Last week I had the chance to treat three patients who had pets, all with dogs. They were all very attached to their pets, and they all lived alone with their pets, as many people do in NYC. Two out of the three needed to be hospitalized and were very sick. I do recognize this is a small number, and as much as I understand the need for randomized controlled studies, I agree with the authors of this paper, sometimes an observation is all that is needed to change things. However, if one ER resident can come across this problem in one week, think of the thousands of people in NYC who live alone with their pets and who are hospitalized under emergency circumstances, often without the ability to return home to arrange for a petsitter. After spending time contacting 311, 911, and the NYC Humane Society, I learned that there is NO government agency in the city of New York who will go to a hospitalized patients home and help arrange for pet care unless the party in question wishes to give up their pet permanently. Not even if the patient is being hospitalized AGAINST THEIR WISHES.
I did some research and there are various pet sitters in NYC, everyone knows about dog walkers in NYC. However, I think there is a need for a charity organization who will help care for people's pets when they are hospitalized. Call it DOGGIE SOCIAL WORK, but there is definitely a need. I have heard of patients who actually will sign out of the hospital against medical advice if they are capable just because there is no one to care for their pet.
I did some research and there is now a federal law to hold communities to a standard in evacuating pets as well as people in the event of a disaster or major emergency, based on the Hurricane Katrina experience in Louisiana. I think a corollary should be that hospitals be required to arrange a pet sitter if someone is hospitalized on an emergency basis and cannot arrange such for themselves.
Thursday, April 24, 2008
Saturday, April 19, 2008
IT integration
Relating to an earlier post, a good colleague, nurse S mentioned the pocket informant as the BEST possible personal orgnaizer on the market, running the windows mobile platform. Soon, this summer, Sony Ericsson will be releasing the Xperia X1so I will be able to have organizer and phone all in one place, touchscreen, playing FM radio, camera, post to blog, RSS feeds, assisted gps (mapping), everything I need! Finally!
Tuesday, April 15, 2008
Topsy Turvy Spin of the News Media
Was looking at my news feeds just now and noticed that on Al-Jazeera they are reporting Carter laying a wreath for Arafat and being refused entrance to the Gaza Strip, the BBC reports an Anti-EU gang attacks Irish MEP Proinsias De Rossa, and the Irish Times reports jobs moving to Northern Ireland. Each of these is ironic in it's own way.
Monday, April 14, 2008
Checking Electric Meters in a Widgetless Wired World
Monday morning, 749 AM. Scramble out of bed to get the door as the doorbell rings. Even in a wired world, every month the doorbell rings early in the morning for the Con Edison meter person to check the meter. The meter maid shows up with an electronic record keeping device, wearing a walkie talkie and a speaker phone that chirps incessantly, but requires me to physically unlock the basement for her to check the meter. Even in a wired world, electric meters must be checked manually.
But how wired is our world? Well, judging by my wireless computer, extremely so!
This sorry state of affairs is due to the general lack of integration of the consumer electronics industry outside the land of mac users who can go from room to room in their house listening to their music on their Airport enabled speakers. My wireless connection doesn't seem to connect in my house, despite the fact that I can connect to my neighbors if I position my laptop in one corner of my room, my laptop battery goes dead after 1 hour, and I can't buy a USB FM transmitter to link my computer speakers to the home theater system (all the ones I can find in the store are powered by cigarette lighters).
I demand a widget. One that will let me connect my PC music output to my home theater, that will connect my paper calendar to my electronic computer, that I can download to my phone. My roommate says I should really stop thinking about a phone as a phone. He says it is an application on a handheld computer, as he sits in the living room and plays pacman on his phone.
Perhaps this is just my inadequacy in getting electronically linked? One of the attendings showed me her calendar on her phone, I asked her, can you really synchronize that with, for example, google calendars? She said she didn't know what that was. I am old school. My version of synchronization is scanning my wall calendar and printing it out, then cutting it to fit inside my leather pocket notepad.
Pocket notepad? Yeah, the other word is "pocket protector". What about a PDA? Nope. If I want to look up a drug dose I have a pocket PDR book. Why? Well, the batteries can't go out, if I drop it, I just pick it up, and if I lose it I just buy another. It costs 7 dollars. Plus, there is NO way that you can crash or stall a book, and once you know the book, you know where to find things fast.
Something tells me that as long as electric meters need to be checked every month by a person, the digital world will remain bound by paper, pen, and human. If that is the case, can't we switch suddenly once all the bugs get worked out? This transition from pen and paper to digital is absurd. It is complicated to remember fifty usernames and passwords in fifty different database/systems, entering the data manually in each, transferring the schedules of my life from bills/pdf/email/text message/verbal announcement/snail mail to my calendar, to carry with me.
I only have one written signature, why can't I have one electronic signature? I need ONE electronic information system to manage my affairs-financial, medical,social, recreational. For example, I should be able to log in to this system with one username and password, and conduct all the business I would do using my brain, eg, pay my bills (bank website/bank statements/atm machines), pay people (cash, check, credit card), keep up with friends (facebook, myspace, IM, cell phones), make travel plans (passport,airline reservation, hotel reservation, car reservation), take a picture (camera), read a book (libary, bookstore), listen to music (speakers, headphones, mp3 player, home theater), make a phone call (cell phone, skype), watch tv (slingbox, tv, dvr, cable box, home theater, remote control, dvd remote, cable remote, sound remote), schedule my week (calendar, phone, pda), compose a patient's medical record (computer, electronic medical record, HIPAA, fax, paper chart, written consents), review a patient's ekg from their private doctor's office (fax machine, photocopy), review their old echo reports (separate computer file), and so on. We do have the current technology to make this possible, we just need to do away with the idea that these are all separate activities.
They are all just information processing, and each has a separate device or technology or government regulation(in parentheses), to process that information, some are paper, some are electronic, some require some hardware, some do not. Everything from meter reading to buying a cheeseburger, it's all processing and exchanging information. We need some "urban planning", some "information architects" in this area. People in the IT world need to stop making LOLcats and facebook widgets and start doing something useful, like the folks who work hard at McD's every day.
In college, I learned about a theory of cultural evolution called the "costly information hypothesis" of Richerson and Boyd. This theory suggests that culture is transmitted easily because it is too costly from an evolutionary standpoint to evaluate each idea/bit of information for yourself, so we take the ideas and behaviors of people who appear to be successful (Britney Spears, Bill Gates), and these spread. This also means that bad ideas spread easily (lolcats).
In our current state of cultural evolution, we have fifty or so systems/classes/types of information exchange which all help us exchange information, yet each is not connected to the other, and each has many intraclass competing technologies. This so called "information sprawl", is a product of people making individual tested leaps in technology, yet no one has unified these technologies into something that simplifies life in a more adaptive way.
Any one technology is relatively low cost to develop and perfect, but the cost of failure in uniting all these classes of technology is so large and the economic benefit of consumers buying many things is so great that it is not adaptive for anyone to produce a unified technology that would simplify your life. Apple appears to be trying to convince us that their sleek machines do this, but in reality, it is just a big peripherals game with the same OS, it's not one unified system.
At the current pace, digital hasn't given us increased simplicity of living, it has made the world more complex because all these activities have a separate form of electronic information attached to them, and each has a separate operating interface and requires a manual backup and user dependent data synchronization. Thinking that the world is wired as it is now is like saying there is no glitch in the matrix. Right now, there is no matrix in the glitch.
But how wired is our world? Well, judging by my wireless computer, extremely so!
This sorry state of affairs is due to the general lack of integration of the consumer electronics industry outside the land of mac users who can go from room to room in their house listening to their music on their Airport enabled speakers. My wireless connection doesn't seem to connect in my house, despite the fact that I can connect to my neighbors if I position my laptop in one corner of my room, my laptop battery goes dead after 1 hour, and I can't buy a USB FM transmitter to link my computer speakers to the home theater system (all the ones I can find in the store are powered by cigarette lighters).
I demand a widget. One that will let me connect my PC music output to my home theater, that will connect my paper calendar to my electronic computer, that I can download to my phone. My roommate says I should really stop thinking about a phone as a phone. He says it is an application on a handheld computer, as he sits in the living room and plays pacman on his phone.
Perhaps this is just my inadequacy in getting electronically linked? One of the attendings showed me her calendar on her phone, I asked her, can you really synchronize that with, for example, google calendars? She said she didn't know what that was. I am old school. My version of synchronization is scanning my wall calendar and printing it out, then cutting it to fit inside my leather pocket notepad.
Pocket notepad? Yeah, the other word is "pocket protector". What about a PDA? Nope. If I want to look up a drug dose I have a pocket PDR book. Why? Well, the batteries can't go out, if I drop it, I just pick it up, and if I lose it I just buy another. It costs 7 dollars. Plus, there is NO way that you can crash or stall a book, and once you know the book, you know where to find things fast.
Something tells me that as long as electric meters need to be checked every month by a person, the digital world will remain bound by paper, pen, and human. If that is the case, can't we switch suddenly once all the bugs get worked out? This transition from pen and paper to digital is absurd. It is complicated to remember fifty usernames and passwords in fifty different database/systems, entering the data manually in each, transferring the schedules of my life from bills/pdf/email/text message/verbal announcement/snail mail to my calendar, to carry with me.
I only have one written signature, why can't I have one electronic signature? I need ONE electronic information system to manage my affairs-financial, medical,social, recreational. For example, I should be able to log in to this system with one username and password, and conduct all the business I would do using my brain, eg, pay my bills (bank website/bank statements/atm machines), pay people (cash, check, credit card), keep up with friends (facebook, myspace, IM, cell phones), make travel plans (passport,airline reservation, hotel reservation, car reservation), take a picture (camera), read a book (libary, bookstore), listen to music (speakers, headphones, mp3 player, home theater), make a phone call (cell phone, skype), watch tv (slingbox, tv, dvr, cable box, home theater, remote control, dvd remote, cable remote, sound remote), schedule my week (calendar, phone, pda), compose a patient's medical record (computer, electronic medical record, HIPAA, fax, paper chart, written consents), review a patient's ekg from their private doctor's office (fax machine, photocopy), review their old echo reports (separate computer file), and so on. We do have the current technology to make this possible, we just need to do away with the idea that these are all separate activities.
They are all just information processing, and each has a separate device or technology or government regulation(in parentheses), to process that information, some are paper, some are electronic, some require some hardware, some do not. Everything from meter reading to buying a cheeseburger, it's all processing and exchanging information. We need some "urban planning", some "information architects" in this area. People in the IT world need to stop making LOLcats and facebook widgets and start doing something useful, like the folks who work hard at McD's every day.
In college, I learned about a theory of cultural evolution called the "costly information hypothesis" of Richerson and Boyd. This theory suggests that culture is transmitted easily because it is too costly from an evolutionary standpoint to evaluate each idea/bit of information for yourself, so we take the ideas and behaviors of people who appear to be successful (Britney Spears, Bill Gates), and these spread. This also means that bad ideas spread easily (lolcats).
In our current state of cultural evolution, we have fifty or so systems/classes/types of information exchange which all help us exchange information, yet each is not connected to the other, and each has many intraclass competing technologies. This so called "information sprawl", is a product of people making individual tested leaps in technology, yet no one has unified these technologies into something that simplifies life in a more adaptive way.
Any one technology is relatively low cost to develop and perfect, but the cost of failure in uniting all these classes of technology is so large and the economic benefit of consumers buying many things is so great that it is not adaptive for anyone to produce a unified technology that would simplify your life. Apple appears to be trying to convince us that their sleek machines do this, but in reality, it is just a big peripherals game with the same OS, it's not one unified system.
At the current pace, digital hasn't given us increased simplicity of living, it has made the world more complex because all these activities have a separate form of electronic information attached to them, and each has a separate operating interface and requires a manual backup and user dependent data synchronization. Thinking that the world is wired as it is now is like saying there is no glitch in the matrix. Right now, there is no matrix in the glitch.
Sunday, April 13, 2008
Resolutions and Opportunity Costs
Have had some time to reorganize, rethink and regroup on vacation, and noticed the amount of time and money I put into things that don't always coincide with my long term goals. In the past, I have had a big problem with scrimping and saving and whined incessantly about this, mostly because it brought back painful memories of times when I was extremely poor, in which I had to scrimp and save to get through each month. For example in medical school and undergrad, I on occasion worked up to 30 hours a week in addition to my studies, just to afford rent and living expenses. I would sometimes be so poor that I had to live on bread and tea and potatoes for up to two weeks. I was constantly calculating how much money I had, where the next dollar was coming from and where it was going. I once walked home 12 miles because I did not have bus fare and my bike was broken.
The point is not to have a pity party, but instead to reflect on the fact that something which has such negative connotations (as per my previous post on negativity), can make financial planning unpleasant simply because it has always reminded you of how poor you are. I am now choosing to focus on the positive things that financial planning can do for me, by allowing me to align my expenditures of time and money with my long term goals.
For example, according to my netflix account I have watched 131 movies, which is about 13.1 movies per month, averaging at about 2.48 per movie. If we consider that each movie is approximately 2 hours long, then I have spent about 26 hours per month watching films. Had I used that time and money to workout instead, I would be able to work out more than 5 hours a week, and would be 325 dollars richer.
Take laundry for example. I just washed three loads of laundry which cost $12.50 and took 3 hours to gather, sort, wash, dry, transport, and fold. If I had chosen to drop it off, this would have cost me about $35.00 dollars, which saved me 20 dollars-which could equal a movie night out.
Just based on this analysis, I could think of several other activities and expenditures which could allow considerable flexibility in future goals. I am now resolving to stop drinking 3 cans of redbull on work days, which should save me about 9 dollars a workday, which is about 144 dollars a month.
Together by just washing my own clothes, not drinking redbull, and cancelling netflix, I could save 196.50 a month, which over a year is about 2400 dollars, or about as much as a vacation costs. In addition, this would prevent me from arguing with a significant other about the cost of a vacation, and allow me to spend 5 hours a week working out.
The point is not to have a pity party, but instead to reflect on the fact that something which has such negative connotations (as per my previous post on negativity), can make financial planning unpleasant simply because it has always reminded you of how poor you are. I am now choosing to focus on the positive things that financial planning can do for me, by allowing me to align my expenditures of time and money with my long term goals.
For example, according to my netflix account I have watched 131 movies, which is about 13.1 movies per month, averaging at about 2.48 per movie. If we consider that each movie is approximately 2 hours long, then I have spent about 26 hours per month watching films. Had I used that time and money to workout instead, I would be able to work out more than 5 hours a week, and would be 325 dollars richer.
Take laundry for example. I just washed three loads of laundry which cost $12.50 and took 3 hours to gather, sort, wash, dry, transport, and fold. If I had chosen to drop it off, this would have cost me about $35.00 dollars, which saved me 20 dollars-which could equal a movie night out.
Just based on this analysis, I could think of several other activities and expenditures which could allow considerable flexibility in future goals. I am now resolving to stop drinking 3 cans of redbull on work days, which should save me about 9 dollars a workday, which is about 144 dollars a month.
Together by just washing my own clothes, not drinking redbull, and cancelling netflix, I could save 196.50 a month, which over a year is about 2400 dollars, or about as much as a vacation costs. In addition, this would prevent me from arguing with a significant other about the cost of a vacation, and allow me to spend 5 hours a week working out.
Saturday, April 12, 2008
site traffic
OK. This site traffic thing I just put on here is interesting. Mostly it is my own visits, yeah, that Brooklyn tag is mostly me, but I wonder who the heck lives in Haskell, NJ and is reading this blog? Out with it. What's in Haskell anyways? It's way out there in Western Jersey in the sticks. , according to google maps anyways. Maybe it's an internet robot. I have few enough of you lot as it is... make a comment! My Cluster Map also shows there is someone in like Chicago somewhere? who like reads this a lot too. Where do you lot come from?
Friday, April 11, 2008
Drums Along the Hudson
I got into a discussion on the attractiveness and natural beauty of cities and their occupants the other day, and the conclusion was that people in Europe are less uptight, and the cities are more beautiful, partly because their architecture is more historic.
However, I have to reconsider this, especially for example when riding the N, Q, R, B or D trains across the Manhattan bridge at dusk/dawn, that New York's beauty is mostly evident at night when the city is lit up, particularly from the water or in it's skyline views. The fact that NYC is surrounded by water should also theoretically make it a beautiful city for me, a California guy raised near the ocean.
In 2009, we are coming upon the 400th anniversary of Henry Hudson sailing up the Hudson river. I am going to make an effort to list all estuarine or river related activities in NYC, and make a resolution to attend some of them in the coming year.
Prime among these as a source of information is the Hudson River Park Trust.
I have NOT been to any of the following venues, that's why they are here. Actually, this is a great idea for a Meetup Group- nautical themed activities in NYC...
6th Annual Drums Along the Hudson Native American Festival and Shad Fest
Saturday, May 3, 2008 11:00 a.m. - 6:00 p.m. Inwood.
400th Anniversary of Henry Hudson
A listing of events to celebrate the 400th Anniversary, including a kayak trip between Quebec and Manhattan
A Dutch group which is participating in a transatlantic sailing race and the 2009 festivities.
Music
Music on a barge in the east river
"River Rocks" at Hudson Piers
Movies
"River Flicks" at Hudson Piers
Athletics
Running/Cycling/Rollerblading on the west side highway/FDR
Kayaking: free kayaking near west side highway at the Downtown Boathouse
Tennis: courts at West Side Highway
Ships/Cruises
Schooners Adirondack and Imagine
Bars/Dining
The Boat Basin
The Ear Inn
Gigino at Wagner Park
Older (2005) listing of urban beach bars/dining
Heliport
Downtown heliport with tours between $ 119-275 per person.
However, I have to reconsider this, especially for example when riding the N, Q, R, B or D trains across the Manhattan bridge at dusk/dawn, that New York's beauty is mostly evident at night when the city is lit up, particularly from the water or in it's skyline views. The fact that NYC is surrounded by water should also theoretically make it a beautiful city for me, a California guy raised near the ocean.
In 2009, we are coming upon the 400th anniversary of Henry Hudson sailing up the Hudson river. I am going to make an effort to list all estuarine or river related activities in NYC, and make a resolution to attend some of them in the coming year.
Prime among these as a source of information is the Hudson River Park Trust.
I have NOT been to any of the following venues, that's why they are here. Actually, this is a great idea for a Meetup Group- nautical themed activities in NYC...
6th Annual Drums Along the Hudson Native American Festival and Shad Fest
Saturday, May 3, 2008 11:00 a.m. - 6:00 p.m. Inwood.
400th Anniversary of Henry Hudson
A listing of events to celebrate the 400th Anniversary, including a kayak trip between Quebec and Manhattan
A Dutch group which is participating in a transatlantic sailing race and the 2009 festivities.
Music
Music on a barge in the east river
"River Rocks" at Hudson Piers
Movies
"River Flicks" at Hudson Piers
Athletics
Running/Cycling/Rollerblading on the west side highway/FDR
Kayaking: free kayaking near west side highway at the Downtown Boathouse
Tennis: courts at West Side Highway
Ships/Cruises
Schooners Adirondack and Imagine
Bars/Dining
The Boat Basin
The Ear Inn
Gigino at Wagner Park
Older (2005) listing of urban beach bars/dining
Heliport
Downtown heliport with tours between $ 119-275 per person.
Thursday, April 10, 2008
Playing the Percentages of Self Sabotage
Had the good fortune to be treated to dinner today, not by a pharmaceutical rep, not on a date, not even by a family member. I was treated to dinner today by a truly great physician, who gave me some insight into his career. We talked about the patients who influence us in choosing a practice environment. For example, in an ICU environment, one can invest a lot of emotional energy in caring for someone who is deathly ill, and still they may only have a 50% chance of living. And even in doing so, one may learn that despite one's best efforts, 50% of truly ill patients may die despite your best efforts, and 50% may live regardless of your care. Thus, you cannot have as your principle of motivation the percentage who live or die. Likewise, if you look at any emergency room, only a few patients look truly ill, surely it is no challenge to determine that they need care. Yet you cannot use "the patient appears well" as your criterion to determine whether they are hiding some grave disease, for in 24 hours they may look different.
As I was walking home, I began to think about life and the focus I place in my life on different things. I reflected on the fact that for example, when I am taking a test and I think it is hard, I could only remember the hardest questions, the 20 percent which I perhaps did not know the answers to. These 20% define how hard the test is, not the 80% which I correctly and perhaps easily answered.
Likewise, I was watching Memphis get beat by Kansas the other night in the final four, they appeared to be on the verge of winning the game, then lost on the basis of some missed free throws.
I was working a shift with a guy who I respect a great deal, and I heard him get off the phone, and I remarked, gosh you were nice on the phone. And he said, yes, it helps keep my calm, it keeps me thinking, and it prevents me from getting stressed out.
In life, relationships, work, it all comes down to percentages. And the outlook that you have can be determined by the percentages, or you can make your outlook change based on how you play the percentages.
For example, you can look at the 10% of your day that is marked by negativity, the computer crashes, you are having a fight with your girlfriend, the answering service puts you on hold, someone yells at you, you don't have enough money to go on that vacation. Those things that you don't like, those little pesky dark clouds, they sometimes turn into big black thunderheads. Something that is negative can have higher emotional tone, it draws attention to itself. And it magnifies itself into something bigger than it should be.
You mull over it. Gee, wouldn't it be ideal if such and such weren't this way? This is something I thought about while watching John Adams, the simpering man was complaining even after he was elected President of the US. After you mull over it, something which is a very very small thing takes up too much of your time. That little thing that strikes you as negative, which probably isn't even a big deal anyways, becomes a bigger thing because you are paying it heed.
This is a big problem for competitive people who for most of their lives have been driven to excel. They know the difference between 90 percent and 99%. It's not just 9%, it's everything, it's life, or death. It's the margin of success or failure.
So, that 9% negative in your day/life/relationship builds and builds until it becomes 20%, 40%, 60%, then finally it screams at you, this day just has to end. This relationship just has to end. This computer has to be rebooted.
It is at times like that, when the negatives pile up that you have to think of something positive. To remember that great time you had when you were sitting on the grass in the summer with your girl, to remember the time when you never wanted to leave her arms, to remember all the great things, because if you let the negatives take over you will be left with nothing, and that is not something you want to be left with.
As I was walking home, I began to think about life and the focus I place in my life on different things. I reflected on the fact that for example, when I am taking a test and I think it is hard, I could only remember the hardest questions, the 20 percent which I perhaps did not know the answers to. These 20% define how hard the test is, not the 80% which I correctly and perhaps easily answered.
Likewise, I was watching Memphis get beat by Kansas the other night in the final four, they appeared to be on the verge of winning the game, then lost on the basis of some missed free throws.
I was working a shift with a guy who I respect a great deal, and I heard him get off the phone, and I remarked, gosh you were nice on the phone. And he said, yes, it helps keep my calm, it keeps me thinking, and it prevents me from getting stressed out.
In life, relationships, work, it all comes down to percentages. And the outlook that you have can be determined by the percentages, or you can make your outlook change based on how you play the percentages.
For example, you can look at the 10% of your day that is marked by negativity, the computer crashes, you are having a fight with your girlfriend, the answering service puts you on hold, someone yells at you, you don't have enough money to go on that vacation. Those things that you don't like, those little pesky dark clouds, they sometimes turn into big black thunderheads. Something that is negative can have higher emotional tone, it draws attention to itself. And it magnifies itself into something bigger than it should be.
You mull over it. Gee, wouldn't it be ideal if such and such weren't this way? This is something I thought about while watching John Adams, the simpering man was complaining even after he was elected President of the US. After you mull over it, something which is a very very small thing takes up too much of your time. That little thing that strikes you as negative, which probably isn't even a big deal anyways, becomes a bigger thing because you are paying it heed.
This is a big problem for competitive people who for most of their lives have been driven to excel. They know the difference between 90 percent and 99%. It's not just 9%, it's everything, it's life, or death. It's the margin of success or failure.
So, that 9% negative in your day/life/relationship builds and builds until it becomes 20%, 40%, 60%, then finally it screams at you, this day just has to end. This relationship just has to end. This computer has to be rebooted.
It is at times like that, when the negatives pile up that you have to think of something positive. To remember that great time you had when you were sitting on the grass in the summer with your girl, to remember the time when you never wanted to leave her arms, to remember all the great things, because if you let the negatives take over you will be left with nothing, and that is not something you want to be left with.
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