after attending a forum regarding the economic crisis at the university of washington yesterday, a few things were brought up that i found very interesting.
the historians were walking us through what had happened between 1929 and 1930 here, and although the state approved to increase large projects to boost employment, it appeared that the governor tied their hands by not raising taxes. photos were provided of "hoovervilles" shantytowns, while mentioning the current homeless "nickelsvilles" (named to spite mayor nickels). i found this thought provoking as such a reality is hard for me to believe had existed and the photos really kicked the reason "home". they feel that the situation today is not much different than in the past, and i hope that we can make good long-term decisions. we can reduce the effects locally by continuing governmental investment in "human capital", such as education, job retraining, and they argue through further unions and worker mobilization to ensure that policies will be aimed towards the people and not corporations. the way that we emerge out of a recession, or a depression for that matter, is to keep people employed to continue to be able to consume and thus prop our own industries up. not through cutting taxes and canning workers, which seems to be the direction many are pointing.
realistically, after seeing an article in the new york times confirming what the historians were saying by college being more and more expensive, i think it will be hard to balance out the short term solutions (which seem rather tempting to most, such as bailing out the auto industry, etc) with the long term solutions (such as keeping or upping taxation levels to keep retraining or education high, ensuring that after the resolution of the crisis we're to re-emerge well). i wrote a message to governor gregoire this morning to note that we will need to convince the people to keep all the social services that we can alive, at a time that we'll be more than ever tempted to hatchet spending.
any comments are more than welcome to ponder through what should be done.
abraços,
Thursday, December 4, 2008
Monday, December 1, 2008
Please Discuss: The Shark
I am posting this for those who were not able to attend but would like to see the show.
I'd also love to discuss the play, as I've not really had a lot of meaningful discussion about it.
Please, if you would like, watch the low-quality streaming video of "The Shark" at
www.youtube.com/user/natejp
I apologize for the quality.
The written script, if you wish to keep along, is available here
Sample discussions:
The logic of cannibalism.
self-destruction vs human nature
the logic of murder
anti-logic.
I'd also love to discuss the play, as I've not really had a lot of meaningful discussion about it.
Please, if you would like, watch the low-quality streaming video of "The Shark" at
www.youtube.com/user/natejp
I apologize for the quality.
The written script, if you wish to keep along, is available here
Sample discussions:
The logic of cannibalism.
self-destruction vs human nature
the logic of murder
anti-logic.
Saturday, November 29, 2008
Filing Right and Wrong: Fictitious Philosophy presented by a Physics Man (excuse my improvisation, but it cut off the title)
post by jones (apparently whom i needed to send an invitation to post?! forgive me!)
"Although I've taken a 4 year college degree in physics, I don't know if I'd exactly say that my specialty is physics. I know quite a bit, but I also know quite a bit about Ubuntu Linux and a little about frisbee, and climbing, and skiing, and whatever else. My point being, I didn't exactly know how to contribute to this blog, so I'm just going to do it any which way.
And that way is going to be with a little philosophy. Recently I read a book called Shantaram. Beyond the fact that I highly recommend it, there was an interesting section where Khaderbai, a wise old muslim-scholar-mafia-lord1 elaborated an ethical framework, which I think is worth looking at because it attempts to form an moral-ethical basis upon which people of all different religions (or lack of religions) can agree. This is ambitious. It's also very prescient. In this world where evil deeds can be done in the name of beliefs, religious or otherwise, a common system from which everyone could start is more than just desirable, it may be essential. So, let's talk about a moral system of ethics, which can be defined simply as a framework in which you can easily decide what actions are good and which actions are bad2.
Khaderbai begins with the generally accepted, scientific history of the Universe. First, there was a big bang, an infinitely small point "full" of structures below the level of even being particles3 quickly exploded out of oblivion. As this point expanded and cooled, particles were able to form. Then from particles, atoms (mostly just hydrogen and helium). Then from atoms, some basic molecules. As these molecules clumped together they began to form stars which could make new elements in their hot, dense cores. These stars eventually "died" shedding these new elements which were able to form more complex molecules ... eventually to the point of life4 ... and so on. His point in telling this story is that the universe is moving from structures which are simple to those that are more complex.
Here is where he leaves the general science by extending history into the future and saying as the universe gets more and more complex we are moving towards an Ultimate Complexity, which from his Muslim stance he is willing to call "God."5 But as he suggests, let's just leave it at Complexity. Now, moving toward Complexity is construed as a Good thing and moving backwards towards simplicity is Not Good.
So, lastly if we'd like to judge an action we can ask ourselves these two questions:
* What would happen if everyone did this?
* Would that help or hinder the movement toward Complexity?
So, for example, "Is it good or bad to kill?" Our answer becomes, "well, if everyone killed, we'd all be dead and we're pretty complex so that would hinder movement towards complexity, so it is bad to kill."6 Khaderbai then continues on to say that in absolutely all cases it is bad to kill. It can get sticky, however, when one asks, "Is it bad to kill that lunatic who is about to kill everyone else?" Khaderbai would say "Yes, it is wrong. If you were to kill that man you would be doing wrong for the right reasons." (remember now that Khaderbai is a mafia leader and does plenty of "wrong" things by his own definition) If you kill Mr. Lunatic, you do wrong, but you are doing it with the idea of complexity in mind. Many people might then say, "well, I guess it was actually right in the end to kill Mr. Lunatic" but the point here is it is your action that matters and if yours is to hinder movement toward complexity, then it is wrong.
Let me quickly summarize his points:
1. The universe is moving from simple structures to ones with increasing complexity.
2. This movement towards complexity, especially the idea of some future Ultimate Complexity is what we can call "good" (and if we're religious we might say we are moving toward God).
3. To judge the rightness or wrongness of an action we must ask, "If everone did this would it help or hinder the movement toward Complexity?" If the former, it is right; if the latter, it is wrong.
This is a very simple, even elegant system. It could be just as easily accepted by many secular people as by many religious believers. It's quite admirable in that aspect.
Unfortunately, there's a bit of a loophole7. The sticking point I came across was not really in the first two points, but in the two questions we ask to find out if something is wrong or not. Specifically, with the first part, "if everyone did this" and the way that it applies firstly to human social structures.
Take this example of a frisbee team. There's a pickup game of frisbee down at Greenlake. Two teams have formed, Blue and Red. Both teams begin playing, but the Red team is going every which way--directionless. Our moral question is, "Is it right for one team member take over and begin directing the other ones around?" (I know, not exactly a huge moral quandary.) The framework above would yield the answer, "No, it's not right because if everyone tried to direct everyone else, none of them would be paying attention to what they're doing and the team would be worse off than before: a simple yelling match instead of at least individual players running around." But, I think it's easy to see that it is right if one player leads. The team then becomes more complex and can use it's individual players in a coordinated fashion. Extending further, maybe one player might become the "handler" (thrower) and another be designated to chase when the frisbee is hucked into the in-zone. The point is that these specializations shouldn't be classified as wrong, which seems to be the case from the above reasoning. It's not wrong, as long as everyone doesn't do it. In fact, it moves us towards Complexity. Actually, it has been said by many8 that in order for evolution to occur you first need differentiation then reintigration, and unfortunately point 3 of Khaderbai's universal system doesn't allow for differentiation to be right or good. So, that's a bit of a problem.
So, you might ask, "Well, why in the hell did you even write about this moral philosophy from a mafia-lord in a half-fictitious book9 which can't even be right?" Well, because I think it's admirable10 and I think he's definitely on to something with points 1 & 2. Asking the questions, "Is what I'm doing good? Is what I'm doing right?"is essential to a well-lived life (or at least Aristotle thinks so). Being a volunteer in Uganda I ask myself these questions a lot more than I think I would back at home in the US. Maybe what's more interesting is when I know the answer to be "no" and still have trouble changing that which I am doing...
Anyway, enough spinning the philosophical cogs. Thanks for reading my musings.
~JONES
Footnotes
1 - I know this description, although accurate, sounds far-fetched and might immediately turn someone off to his words. Let's just look at the ideas for now.
2 - Or right and wrong. I'm going to use these terms interchangeably so as not to split linguistic hairs.
3 - Particles being things like electrons, protons, neutrons, etc.
4 - Sorry biologists. I know there's a lot of history here too, more in fact, but in the interest of time and not sticking my foot in my mouth, I'll leave that section to you.
5 - His argument makes a lot of sense, although a strict science perspective might raise the disagreement that increasing entropy implies increasing disorder, which is simpler than order. Also, we're going to ignore talk of the Heat Death of the Universe.
6 - I hope everyone agrees that should be the answer. I also encourage you to try out some other moral quandary in the system. I'm going to take a minute to do it now too, "Is it bad to only sit in my house and read all day?"
7 - Mystics might say that as long as we're using words to try to describe reality we can never capture the Truth.
I also wanted to add on the point here that we're talking about human actions, but you could also try to extend this other "acts of nature" and say that a planet-killing asteroid hitting Earth would definitely be "bad." However, similarly to how I will argue in a moment, it doesn't apply well to predators - "if everyone (now including herbivores) decided to exclusively kill other animals to eat that would be hinder movement toward complexity and be bad." But, complex eco-systems of predators, herbivores, scavengers, etc. is fairly clearly closer towards captial-c Complexity.
8 - I'm thinking specifically of Wilber in The Marriage of Sense and Soul and Arthur Koestler in The Sleepwalkers. A quote from the latter:
The process of evolution may be described as differentiation of structure and integration of function. The more differentiated and specialized the parts, the more elaborate coordination is needed to create a well-balanced whole. (527)
9 - Also, I don't know how fictitious this book is. I know it's at least partly, if not mostly true. If someone's bored and wants a research project...
10 - With my interest in secular philosophy, I've been told I really need to read some Bertrand Russel. Can anyone give me some suggestions on where to start (or be so indelibly kind as to send me something by him)?"
"Although I've taken a 4 year college degree in physics, I don't know if I'd exactly say that my specialty is physics. I know quite a bit, but I also know quite a bit about Ubuntu Linux and a little about frisbee, and climbing, and skiing, and whatever else. My point being, I didn't exactly know how to contribute to this blog, so I'm just going to do it any which way.
And that way is going to be with a little philosophy. Recently I read a book called Shantaram. Beyond the fact that I highly recommend it, there was an interesting section where Khaderbai, a wise old muslim-scholar-mafia-lord1 elaborated an ethical framework, which I think is worth looking at because it attempts to form an moral-ethical basis upon which people of all different religions (or lack of religions) can agree. This is ambitious. It's also very prescient. In this world where evil deeds can be done in the name of beliefs, religious or otherwise, a common system from which everyone could start is more than just desirable, it may be essential. So, let's talk about a moral system of ethics, which can be defined simply as a framework in which you can easily decide what actions are good and which actions are bad2.
Khaderbai begins with the generally accepted, scientific history of the Universe. First, there was a big bang, an infinitely small point "full" of structures below the level of even being particles3 quickly exploded out of oblivion. As this point expanded and cooled, particles were able to form. Then from particles, atoms (mostly just hydrogen and helium). Then from atoms, some basic molecules. As these molecules clumped together they began to form stars which could make new elements in their hot, dense cores. These stars eventually "died" shedding these new elements which were able to form more complex molecules ... eventually to the point of life4 ... and so on. His point in telling this story is that the universe is moving from structures which are simple to those that are more complex.
Here is where he leaves the general science by extending history into the future and saying as the universe gets more and more complex we are moving towards an Ultimate Complexity, which from his Muslim stance he is willing to call "God."5 But as he suggests, let's just leave it at Complexity. Now, moving toward Complexity is construed as a Good thing and moving backwards towards simplicity is Not Good.
So, lastly if we'd like to judge an action we can ask ourselves these two questions:
* What would happen if everyone did this?
* Would that help or hinder the movement toward Complexity?
So, for example, "Is it good or bad to kill?" Our answer becomes, "well, if everyone killed, we'd all be dead and we're pretty complex so that would hinder movement towards complexity, so it is bad to kill."6 Khaderbai then continues on to say that in absolutely all cases it is bad to kill. It can get sticky, however, when one asks, "Is it bad to kill that lunatic who is about to kill everyone else?" Khaderbai would say "Yes, it is wrong. If you were to kill that man you would be doing wrong for the right reasons." (remember now that Khaderbai is a mafia leader and does plenty of "wrong" things by his own definition) If you kill Mr. Lunatic, you do wrong, but you are doing it with the idea of complexity in mind. Many people might then say, "well, I guess it was actually right in the end to kill Mr. Lunatic" but the point here is it is your action that matters and if yours is to hinder movement toward complexity, then it is wrong.
Let me quickly summarize his points:
1. The universe is moving from simple structures to ones with increasing complexity.
2. This movement towards complexity, especially the idea of some future Ultimate Complexity is what we can call "good" (and if we're religious we might say we are moving toward God).
3. To judge the rightness or wrongness of an action we must ask, "If everone did this would it help or hinder the movement toward Complexity?" If the former, it is right; if the latter, it is wrong.
This is a very simple, even elegant system. It could be just as easily accepted by many secular people as by many religious believers. It's quite admirable in that aspect.
Unfortunately, there's a bit of a loophole7. The sticking point I came across was not really in the first two points, but in the two questions we ask to find out if something is wrong or not. Specifically, with the first part, "if everyone did this" and the way that it applies firstly to human social structures.
Take this example of a frisbee team. There's a pickup game of frisbee down at Greenlake. Two teams have formed, Blue and Red. Both teams begin playing, but the Red team is going every which way--directionless. Our moral question is, "Is it right for one team member take over and begin directing the other ones around?" (I know, not exactly a huge moral quandary.) The framework above would yield the answer, "No, it's not right because if everyone tried to direct everyone else, none of them would be paying attention to what they're doing and the team would be worse off than before: a simple yelling match instead of at least individual players running around." But, I think it's easy to see that it is right if one player leads. The team then becomes more complex and can use it's individual players in a coordinated fashion. Extending further, maybe one player might become the "handler" (thrower) and another be designated to chase when the frisbee is hucked into the in-zone. The point is that these specializations shouldn't be classified as wrong, which seems to be the case from the above reasoning. It's not wrong, as long as everyone doesn't do it. In fact, it moves us towards Complexity. Actually, it has been said by many8 that in order for evolution to occur you first need differentiation then reintigration, and unfortunately point 3 of Khaderbai's universal system doesn't allow for differentiation to be right or good. So, that's a bit of a problem.
So, you might ask, "Well, why in the hell did you even write about this moral philosophy from a mafia-lord in a half-fictitious book9 which can't even be right?" Well, because I think it's admirable10 and I think he's definitely on to something with points 1 & 2. Asking the questions, "Is what I'm doing good? Is what I'm doing right?"is essential to a well-lived life (or at least Aristotle thinks so). Being a volunteer in Uganda I ask myself these questions a lot more than I think I would back at home in the US. Maybe what's more interesting is when I know the answer to be "no" and still have trouble changing that which I am doing...
Anyway, enough spinning the philosophical cogs. Thanks for reading my musings.
~JONES
Footnotes
1 - I know this description, although accurate, sounds far-fetched and might immediately turn someone off to his words. Let's just look at the ideas for now.
2 - Or right and wrong. I'm going to use these terms interchangeably so as not to split linguistic hairs.
3 - Particles being things like electrons, protons, neutrons, etc.
4 - Sorry biologists. I know there's a lot of history here too, more in fact, but in the interest of time and not sticking my foot in my mouth, I'll leave that section to you.
5 - His argument makes a lot of sense, although a strict science perspective might raise the disagreement that increasing entropy implies increasing disorder, which is simpler than order. Also, we're going to ignore talk of the Heat Death of the Universe.
6 - I hope everyone agrees that should be the answer. I also encourage you to try out some other moral quandary in the system. I'm going to take a minute to do it now too, "Is it bad to only sit in my house and read all day?"
7 - Mystics might say that as long as we're using words to try to describe reality we can never capture the Truth.
I also wanted to add on the point here that we're talking about human actions, but you could also try to extend this other "acts of nature" and say that a planet-killing asteroid hitting Earth would definitely be "bad." However, similarly to how I will argue in a moment, it doesn't apply well to predators - "if everyone (now including herbivores) decided to exclusively kill other animals to eat that would be hinder movement toward complexity and be bad." But, complex eco-systems of predators, herbivores, scavengers, etc. is fairly clearly closer towards captial-c Complexity.
8 - I'm thinking specifically of Wilber in The Marriage of Sense and Soul and Arthur Koestler in The Sleepwalkers. A quote from the latter:
The process of evolution may be described as differentiation of structure and integration of function. The more differentiated and specialized the parts, the more elaborate coordination is needed to create a well-balanced whole. (527)
9 - Also, I don't know how fictitious this book is. I know it's at least partly, if not mostly true. If someone's bored and wants a research project...
10 - With my interest in secular philosophy, I've been told I really need to read some Bertrand Russel. Can anyone give me some suggestions on where to start (or be so indelibly kind as to send me something by him)?"
Wednesday, November 19, 2008
Another story
First, thanks to BurnPTCruisers for the in-depth comment. I should clarify that I was not in med school at the time of this incident and didn’t have the knowledge I have now (which, granted, is still extremely limited in actual clinical usefulness). But I did what I think any of you would have done in the same situation, which is to say, “If the poor bastard needs oxygen, then let’s give him oxygen!” It is very difficult to hurt somebody with too much oxygen.
I think the bottom line here was that our boss was thinking very short-sightedly, and did not realize that if we had done what he told us to do and the patient was harmed, the company would have been in MUCH bigger trouble. In his defense, he eventually came around to this (but for crying out loud, it shouldn’t even have been an argument!).
*****************
Below is a report that I wrote up after a particularly sticky encounter with a patient at the hospital. The issue here is: the patient snapped her own IV line and walked out of the hospital. This is dangerous, because if the IV is not properly discontinued, she runs the risk of bleeding out. I caught up with her, wrestled with her a little bit, but eventually let her go because I didn't want to get MY ass locked up for assault. In case anything legal ever came of that situation, I wrote up my version of the story...
18 May, 2007
Patient was mid-30 year old female, possibly Native American, brought in by ambulance with a chief complaint of “too drunk for detox.” Patient was admitted to [the hallway where we put the inebriated to sleep it off], remained unarousable for most of her stay. Fluids were administered through an IV to her left hand. After approximately 2 hours, the patient awoke and I witnessed her sitting upright in bed. At approximately 1930 hours, patient was noticed by nurse and myself to be missing. The IV line had been severed and the patient’s belongings (coat and hat) had been left in orange bag beneath bed. Witnesses reported patient to have exited the south end of the ER.
I began searching the hospital for the patient while the nurse contacted security. I found the patient near the main staircase of the lobby, and called her name several times without response. I caught up with the patient and tried to convince her to return to the ED simply so we could pull out her IV and she could get her belongings. The patient refused, asking me on two occasions to pull out her IV there in the lobby. When I asked the patient if she wanted her belongings, she answered “They’re just possessions. Why would I want more possessions?” On two occasions, I took hold of the patient’s arm and attempted to escort her back to the ER, but on both occasions she resisted and said “No touching.” Several people witnessed this exchange. About two minutes after I had initially made contact with the patient, she exited through the lobby doors.
I returned to the ER and reported to the nurse that I had made contact with the patient, but she had refused to return to the ER. The nurse and I reported this to three security officers and the on-duty police officer. Security told us that once the patient was off hospital property, there was nothing they could do. The police officer and myself went outside to the ambulance bay and witnessed the patient walking eastbound on the north side of [omitted] Street. A security officer also witnessed the patient walking away. Security contacted the precint police with a physical description of the patient, who reported they would begin looking for the patient. I returned to the ER and took possession of patient’s belongings, arranging for them to be deposited in the lost and found.
I think the bottom line here was that our boss was thinking very short-sightedly, and did not realize that if we had done what he told us to do and the patient was harmed, the company would have been in MUCH bigger trouble. In his defense, he eventually came around to this (but for crying out loud, it shouldn’t even have been an argument!).
*****************
Below is a report that I wrote up after a particularly sticky encounter with a patient at the hospital. The issue here is: the patient snapped her own IV line and walked out of the hospital. This is dangerous, because if the IV is not properly discontinued, she runs the risk of bleeding out. I caught up with her, wrestled with her a little bit, but eventually let her go because I didn't want to get MY ass locked up for assault. In case anything legal ever came of that situation, I wrote up my version of the story...
18 May, 2007
Patient was mid-30 year old female, possibly Native American, brought in by ambulance with a chief complaint of “too drunk for detox.” Patient was admitted to [the hallway where we put the inebriated to sleep it off], remained unarousable for most of her stay. Fluids were administered through an IV to her left hand. After approximately 2 hours, the patient awoke and I witnessed her sitting upright in bed. At approximately 1930 hours, patient was noticed by nurse and myself to be missing. The IV line had been severed and the patient’s belongings (coat and hat) had been left in orange bag beneath bed. Witnesses reported patient to have exited the south end of the ER.
I began searching the hospital for the patient while the nurse contacted security. I found the patient near the main staircase of the lobby, and called her name several times without response. I caught up with the patient and tried to convince her to return to the ED simply so we could pull out her IV and she could get her belongings. The patient refused, asking me on two occasions to pull out her IV there in the lobby. When I asked the patient if she wanted her belongings, she answered “They’re just possessions. Why would I want more possessions?” On two occasions, I took hold of the patient’s arm and attempted to escort her back to the ER, but on both occasions she resisted and said “No touching.” Several people witnessed this exchange. About two minutes after I had initially made contact with the patient, she exited through the lobby doors.
I returned to the ER and reported to the nurse that I had made contact with the patient, but she had refused to return to the ER. The nurse and I reported this to three security officers and the on-duty police officer. Security told us that once the patient was off hospital property, there was nothing they could do. The police officer and myself went outside to the ambulance bay and witnessed the patient walking eastbound on the north side of [omitted] Street. A security officer also witnessed the patient walking away. Security contacted the precint police with a physical description of the patient, who reported they would begin looking for the patient. I returned to the ER and took possession of patient’s belongings, arranging for them to be deposited in the lost and found.
Saturday, November 1, 2008
A half-assed contribution
Disclaimer: I wrote this essay for an ethics assignment a few days ago. It was a throw-away paper, so I probably put less time into it than I would have put into a real blog post. I don't even know exactly what the hell I'm talking about by the end, but if you have some time to kill, you might find this interesting.
Our last patient of the day was a middle-aged gentleman with terminal lung cancer. He was being discharged from the hospital back to his home to begin hospice care, where he would likely die within a few weeks. He needed a constant supply of high levels of supplemental oxygen just to stay conscious, but when we entered the room, he smiled and waved.
I was working as an Emergency Medical Technician (EMT) for a small, private ambulance company and we were dispatched to transport this patient to his home. This trip would likely take close to an hour, but long-distance transfers were common for our company. However, when we reviewed his chart and noticed the amount of oxygen this patient would require, my partner and I realized we did not have enough on the ambulance that day to make the trip. We called our supervisor on the radio to give him this news, and he informed us that it could be another hour before the next available ambulance could get to the hospital. To our surprise, we were then advised to transport the patient anyway, while giving him less oxygen than he needed.
With this case, I can identify a conflict between patient care and business. First, with patient care, we were being asked to place the patient in a situation that could easily have been harmful to him. However, in terms of the business, it was likely that our superior had feared that delaying this patient’s transport for another hour would have reflected poorly on the company, which could have jeopardized future business with this particular hospital.
My partner and I were in agreement that it was simply too risky to transport this patient with the limited supply of oxygen we had on-hand. By knowingly placing the patient in a potentially dangerous situation, we would have been violating our professional ethics as EMTs, as well as our moral standards as human beings. In addition, we clearly would have been acting under negligence and could have faced legal repercussions if the patient had suffered any injuries. For these reasons, it was an easy decision to refuse to transport the patient and request that our supervisor call the next available ambulance.
Though I was taken aback by my supervisor’s request, I was also able to see the issue from his point of view. Like the operator of any small business, his top priority is the company. As a small business, his company must remain competitive with larger companies. Consequently, a single contract with a single hospital comprises a larger percentage of the total revenue earned. In an economic sense, a single contract is more valuable to a smaller company than it would be to a larger company. This is a reasonable business model for most companies; however, there are many more ethical issues at stake when the product being sold is patient care.
At our patient’s bedside, it was clear to us that we could not transport him. As EMTs, we had been trained to think with protocol in mind, and to always remember the legal consequences of negligent action. I do not know of a single EMT, paramedic, or physician who would have made a different decision than we did, and even our supervisor later admitted that he had been hasty and careless in his handling of the situation. This situation was unfair to everyone involved: we were asked to knowingly endanger a patient, and as a result, we were forced to stand up to our supervisor and put our own positions as employees on the line. Even if we had agreed to transport the patient, he would most likely have preferred to wait for the next ambulance.
Though I have never operated an ambulance company and have no experience with medical administration, I imagine that balancing business and medicine is a formidable task. As a former EMT and current medical student, I have been trained to think of the patient as priority number one. But medical administrators have to balance patient care with the demands of the business; if the company suffers or fails, patients may be negatively impacted as well.
So how is this balance determined? In the case I have described above, it might have been useful to have a third party mediator who could look at the case from both my perspective as an EMT and my supervisor’s perspective as the company operator. From my perspective, the refusal to transport the patient put him in no additional harm, but did have the consequence of placing me in an uncomfortable position with my supervisor. From my supervisor’s perspective, my decision may have somewhat tarnished the ambulance company’s reputation as a fast and reliable provider of care, but in the long run, it likely protected the company’s reputation as a safe provider of care. It would have been helpful to have a third party mediator who could have identified these issues and presented them to both parties.
I believe that the best patient care is delivered when both the healthcare provider and the administrator has a basic understanding of the issues that the other party faces. It is easy as a healthcare provider to only think of the patient in front of you and forget about all of the other hidden elements that contribute to (or detract from) that patient’s care. As a newcomer to medicine, I hope that there will be communication between the healthcare providers and the administrators wherever I decide to work in the future. If I do not get involved in medical administration myself, I can only hope to have the opportunity to learn enough about it to begin to see these hidden elements, and to use this knowledge to the advantage of my patients.
Our last patient of the day was a middle-aged gentleman with terminal lung cancer. He was being discharged from the hospital back to his home to begin hospice care, where he would likely die within a few weeks. He needed a constant supply of high levels of supplemental oxygen just to stay conscious, but when we entered the room, he smiled and waved.
I was working as an Emergency Medical Technician (EMT) for a small, private ambulance company and we were dispatched to transport this patient to his home. This trip would likely take close to an hour, but long-distance transfers were common for our company. However, when we reviewed his chart and noticed the amount of oxygen this patient would require, my partner and I realized we did not have enough on the ambulance that day to make the trip. We called our supervisor on the radio to give him this news, and he informed us that it could be another hour before the next available ambulance could get to the hospital. To our surprise, we were then advised to transport the patient anyway, while giving him less oxygen than he needed.
With this case, I can identify a conflict between patient care and business. First, with patient care, we were being asked to place the patient in a situation that could easily have been harmful to him. However, in terms of the business, it was likely that our superior had feared that delaying this patient’s transport for another hour would have reflected poorly on the company, which could have jeopardized future business with this particular hospital.
My partner and I were in agreement that it was simply too risky to transport this patient with the limited supply of oxygen we had on-hand. By knowingly placing the patient in a potentially dangerous situation, we would have been violating our professional ethics as EMTs, as well as our moral standards as human beings. In addition, we clearly would have been acting under negligence and could have faced legal repercussions if the patient had suffered any injuries. For these reasons, it was an easy decision to refuse to transport the patient and request that our supervisor call the next available ambulance.
Though I was taken aback by my supervisor’s request, I was also able to see the issue from his point of view. Like the operator of any small business, his top priority is the company. As a small business, his company must remain competitive with larger companies. Consequently, a single contract with a single hospital comprises a larger percentage of the total revenue earned. In an economic sense, a single contract is more valuable to a smaller company than it would be to a larger company. This is a reasonable business model for most companies; however, there are many more ethical issues at stake when the product being sold is patient care.
At our patient’s bedside, it was clear to us that we could not transport him. As EMTs, we had been trained to think with protocol in mind, and to always remember the legal consequences of negligent action. I do not know of a single EMT, paramedic, or physician who would have made a different decision than we did, and even our supervisor later admitted that he had been hasty and careless in his handling of the situation. This situation was unfair to everyone involved: we were asked to knowingly endanger a patient, and as a result, we were forced to stand up to our supervisor and put our own positions as employees on the line. Even if we had agreed to transport the patient, he would most likely have preferred to wait for the next ambulance.
Though I have never operated an ambulance company and have no experience with medical administration, I imagine that balancing business and medicine is a formidable task. As a former EMT and current medical student, I have been trained to think of the patient as priority number one. But medical administrators have to balance patient care with the demands of the business; if the company suffers or fails, patients may be negatively impacted as well.
So how is this balance determined? In the case I have described above, it might have been useful to have a third party mediator who could look at the case from both my perspective as an EMT and my supervisor’s perspective as the company operator. From my perspective, the refusal to transport the patient put him in no additional harm, but did have the consequence of placing me in an uncomfortable position with my supervisor. From my supervisor’s perspective, my decision may have somewhat tarnished the ambulance company’s reputation as a fast and reliable provider of care, but in the long run, it likely protected the company’s reputation as a safe provider of care. It would have been helpful to have a third party mediator who could have identified these issues and presented them to both parties.
I believe that the best patient care is delivered when both the healthcare provider and the administrator has a basic understanding of the issues that the other party faces. It is easy as a healthcare provider to only think of the patient in front of you and forget about all of the other hidden elements that contribute to (or detract from) that patient’s care. As a newcomer to medicine, I hope that there will be communication between the healthcare providers and the administrators wherever I decide to work in the future. If I do not get involved in medical administration myself, I can only hope to have the opportunity to learn enough about it to begin to see these hidden elements, and to use this knowledge to the advantage of my patients.
Tuesday, October 28, 2008
Sorry for the hiatus
Natty is very correct....I have been somewhere between the ceiling and the floor with a noose around my neck. Between the stock market, economy, and UW football...
But yes, we must get together and have a couple beers so I can help explain what's going on. Honestly, if anybody tells you they know what's going on, they are full of $h!+ and you should ignore them.
But yes, we must get together and have a couple beers so I can help explain what's going on. Honestly, if anybody tells you they know what's going on, they are full of $h!+ and you should ignore them.
Wednesday, October 22, 2008
A Survey Of Sorts
I'm interested to know, from all of you non-theatre folks (and you too, Michelle, if you want to join in) what it would take to get you to go out and see more theatre.
All of you are very supportive of the work that I have done in Seattle, and come to see the shows I've acted in, the shows I've directed, and the shows of Emerald City Scene. But that is a very tiny percentage of theatre in Seattle. What I'm curious about is this:
a) if you enjoy the shows you come to see that I am involved in
and
b) if you do enjoy them, why not go see other companies productions?
and
c) if you have seen other companies productions, which ones? and did you like them?
and
d) how could a theatre company grab your attention and get you to come see shows, if you aren't affiliated with someone involved in the show?
If and When I come back to Seattle, I'll be working on forming a new "company" and I'm very interested in these responses.
All of you are very supportive of the work that I have done in Seattle, and come to see the shows I've acted in, the shows I've directed, and the shows of Emerald City Scene. But that is a very tiny percentage of theatre in Seattle. What I'm curious about is this:
a) if you enjoy the shows you come to see that I am involved in
and
b) if you do enjoy them, why not go see other companies productions?
and
c) if you have seen other companies productions, which ones? and did you like them?
and
d) how could a theatre company grab your attention and get you to come see shows, if you aren't affiliated with someone involved in the show?
If and When I come back to Seattle, I'll be working on forming a new "company" and I'm very interested in these responses.
Thursday, October 9, 2008
A little levity, please...
I saw B-squared recently, but due to a rousing round of "The Farmer's Game," neglected to get a good explanation of the current financial buggery our country seems to be undergoing. I guess that will have to wait until next time (if we make it that long). But while I check CNN.com obsessively during class, I am always amused by the stock photos they use to describe the meltdown. They particularly enjoy to capture the angst of the poor brokers, sitting on the floor of the NYSE with their heads in their hands, amidst the litter of the tickertapes and whatever the hell else it is they throw around down there. Fortunately, somebody funnier than me has put together a collection of these sad brokers and, since this is the Internet, has added witty captions (image 15 is my favorite). Click any of the pictures to start the slideshow. Bonus: I also just discovered an entire website devoted to this emerging fad.
And to burnPTCruisers: I'm not trying to deviate from the desired format for this blog. I've got another bigger post in the planning states, but this blog has been quiet for a while so I thought I'd try to liven it up a bit :)
And to burnPTCruisers: I'm not trying to deviate from the desired format for this blog. I've got another bigger post in the planning states, but this blog has been quiet for a while so I thought I'd try to liven it up a bit :)
Wednesday, September 24, 2008
Why Drama Education? Part One: Creative Thinking
Preface:
At the moment I am employed by Seattle Repertory Theatre as their Education Intern. This means that I am spending most of my time these days bringing theater into the classroom, or bringing students into the theatre. But with all of the things that schools are expected to do these days – provide healthy lunches to students, educate them about substance abuse, teach sex ed (or “no sex!” ed), and provide after-school daycare, not to mention teach kids to read and write so they don’t fall through the cracks and math and science so we can keep up with China – what is the value of art? And do we have time in our busy schedules for Drama education? Why take a whole class period to do a prep workshop with a teaching artist, just to spend another full class period or two taking a field trip to the Rep to watch “The Three Musketeers”?
There are some very idealistic answers out there such as, “Art is what we live for!” or other things that invoke the soul, but I will leave metaphysics out of this discussion for now. Not because I disagree with the idealists about the power of art in the world, but because most educators I know (especially teaching artists) are incredibly down to earth about what they do. I’m sure if you asked each of them why arts in education is important, you would get several different answers. These are mine, and as I am a drama student/educator/enthusiast, they will be in the realm of drama.
DRAMA ENCOURAGES CREATIVE THINKING
In many standard classrooms – teaching any topic – there is a propensity to encourage correct answers over incorrect answers. In basic studies, such as grade-school level math, geographic memorization, scientific principles, and historic facts, the model of “correct versus incorrect” makes a ton of sense. Because 1+1=2, no matter what any “decide-for-yourself Montessori mom” may say. (I love Montessori school, but seriously? Math is not very kumbaya!) Columbus ran aground in 1492, Baton Rouge is the capitol of Louisiana, and water is made up of oxygen and hydrogen.
However, as we all find out when we get older, most of the important problems in life that we will be expected to solve are not so black and white. What is the most effective way to combat an auto-immune disorder? What transportation modes will be best for the Puget Sound region in the next ten years? What are the best financial decisions that someone can make so that their kids can go to college in fifteen years? How do we get more butts into the theater? How can one person with a given skill set most effectively make a positive impact on the world? These are all complicated questions with no correct answers, and they all require some amount of creative thinking, experimenting, failing, being bold, and outlining objectives and tactics for achieving those objectives.
The funny thing about school is that we begin to encounter gray-area questions at different points in each field. As soon as we have mastered grammatical rules, grammar class turns into a creative course on writing styles in prose and poetry. But at what point in business classes is there more than one right answer? College? 3rd year of college? Dave is in 2nd year medical school and there’s still a predominant culture of having the right answer. When med students turn into doctors they need to make judgment calls on which of several treatments will be most effective, and “being right” is more about finesse and je ne sais quoi than it was in school.
Drama education prepares students – even those who never plan to pursue drama as a career – to think creatively in these gray areas. Forgetting drama history classes for a moment, there are no correct answers in the acting classroom. There are bold choices that you need to justify. There are characters and situations you need to establish. There are requirements to think on your feet. You need to know your strengths and the strengths of your scene partner. And Drama education, unlike most other areas, does not require as much in-class foundation building as the rest of education. You have experience living in the world? Great! You get to think creatively about how you are going to approach a problem – or in drama terms, what is the tactic you are going to apply in order to overcome your obstacle and get to your objective?
And this is the first of many reasons why I believe Drama in education is valuable. It trains students to think about the various ways to creatively tackle a problem – without fear of getting marked down for being wrong – well before other areas of study have built a base upon which students can be creative. And to tell you the truth, I desperately want my future scientists to be bold in their hypotheses, I want my future geographers to seriously consider character and setting when they study distribution of wealth, and I want my business execs to think on their feet (not to mention be killer public speakers!). Drama builds these foundations.
At the moment I am employed by Seattle Repertory Theatre as their Education Intern. This means that I am spending most of my time these days bringing theater into the classroom, or bringing students into the theatre. But with all of the things that schools are expected to do these days – provide healthy lunches to students, educate them about substance abuse, teach sex ed (or “no sex!” ed), and provide after-school daycare, not to mention teach kids to read and write so they don’t fall through the cracks and math and science so we can keep up with China – what is the value of art? And do we have time in our busy schedules for Drama education? Why take a whole class period to do a prep workshop with a teaching artist, just to spend another full class period or two taking a field trip to the Rep to watch “The Three Musketeers”?
There are some very idealistic answers out there such as, “Art is what we live for!” or other things that invoke the soul, but I will leave metaphysics out of this discussion for now. Not because I disagree with the idealists about the power of art in the world, but because most educators I know (especially teaching artists) are incredibly down to earth about what they do. I’m sure if you asked each of them why arts in education is important, you would get several different answers. These are mine, and as I am a drama student/educator/enthusiast, they will be in the realm of drama.
DRAMA ENCOURAGES CREATIVE THINKING
In many standard classrooms – teaching any topic – there is a propensity to encourage correct answers over incorrect answers. In basic studies, such as grade-school level math, geographic memorization, scientific principles, and historic facts, the model of “correct versus incorrect” makes a ton of sense. Because 1+1=2, no matter what any “decide-for-yourself Montessori mom” may say. (I love Montessori school, but seriously? Math is not very kumbaya!) Columbus ran aground in 1492, Baton Rouge is the capitol of Louisiana, and water is made up of oxygen and hydrogen.
However, as we all find out when we get older, most of the important problems in life that we will be expected to solve are not so black and white. What is the most effective way to combat an auto-immune disorder? What transportation modes will be best for the Puget Sound region in the next ten years? What are the best financial decisions that someone can make so that their kids can go to college in fifteen years? How do we get more butts into the theater? How can one person with a given skill set most effectively make a positive impact on the world? These are all complicated questions with no correct answers, and they all require some amount of creative thinking, experimenting, failing, being bold, and outlining objectives and tactics for achieving those objectives.
The funny thing about school is that we begin to encounter gray-area questions at different points in each field. As soon as we have mastered grammatical rules, grammar class turns into a creative course on writing styles in prose and poetry. But at what point in business classes is there more than one right answer? College? 3rd year of college? Dave is in 2nd year medical school and there’s still a predominant culture of having the right answer. When med students turn into doctors they need to make judgment calls on which of several treatments will be most effective, and “being right” is more about finesse and je ne sais quoi than it was in school.
Drama education prepares students – even those who never plan to pursue drama as a career – to think creatively in these gray areas. Forgetting drama history classes for a moment, there are no correct answers in the acting classroom. There are bold choices that you need to justify. There are characters and situations you need to establish. There are requirements to think on your feet. You need to know your strengths and the strengths of your scene partner. And Drama education, unlike most other areas, does not require as much in-class foundation building as the rest of education. You have experience living in the world? Great! You get to think creatively about how you are going to approach a problem – or in drama terms, what is the tactic you are going to apply in order to overcome your obstacle and get to your objective?
And this is the first of many reasons why I believe Drama in education is valuable. It trains students to think about the various ways to creatively tackle a problem – without fear of getting marked down for being wrong – well before other areas of study have built a base upon which students can be creative. And to tell you the truth, I desperately want my future scientists to be bold in their hypotheses, I want my future geographers to seriously consider character and setting when they study distribution of wealth, and I want my business execs to think on their feet (not to mention be killer public speakers!). Drama builds these foundations.
Thursday, September 11, 2008
The Most Awesome Thing Ever!!
Ok, so maybe that's a little overboard. But, in the financial world, a Roth IRA is the most awesome thing ever. A Roth IRA is an individual retirement account that you fund with after-tax money. The current amount that you are allowed to fund is $5,000 per year. So what's so great about this thing?? Because Roth IRAs are funded after-tax (you have already paid the taxes on your income), when you take the money out when you retire, the money is taken out is not taxed. Because our government has a progressive tax structure (lower income pays a lower tax rate than higher income which pays a higher tax rate) and we are in our mid-20s, hopefully earning the least amount of money in our career, this becomes a no-brainer. Your current tax rate is somewhere between 15% and 25%, however, when you're older your tax rate could be 38% or higher (depending on who becomes president between now and then). That means the cost to you is 15% now, but could be 38% later. I say pay the taxes now and reap the benefits later.
So why doesn't everybody do this? One is that you have to be under a certain income (I believe it's $100k). Second is that you cannot take the money out until 59 1/2 years old. If you take out the money before then, then you will be major penalties. So, even if you can only put in $200 a month or whatever, set up an account with any brokerage firm (T. Rowe Price, Fidelity, Scottstrade, etc).
Best of luck and keep saving!
B-Squared
So why doesn't everybody do this? One is that you have to be under a certain income (I believe it's $100k). Second is that you cannot take the money out until 59 1/2 years old. If you take out the money before then, then you will be major penalties. So, even if you can only put in $200 a month or whatever, set up an account with any brokerage firm (T. Rowe Price, Fidelity, Scottstrade, etc).
Best of luck and keep saving!
B-Squared
Monday, September 8, 2008
Fannie, Freddie and our Bloated Government
The mess that is Fannie and Freddie is extremely confusing and honestly can't be explained in a blog setting. The next time we all meet up I'll explain. I'm sorry but I've tried to write this twice and it is just so complex that I can not write this and have it make any sense.
B-Squared
B-Squared
Sunday, September 7, 2008
What does it all mean?
Can I make a humble request to out resident financial expert, b-squared, to explain what is going on with Fannie and Freddie? It's all over the news and seems like sort of a big deal... so the government is taking them over, but what does that mean? For those of us who don't have a mortgage, should we care?
Saturday, September 6, 2008
The Artist & The World
(A Monologue)
Nathaniel: (to the world)
It was dinner time, August 31st, 2008. There I was with my family: my mother, my father, and my brother, with the cat Doctor perched at the window behind. You see, I was shortly leaving for Paris, my father had come up from Texas to spend time with me before leaving, and we were having our last supper as a family for a while (of course, typically all of our dinners fall under that category, so this was not such a tremendous occasion, yet it had the feeling of a tremendous occasion both because of my upcoming departure and that of my brother going back to school for the 4th time). My mother posed the question to us both why we made decisions that are so different from what normal people do. I was shocked. A bit confused, you see. I didn't see my decisions as being altogether that strange. Granted, moving across the sea without much of anything over there is strange, but the other decisions in life I had made, decisions that led me to that place, etc...I didn't find those very strange. What she meant was, why do I not care about money...or, more of the effect of, why do I continually put myself in a place where I cannot make any money. Normal people care about that. Given my actions, I do not, she insinuated. So why is this?
At the airport, before checking in, after being dropped off by my mother and brother, I went down to have a cigarette. It would be my last for several hours (thankfully in Copenhagen, they have smoking stalls installed in the airport). A man came up to me while I was smoking outside of the SeaTac airport. Of course, he asked me for a cigarette, which I gave him one. He offered me a Marilyn Monroe Zippo Lighter in exchange for three more cigarettes...but as you can imagine, I declined. I told him I had to save my cigarettes, I'm moving to Paris! He asked what I do. I told him, "I work in the theatre." "Where?" he asked. It looked like he hadn't heard me. This man was not "all the way there" you see. "I work in the theatre," I repeated. Am I insane? Is this not a normal response to someone who asks where you work? Well, he still couldn't get it. I told him I was an actor, a lie, of course, but better than trying to explain Director or Production Manager. For God's sake, he must know what an Actor is! How could you not? He didn't. He asked if I was a double...or...or...something something something. I told him, "No, I act in small plays. Nothing too big, I'm not famous" (Though, I was wearing a fashionable outfit and could've been mistaken for celebrity, should've been mistaken for celebrity if this man was not out of his wits). "Of course not, no, not yet!" He said and finally, I thought that he understood what it meant that I work in the theatre. And then he asked me, "Where do you work?"
These two encounters, linked together so close in time, along with the "indefinite hiatus" of Emerald City Scene caused me to really think again about art's position in this world. You see, there's almost nothing that gets more attention and is thought higher of than art. When you really think about it, that is what gets all of the attention. Not even a man or woman who has led a country out of nothingness into prosperity receives the kind of attention that Halle Barry receives (She's only half-black, by the way, did you know that? So is this Barack Obama. Who does he think he is claiming to be the first Black Presidential Nominee?) Why does this happen? Because so few actually reach the level of recognizable. Most are left behind in the gutter...due to NO MONEY BEING AVAILABLE IN THE ARTS. Sure, once you reach the higher levels, your Opera's, Regional Theatres, big Museums, and so forth, you've got tons of money...far more money flows into those organizations than most small-mid level businesses, is my guess. But until you reach that level, you're all alone, pal. And to tell the truth, most just can't make it. In other business, other fields, if someone wanted to spend a little time not making a whole lot of money, soon they'd be slowly moving up the ladder into a place where they are making a comfortable amount of money and then, if they have the ambition to, they keep on rising to make a significant amount of money. Here is where most of the world, most of my non-artist friends will be. They will be lying in heaps of money. I, on the other hand, must make the choice. Make Money, Do Art. Make Money OR Do Art. I can EITHER Make Money OR Do Art.
And what I find to be the real pincher of it, is that without art in this world, there'd be nothing to make money for. Survival takes very little. It's the artistic ventures that we want to enjoy, that have the life in them. For every person out there working for some truly insignificant product and making more than enough for survival, there are a handful of artist out there hoping they can continue to do what they love and continue to provide entertainment and knowledge for the world without a scrap of money out of it. But hours and bills rack up.
To answer my mother's question, I don't think that I've made such different choices. The truth of myself and most other artists is we follow the same formula. We start in lowpaying positions and hope to move up the ladder of recognition to someplace where we can truly be comfortable financially and doing the job that we were trained and born to do. Unfortunately, in this field, it's very difficult to make it up to that second rung...and from there, ten times harder to make it to the third rung, and so on. It's very easy to just go back down to the bottom, though, and find a new ladder to climb.
Nathaniel: (to the world)
It was dinner time, August 31st, 2008. There I was with my family: my mother, my father, and my brother, with the cat Doctor perched at the window behind. You see, I was shortly leaving for Paris, my father had come up from Texas to spend time with me before leaving, and we were having our last supper as a family for a while (of course, typically all of our dinners fall under that category, so this was not such a tremendous occasion, yet it had the feeling of a tremendous occasion both because of my upcoming departure and that of my brother going back to school for the 4th time). My mother posed the question to us both why we made decisions that are so different from what normal people do. I was shocked. A bit confused, you see. I didn't see my decisions as being altogether that strange. Granted, moving across the sea without much of anything over there is strange, but the other decisions in life I had made, decisions that led me to that place, etc...I didn't find those very strange. What she meant was, why do I not care about money...or, more of the effect of, why do I continually put myself in a place where I cannot make any money. Normal people care about that. Given my actions, I do not, she insinuated. So why is this?
At the airport, before checking in, after being dropped off by my mother and brother, I went down to have a cigarette. It would be my last for several hours (thankfully in Copenhagen, they have smoking stalls installed in the airport). A man came up to me while I was smoking outside of the SeaTac airport. Of course, he asked me for a cigarette, which I gave him one. He offered me a Marilyn Monroe Zippo Lighter in exchange for three more cigarettes...but as you can imagine, I declined. I told him I had to save my cigarettes, I'm moving to Paris! He asked what I do. I told him, "I work in the theatre." "Where?" he asked. It looked like he hadn't heard me. This man was not "all the way there" you see. "I work in the theatre," I repeated. Am I insane? Is this not a normal response to someone who asks where you work? Well, he still couldn't get it. I told him I was an actor, a lie, of course, but better than trying to explain Director or Production Manager. For God's sake, he must know what an Actor is! How could you not? He didn't. He asked if I was a double...or...or...something something something. I told him, "No, I act in small plays. Nothing too big, I'm not famous" (Though, I was wearing a fashionable outfit and could've been mistaken for celebrity, should've been mistaken for celebrity if this man was not out of his wits). "Of course not, no, not yet!" He said and finally, I thought that he understood what it meant that I work in the theatre. And then he asked me, "Where do you work?"
These two encounters, linked together so close in time, along with the "indefinite hiatus" of Emerald City Scene caused me to really think again about art's position in this world. You see, there's almost nothing that gets more attention and is thought higher of than art. When you really think about it, that is what gets all of the attention. Not even a man or woman who has led a country out of nothingness into prosperity receives the kind of attention that Halle Barry receives (She's only half-black, by the way, did you know that? So is this Barack Obama. Who does he think he is claiming to be the first Black Presidential Nominee?) Why does this happen? Because so few actually reach the level of recognizable. Most are left behind in the gutter...due to NO MONEY BEING AVAILABLE IN THE ARTS. Sure, once you reach the higher levels, your Opera's, Regional Theatres, big Museums, and so forth, you've got tons of money...far more money flows into those organizations than most small-mid level businesses, is my guess. But until you reach that level, you're all alone, pal. And to tell the truth, most just can't make it. In other business, other fields, if someone wanted to spend a little time not making a whole lot of money, soon they'd be slowly moving up the ladder into a place where they are making a comfortable amount of money and then, if they have the ambition to, they keep on rising to make a significant amount of money. Here is where most of the world, most of my non-artist friends will be. They will be lying in heaps of money. I, on the other hand, must make the choice. Make Money, Do Art. Make Money OR Do Art. I can EITHER Make Money OR Do Art.
And what I find to be the real pincher of it, is that without art in this world, there'd be nothing to make money for. Survival takes very little. It's the artistic ventures that we want to enjoy, that have the life in them. For every person out there working for some truly insignificant product and making more than enough for survival, there are a handful of artist out there hoping they can continue to do what they love and continue to provide entertainment and knowledge for the world without a scrap of money out of it. But hours and bills rack up.
To answer my mother's question, I don't think that I've made such different choices. The truth of myself and most other artists is we follow the same formula. We start in lowpaying positions and hope to move up the ladder of recognition to someplace where we can truly be comfortable financially and doing the job that we were trained and born to do. Unfortunately, in this field, it's very difficult to make it up to that second rung...and from there, ten times harder to make it to the third rung, and so on. It's very easy to just go back down to the bottom, though, and find a new ladder to climb.
Thursday, September 4, 2008
Arya's Random Thoughts
I hate September. All my life September has represented anxiety about looming deadlines. When you're in K-12, September means the end of freedom, new classrooms full of people who could get along with if you had to, deadlines, and stress. Eventually you graduate, and the story continues in college. Register for classes, buy books, pick majors, etc. Then you graduate again. But it's not over. Now I stress out about Test schedules and Grad school applications. In summary: Fuck September. I take solace in the fact that, Someday, September will be just another month.
Monday, September 1, 2008
Touched for the very first time
While I was a medical assistant for the ER, I worked with a diverse team of health care providers who all had a role in patient care. The team could be divided into three basic groups: doctors, nurses, and support staff (this group included medical assistants like myself). The doctor group could then be further divided according to each person’s level of experience: medical students, residents, and attendings.
Right now I am a lowly medical student, a second year medical student at that. My responsibilities for patient care are zero, while my responsibilities for my schoolwork are everything. But in ten short months, I will begin my third year, which is comprised of clerkships; miniature rotations (usually 4-8 weeks) that will take me through the various medical specialties. It is then that, I am told, I will begin learning the hallowed practice of “how to do stuff to people.”
I like the field of Emergency Medicine, and I am reasonably certain that I will be an ER doc when I grow up. In this field, as in many medical fields, I will be given the legal right to take a knife and perform acts upon another human being that, in any other circumstances, would land me in prison. Of course, my right to perform these acts is based upon the assumption that I will always be acting in the patient’s best interests. “Well, naturally,” you’d say, rolling your eyes. “You’ll be a doctor. Of course you’ll be acting in the patient’s best interests, right?”
A chest tube is a long, plastic tube that is inserted into the thorax to help re-inflate a collapsed lung. The procedure sounds fairly straightforward: make a small, deep slice between the ribs to reach the pleural cavity (the “sac” that contains the lungs). Stick the tube in there to drain any air or liquid that has collected outside of the lung, decompressing the cavity and allowing the lung to re-expand. Stitch the tube to the skin of the chest to keep it in place. That’s it! There are more steps involved in making macaroni and cheese. (You can see a NSFW photo of the finished product here).
Ha, I got you! The gory chest tube photo is here. Many blunt or penetrating traumas to the chest require a chest tube, so this is a very common procedure in the ER. Now, before I ever give somebody a chest tube, I will do everything I can to learn as much as possible about the procedure. I will read about it, I will watch videos of it, I will observe the real thing in the ER. But no matter how prepared I might be, there will be that first time when I actually take the tube in my inexperienced little hands and actually shove it through some guy’s ribcage.
This is the conundrum, laid out in lovely outline-y form:
So what is the best way to train the new docs? I have no answer for this, since my real training has yet to begin. Say two patients come in who both need a chest tube: one is a homeless guy with no family and the other is a 35-year-old woman with a husband and two kids. Which patient do I take and which patient does the more experienced attending physician take?
In reality, we would both take both patients. Under no circumstances would a rookie doctor be allowed to do a dangerous procedure without supervision. Now, it is probably a bit riskier to be treated by a rookie under careful supervision than it is to be treated by an experienced doc alone, but I think that’s the price we need to pay now as a society to train the new docs who will take care of us when we’re older.
If it is in fact riskier to be treated by a rookie under supervision, this means people are dying because of their doctors’ lack of experience. This is going on right now, in hospitals all across the country. As an inexperienced doctor, I will be asking my patients to take a chance with their lives. I will be asking them to submit to what may be inferior care in order to contribute to my training and therefore to the betterment of society as a whole. This is huge and, frankly, it scares the hell out of me.
One evening at the hospital, I watched two young residents put a nasogastric tube into a little old lady. This is a long, thin tube that goes down through the nose, down the throat, and into the stomach. I think they were doing this to take a sample of the stomach juices, which they could test for blood and see if she was bleeding somewhere in her upper GI tract. Unfortunately for the patient, these two residents suffered from a common condition called “Immature Doctor In Occupational Training Syndrome” (that is, they were I.D.I.O.T.S.). The whole time that they were doing this procedure, they were ignoring the patient and chatting with each other about their plans for the weekend. They did not notice how roughly they were handling the patient. They did not notice that the patient was crying from the pain of the procedure.
I think the best thing inexperienced doctors can do is to just take it seriously. Every time we perform a procedure in training, we need to recognize that the patient is giving us a gift by helping us become better doctors. We can’t refrain from learning and practicing new procedures, and ethically, we can’t choose who we practice on based on our level of experience. So we thank them by recognizing the added risk, doing our best to minimize that risk, and then making sure that risk is justified by taking it seriously. Every time.
Incidentally, I went a bit overboard with this post with the luxury of the three-day weekend. I hope you enjoyed reading all of this, but future posts will probably be shorter. And thanks to BurnPTCruisers for putting this blog together. This is a great idea, and I hope we can keep it going.
-- DMD
Right now I am a lowly medical student, a second year medical student at that. My responsibilities for patient care are zero, while my responsibilities for my schoolwork are everything. But in ten short months, I will begin my third year, which is comprised of clerkships; miniature rotations (usually 4-8 weeks) that will take me through the various medical specialties. It is then that, I am told, I will begin learning the hallowed practice of “how to do stuff to people.”
I like the field of Emergency Medicine, and I am reasonably certain that I will be an ER doc when I grow up. In this field, as in many medical fields, I will be given the legal right to take a knife and perform acts upon another human being that, in any other circumstances, would land me in prison. Of course, my right to perform these acts is based upon the assumption that I will always be acting in the patient’s best interests. “Well, naturally,” you’d say, rolling your eyes. “You’ll be a doctor. Of course you’ll be acting in the patient’s best interests, right?”
A chest tube is a long, plastic tube that is inserted into the thorax to help re-inflate a collapsed lung. The procedure sounds fairly straightforward: make a small, deep slice between the ribs to reach the pleural cavity (the “sac” that contains the lungs). Stick the tube in there to drain any air or liquid that has collected outside of the lung, decompressing the cavity and allowing the lung to re-expand. Stitch the tube to the skin of the chest to keep it in place. That’s it! There are more steps involved in making macaroni and cheese. (You can see a NSFW photo of the finished product here).
Ha, I got you! The gory chest tube photo is here. Many blunt or penetrating traumas to the chest require a chest tube, so this is a very common procedure in the ER. Now, before I ever give somebody a chest tube, I will do everything I can to learn as much as possible about the procedure. I will read about it, I will watch videos of it, I will observe the real thing in the ER. But no matter how prepared I might be, there will be that first time when I actually take the tube in my inexperienced little hands and actually shove it through some guy’s ribcage.
This is the conundrum, laid out in lovely outline-y form:
- If I want to be an ER doc, I will have to learn how to put in a chest tube
- This means I will need to practice on real people
- This means there will be “that first person” who I will operate on with zero experience
So what is the best way to train the new docs? I have no answer for this, since my real training has yet to begin. Say two patients come in who both need a chest tube: one is a homeless guy with no family and the other is a 35-year-old woman with a husband and two kids. Which patient do I take and which patient does the more experienced attending physician take?
In reality, we would both take both patients. Under no circumstances would a rookie doctor be allowed to do a dangerous procedure without supervision. Now, it is probably a bit riskier to be treated by a rookie under careful supervision than it is to be treated by an experienced doc alone, but I think that’s the price we need to pay now as a society to train the new docs who will take care of us when we’re older.
If it is in fact riskier to be treated by a rookie under supervision, this means people are dying because of their doctors’ lack of experience. This is going on right now, in hospitals all across the country. As an inexperienced doctor, I will be asking my patients to take a chance with their lives. I will be asking them to submit to what may be inferior care in order to contribute to my training and therefore to the betterment of society as a whole. This is huge and, frankly, it scares the hell out of me.
One evening at the hospital, I watched two young residents put a nasogastric tube into a little old lady. This is a long, thin tube that goes down through the nose, down the throat, and into the stomach. I think they were doing this to take a sample of the stomach juices, which they could test for blood and see if she was bleeding somewhere in her upper GI tract. Unfortunately for the patient, these two residents suffered from a common condition called “Immature Doctor In Occupational Training Syndrome” (that is, they were I.D.I.O.T.S.). The whole time that they were doing this procedure, they were ignoring the patient and chatting with each other about their plans for the weekend. They did not notice how roughly they were handling the patient. They did not notice that the patient was crying from the pain of the procedure.
I think the best thing inexperienced doctors can do is to just take it seriously. Every time we perform a procedure in training, we need to recognize that the patient is giving us a gift by helping us become better doctors. We can’t refrain from learning and practicing new procedures, and ethically, we can’t choose who we practice on based on our level of experience. So we thank them by recognizing the added risk, doing our best to minimize that risk, and then making sure that risk is justified by taking it seriously. Every time.
Incidentally, I went a bit overboard with this post with the luxury of the three-day weekend. I hope you enjoyed reading all of this, but future posts will probably be shorter. And thanks to BurnPTCruisers for putting this blog together. This is a great idea, and I hope we can keep it going.
-- DMD
Sunday, August 31, 2008
how do you invest in the stock market?
So now that you're earning at least 3.75% on your savings account (see prior post), you're probably wondering what is the next step? Whenever you start a new job, you need to immediately enroll in the 401(k) (or 403(b) if working for the government) plan offered by your employer. Why is this so important? Employers almost always match a certain percentage of the amount you contribute. Often, they match $0.50 of every $1 you invest up to 6% of your income. So, if you invest 6%, you automatically have 9% put into your account. That's a guaranteed return of 50%. Nowhere else in the world will you get this kind of return on your money. Do this for 15 or 20 years when you're in your early to mid-20s and you will be a millionaire by the time you retire. By the way, employers match your 401(k) investments because they no longer offer pensions or other monthly payments like they used to a generation or two ago.
However, if you are unfortunate and your company doesn't match your 401(k), you should invest in a Roth IRA. Stay tuned for my next post where I will translate this crazy language.
Here's to monetary success!
B-Squared
However, if you are unfortunate and your company doesn't match your 401(k), you should invest in a Roth IRA. Stay tuned for my next post where I will translate this crazy language.
Here's to monetary success!
B-Squared
Thursday, August 28, 2008
how to afford coffee, wine, and tea...
Just wanted to let everybody know about the best way to earn interest on your savings. If you have a Washington Mutual (www.wamu.com) checking account, you are eligible to receive 3.75% on your money if you open an online savings. The online savings is the exact same as a regular savings in that you use your ATM card just the same to take out money, you can use the teller to deposit money, etc. The interest amount I receive in one month is more than I made in interest for an entire year with a regular savings. If you don't want to deal with WaMu, there are other banks out there with online savings like ING Direct, although the interest rate is not as high as WaMu.
Here's to monetary success!
B-Squared
Here's to monetary success!
B-Squared
how to appreciate coffee, wine, and tea... (amongst other things)
SECOND SECTION: how to appreciate coffee, wine and tea (amongst other things)
ok, i'd like to describe a seemingly less practical skill. while i was an intern at starbucks, i was taught the invaluable skill, to me, of tasting. while people may love to trash-talk this company, i maintain that they are doing a good job of educating coffee drinkers, in an ability that i believe crosses over rather nicely into tasting various different things.
essentially, tasting is comprised of breaking down the different senses involved. sometimes this requires you to close your eyes when you drink (or eat) to focus on either the aroma, or the taste. when you experience something, try to break down different components that make up whatever you may be tasting.
the key is building confidence in your discerning abilities. thus practice is highly important, for you to become accostomed to presenting your thoughts behind the different aspects of whatever you may be tasting. sit down with your significant other, friends, co-workers, and so forth. practicing this on a daily basis will make you more aware of the subtleties in what you're trying.
it also is important that you try different things alongside each other, which will allow you to be able to compare them and discern their differences or similarities more accutely.
first, i'd focus on the visuals:
a) with coffee, maybe look at the color of it, if it's a dark, rich color, or a lighter hue.
b) with wine, look at how it clings to the glass (its "legs", indicating how sweet a wine is), the shade/hue.
c) with tea, could be yellow, green, red, orange... many different shades!
secondly, look for the aroma (there are different "polite" ways of doing this, including the wafting of your hand above the cup rather than putting your nose over the side of the cup, or food. obviously this will be determined by who you're doing this around) just call out whatever first comes to your mind!:
a) with coffee, there can be all sorts of different aromas present, such as grapefruit, citrus, earthy tones, herbal tones, etc.
b) with wine, once again, there are a myriad of different aromas, some may be oaky, others may be very berry or floral, minerally...
c) with teas, again there are many possibilities. from grassy green teas, to berry like infusions.
lastly, focus on the taste:
a) with coffee: look for the body (weight of the liquid on your tongue, how the flavor fills your mouth), the acidity (if your sides of your tongue tingle), and the characteristics of the flavors. example: you could get a "light bodied", "bright acidity" coffee, with "citrus notes".
b) with wine: once again, the body, acidity, and characteristics. example: an "oaky" wine, with tannins and blackberry notes.
c) tea: also, body, acidity, and characteristics. a "toasty", "bright acidity", with medium body, for a light black tea.
and there you go! you have the tools that you need, now call out your creativity and go for it. i promise you, trying something will never be the same, as you'll be able to break something down into it's nuances. this may incur you spending more money on such things in the future, though (just to warn you! :)).
i'm currently at remedy teas here in Seattle, my favorite tea shop, escaping the weather with the help of two different teas, and enjoying the ambiance that this place harbors. it is definitely my winter haunt. tea shops and cafés serve as hubs of community, and provide an extra kick of energy, in my opinion.
hope this is helpful!
abraços,
burnptcruisers
ok, i'd like to describe a seemingly less practical skill. while i was an intern at starbucks, i was taught the invaluable skill, to me, of tasting. while people may love to trash-talk this company, i maintain that they are doing a good job of educating coffee drinkers, in an ability that i believe crosses over rather nicely into tasting various different things.
essentially, tasting is comprised of breaking down the different senses involved. sometimes this requires you to close your eyes when you drink (or eat) to focus on either the aroma, or the taste. when you experience something, try to break down different components that make up whatever you may be tasting.
the key is building confidence in your discerning abilities. thus practice is highly important, for you to become accostomed to presenting your thoughts behind the different aspects of whatever you may be tasting. sit down with your significant other, friends, co-workers, and so forth. practicing this on a daily basis will make you more aware of the subtleties in what you're trying.
it also is important that you try different things alongside each other, which will allow you to be able to compare them and discern their differences or similarities more accutely.
first, i'd focus on the visuals:
a) with coffee, maybe look at the color of it, if it's a dark, rich color, or a lighter hue.
b) with wine, look at how it clings to the glass (its "legs", indicating how sweet a wine is), the shade/hue.
c) with tea, could be yellow, green, red, orange... many different shades!
secondly, look for the aroma (there are different "polite" ways of doing this, including the wafting of your hand above the cup rather than putting your nose over the side of the cup, or food. obviously this will be determined by who you're doing this around) just call out whatever first comes to your mind!:
a) with coffee, there can be all sorts of different aromas present, such as grapefruit, citrus, earthy tones, herbal tones, etc.
b) with wine, once again, there are a myriad of different aromas, some may be oaky, others may be very berry or floral, minerally...
c) with teas, again there are many possibilities. from grassy green teas, to berry like infusions.
lastly, focus on the taste:
a) with coffee: look for the body (weight of the liquid on your tongue, how the flavor fills your mouth), the acidity (if your sides of your tongue tingle), and the characteristics of the flavors. example: you could get a "light bodied", "bright acidity" coffee, with "citrus notes".
b) with wine: once again, the body, acidity, and characteristics. example: an "oaky" wine, with tannins and blackberry notes.
c) tea: also, body, acidity, and characteristics. a "toasty", "bright acidity", with medium body, for a light black tea.
and there you go! you have the tools that you need, now call out your creativity and go for it. i promise you, trying something will never be the same, as you'll be able to break something down into it's nuances. this may incur you spending more money on such things in the future, though (just to warn you! :)).
i'm currently at remedy teas here in Seattle, my favorite tea shop, escaping the weather with the help of two different teas, and enjoying the ambiance that this place harbors. it is definitely my winter haunt. tea shops and cafés serve as hubs of community, and provide an extra kick of energy, in my opinion.
hope this is helpful!
abraços,
burnptcruisers
Wednesday, August 27, 2008
No puedo hablar espanol
After encountering Spanish-only speaking patients on two separate occasions this month, I have decided that I would like to relearn Spanish and become as fluent as possible (even at my best, both my speaking and listening comprehension were pretty pathetic). I have started to read through my old Spanish text book. Although that will probably help me with grammar for reading and writing purposes, it still renders me useless in the world of verbal communication...which is precisely what I need to be able to do with my patients.
How can I improve? I've thought about getting Rosetta Stone. It's a shitload of money, but I figure it's worth it if it works. I don't want to shell out the dinero if it's not going to help me. What would you all recommend? Has anyone tried Rosetta Stone?
How can I improve? I've thought about getting Rosetta Stone. It's a shitload of money, but I figure it's worth it if it works. I don't want to shell out the dinero if it's not going to help me. What would you all recommend? Has anyone tried Rosetta Stone?
first post... JOB HUNTING!
INTRODUCTION
my idea's for this blog: spread experience and knowledge. i have many amazing friends, each of which has their own expertise. i think that we each have something to share, where my original idea was more along the academic side (inspired by intersections between different approaches such as a geographer working with an anthropologist), i believe we can first start approaching issues individually and later see how it goes. (to all those who don't know me, please know that i intentionally do not capitalize, outside of names of places generally, please do not take this as being illiterate).
FIRST SECTION: job hunting
although i am currently working pro-bono with the university of washington, i am looking for a job that will be able to provide me with a paycheck, which led me to a rather large dilemma: do i go to temp agencies to look, or should i focus principally on searching for positions on my own.
let's look at the advantages for each path:
A) with a temp agency, you are able to have other people proactively looking for positions that would suit your abilities. also, you are able to leave the job if it doesn't turn out to be what you are hoping for, essentially giving both you and the employer a "try out" time. another positive point is that you do not have to have a pre-existing relationship with the potential employer, as the temp agency is already connected with the businesses. another positive point is that this accelerates your ability to make a form of income, despite your positions not necessarily being closely aligned with your interest.
B) looking for positions on your own may make the company more likely to hire you, as it would be theoretically cheaper for them to hire you. temporary employees are sometimes looked upon as "lesser employees" unfortunately inside the company. by choosing the specific positions, you have a better chance for getting a position in your interests.
i find that although going through temporary agencies could provide you with a stigma upon you entering an occupation, they can indeed lead to good paying, full-fledged employment. in my opinion, should you have already spent much time looking for a permanent job, you can sign up with multiple temporary agencies in order to spread out your chances at finding a job. sometimes the agencies will have information regarding positions that aren't visible on sites such as craigslist, monster, or careerbuilder. temporary agencies specialize in particular sectors, or even employers. for example, if you're looking for supply chain positions, corestaff has contact with many folks inside amazon.com. if it's non-profit that you want, some smaller agencies such as woods and associates or molly brown temps can definitely help you reach out.
in conclusion, my opinion is that by hedging your bet by getting out there on many different job search engines, looking daily at positions, getting into contact with temp agencies can provide the best approach for finding a job... now, i'll just keep up my efforts 'til they pan out, and will post when i hear back. :)
abraços,
burnptcruisers
on a nerdy, theoretical level, i feel that i must discuss the current function of having "temporary work" in the marketplace. the market is supposed to be increasingly flexible, ideally providing for employees to move on when they no longer enjoy their profession, and providing flexibility for employers to drop expenses and man-hours when needed. however, this can help contribute to unemployment, especially in the cases of recession.
labor, unlike capital and money, is not as mobile as the popular proponents of the current macro-economic policies would like. take the example of a farmer, moving to a highly technologically based workplace: he'll have to invest time and money into retraining his abilities, imagine having to train to work with a computer if you are not so familiar with it initially!
my idea's for this blog: spread experience and knowledge. i have many amazing friends, each of which has their own expertise. i think that we each have something to share, where my original idea was more along the academic side (inspired by intersections between different approaches such as a geographer working with an anthropologist), i believe we can first start approaching issues individually and later see how it goes. (to all those who don't know me, please know that i intentionally do not capitalize, outside of names of places generally, please do not take this as being illiterate).
FIRST SECTION: job hunting
although i am currently working pro-bono with the university of washington, i am looking for a job that will be able to provide me with a paycheck, which led me to a rather large dilemma: do i go to temp agencies to look, or should i focus principally on searching for positions on my own.
let's look at the advantages for each path:
A) with a temp agency, you are able to have other people proactively looking for positions that would suit your abilities. also, you are able to leave the job if it doesn't turn out to be what you are hoping for, essentially giving both you and the employer a "try out" time. another positive point is that you do not have to have a pre-existing relationship with the potential employer, as the temp agency is already connected with the businesses. another positive point is that this accelerates your ability to make a form of income, despite your positions not necessarily being closely aligned with your interest.
B) looking for positions on your own may make the company more likely to hire you, as it would be theoretically cheaper for them to hire you. temporary employees are sometimes looked upon as "lesser employees" unfortunately inside the company. by choosing the specific positions, you have a better chance for getting a position in your interests.
i find that although going through temporary agencies could provide you with a stigma upon you entering an occupation, they can indeed lead to good paying, full-fledged employment. in my opinion, should you have already spent much time looking for a permanent job, you can sign up with multiple temporary agencies in order to spread out your chances at finding a job. sometimes the agencies will have information regarding positions that aren't visible on sites such as craigslist, monster, or careerbuilder. temporary agencies specialize in particular sectors, or even employers. for example, if you're looking for supply chain positions, corestaff has contact with many folks inside amazon.com. if it's non-profit that you want, some smaller agencies such as woods and associates or molly brown temps can definitely help you reach out.
in conclusion, my opinion is that by hedging your bet by getting out there on many different job search engines, looking daily at positions, getting into contact with temp agencies can provide the best approach for finding a job... now, i'll just keep up my efforts 'til they pan out, and will post when i hear back. :)
abraços,
burnptcruisers
on a nerdy, theoretical level, i feel that i must discuss the current function of having "temporary work" in the marketplace. the market is supposed to be increasingly flexible, ideally providing for employees to move on when they no longer enjoy their profession, and providing flexibility for employers to drop expenses and man-hours when needed. however, this can help contribute to unemployment, especially in the cases of recession.
labor, unlike capital and money, is not as mobile as the popular proponents of the current macro-economic policies would like. take the example of a farmer, moving to a highly technologically based workplace: he'll have to invest time and money into retraining his abilities, imagine having to train to work with a computer if you are not so familiar with it initially!
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