Physician, heal thyself

"Physician, heal thyself" Luke 4: 23

My professional goal is to assist the human body in healing itself. Be it through medication, lifestyle changes, surgery or other interventions, my efforts are for people to live better, healthier lives. I have spent 11 years since I graduated from High School working toward this, with at least another 4 to go. The vast majority of my waking hours are spent caring for others. It is truly one of my passions.

And yet.

We spend so little time caring four ourselves. It is our own doing. There is no question that there are not enough doctors to truly see the patients who need medical care. There is a supply/demand mismatch, and we created this. With restrictions on the number of new medical students every year, as well as restrictions on the number of residents who match, we are ensuring there will always be a significant demand for our services.

Likewise, rigorous entry requirements, significant time and financial investments also put limits on the number who apply. With a population that is growing significantly faster than the number of doctors, there will be no shortage of work for those who pursue medicine as a career.

And this job security is the very thing that hinders our own self-care.

Though time has passed, the memory of my kidney stone is still fresh. Yet even more clear is the realization that I did it to myself. See, the stone hit on my last day of three continuous months on the Trauma service. Three months of 14+ hour days, 6-7 days a week, with 1-3 30 hour shifts per week thrown in for good measure takes its toll on the body. Add to that the fact that all day long you are running: to the Trauma bay to run the traumas, to the ER to see surgery consults, to any and every floor and clinic in the hospital to see consults, dealing with and organizing transfers from smaller hospitals, to the OR. Most days, the first time I had anything to drink, let alone to eat was at 7 pm or later when I finally sat down to have some dinner.

Fact: That is not conducive to being healthy. This is only compounded by the paucity of time available to exercise. We try to fit it in when we can. Often the choice is between one more precious hour of sleep, one hour of actually seeing your family before they head off to bed, or getting in that workout. It isn't hard to guess that the workout often loses.

How do we reconcile this seeming hypocrisy?

I wish I knew. I refuse to try to justify it. I know we need to work long hours to get the work done. I recognize that medicine is a rather unforgiving career, and has a history that is much worse than its present. But that doesn't excuse the self-abuse. I told my daughter that it has probably been at least 13 years since I could honestly say I wasn't tired. Most of that has been due to my efforts to get where I am today. That isn't healthy, and it isn't sustainable.

Yet the winds of change are blowing. A new generation of us are entering the profession. A generation who believe that a well balanced physician, who cares for him/herself, who has at least a little time to nurture a family or friendships, is better equipped to really connect to his patients and care for them as human beings.

Not as diagnoses.

I could care less

In the written language, there are few phrases that irritate me more than this: "I could care less."

Why does it irritate me so? Because it makes no sense. It is often used in place of the original phrase (penned by the British) of "I couldn't care less." This statement works. It makes sense. When I say it I mean exactly that: I care so little about [insert particular comment/rant/article/person here] that I actually could not care less. That is to say, on my care-o-meter I am officially at or below zero.

So where did the illogical derivative come from? Well, leave it up to us good old Americans to take something that actually makes sense, and turn it around so that it doesn't. But this raises the question: What happened to the negative? Perhaps some sarcastic punk wanted to really emphasize his/her apathy when he/she said to his/her equally stoned mate "Dude/ette, like I could care less." Now, that makes sense. The person is, in a sarcastic manner, emphasizing that he/she is totally apathetic. Sounds like a reasonable language permutation to me.

In the ensuing years, though, this phrase was repeated again and again, by ignoramuses (my own personal bias there) until it actually came to resemble a proper use of language. Now, there are plenty of places discussing this improper use of the phrase. I link because I care. The point that some (not all) of these references clearly make is that, in the spoken language, vocal inflection can lend meaning to the phrase "I could care less." Delivery can emphasize the sarcasm the speaker may have intended.

However, the written word cannot. I have previously evangelized that all written communication on the internet should have 'sarcastic green', a vile color that is used to warn the unsuspecting reader that the offensively colored words are meant to be sarcastic. Think of the confusion this would clear up. Lamentably, this idea has not gained widespread acceptance, and we, the readers, are forced to infer (often from barely literate writers) what passes as sarcasm. In the end, failure ensues, ideas are miscommunicated and a visual diarrhea of smileys is used in an effort to smooth things over.

My personal bias (again) is simply this: Most people who write and say that they "could care less" are simply stupid. They aren't trying to be witty or sarcastic. They are ignorant, and haven't given thought to just how silly it sounds/reads when they say/write "I could care less." Perhaps I should give them the benefit of the doubt.

Unfortunately, most bloggers haven't given me a good reason to. In the end, as evidence by the fact that I wrote this article, I actually could care less.

iPod and Nike+: A Match Made in Heaven

A while ago I wrote an article I titled: iPod and Nike, a match made in marketing. It isn't a long article, but in short, I slammed the idea as nothing more than a lame gimmick to get people to buy more stuff. I even went so far as to say "I wouldn't be interested at all."

Two years later I have to say the following: Not only is it a gimmick, it is the coolest freaking gimmick in the world.

I said I didn't see new runners being motivated by this scheme. WRONG. I also said I didn't see current runners getting into it either. Again, WRONG. A friend of mine mentioned that he had picked this up and was really enjoying his first foray into the world of running. The more we talked, the more intrigued I was by the idea. There was, however, one problem: I only have a 30 gig hard drive based iPod. The system only works with the Nano (they don't want to encourage people to jostle their hard drive around and then call them when it stops working).

Wait, what I meant to say was I only had a 30 gig iPod. Being the sucker I am, I now also have a 3G black 8 gig Nano. I now also have the Nike+ sport pack. This morning I plugged it in, put on my new Nike+ shocks shoes and fired up some good tunes (a little Testament at 5 am). I told the iPod I wanted to run for 30 minutes, then hit start. Then I started running. Well, okay, jogging. Calling it running is a bit unfair to, well, running.

After five minutes a voice calmly let me know I had been going for five minutes. I pushed the select button and that same voice told me how long I had been running, how far I had gone, what my current pace was. Once it was all over it told me how far I had gone, how many calories I had burned (calculated pretty well based on your weight which you enter), and what my average pace was.

I then plugged my iPod into my computer and all that information was uploaded to my Nikeplus.com page. On my Nike+ page I now have goals. I also joined a competition for beginning runners: the first to run 50 miles. I might not win, but heck, I might. And if I don't, I have something to work towards.

Overall, I love it. Sure, I can see that it is a gimmick. But I actually see it as a very motivating gimmick.

NIN and the Future of Music

Years ago a little program revolutionized the music world. Its name was Napster.

Napster wasn't the first way to find music on the internet. Usenet and IRC had been around for years. However, both of those solutions required a bit of tech-know-how to use and were not accessible to the mainstream user. Enter Napster. A clean, easy to understand interface and instant access for millions of people (many of them college students) to begin sharing and downloading music was born.

Along came Metallica and the RIAA.

Sure, they weren't the only ones, but they became the most vocal. Lawsuits ensued, the service was shut down, the RIAA declared victory and then realized that, just like Obi-Wan Kenobi, "If you strike [it] down, [it] shall become more powerful than you can possibly imagine."

Dozens of alternatives to Napster sprung up in the wake of the ruling. Audio Galaxy, Scour Exchange, Soulseek and others filled the gaps. As these were all services with centralized servers, a new generation of peer to peer programs appeared, without centralized servers, allowing true direct peer to peer connection to download, such as Gnutella, eDonkey, and Kazaa. As the RIAA continues to kick against the pricks, new ways to find music in the internet continue to flourish.

This article has nothing to do with the legality or morality of downloading music. Let's just establish that here and now.

What I find most disconcerting is the "head in the sand" attitude that the RIAA as a whole, and many artists and labels seem to have about downloading. Digital music is not just the future of music, it is the present as well. Apple has made itself a household name based on the premise that people want to be able to have access to lots of music, all the time. This can only happen with digital music. Heck, my very nice (at the time I got it) Sony Discman has been buried in a drawer of mine for over 2 years now. And this certainly isn't because I don't love music.

The truth, as I see it, is you cannot win out against downloading. It has proliferated since the RIAA decided to crusade against it, and shows no signs of slowing down. Intelligent artists and labels should be using it to help themselves, instead of insisting it is going to lead to the ruin of music as we know it.

Sadly, very few of them are doing just that. Yet there are pioneers.

Radiohead released their album In Rainbows to the internet last October, allowing people to pick their own price. While the figures have not been widely released, there is no question that Radiohead did well with their effort. Saul Williams released his third album in digital format, allowing people to download for free or for $5. While not a rousing success, it is worth noting that nearly 30,000 people have payed the $5 to purchase the album (released in Nov 2007) as compared to the 30,000 who have purchased his previous release since 2004.

But the most overwhelming success is that of Trent Reznor. The mastermind behind Nine Inch Nails, Reznor has very publicly spoken out against the recording industry and, after his release of Year Zero in 2007, severed all ties with his label and declared his forthcoming material would be self-published and released. In the beginning of March 2008, Ghosts I-VI was released. Ghost I was available free for download to anyone who wanted. If you wanted to download the other 3 albums, all that was asked was $5. If you wanted more than that (physical media, collector's sets), there were plenty of options.

Think about that for a minute. $5 for 36 songs. Each of the downloaded tracks had unique album art embedded in the tag, was at a high quality, and was ready to be loaded into iTunes (or your digital jukebox of choice: foobar2000 for me) and loaded onto your digital device. No DRM, no need to authorize your computer to play the song (iTunes, I'm looking sternly in your direction), and no limit to the type of player you could play it on. Want to burn them to a CD? Go for it. No problem. But how did this work out for Reznor? All we have are the first week's figures: Reznor took home $1.6 million in sales and scored 781,917 total transactions.

Does this include everyone who downloaded the album? Of course not. There are probably many more who downloaded the album for free from some other source. But can anyone call that a failure? I think not. And now, two months later, Reznor has again spit in the face of the RIAA and released The Slip. Another full album, this one is free in a variety of formats that will appeal to the most casual listener or to the most hard-core audiophile (24/96 WAV format is much higher quality than you could even get on a physical CD). Again, each track has unique album art embedded in the tag, the download comes with a .pdf file of the albums booklet. Physical copies will be available in a couple of months as well. According to Trent "this one is on me."

Why do this? In the first place, NIN is in that upper echelon of bands that could pull this off. There needs to be a certain, dedicated fan base who will, out of loyalty and love for the music, support the artist. The beauty of it, though, is that now Trent Reznor has complete control over his music. He controls the quality of what is available for download on the net, he certainly gains new fans as this album is spread around and talked about (heck, I would never have said I was a NIN fan, but here I am devoting time and energy to talk about Reznor). He has no middle man sucking him dry, telling him how and what to do. He has no contractual obligations to fulfill. The music remains just that: music. It no longer becomes muddied by the turbulent waters of large record labels and pompous, self-serving executives. The connection between artist and fan becomes that much more real, that much more pure.

Trent Reznor has embraced the new medium. He is quietly revolutionizing the way music reaches the ears of the audience. Let's only hope other artists will follow his lead.