently got married thank god and is now Sarah Steingold. During her second year, she started the Southwestern Jewish Alliance, which is now defunct. That same year she served as the editor of The Murmur, a quarterly newspaper designed to serve as a humorous outlet for medical students. At that time I had just moved to Dallas, and submitted a witty and intelligent criticism of the first week of medical school that she, without asking me, modified before including it in the paper. She expunged all the funny spicy parts and replaced them with hackneyed jokes, and introduced GRAMMATICAL MISTAKES. I sent her an email she probably never received because her internet-watch software picked up all the curse words and deleted the message before it got to her unblemished eyes.

This morning, she made everyone on the medicine 2a team (eight of us) brownies for valentine’s day. Later on in the morning I asked her what she was doing with her husband to celebrate the occasion and she told me with a self-satisfied look that she does not celebrate valentine’s day. I took the bait and asked why. Though I was blinded by the light reflecting off the Hebrew letters on her necklace that spell her name, I am sure she gave me a look of disgust as she said, “It’s Saint Valentine’s day, Reuben.”

An hour later I was waiting with Sarah, another student, and two residents as several members of the team were visiting a patient with tuberculosis. Somehow the hospital hallway conversation made its way to hot dogs and Dr. Vorth mentioned that though he is not jewish he has always eaten Hebrew National hot dogs. Sarah quickly pointed out that Hebrew National hot dogs are in fact not kosher. I should have known better, but I told her that they are widely consumed in kosher households, presumably because they say “kosher” on the package. She replied by telling me that Hebrew National has numerous documented instances of Kashrut violations and that no one who really keeps Kosher would allow anything made by Hebrew National into their home. It has been years since I have felt the masturbatory condescending slobber of this type of orthodox jew, and I should have known better, but I told her that everyone keeps kosher in their own way. To this she replied, with arms flailing, that you can not be pregnant in your own way, that you either keep kosher or you don’t.

When considering how to strangle someone, I recommend the Littmann Cardiology III stethoscope. Its single-shaft design won’t get caught up in your victim’s hair, and the diaphragm serves as a great handle for extra leverage. It’s the perfect length for most necks, and, when you’re finished, you can use it to confidently verify the absence of breath sounds.

So not only am I amnestic to whatever happened on Saturday after dinner, my memories do not resume until Monday morning. Very unsettling.

Last night Benji celebrated his 31st birthday with a house party of about 50 poorly-dressed people drinking and guitar-strumming. Many stories from last weekend were discussed, for example, Felber recounted my staring at a kitchen cabinet (not the contents of the cabinet, just the door itself) for 30 minutes. Very unsettling not to remember any of this, but at least it’s clear I had a good time. It got me to thinking about the value of non-remembered experiences, and I had a quick discussion with Rodney on the subject. In his usual mode of impartiality he insinuated memory of an event a single attribute among many, so that a non-remembered event might be just as valuable to someone as a remembered event. He suggested that many of us will forget much of our lives toward the end of our life and this does not devalue the forgotten experiences. He suggested that being tortured for 24 hours is a very significant occurrence, even if you don’t remember it the next day. Certainly his examples ring true, but on reflection they don’t really support the idea that memory is just one aspect of an event, competing with all other aspects for value. Memory is more important than that.

As you undergo an event, it has an experiential value which can be positive, or negative, or both (the zen farmer would say you have no way of knowing what its value is). If, at the end of that event, you forget it immediately (e.g. last Saturday night and Sunday), it does not lose the value it had as it was being experienced, but can not take on any additional value. As long as the memory of that event persists, however, it continues to have value – a value that changes over time. Usually its value becomes progressively smaller until the memory disappears. Sometimes its value can become suddenly much larger, for example if a trivial comment you made to a friend last week gets back to your boss and forms the basis for your dismissal. Photographs have the effect of increasing a memory’s value with each viewing, and since most photographed events are positive, we obsess over photographs for good reason, as they interrupt the tendency to forget and allow an event to continue to have value indefinitely. Unfortunately that obsession, when unchecked, interferes with the event itself, most obviously when tourists are so busy snapping photos they forget to see what they’re shooting.

A somewhat ridiculous but instructive way to think about successful living is to divide one’s life into discrete moments, and assign a satisfaction score to each moment. My satisfaction score is the sum of all the forces that make me happy at this moment, minus the sum of all the forces that make me unhappy at this moment. Positive memories act as forces that make us happy as long as we remember them, and now it’s easy to see why a remembered event is so much more valuable than a forgotton event. I may have had the time of my life last weekend, but the total value of that good time pales when compared to the more modestly good but remembered time I had last night, because the more modestly good time I had last night will continue to contribute to my moment-to-moment happiness, and therefore my total overall cumulative life happiness (!) for as long as I remember it. Conversely, bad memories continue to contribute negatively to TOCLH for as long as they are remembered, and once you forget a bad memory, you benefit from more happiness from the time you forget the bad memory until you die. This is of course the idea behind Eternal Sunshine of the Spotless Mind.

There are ways in which an event can be valuable other than its experiential value; for example, one may have no memory of lifting weights for 20 years but still benefits from having great physical strength. In the case of last weekend, I added to the debaucherous vibe at the cottage. That has some value.

A second wrinkle is that my “memory” of last weekend is being repopulated by people discussing it. I now have an image of myself staring at a kitchen cabinet door for 30 minutes. Felber told me in the middle of the kitchen cabinet show he walked up to me and said something, I turned to him briefly, barely acknowledged his statement or his presence, and quickly returned my attention to the cabinet. Now I have formed what I call a pseudomemory, and these seem to be no less valuable than real memories, except that they may differ from actual events. If you tell a lie enough times and with enough force, you form a pseudomemory of it – not just of the lie, but of the content of the lie. For example if you tell everyone you hit a home run when you were in 8th grade, you may actually form a pseudomemory of hitting a home run in the eighth grade. This is important if you’re called upon to verify the lie.

The value of a memory has the potential to be of much greater value than the event itself – in the case of a pseudomemory generated by a lie, the value of the pseudomemory is infinitely greater than the event itself because there is no event itself. This means that you could add great value to your life by forming positive pseudomemories, but for most people the value of a memory will be proportional to its correlation with the truth. This is to say that my valuation of the pseudomemory of staring at the kitchen cabinet for 30 minutes is dependent on my believing Felber’s story. In fact, my instinct, on hearing his story, was to corroborate it. If I don’t demand evidence to validate the story, you can see how in time the line between pseudomemory and memory could blur, and ultimately I could forget Felber’s telling the story and recall only the pseudomemory of staring at the cabinet. At that point I will truly believe that the pseudomemory corresponds to actual events, and if Felber was pulling my chain, the deception will be complete, and the story will be a truth. What is necessary for deception to become truth is to relax the demand for experiential evidence and corroboration; this is called faith.

Somewhere in between memory and pseudomemory is a dream.

Greek mythology has it that humans originally had four arms, four legs, and two faces, but then Zeus freaked out and split all of us in half, sprinkling us about the globe, condemned to spend our lives looking for our other half. This idea describes the strong version of soulmate, which is that there is a particular other person out there who will make me complete, and I have to find her. There are people who believe this, but I don’t know any. The weak version of soulmate, however, is a universally prevalent subscription. The weak version of soulmate is that ultimately I need to be in a committed relationship to be happy. Why would anyone, much less nearly everyone, believe this?

High-tech fertility aside, it takes a man and a woman to make a baby. If we are hard-wired to make babies (and we certainly are), it makes some sort of intuitive sense that the man and woman who make the baby should raise the baby, and voilá, the couple concept. Some goofball 10,000 years ago realized this, decided without any reflection that it should be one man one woman, and what Rachel is responding to is the weight of 10,000 years of cultural conditioning. Or not. Perhaps, in the same way we are hard-wired to make babies, we are hard-wired to find a soulmate. I’m not going to solve the nature/nurture problem here, the answer is always somewhere in between. What is clear is that social cues from every direction reinforce the belief, all day every day, from the time we’re old enough to think.

More importantly, it doesn’t matter if the couple concept is in our DNA. In any given six hour period, I have the impulse to eat six chocolate bars dipped in peanut butter. This might be because everyone else loves chocolate and peanut butter, or it might be that I’m brainwashed by the convincing Reece’s Pieces advertising, or it might be that chocolate dipped in peanut butter is just incredibly fucking delicious. Some combination of my genetics and environment generates a constant impulse to eat chocolate dipped in peanut butter, but I resist the impulse, because the impulse is bad for me.

I think the logic most people use to support the couple concept is, I want kids, so I have to find a soulmate to have kids with. To escape this mentality, one must untangle reproduction from exclusive romance. But who wants to be a single parent? Not me–two people raising children is definitely better than one. But who says two is better than three? Or six? My point is not that it takes a village to raise a child, or that a hippie commune/kibbutz is the right model, only that our sociology doesn’t have to follow our physiology. There are lots of alternatives to conventional families, which wouldn’t merit consideration if the conventional family worked, but, most of the time, it doesn’t. The conventional family doesn’t work firstly insofar as most conventional families are totally fucked, and secondly insofar as the notion of the conventional family sustains the couple concept, which is a sham. It occurs to me that the reason most families are totally fucked might be that they are built on a sham.

Essential to the couple concept is the faith that your interest in your soulmate will last into the near and remote future. In this way, belief in the couple concept is a lot like belief in god, except that belief in god is much less likely to hurt you, because even the most devout can not actually rely on god for anything tangible (because there is no god). Faith in the permanence of another’s love underlies the surrender of our emotional-if not our financial-independence. Beautiful as this may be, we all know the statistics that demonstrate that this faith is misguided, that the couple concept is a deception, and when the deception declares itself, the consequences are often horrendous. But like the religious, we ignore the obvious and in its place substitute a comforting untruth, so that along with the deaths of our companions, divorce will be the worst thing that happens to most of us. Perhaps this is why soulmate has two accepted spellings: soulmate and soul mate.

The couple concept, for all the harm it does us, harms us most by taking happiness out of our hands. I can not imagine anything more tragic than believing that you are incapable of bringing about your own fulfillment, but this is exactly what the couple concept implies.

People frequently frame wanting to get coupled not with a desire for companionship per se, but as a way to avoid negative outcomes like growing old alone. This points to the irony that to the extent that the couple concept is not a sham, to the extent that your finding someone is essential to your happiness, it is essential because everyone believes it. If we all think we need to be in a couple to be happy, we all couple off and have families that leave us no time for anyone else, so single people run out of friends as they get older. How much more fun would it be if we grew old with our friends, rather than growing apart from them as we segregate ourselves into nuclear units.

It’s national singles week. Anyone craving chocolate dipped in peanut butter?




Sandra Tsing Loh on marriage

To sustain your own happiness, I recommend that you adopt the following strategies.

1. Eat a mango every day. Let me quote from Andrew Weil’s The Marriage of the Sun and Moon.

An Indian I met in Bombay told me that at the height of the season, people lie on the sidewalks with glazed looks of ecstasy as they let ripe mangos drip into their mouths. In his Autobiography of a Yogi, the late Paramahansa Yogananda wrote that it is impossible for a Hindu to conceive of a heaven without mangos. Recently I came across the following exchange between the great Hindu saint, Ramakrishna, and his chief disciple, Narendra:

Narendra: Is there no afterlife? What about punishment for our sins?

Master: Why not enjoy your mangos? What need have you to calculate about the afterlife and what happens then and things like that? Eat your mangoes. You need mangos.

2. Exercise in the morning. Waking up to an alarm is the worst part of the day, and waking up to an alarm that sounds an hour earlier is more painful, but that additional pain is psychological, not real, as the amount of pain you feel on hearing your alarm sound is only loosely correlated with how long you’ve slept. So play mind games with your mind games: focus on how great it is to get out of bed to exercise, which brings joy, rather than getting out of bed to go to work, which brings tribulation. Offer yourself an incentive to rise an hour earlier, such as a mango. After you’ve exercised, the day, no matter what happens, is already a success. Work ends with a sense of satisfaction and accomplishment, rather than the usual dread that now you’re exhausted and have to go to the gym, which half the time you don’t do because you’re too exhausted, which you then feel guilty about. First thing in the morning is the time for exercise.

3. Make progress on your A tasks. This is my plug for the 43 folders lifestyle. A tasks are projects that, when completed, will offer lasting improvements to your life. Completed B tasks improve your life in the short term, and C tasks do not improve your life at all. The problem is that our to-do lists are filled with C tasks, like paying the electric bill or going grocery shopping. Though we love to check these items off our to-do lists, and we feel so accomplished having checked them off, the evil of C tasks is that the accomplishment we feel is false. C tasks need to get done, but completing them just keeps you from falling behind. Only A and B tasks move you ahead, so put off renewing your driver’s license for writing the next chapter in your novel or looking for a better job, not the other way around.

4. Keep your friends close. Lovers come and go, family is there forever no matter what, but your friends will keep you sustainably happy if you make the effort to keep them close. Keep them in your life – your daily life. That doesn’t mean you have to communicate every day, but you’re in trouble when all you can talk about is the big stuff like milestones, or reminisce about when you were in each other’s daily lives. It turns out that the milestones are the same for everyone, which makes them empty conversation pieces, which is strange because they feel like they should be really important. Satisfying conversations are built on details, the more irrelevant the better. If you haven’t spoken in a while, cover the big stuff in five minutes and spend your time talking about the fabulous curry you just whipped up or what you were thinking about this morning on the subway. Your college friends can stay daily friends through group email. Without any introduction or conclusion, write down what you said to the girl who was standing next to you today at the salad bar and send it to those seven peeps you’ve been meaning to call. Or start a blog and get your friends to read it.

5. Avoid instant messaging. IM is an acceptable medium for dialogue, if you’re a woodpecker. There is something about communicating in acronyms and emoticons that drains the soul.

6. Go out without corrective lenses. All day you wear your contacts or glasses and see clearly. If you make a habit of socializing without them, you will soon come to associate the blurry haze of myopia with the good feelings that accompany flirtation and inebriety. After enough repetition, the simple act of walking out of your apartment with uncorrected vision loosens you up. It’s like the first drink of the evening is on Pavlov.

7. Presort your laundry. Laundry is the paradigmatic C task; therefore, because time is your most valuable resource, you are charged with minimizing time spent doing laundry at all costs. The most obvious approach is to expand your wardrobe in such a way that you can lengthen the interval between laundry days, but if you’re not ready for that investment, an easier strategy is to get another hamper and divide your dirty clothes into whites and colors as you go. Couple this with making sure everything tossed into its proper bin is right side out, and be amazed at how much time you shave off this day-wasting chore.

8. Shower frequently.

9. Balance the ugly with the beautiful. Consumption of current events media is self-reinforcing, because as you learn more of the world’s horrors, the more interested in them you become. For some, this spiral culminates in activism, much to the annoyance of their friends. Most of us won’t end up in this unfortunate state, but because world news makes competing interests seem unimportant, we run the risk of saturating ourselves with misery. Counter this by being mindful of your consumption of news, news commentary, history, and politics; demand equal time spent on media that instead makes you glad to be alive. If you need some suggestions, you can start here, here, here, or here.

>I wanted to ask you: when you give your
>tPA lecture, are you reading or have you
>pretty much memorized it or are you just
>talking? I got the feeling that the sentence
>structure seemed too well-thought-out to
>be off-the cuff, and you spoke in a very
>measured cadence, like someone reading.
>But at the same time, you seemed well engaged
>with the audience and didn’t noticeably look at
>your notes.

I learned most of what I know about presenting during a one-hour lecture I attended as a second year medical student six years ago. In the first two years, medical students are subjected to an endless stream of presentations at the hands of people who have no training in how to present, namely, doctors. Some of them are good at it, some are horrible. I didn’t think much of what made a good or bad presentation, though, until Dr. Foster gave us his diabetes talk.

Daniel Foster is a diabetes expert, and was the chairman of internal medicine at the time. He waltzed into the auditorium a few minutes late, while 150 of us waited. He grabbed a piece of chalk and wrote something on the blackboard and spoke. Every few minutes, he wrote a word or two on the blackboard. He never stopped speaking, except to ask questions to the audience. He spoke about diabetes the way someone would speak about a recent road trip. 150 pairs of eyes on him, totally engaged. How did he do it? It’s not like diabetes is an exciting subject.

There are two parts to any presentation, content and delivery, and they are equally important. Developing good content requires an appreciation of what your audience is interested in and a mastery of the topic. I won’t say anything more about content, but that’s only because getting people to develop good content is complicated, while improving delivery is straightforward and more interesting. But content is crucial; the problem with getting a degree in writing is that the most important part of writing is something you can’t teach, namely, having something to say.

It’s easy to see how Dr. Foster held our attention when you contrast his lecture with the usual powerpoint presentation, where the presenter reads her slides. When your parents read you to sleep, sometimes you would follow along in the book, and it was stimulating, but that is because you barely knew how to read, so hearing written words vocalized was minor magic. As an adult, hearing someone read causes a reflex boredom response, and hearing someone read words that you can see causes a reflex boredom response so severe that most people will focus their attention on something else (like the folds in their pants) to stop the pain.

The reason that presenters prepare slides full of text, which they proceed to read to the audience, is that reading your slides is the easiest way to get through a presentation. But reading your slides sucks. Stop it.

Ideally, we would be able to present like Dr. Foster, promptless, emphasizing important points as they come up by writing them on the blackboard, but that requires a degree of familiarity with the topic that is really hard to achieve, and most of us won’t get there for most of our presentations because most of us are not experts on most of what we present. What we *can* do is recognize what it is about that approach that makes it so engaging and try to emulate it.

The problem with powerpoint is that it takes the audience’s attention off the presenter and onto the screen, which, when the screen is filled with words, is less interesting than a human face, especially when the human is reading the words on the screen. The key to presenting well is to make sure that when the audience’s attention is on the screen, what is on the screen is more interesting than your face. Fortunately, there’s a lot of stuff out there that is more interesting than your face, in fact, just about anything is more interesting than your face, except words that you’re reading.

Once the text is off of your slides, the challenge is to remember what to say. I learned to do this by delivering wedding speeches. Most speakers at weddings stare at the sheets they’ve prepared and read their speeches, which invokes the reflex boredom response. Better speakers look up every few words, which is better, but they’re still reading. To avoid the reflex boredom response, you can’t read your speech. You can use prompts, like an outline on note card, but sentences coming out of your mouth have to sound spontaneous, which for those of us who aren’t actors means the sentences have to *be* spontaneous. I write a wedding speech out in its entirety, then I read it a few times, and then I make an outline that fits on a note card. Then I practice the recitation from the note card, referring to the speech as needed, you can actually do this in your head, on an airplane, it’s easy. After a couple of iterations, you don’t need the speech. After a couple more iterations, you don’t need the note card.

I do the same thing for my presentations. I write out exactly what I want to say, slide by slide, and then I read it a bunch of times. When I think I’ll know a lot more about what I’m presenting on than my audience, I can either be prompted by the pictures on the slides, or plug pithy prompts into the slides (this of course is why Dr. Foster can be so flippant and therefore so engaging – he knows more about diabetes than anyone). In other cases, I’ll deliver the presentation from an outline. When I’m presenting to people who know more about the topic than I do, I present straight from my “speech,” trying to look up and sound as natural as possible. This allows me to feel safe in that I won’t forget my lines, while keeping the audience interested. As I become a more experienced presenter, I read less and spontaneously say more.

Special mention should be made of whiz-bang features in powerpoint that drop or twirl words onto the screen, allow for special effect transitions, blink, or make noise. These are gimmicks in the lowest sense: they replace content with fluff. I am sure there is an inverse relationship between the concentration of powerpoint gimmicks in a given presentation and the amount of time spent in its preparation.

The governments of Lebanon and Palestine have become indistinguishable from the Hezbollah and Hamas militias that have as their explicit goal the elimination of the jewish people. And that’s just two borders: The governments of Syria, Iran, Iraq, and to a lesser extent, Egypt and Jordan are all straightforwardly or latently hostile to Israel, and, to one degree or another, participate in the effort to reclaim the area as an arab state and expel the jews from the region and really the earth.

Jews and arabs have been at war over this slice of land unofficially since the dawn of time and more formally for about a century. Untold numbers of thousands of deaths on both sides, and there is NO END IN SIGHT. It’s clear to me that the people pulling the strings in the countries surrounding Israel, if not the inhabitants of those countries, will not be satisfied until the region has been cleansed of hebrew-speakers, and I’m not sure the Israelis want anything less with regard to the arabs. These two groups of people genuinely hate each other and a significant segment on both sides seems happy to die to advance the destruction of the other.

I’ve had enough of teenagers dying for their fathers’ cause. If we agree there is no foreseeable conclusion, every death is by definition in vain. We get the point. There’s no end to the hatred and killing. Enough is enough.

I propose that we take all the Israeli jews and move them to Wisconsin, leaving the irrigated desert that is Israel to the arabs to do with what they please.

The Wisconsin Plan will not put an end to the hatred between arabs and jews, but it will stop the killing. You could argue that to give up Israel now would be a disgrace to all those who have died in her defense. That may be true, but the importance of that disgrace pales in comparison to the value of a single needless death prevented.

You could argue that only a diaspora jew born 35 years after the holocaust could be stupid enough to suggest that jews don’t need their own state. I don’t doubt that there could be another holocaust – even those who squint through the narrowest peephole recognize the holocausts going on right now all over the world, and it’s obvious that until women take over, the hatred, greed, and aggression that facilitates these holocausts will never go out of style. But I believe that the likelihood of this happening in Wisconsin is sufficiently small that the steady stream of teenagers dying in the name of israel is unjustified. I could be proven wrong on this account; there is no shortage of bigotry in backwoods America, and if this bigotry develops into a force of sufficient magnitude that jews are compelled to flee, I’ll admit my error. But it’s a chance I think is worth taking.

You could argue that there is something about eretz yisrael, something intrinsic to the dirt and stones that make up the buildings in Jerusalem that is vital to the jewish people and worth dying for. If you are in this group, I urge you to stay behind, when everyone else gets on the boat to Wisconsin, to carry on the fight.

It’s also worth considering what a few million jews could do for Wisconsin. Note that while Israel is being bombed from every direction, most Israelis live a modern, comfortable life. All sorts of inventions, vaccines, and expertise come of out Israel, which until not long ago was a mostly cropless sand dune. Wisconsin is the dairy center of America, and I have always felt our potential in this area is unfulfilled. I guarantee that if the Israeli population relocated, within a generation the US would take the lead in manufacturing fine cheeses and other milk products.

There’s another reason why arab and israeli boys and girls dying over a small piece of land is stupid, and that is that we are all going up in smoke. This is not apocalyptic drivel or a critique of George Bush, it is the obvious consequence of technology’s course. 25 years ago, if you wanted to make a movie, you had to have a substantial reservoir of money, time, and expertise. Today, any schlep with a digital camera and a computer can make a movie, and in fact today most movies are made by just such schleps with iMovie. A farmer with 1000 acres used to be able to produce 20 bushels of corn per harvest; today the same farmer can produce 200. Until recently, ultrasound was only available to hospital-based specialists and big companies, now any doc can own and use cheap, portable machines that make better images than their progenitors, which took up most of a room. Technology can only move in one direction, and though the idea that science can be used for good and evil is cliché, the conclusion of this line of reasoning is relegated to doves and hippies on the media fringe, when in fact it is clear and incontrovertible. The US first, now Pakistan and North Korea, soon Iran, and the reservoir of time, money, and expertise needed to make a very powerful weapon will continue to fall, until it falls to a level where any schlep can make one. The iBomb.

I’m not alarmed by this; there’s not much to be done about it. And I’m not a nihilist, the world is ours for now, let’s do a good job with it. But let’s recognize that arabs and israelis killing each other is not going to change any outcome, so fuck Israel. Israel is not too important not to die for, jews(and arabs) are too important to die for Israel.

> how about insert?  there’s a button on my pc keyboard, probably could
> find out how to on the mac if i tried but that’s what you are for.

Evelyn writes:

>insert? you mean paste?

Hillery writes:

>no, I think he means as opposed to “typeover”, yes, babe?

This is called overstrike mode. 95% of the overstrike mode commentary on the web concerns the issue that most of us associate with the insert key: we accidentally hit it and then what we type overwrites what’s in front of it, forcing us to undo what we just screwed up and turn off overstrike mode. After a couple iterations this becomes really annoying, and the presiding sentiment among most PC users who have given any thought to the insert key is how can I disable the fucking thing.

That said, I can see how overstrike mode could be useful, as it allows you to replace a word without having to take your hands off the keyboard. Thing is, the cursor has to be in front of the word you want to replace, which, unless you are right above or below the position in question, is faster to do with the mouse, so you have to take your hands off the keyboard anyway. Mac users replace words or groups of words by double-clicking on them or dragging over them, which requires a move to the mouse, a move to the keyboard, and then back to the mouse to put the cursor where you want it, and then back to the keyboard to resume typing. It’s a frustratingly slow process actually, and I would welcome a more efficient editing method. I thought I would use my PowerMate for this purpose  by having it slide the cursor back and forth, but it didn’t save much time and I like it better as an iTunes volume control. I remember a device from the early mac days that attached to your head and positioned the cursor on the screen wherever you looked, by tracking your eye movements through muscles on your temples. It came with a peripheral that attached to your keyboard and added two “mouse” buttons below the space bar. The ad ran in MacWorld in the late eighties under the banner, “Look Ma, No Hands!” and disappeared after a couple of years. Must not have worked, but what a cool idea. 

So. The insert key is not on macintosh keyboards, and overstrike mode is not supported in most macintosh apps. Microsoft Word features an overstrike mode, but, in typical Microsoft fashion, it is implemented exactly as it is on a PC, except there is no insert key on a mac, so the fastest way to activate it is to click on the status bar “OVR” button, which means you have to take your hand off the keyboard, so you might as well double-click the word you want to replace. Note that in many applications you can use the command or option key + backspace or delete to erase the entire word before or following the cursor, respectively.

It’s interesting that word processor editing conventions haven’t changed since they were originally conceived in the seventies. At that time, computer scientists were coming to grips with GUIs and the mouse, and while I’m the last to disparage these advances, which were largely responsible for bringing computers to people who didn’t care about computers, the keyboard is fast and the mouse is slow. I envision a mouseless editing mode that might work like this: You want to replace three words that appear in the paragraph above the one you’re working on. You hit the edit button on your keyboard, which would perhaps be on the other side of the caps lock key (does the caps lock key really need to be two keys wide? Who uses the caps lock key?). Hitting the edit key activates edit mode, where labels appear around the window such that each cursor position on the screen is mapped to a row letter and column number. You punch in the beginning coordinate and, if you want to select text, an end coordinate. Then you key in the new text to replace the selected text, hit the edit key again, the coordinate labels disappear, and the cursor is back to its original position. I bet once you got used to this system it would be fast as shit and, more importantly, wouldn’t interrupt your flow by forcing your hands away from the keyboard.

On the other hand, we now have a small but vocal group of computer geeks who advocate not for tools to make word processors more efficient, but for a return to the typewriter.

Another example is the hot water knob. Most people turn on the cold water first, so it’s hard to appreciate when, as you turn on the hot water, turning the knob is actually making more hot water come out of the faucet. Often the friction zone on the hot water knob is less than a single revolution, but it might take a couple of revolutions from the off position to get there, so that getting the temperature right on an unfamiliar faucet can be challenging. Ideally, the strategy for operating a new faucet would be to assess the friction zone for the hot and cold knobs individually, which would involve testing the hot with the cold off and the cold with the hot off. Because cold water is usually high-pressure and hot water is usually low-pressure, you can shortcut this methodical approach by reversing what your mother trained you to do: turn the hot water on first, then titrate the cold water to effect.

I apply the friction zone concept when I am providing analgesia for a painful procedure I’m doing on a patient, such as popping a dislocated shoulder back in, or shocking a heart with a defibrillator. The classic drug to use for this purpose is morphine; the trick is to give the right amount. For a given patient, the first ten milligrams might be insufficient to adequately manage the pain of the procedure, and, if I give twenty-five milligrams, the patient is unarousably unconscious. So the first ten milligrams are not important, and all the morphine I give after the twenty-fifth milligram is unimportant, what counts is the friction zone in between ten and twenty-five milligrams. In medicine we call this the therapeutic index. Doctors prefer to use drugs with a wide therapeutic index, so that it’s easy to produce the desired response without having to worry about adverse effects.

In romance, you can look at the push-pull game as a question of scoping out the friction zone with regard to the amount of interest you show. There is a point on the level of interest continuum below which you won’t register on her radar, and a point above which she’s not going to be interested in you because you’re showing too much interest. The goal of the first phase of dating is then to, um, find her friction zone.

Last week I saw An Inconvenient Truth. The movie is Al Gore giving a slide show (in Keynote, incidentally) about global warming, punctuated by clips that show Mr. Gore ostensibly carrying out his day to day business, which coat him with a What A Good Guy varnish. He makes a lot of compelling arguments, and it’s hard not to walk out of the theater feeling that the earth and its inhabitants are fucked. The strongest support for skeptics, however, appeared while I was waiting in line. A lady from PETA was walking around distributing flyers while shouting that if you’re concerned about global warming, the most important contribution you can make is to become a vegetarian, and “It’s not in the movie!” The flyer presented a number of equally persuasive arguments that the vaporized byproducts of raising livestock for meat consumption are more potent in effecting climate change than emissions from fuel consumption.

What is a lay observer to make of this? PETA’s “facts” seem just as true and relevant as Al Gore’s “facts.” In the face of competing facts, where do we find the truth? We are routinely confronted with this and have adapted our grade-school understanding of a fact as a truth to understanding facts as shades of truth as seen through the lens of the agendas that generate them. Confounding our attempts to know the truth are not only the agendas of the viewpoint generators, but also the agendas of the medium through which the viewpoints are presented. A given medium may have a substantive agenda (The San Francisco Examiner vs. The Washington Times), but the media are of course driven mostly by profit, and alarmism sells. This further complicates our consumption of facts, especially in cases of high alarmist potential like global warming.

Yesterday, as I was making my way through the backroads of maritime Canada, I came across an article in a regional newspaper that described a young lady who developed aplastic anemia, which is when your bone marrow stops making blood cells. The title of the front-page piece is “Teenager diagnosed with blood disorder often caused by environmental poisoning.” Two sentences are devoted to what caused her condition: “The cause of her disease is unknown. Causes of aplastic anemia include a genetic disposition – in this case, already ruled out – and environmental poisoning.” Any lay reader would conclude that this poor girl was poisoned by an environmental toxin and, holy shit, I might be next. In fact, of the cases of aplastic anemia where the cause is known, the great majority are the result of infectious agents(usually viruses), and of the very small proportion of cases that are thought to be caused by a toxin, the great majority are prescribed medications. So the likelihood that an environmental poison caused her condition is tiny, which is exactly opposite to the message that the article tries to convey*.

Now this is the New Brunswick Telegraph-Journal, not the Times, but the distortion is still sickening. Particularly sickening to me, because the only reason I’m aware of the distortion is because I have training in the issue at hand; since I don’t have training in 99% of the issues that come up in the media, the 1% of stories where I can identify the distortion serves as a marker for the other 99%.

So I go about trying to distill the truth from the facts by evaluating for credibility, and there is a friction zone effect here. Organizations or people who broadcast their agenda too quietly are not heard, and those that jump up and down and scream and shout are probably incapable of producing rational conclusions, as their agendas assume an unassailable stature–the hallmark of dogmatism. The paradigmatic example of this is PETA, so even if they’re correct–and the boy who cried wolf was eaten by a wolf–I can’t credit their arguments. What about Al Gore? The movie takes pains to convince us that climate change is *really* his passion, that one of his old professors sparked his interest decades ago. But then what’s up with the segment on his son, who almost died in a car crash, and all the shit about the oh so wonderful farm where he grew up? I went into the film with the assumption that Al Gore was done with politics, because he said he was done with politics, and I found myself wondering what on earth was going on with these interludes. If they wanted to break up the slide show, they could have found ways to do it that don’t pedestalize Mr. Gore. Now all I hear about is Gore 2008. And in retrospect, the film feels more and more like campaign speech. Blech.

So everyone has an agenda, and the problem is compounded by americans consuming entirely american media, liberals consuming liberal media, religious zealots consuming religious zealot media. Not too surprising that we’re becoming more polarized.

So, I ask again, what is the lay observer to make of this? I try to expose myself to competing viewpoints. KCRW’s Left, Right & Center is a show that at least makes an attempt at this, I would be interested if any of you know of other media that adopts a point-counterpoint format. Otherwise, read the San Francisco Examiner AND The Washington Times (you can cheat by isolating their Op-Ed pages), have a look at some international news outlets, surf the enemy.

This strategy at least makes me feel less like a victim, but the bottom line is that unless you saw it yourself, you can never really know. I can investigate the source data for one domain (medicine), because that’s my job, but for everything else I’m at the mercy of the media and the choir-preaching maze of factgendas that more often than not leave me concluding that the truth is not inconvenient, it’s unobtainable.

*Fuhrer M. Blood 2005 Sep 15;106(6):2102-4.

This one lives right next to the laundry room and today is doing laundry at the same time as I am. She’s in her late twenties, wiry, doesn’t speak english. I come down with some dirty clothes, her wet clothes are still in the washing machine. I consider whether to knock on her door, move her clothes to the dryer, or put them on top of the dryer. I decide on the second option and then put a load the washing machine.

45 minutes later I come down and her clothes are finished, and I want to move my clothes over. Faced with another set of socially charged options: pile the clothes on the table, fold the clothes on the table, wait, or knock on her door. I knock on her door and ask her to deal with her laundry, which is she happy to do. She’s very friendly but speaks french with a thick quebec accent, so I can’t communicate with her beyond the basics.

She piles her clothes into a basket, smiles at me, thanks me for something I don’t understand (perhaps for alerting her that her clothes were done), and returns to her room. I start moving my clothes from the washing machine to the dryer and find

a pair of her undies.

Cute undies. Hello Kitty undies. When I moved her clothes from the washer to the dryer, I missed a pair of her undies. Now what do I do. Options:

a. Knock on her door and give them to her. If I do this, I run the risk of her thinking that I’m hoarding her underwear and trying to generate a pseudosexually charged situation by knocking on her door with them in my hand. It’s weird. I can’t do it.

b. Leave them in the laundry room. Unlike anonymous clothes that are often found in washing machines, we both know that I know that these are her clothes, and also that I know which door is hers. I can’t leave them in the laundry room.

c. Toss them. This felt like a very good option, except that I would be throwing away her perfectly good clothing.

What would you have done?

And then the right answer came to me:

d. Dry them. When they’re dry, I can knock on her door and give them to her pretending that *she* was the one who left them in the machine.

I’m so proud of myself.

My biggest problem at the moment is Made In China stickers. Like most things made in China, they seem adequate in the showroom, but once you get them home, they fuck you. I just bought a desk lamp that has not one but two Made In China stickers. When I discovered the second sticker (hidden inside the lampshade), I almost returned the thing.

Instead, I have developed a specialized heating, lubricating and peeling apparatus so that after breaking four fingernails you don’t have to reach for power tools that destroy the item the sticker was affixed to. In this way, the HLP Made In China Sticker Remover will pay for itself in no time. Get one while supplies last.

my take on the inuit condition, informed only by conversations with biased observers:

for tens of thousands of years, a small group of people lived in the tundra, where no one else wanted to live. they survived as a nomads; their peripatetic struggle against the elements made for a hard life and a young death, but it was their way and I would like to think, though I have no way of knowing, that they found as much happiness in their lives as we do in ours.

then the white men came with guns. they told the inuit to stop moving around. the inuit could not stop moving around, they knew of no other way to live. so they kept moving around, following the fish and the caribou. and so the white men shot their dogs. and that was the end for the inuit.

the white men built communities for the inuit and gave them snowmobiles, which require gas to run, and suddenly the inuit man needs something he’s never needed before: gas money. the inuit man does not know how to make money, he knows how to survive in the tundra.

two generations later, the inuit still do not know how to make money, and even if they still knew how to survive in the tundra, it is a skill no longer of any use. they are trapped in between two lifestyles and trapped in settlements isolated from the western world around them by thousands of miles of roadless snow and ice. in exchange for stripping them of their lives, white men pay white men and women double-salary to come up to these settlments and run them like white towns. because there are almost no opportunities to make a living here, most of the locals are given money. all health care, including medications and plane flights to see white doctors in the south, is free. white teachers, social workers, policeman, and pilots put an ivory sheen on the long, dark winters. many of the quebec inuit are taught french instead of english, which in my mind is like taking a dying animal and pouring battery acid on its wounds. the snow, of course, couldn’t be any whiter.

as a result, inuit communities are devastated by the plagues of boredom, alcoholism, domestic violence, depression, hopelessness, helplessness. my solution: either build roads to montreal and toronto so that they can construct a contemporary life for themselves, or give them back their dogs and let them follow the fish and the caribou.

Part of the Puvirnituq photoset.

First is what Benson and Klipper* refer to as The Relaxation Response, in their book of the same name. Their thesis is that across many cultures and religions exists a ritualistic activity that brings about a sense of calm and well-being in its participants. Benson & Klipper take an anthropologic approach to this activity and propose a simple maneuver that they advocate as a distillation of the common elements in these various practices, which all tap into a physiologic reflex to bring about that peaceful, easy feeling. This approach boils down to focusing on your breathing and repeating the word “one” to yourself between breaths.

It works. After a few earnest minutes you start to feel tranquil; anyone who has done yoga or anesthesia knows it works. I suspect Benson&Klipper are correct about the reflex, and it’s a useful skill to tap into when you’re anxious or can’t fall asleep. More than just relaxing, it feels good. This is distinct, however, from mindfulness.

I discovered mindfulness accidentally while doing drugs in my late teens and early twenties, and I think a lot of stoners make a habit out of marijuana–which has little if any physiologically addictive properties–because it promotes mindfulness(though nobody in those circles refers to it by that name, and I didn’t understand it as such until many years later).

One of the most important effects of marijuana is that it potentiates sensation. Experienced users learn to take advantage of this in all sorts of interesting ways, but its most immediate and accessible form is the heightening of sound and taste.

Now if the ability of marijuana to make music more compelling were limited to the time when the user is intoxicated, it would be neato and fun but not important from a lifehack perspective. The genius of this drug is that it teaches us to compartmentalize our attention. Unlike the meditative breathing buddhist, who must train herself to exclude distraction and be here now, this ability forces itself on the stoner as the sensation at hand is so overwhelming that to divert any neurons from its appreciation is abhorrent.

The type of mindfulness I practice in my sober thirties has to do with recognizing how an activity’s perceptual resolution** affects my appreciation of that activity. For example, reading is an inherently high resolution task–if you want to get anything at all out of what you’re reading, you have to devote a lot of attention to it. Since the total amount of attention you have is fixed, like the space on a computer screen, every pixel of attention you devote to one activity takes away from your appreciation of another activity. So, if I’m eating six-day old rice and beans, I’m happy to yield to my urge to read this week’s New Yorker at the same time. But when I have butter chicken from Bombay Mahal delivered, the magazine is put away and the music turned off.

I take the concept of perceptual resolution a step further and organize my tasks into high resolution (studying, flirting) and low-resolution (paying bills, talking to mom), so that I can plan my consumption of high resolution content (talk show podcasts, bob dylan records) and low resolution content (jazz, Boing Boing).

I have also become very protective of my attention pixels and am frustrated when they are unwantingly expropriated, by construction workers across the street, the bus-riding mobile phone user, or my email program. In addition to lengthening the refresh times of my email and RSS feeds, one of my all-time greatest lifehacks has been the purchase of insulating headphones.

*Herbert Benson with Miriam Klipper, “The Relaxation Response.” Copyright 1975 by William Morrow and Company. ISBN 0-380-00676-6.

**Elliott Malkin named this concept.

1. Fertility differs considerably between men and women. Men are
fertile from puberty through at least the 9th decade of life, and
some men are fertile into the 10th decade. Although there is some
decrease in fecundity, spermatogenesis is active throughout these years.

2. Women are fertile only for the 12 hours after the monthly
discharge of an egg from the dominant follicle in the ovary.

3. The other main difference between male and female fertility is the
rapacious apoptosis that occurs in ovarian follicles. Of the 3
million to 4 million follicles present at the time of fetal ovarian
differentiation, only a million or so persist at birth; 400,000 to
500,000 at menarche; and none beyond the sixth decade.

Men are fertile almost every minute of the time they spend on earth,
women are fertile 12 hours a month for 35 years, amounting to a grand
total of 30 weeks’ fertility over their entire lives. This fact
explains much of how men and women relate.

My sister Rachel has recently entered single adulthood and often
seeks my counsel on matters dating. I have discovered, while trying
to use my expertise in this area to optimize her love life, that
today’s woman is fucked.

I know this when I hear her describe her latest date, she’s so into
this guy she says, and he seems into her, but she’s not sure. She
describes him to me. Bright, successful, attractive, socially
intuitive, jewish. How much interest should she show? How much
cleavage should she show? How long does she have to wait to have sex
with him? Trying to answer these questions, I sense a sort of
futility to all the attention they’re paid, and it is the feeling of
futility that brings it into focus: Men and women want different
things, everyone knows that, but their discrepant goals are not
fairly distributed. The evolutionary expression of our biology sets
men and women in a Darwinian rivalry that women can not win.

A woman, if she becomes pregnant at every opportunity between
menarche and menopause, can have at most thirty or forty children. A
man can repopulate the world in a week. Is it therefore any wonder–
given that our instinctual purpose is to produce as many offspring
that survive to reproductive age as possible–that men seek variety
and women seek security?

Since women can have so few children, a woman maximizes her
evolutionary potential by assuring that each of her children is
offered the best individual chance of survival; it is thus in her
best interests to find a partner likely to effect an environment
where each child will survive to reproductive age. This instinct
manifests itself in modern society as the desire for a protector and
provider: a big strong rich man.

That man maximizes his evolutionary potential by impregnating as many
women as possible. Since there is essentially no limit to the number
of children physiology permits him to father, it is in his best
interest not to maximize survival of any one of his children but to
maximize his number of children. This instinct manifests itself in
modern society as the desire to fuck every woman on the planet.

These goals intersect at every encounter between a man and a woman.
While women channel their energies into finding and retaining a big
strong rich man, men are busy disseminating inseminating. The result
is that once a couple has sex, the man becomes more and more
valuable to the woman, while the woman becomes less and less valuable
to the man.

That sense of dread I have when Rachel describes this guy–I now know
exactly why she’s headed for a broken heart.

Related commentary from 2000 and 2004.

Elliott and I had planned to drive all over New Orleans and explore the ruins, but lost interest after finding this flyer in our hotel lobby, and felt kind of ashamed of ourselves.

We got over that feeling though, and the next day spent several hours touring deserted neighborhoods and abandoned, flooded houses.

Microwave. Acquired in 2002 from a friend in Dallas who had just
purchased it but then moved into an apartment with a built-in one.
Works perfectly, except that after approximately 50 seconds at high
power, it bursts into flames.

Although at first this is alarming, you will soon learn that you have
three to four seconds of warning with flashes of light and that
“bzzzzt” sound before the right side explodes into a ball of fire and
burning plastic. The fire is easily put out by turning off the
microwave and blowing out the flames. On only one occasion have I had
to use my fire-extinguisher equivalent (windex), and the inside
needed cleaning anyway.

This microwave is perfect for heating up things that need less than
50 seconds. I have been using it mostly to melt butter. Now that I
have a new microwave, this gem of a japanese appliance is looking for
a new home. Goes to the first person who can carry it away.

aboard a plane to austin, still on the JFK tarmac. captain just announced that the plane is overweight so eight people have to come off before we can leave. good to be back in the states, fuckin supersize fries.

the doors opened for the silver jews concert at six (sic). there were two opening bands, we arrived at 9:15 after eating at a highly authentic low-quality mexican food restaurant around the corner from elliott’s loft. when we got there we found out that berman & co were already on stage. we arrived in the middle of the first song.

everyone who follows this band knows that david has had some tough years with depression, multiple drug addictions, and a suicide attempt. he looked fairly well put together considering. his voice was predicably worn but easily recognizable – he’s one of these male singers who don’t really sing, he talks melodically over the music. his wife cassie has a strong stage presence, and the affection he demonstrated toward her onstage was one of the coolest parts of the show. the set was ridiculously short, a little more than an hour. he played a lot of the greats, but they’re all great so anything he played would have been great: random rules, how to rent a room, pet politics, horseleg swastikas, dallas, punks in the beerlight, sometimes a pony, trains across the sea. toward the end cassie played an excellent dead-esque country song, which dave said she wrote. elliott claims to have recognized it, though i am sure i have never heard it.

webster hall is a superb venue, an old building with a balcony, ornate carvings in the walls and one enormous disco ball. dave was uncomfortable on stage. the show ended shortly after ten and the audience was incredulous. none of the ~500 of us were willing to leave. the lights went up, the background music came on and finally after 15 minutes he came back and sheepishly told everyone how lazy he is, that he’s “been avoiding this for 15 years, gimme a break.” that said, he seemed genuinely touched and surprised at the adulation. he played _there is a place_ as an encore. during that song, a fan jumped on stage and grabbed dave’s red trucker cap, which was on the ground next to him, and did a bellyflop back into the cowd. cassie, so much more composed than dave (who seemed put out just by being on stage) politely demanded that he give it back. she said it was dave’s lucky hat. the fan returned it.

when dave wasn’t strumming his guitar, he was searching for a pack of cigarettes in his pants, and ultimately had to excuse himself for a few minutes to find one backstage. i got the impression that the guy is just cashed out, a jittery former addict now trying to keep it together, touring for cash. he couldn’t even remember his own lyrics. he was reading them from cheatsheets and even still made a couple errors, but his myth is so overwhelming he could have spent an hour pissing all over us and we would have loved it. great show.

picture courtesy of thesevensteves.

Then elliott offered up a much more appealing sect, Humanistic Judaism. These guys reject god, which has the advantage of making the religion compatible with the sensibilities of most living jews, and they recognize the appeal of jewish traditions. Unfortunately, they reconcile the crease by reformulating the traditions in such a way that they make sense in a godless universe. This is the sort of delusion we associate with the bible as metaphor people who, for example, suggest that creation and evolution are not mutually exclusive because the seven days actually represents seventy million years or whatever. Furthermore, Humanistic Jews censure any mention of a higher power and exclude those aspects of jewish culture that they are unable to twist into a secular form, and I’m not willing to give up my favorite jewish prayers. Another inadequate solution.

Reubenistic Judaism rejects the supernatural, but retains jewish traditions for traditions’ sake, admitting that these traditions are based on bullshit but that they are fun to do, and make us feel part of a larger culture, which feels good. Reubenistic rabbis deliver sermons that decry faith of any sort in favor of a rational approach to modern problems. Talk of god is not avoided, god is accepted as a fabricated remnant of an obsolete ideology. Biblical stories are actively discussed and applied to contemporary life, but are read not as the word of a supernatural being, but as the collective voice of generations of smart people whose ideas are sometimes insightful and sometimes silly and irrelevant. Individuals are encouraged to draw meaning from or reject biblical dictums as they see fit. The positions of other religions or individual thinkers are put forward and considered with equal appreciation and scrutiny. While Reubenistic Jewish leaders endeavor to account for competing viewpoints with sensitivity and fairness, all people and belief systems are not judged equal, and blatantly absurd notions such as original sin are ridiculed.

Intermarriage is encouraged. Charities that bring about the assimilation of Palestinians into Israeli life are supported, as are secular political leaders. Young Reubenistic Jews are directed to act in ways that consider the consequences of their actions, rather than adhering to rule-based credo. The old testament is presented as an enchanting work of fiction inspired by the events and beliefs of a distant era. Death is the end of a Reubenistic Jew’s existence, and the religion’s primary mission is to disseminate strategies that enable its adherents to maximize their enjoyment of their limited number of sentient days.

Reubenistic Jews are atheists. They do not believe that to be atheist one must be able to prove there is no god; Reubenistic Jews do not have a proof that there is no god and do not intend on developing one. Reubenistic Jews hold that it is not the responsibility of the atheist to prove there is no god, it is the responsibility of the believer to prove god’s existence. Similarly, Reubenistic Jews hold that it is not the responsibility of those who do not believe in the tooth fairy to prove there is no tooth fairy.

Reubenistic Jews may wear a yarmulke, keep kosher, light candles on shabbat, fast on yom kippur, and avoid chametz on passover. They might perform the holiest mitzvah through a hole in the sheets. The synagogue holds service for all major holidays; any and all jewish rituals are fair game and the content of any service is decided by each congregation. Reubenistic Jews draw a clear line, however, between ritual and the supernatural beliefs that underlie them. The rituals are celebrated as enjoyable traditions that connect a group of people to their ancestors and to each other, whereas the supernatural beliefs are discarded as both false and beside the point.

The Reubenistic Judaism homepage is Web 2.0 compatible. Use of public transportation to and from the synagogue is encouraged, however, sanctimonious environmental activists, or any other sanctimonious activist, is forbidden to enter. At the end of the friday evening service, the melody that Adon Olam is sung to is based on the wishes of the youngest person in the sanctuary who is able to voice a preference.

They tore down that building across the street, and started rebuilding it. A few weeks ago I realized, in one of those moments where your heart just sinks, that in its place will be a four-story building, and out my window I will see nothing more exciting than the occasional bedroom view, when one of my neighbors forgets to lower the blinds. Since then, as the new building comes up, my days under the spell of the cross have taken on increasing meaning. Yesterday they built the ceiling on the third floor, and out my window this evening the fourth floor is almost finished. They built the two sides of the floor, and, in a thoughtful gesture, have left the middle unbuilt, as if to say, this is your last evening, enjoy.

This is one of so many examples of the importance of stimulus vs. context. I would have moved into this apartment if there were no view; for example if there were a four-story building across the street from me before, and they tore it down and replaced it with another four-story building, I would have enjoyed my view during the construction but would not be bothered by the loss of the view when the fourth story was rebuilt. In this case, I have come to understand my apartment as one with a view of the mountain and the cross, and I earnestly feel wronged by its obliteration. Hurt, even.

When you recognize that most of how you respond to something is contingent not on the thing itself but on your expectations of that thing, you can conduct yourself in such a way that you’re more likely to be pleasantly surprised and will enjoy many more good moods-I call this managing expectations. I go about this by minimizing exposure to preconceptual bias as much as possible. For example, once I decide I’m going to see a movie I will actively avoid talking about it, reading its reviews, I even try to steer clear of the trailer. When I’m being set up on a blind date, I don’t want to know what you think of her, just give me her number and I’ll arrange it. Expectations are the enemy of a good time.

The problem isn’t that there isn’t enough food for everyone, the problem is that the people in developing countries are eating their available food too fast. We need to slow them down, encourage them to chew. The way to do this is put braces on everyone in the third world. Remember how deliberately you ate when you had braces? It took me 30 minutes to get a turkey sandwich down. And braces turn even the smallest spread into The Meal That Keeps On Feeding, as in little bits of lunch from three days ago – like an extended release tablet. Lastly, I find that orthodontists are underappreciated and underpaid at home, and could use a morale boost – in the form of a couple billion new customers.

I even have an inspirational slogan: Brace Yourself.

a. confess. so therapeutic! catholicism blows, but this they got right.
b. make anything a potential topic of conversation. nothing says I won’t judge you like an open source personality.
c. have come to appreciate that all of my perversions and inadequacies are out there in numbers, so I don’t feel so bad, which makes it okay to talk about, which gives me access to everyone else’s perversions and inadequacies, which makes me feel not so bad.
d. benefit from the world’s suggestions and improvements to my personality. A living, breathing wikipedia is what I am.

highly recommended. postsecret operates on this principle, except that it’s anonymous, so you don’t benefit from parts b or d. bottom line is that if you haven’t killed or raped, whatever’s lurking in your mind and past that you think is inexcusably horrid or unredeemably pathetic is actually within two standard deviations of the mean. if you’ve killed or raped, that’s fucked up. keep that shit to yourself.

Me: Hi.

Her: Hi. Finished with the washer?

Me: Yes. All yours.

Her: Thanks.

Me: I’m Reuben, how are you.

Her: Lisa. Hi.

Me: Are you a new arrival to our fine apartment building? This is our first laundry encounter.

Her: I moved here not long ago. I live with my boyfriend Tom.

Me: Great, welcome. I also live my boyfriend, who’s also named Tom!

Her: [Smiling, finally] Oh. Um, I don’t really have a boyfriend, I thought you were hitting on me.

Me: [As I walk out with my clothes] I don’t really have a boyfriend either, and I was hitting on you.

Night 1: 50 grams of lead, delivered to the left chest.
Night 2: A 44-French plastic tube, inserted into the left chest as well as several stitches to hold it in place.
Night 3: A dozen units of blood.
Night 4: An 8-millimeter plastic tube inserted into his windpipe, so that a machine could breath for him.
Night 5: Intravenous antibiotics.
Night 6: A nine hour operation where his chest was cracked open and his organ injuries were repaired.
Night 7: Another ten units of blood.
Night 8: His discharge paperwork, and advice to be good this year so that next Hannukah he’ll get better presents.

I recently saw a 22 year old lady who flipped over her honda civic and was transported by helicopter (of course) to our fine facility. Although there were no obvious injuries, she was really freaked out. That’s understandable. This freaking out however made it difficult to examine her, as everywhere I touched her hurt, even places that were obviously uninjured. This is a fairly common problem in an emergency department, and it doesn’t take long to figure out how to deal with it: you have to adjust your threshold for calling a point on the body tender, much like you do with a scared two year old. You touch a scared two-year old’s hand, and he screams, the wrist makes him scream, the elbow, more screams, but then you move the shoulder and he really screams.

So I applied the same principle to this lady, and I came away with the impression that there wasn’t much wrong with her. I asked for a CT scan of the head and neck, which are low-radiation tests. The nurse asked why I didn’t also scan her chest and belly, which are high-radiation tests, and I told her that I didn’t think she needed those tests, and I went back upstairs to join my team, who were rounding on our admitted patients. A few minutes later our boss, Dr. J, was paged, and told us that he had to go downstairs, but we should keep rounding. A few moments later, he was paged on the hospital-wide overhead, so I went back down, thinking something of interest was happening in the area where new patients are seen. Dr. J was standing at the bedside of my patient, feeling her belly, and she was screaming. The nurse said, can we do a full-body scan? Sure, he said. Thank you, the nurse said, looking at me quite satisfied.

Later on that evening, I examined another young lady who I didn’t think needed any tests after her car accident, and Dr. J asked me to get another full-body scan. As I put the requisition in, I thought about the nazis who, when asked to explain how they could kill innocent people, claimed they were just following orders.

Why is it that so many people at this institution are needlessly irradiated? Let’s look at the incentives.

1. The physicians. Much has been said about how today’s legal environment leads to extra testing, I won’t rehash it. It’s clear that the way we deal with bad medical outcomes, which is harmful to everyone involved except the lawyers, needs to be changed; the problem is that the people who make the laws that determine how we deal with bad medical outcomes are lawyers. So for now, we’re stuck with physicians being incented to overtest, and we hear a lot about the fiscal result of this. But a much more dangerous consequence of the shift from the patient needing to prove that she needs the test to needing to prove that she doesn’t need the test is that the culture of medicine more and more embraces tests, medications, and other interventions. Tests, however, are in and of themselves bad, and so are medications, to say nothing of surgeries. When you’re torn about whether to test or treat, the answer is always no. Contrast this with the first rule of managing trauma, according to the manual I was given at my orientation, which states that one should always assume the worst. This makes sense in a patient who is unwell, but, again, most of the patients we see are fine and assuming the worst does not help them, it hurts them, even if they don’t know it. Ordering an unnecessary CT scan is painless assault.

2. The nurses. The nurse’s goal is to only bring the patient to the CT scanner once, because moving patients is extra work. Therefore the nurses are incented to scan every inch of the body on the first trip.

3. The patients. Most patients not only don’t realize that tests are bad, they happily absorb radiation and say thank you doctor, can I have another. In fact I have found that the more tests you order, the more grateful the patient. If I keep a patient six hours and order 20 tests, the patient thinks she has received a high level of care, not knowing that the son that she has in ten years won’t be able to do long division because I zapped her ovaries today. If I keep the patient six hours and just observe her to make sure her pain gets better and not worse, she’s pissed.

And where are the incentives not to test? Do we reward doctors who order fewer tests, but do just as well for their patients? Do we protect doctors from ambulance-chasing lawyers? And what would become of the resident who tells his boss that he doesn’t think the test is indicated, and if you want it, you can order it yourself? Let me tell you about the incentives for me not to do that. See you in Nuremberg.

Why is it that the only perfume I ever notice is the one my first
girlfriend wore? Stimulus vs. context.

Why is it that drinking scotch immediately puts me in a good mood,
long before the alcohol has a chance to take effect? Stimulus vs.
context.

Why is it that when people of latin descent come to the ER complaining
of belly pain we never find anything, but when people of eastern
european descent come to the ER complaining of belly pain, they
usually end up in the operating room? Stimulus vs. context.

Why is it that when I tell my mom I like her dress she thinks I’m a
mensch, but when I tell my date I like her dress she thinks I’m a lecher?
Stimulus vs. context.

Why is it that the more strongly a movie is recommended, the less
likely I am to be impressed with it? Stimulus vs. context.

Why is it that some cultures dance and sing at the death of an
elderly person, while we deny, mourn and feel victimized?

At approximately 5:00 this evening I arrived at the McGill Gymnasium, swiped my ID through the scanner and entered. I put all my stuff in my locker, exercised, showered, returned to my locker at about 7:30. I flipped open my wallet to check to see if I had any subway tickets, and zap I knew my credit card was gone, and I knew for certain that it was stolen from my locker.

I keep exactly four cards in the front pockets in my wallet, so that the inside of my wallet is perfectly consistent and any alteration of its appearance triggers an alarm, like the reminder you posted on the refrigerator to water your plants that after two weeks becomes an unnoticeable part of your refigerator until someone moves it, making you wonder why your refrigerator looks different. Several times I have walked away from a cashier and was about to stuff my wallet in my pocket when I noticed a card was missing – sitting on the counter.

I opened my wallet to get out my McGill ID, so I know that the card was in my wallet when I entered the gym. My lock, issued by the gym, showed no signs of tampering – that’s right: an inside job. The thieves left everything else in my wallet, including the $55 dollars cash. I thought this was because these were socially conscious, robin hooding thieves who steal from big companies and not individuals (knowing I wouldn’t have to pay for the fraudulent charges on my card). Roy thinks they took only the card to prolong the period where I wouldn’t notice it was gone; these motherfuckers didn’t know they were dealing with an implementer of error-reducing good habits. They call me The Implementer.

Those of us who grew up on a mouse and keyboard interact with our computer the way we interact with a stack of books on our desk, or a refrigerator, or a bicycle. When I double-click on a folder of halloween pictures, my brain treats the act of opening the folder and the contents of the folder no differently than a physical photo album sitting on my bookshelf. This is exactly the point of a point-and-click interface, it feels like real life, but physical photo albums don’t crash, and the conflation of the real and the digital represents an illusion that vanishes when on top of my pretty digital desktop appears a smattering of uninvited, primitive computer-text that starts with SYSTEM FAILURE.

My mother never let computers dupe her in this way. To my mother computers are mysterious, fragile, not to be trusted. When she is presented with digital information, her instinct is to bring it out of the computer and into real life. I do exactly the opposite. I recently acquired a boxful of family photos, and my reaction was that they were too precious to stay in the box or even to frame and mount on my wall, as my apartment is susceptible to earthquake, fire, flood, and theft – I had to secure these photos for all eternity by posting them on Flickr. Posting them on Flickr? Talk about being duped. Flickr could tomorrow disappear off the face of the earth, they could without warning start charging a zillion bucks a month, they could sell my pictures to North Korea. What’s more likely to be around in twenty years, the bar mitzvah photo album that lives under the coffee table in my dad’s Philadelphia living room or Flickr? How silly. When I got my computer to the repair shop, the technician opened her up and showed me logic board stir-fry. Thank god for extended warranty.

The appropriate way to deal with the illusion of data as real, and not the invisible stream of particle-switches that it is, is to create redundancy. The more it matters, the more redundancy you need. I recently toured a medical helicopter that had two completely separate engines, only one of which is used at a time. Think of your computer workspace not in terms of what you would do if it crashed, but in terms of how to minimize the inconvenience when it crashes. My mom prints out emails I send her and saves them in a folder in her solid oak desk.

>I have decided after much thought that I’m agnostic in the face of
>science and atheist in the face of religion. But that I identify
>strongly as a jew. This is something non-jews (and jews) have a lot
>of trouble understanding.

I have to explain this all the time. Judaism is a culture that has evolved from a group of people who shared a religion; I reject the religion while strongly identifying with the culture.

Religion is a belief system based on faith in ideas that are either incompatible with observational science or outside its umbrella (ie not provable or disprovable). The prevailing example of such an idea is the existence of a god or gods.

Culture is a set of behavior patterns shared by a group of people with a common background. Jews for example wear yarmulkes on their heads, avoid pork, circumcise their baby boys, make use of self-deprecating humor, guilt-trip their children, and go to medical school.

The line between the religion and the culture that surrounds it is sometimes blurry, so, for example, I fast on yom kippur, light candles on shabbas, and favor jewish girls at the same time that I dismiss the notion of a god and the divine texts that form the basis of these traditions. There’s a hypocrisy here most fully realized at the crease that separates opposing pages of a North American siddur (jewish prayer book). I happily go to synagogue and sing jewish prayers with the congregation, following along the righthand page in Hebrew, a language I can read but not understand. Occasionally I make the mistake of looking over to the English translation on the left, where I see what it is that I’m actually singing, and it disgusts me.

Modern secular judaism encompasses the majority of diaspora jews, and soon its leadership will be two generations removed from the holocaust. Without discrimination or a common belief system to isolate us, I believe assimilation is inevitable, and am not sure if this represents a loss or triumph for society.

To Carlie
by Scott Brandt
December 2000

I sit here naked,
more drunk than horny
and think about you.

Drunk, I like to think about you.

In the blurry haze of the moon
I will imagine your face and your laugh.
Your body pressed close againt mine.
Your breaths rapid.
My desire reflected in the core of your eyes.

The feeling of fulfillment
tinged with excitement and fear.
Fear of commitment.
Fear of compromise.
Fear of stasis.

Ah, the sweetness of your breath,
enveloping and inviting.
Calling me to your spirit.
What is a song without dissonance?
What is life without sorrow?

The honey is bitter
and the vinegar sweet.
You dream sweet bliss in my arms.
The moon smiles.