Home
Now in 23rd Grade
 
 [Most Recent Entries] [Calendar View] [Friends]

Below are the 20 most recent journal entries recorded in Now in 23rd grade (aka, Senior Medical Resident)'s LiveJournal:

    [ << Previous 20 ]
    Thursday, June 11th, 2009
    10:32 pm
    Let's get this health reform started!
     I am touched and honored that my letter to the AMA resonated with so many other health care providers, and even more with patients. It was humbling to read through the comments on the HuffingtonPost and see how many people want desperately to restore the integrity of the profession, and to see physicians practice on behalf of their patients.

    I must admit that I was also amused by the number of Star Trek references (I actually get very few of those in my daily practice). The best was "Dammit, Jim! I'm a doctor, not a profit-center!" I was also honored to be recommended for the Nobel Peace Prize, but I think that's a bit premature -- we need to get health care reformed passed (with a public health insurance option) before I'll entertain thoughts of a Nobel. :-)

    In just one day, we saw an incredible impact: the AMA retracted its opposition to the public health insurance option. This just shows how we are on the right side of history. We know that we must do what is in the best interest of our patients if we are ever to have a health care system that works.

    There was one theme in the comments to my letter that occurred time and time again - something that I know is not true: patients and the public believe that I am a unique physician in my desire for a patient-centered health care system; one without profits, salary or income as my first concern.

    Quite to the contrary, I know there are thousands of doctors who believe that we can be the professionals that we dreamed of being when we applied to medical school. If you are a physician who shares this vision of health care, please sign the petition to support the public health insurance option, join the National Physicians Alliance, and talk about these issues with your colleagues.
    If you are not a physician, you can send the above links to your friends in health care, as well as your own health care provider. You can also support our campaign to advocate on behalf of patients first.

    I know I am not alone in my belief that physicians have a duty to ensure that the health care system works for our patients. But we need to work together to ensure that our policy leaders hear our voices, because we know the opposition will be strong, will be organized, and will attempt to scare our patients into believing the current dysfunction system is the best that America can do.

    That is not true. We can have affordable, high quality health care in the United States, and we can do it while still offering the choice to our patients of keeping their current insurance plan if they like it, selecting another private plan, or choosing a quality public health insurance plan.

    Health care reform will happen this year. We will make the health care system work for our patients.
    Wednesday, June 10th, 2009
    10:17 pm
    Dear AMA: I quit!
     Dear American Medical Association,

    I recently had the opportunity to read your response to the Senate Finance Committee proposal for health care reform, and it is clear to me that I cannot remain a member in your organization. Please remove my name from your membership rolls, effective immediately.

    In reading the response, I was frustrated and disheartened by the fact that you couldn't get through the second paragraph before bringing up the issue of physician reimbursement. This merely highlights how the AMA represents a physician-centered and self-interested perspective rather than honoring the altruistic nature of my profession. As a physician, I advocate first for what is best for my patients and believe that as a physician, as long as I continue to maintain the trust and integrity of the profession, I will earn the respect of my community. The appropriate financial compensation for my endeavors will follow in kind.

    I encourage the AMA leadership to read Atul Gawande's recent article describing how physician culture drives up the cost of health care without benefiting patient outcomes. At the heart of this problem are physicians who have a vision of themselves as money-generating profit centers rather than professionals serving the public good. The AMA represents, and encourages, this mindset with its single-focus on physician reimbursement over all other health care reform issues.

    However, the most disappointing aspect of the AMA's response to the proposed health care reforms was the opposition to the public health insurance option. I simply cannot support an organization that opposes the public health insurance plan for my patients. Instead of advocating for patients, the AMA is supporting the private insurance industry, which has been a driving force in creating the dysfunction health care system we have today.

    But this should not have surprised me: when health care reform has been necessary, the AMA has always stood on the wrong side of history. The AMA opposed the creation of Medicare in the 1930s, when it was first proposed as part of Social Security. The AMA opposed Medicare again in the 1960s, going as far as to hire an actor named Ronald Reagan to read a script to the AMA Auxiliary declaring Medicare as the first step toward socialism, and concluding with the statement that if Medicare were to become law, "One day, we will awake to find that we have socialism.... One of these days, you and I will to spend our sunset years telling our children, and our children's children, what it was once like in America when men were free."

    That was 50 years ago ... and none of that has come to pass. And yet this year, the AMA argues that a public health insurance plan will destroy the private insurance market. I challenge the AMA leadership to cite a single example of an industry where involvement by the government has lead to the elimination of private enterprise. This has not been the case with the creation of public police forces in the second half of the 1800's (private security companies still exist), we have a robust system of public and private colleges existing the same market, and bookstores still sell books despite the presence of public libraries. A mix of public and private enterprises in the market is a truly American solution to ensuring equal access, as well as competition to drive quality improvement. In fact, the creation of the public health insurance option will *increase* competition, as demonstrated by the AMA's own studies showing that 94% of health insurance markets only have 1 or 2 providers in the market.

    It would appear that the AMA's position against the public health insurance market is driven by out-dated political ideology that blindly supports private industry rather than a careful examination of the facts of the current situation.

    The AMA seems to be fixated on the fact that Medicare and Medicaid payments are lower than other payers. Let's go back to the history again: because the AMA opposed the creation of Medicare, physicians were not represented at the table when the system was designed. As a great policy wonk once said, "If you're not at the table, you're on the menu." And thanks to the dismal leadership and short-sightedness of the AMA in the 1960s, physicians were not a full partner in the creation of Medicare. And we're still feeling the reprocussions of that today. And yet now in 2009, the AMA is going to repeat that mistake by opposing the public plan.

    The health care system is broken, and physician leadership is needed now more than ever to help direct the reforms that are desperately needed. However, the AMA has not shown itself to be the organization to provide that leadership in restoring the profession of medicine. New physician leadership is needed to fully achieve a reformed health care system that works for our patients and for our country.

    Sincerely,

    Chris McCoy, MD
    Saturday, May 30th, 2009
    7:07 pm
    Residency, by the numbers
     444: Number of inpatient admissions worked up
    109: Nights on call
    1: Call nights in which I got absolutely no sleep
    11: Number of admissions to the MICU during that no-sleep night
    0: Call nights in which I admitted no patients
    0: Patients admitted over a call night on oncology covered by a colleague when I was away for a conference
    3: number of times I biked home in the rain
    1: number of times caught by a rain storm on the way to work
    5: Codes run
    0: Peripheral IVs placed
    0: Urinary catheters placed
    5: Central lines placed
    1: Pap smears performed
    2: Patients treated with adenosine for SVT
    97: Most number of hours worked in a 7-day period (on Gen Med as a senior)
    5:15: earliest time in the morning I arrived for a shift (in the MICU as an intern)
    8: most hours of sleep on a call night (on 10-3)
    6,413: Hours spent in the hospital on inpatient services; add another 1,600 hours for the ten months of electives and outpatient clinic for about 8,000 hours total
    Wednesday, April 22nd, 2009
    10:57 pm
    Can we find compromise on the public health insurance option? Should we?

    (Cross-posted at the National Physicians Alliance Blog.)

    The major battle lines in the upcoming debate about health care reform will likely be drawn around the idea of creating a choice of a public health insurance plan to compete in the market with regulated insurance companies. Republicans have made it clear they will not support such a plan, and many Democrats have announced they will oppose reform that lacks this option.

    Compromise is as American as motherhood, apple pie and the creation of the US Senate. Undoubtably, our political leaders will attempt to find compromise on this issue as well. While it is less important for the House (where the majority party has near total control), it will be necessary to obtain the 60 votes that may be needed in the Senate. However, the two positions appear mutually exclusive at the moment.

    But I think there will be proposals that will attempt to find a middle ground. I anticipate they will be focused on the area of competition, since that is a linch-pin of modern GOP talking points. In particular, they are many places in the country with only one or two private health insurance providers, so the creation of a public health insurance plan would engender competition in those markets. (These areas also tend to be rural, which may attract the votes of Senators from important states such as Iowa and Maine.)

    One approach that has been suggested for similar debates in the past is to create a public plan only for people who live in areas that lack competition among private plans. Thus, the public health insurance option would create competition and choice for those who currently don't have it.

    Is this a compromise we could live with? Or should every American have the option of enrolling in a public-sponsored insurance plan, regardless of how many private options they also have?


    Now, consider the alternative proposal that will be suggested to stimulate competition: allow Americans to purchase health insurance across state lines. Currently, health insurance is regulated at the state level. Some states have passed laws requiring health insurance to be quite comprehensive; other states have only minimal requirements. However, if people could choose insurance from any carrier in any state, it would create more options for everyone to choose from.

    I would call this type of proposal the "UnderInsure America Act". It would lead to many more people purchasing inexpensive and, too late for them to realize, inadequate coverage.

    Now, how does that first compromise look in comparison? Maybe it is something worth considering ... it would create public plans for some people, allow us to work out the details, have a model to expand to other markets as insurance companies exit, etc.

    On the other hand, the public insurance plans would likely exist only in rural areas, which have a much different population than urban centers. It may be harder for those plans to build the numbers necessary to demonstrate efficiencies over private insurers.

    Is this a compromise we could consider?

    Monday, December 1st, 2008
    8:35 pm
    I'll be keeping my day job

    So, Obama has nominated Hillary for Secretary of State. Umm, I guess my political musings haven't been particularly prescient. Hillary for SoS? I didn't think so. And now it seems Sarah Palin is the face of the GOP, as opposed to a one-hit wonder who would drop off the ticket within two weeks.

    Yeah, I'll keep my day job. Hopefully, I'm slightly better at it.

    Current Mood: Humbled

    Friday, November 14th, 2008
    9:18 pm
    Transition: From Hope to ?

    Indiana? And Nebraska's second district? Wow ... I thought I was going on a limb when I called North Carolina for Obama.

    But now the warm, fuzzy, post-election feeling is starting to fade. And reality sets in. This country is in a deep, deep hole. And we're still sinking deeper by the day. President Obama has his work cut out for him.

    (As an historical aside, President Reagan also started his first time in a deep recession, but as I recall, things had turned better by the time the '84 election around. Will Alaska be the only remaining red state on the 2012 map?)

    The hot gossip of the moment is whether Hillary will be part of Obama's Cabinet. Don't count on it. There is no place in the Cabinet that would meet her goals and agenda. And Hillary subordinate to Obama? I can't imagine it.

    I suspect their clandestine meeting in Chicago was to allow Obama to talk with Hillary about who she would suggest for Cabinet positions. As Bill did many years ago, Obama will fill his Administration with the best-qualified, not just the best-friends. But even if Hillary were the most qualified person for Secretary of State (and I don't think she is), I don't think she'd want the position.

    No, Hillary's seat in the Senate is a nice place to be. As a member of the Senate HELP Committee, Obama's health care plan has to go through her. Plus, she's on the Armed Forces Committee and the Environment and Public Works Committee. She has a lot of power just where she is now. And unless she's the Decider, I can't see her working in the Executive Branch.

    There's another issue that is beginning to come up from the left-wing of the Democratic Party: what to do about Bush and torture. This is the single issue that most disturbs me about the Bush Administration and his legacy. He has immensely damaged the image of America as a nation of laws and justice. We must forcefully condemn those actions as antithetical to everything America stands for.

    However, how to do that? Put Americans on trial? When they were instructed that their actions were legal ... by the Justice Department itself? That doesn't seem right, and in fact, violates the ex post facto clause of the Constitution. I think the best response is to clearly state that the rules have changed, and we will never allow Americans to torture again. This change in policy could in theory be reversed by a future administration (since it appears the current administration is impervious to laws passed by Congress), but I hope that no administration would ever go into that dark place again.

    We need to move on and move forward. We should relegate the Bush administration to the dustbin of history, where it belongs.

    Current Mood: Hopeful

    Sunday, November 2nd, 2008
    8:30 pm
    Final Election Thoughts

    I'll be on call tomorrow, on the eve of the election, so I won't be going to a Bruce Springstein concert this time. (Apparently, though it didn't work for Kerry in Ohio in 2004, he's doing it again for Obama.) Instead, I'll be doing emergent pre-operative evaluations on the elderly who fall and break their hips on Election Eve. There are worse things to be doing in my distracted state of mind (MICU?).

    But before I disappear into the hospital for 30 hours, I wanted to toss out a few disconnected pre-election thoughts.


    • Election Day is way better than Christmas: Not only is it for everyone (except felons), but it only comes once every 4 years. And unlike Christmas, when you are likely to get nice gifts from friends and family, on Election Day there is always a possibility that you'll really get a lump of coal. And not just any chunk ... one that will stick around for 4 (or 8!) years. It's like fruitcake! Only your fruitcake doesn't show up on the front page of the national papers on a regular basis reminding you how you didn't get that cool thing you really wanted instead.

    • Sarah Palin - the gift that keeps giving? Sarah in 2012? Please, pretty please, don't throw us in that briar patch! Let's see, she would be a second term Alaska governor running against ... an incumbent Barack Obama. (Or, more disturbingly, Joe Biden carrying forth with the legacy of an Obama Presidency.) By then, Barack will have solidified his national security credentials, and Sarah will have ... invaded Russia? Do you remember what happened with Dan Quayle after his ticket lost the election in 1992. Neither do I ....

    • Hillary done in by a non-issue: It's amazing to think that Hillary's biggest flaw in the eyes of the Democratic primary electorate was her vote to approve the use of force in Iraq in 2002. That irritated the left-wing of the party, and gave Obama an issue to use to peel away idealistic voters. And now? Iraq is a complete non-issue. Barack's signature issue that defined him from Hillary ... is a nonplayer. How would Hillary do against McCain in the context of the economic turndown that has dominated the election since September? Quite well, I suspect. So yes, she could have been President. If I were her, that thought would keep me up at night.

      I wonder if she'll support a movement to shift the primary season so it is closer to the general election, as to lessen the chance of the issues changing so dramatically from the primaries to November?


    • Atheists: don't bother running in North Carolina. Though the country was founded by a group of Christians, they had good sense to explicitly state in the Constitution that there should be no religious test for public office. Sure, it's tacked on near the end in Article VI, but it's there. Perhaps Senator Dole should be reminded of the wisdom of the Founders.

    • Fortuitous Five? While door-knocking this afternoon, I found a five dollar bill on the sidewalk. No one was around, no clear owner. So I donated it to the cause.

    • The spectrum of Obama's supporters: amazing. Today, I talked with naturalized citizens from Africa, Mexico, and Eastern Europe. But the best moment was when an older Vietnamese man told me (through his teenage daughter, who was translating) that he would be voting for Obama. His face lit up when I responded with the only Vietnamese that I know: cam on.

    • My wildest prediction: Obama takes North Carolina. He'll also take VA, PA, OH, FL, CO, and NV. We'll know the election is over when they call NC for him. Or Colorado. Or Florida. Or Ohio.

      But he won't take Missouri.


    • McCain's (only) path to victory: he manages to win Pennsylvania. And Ohio. And Florida. And Nevada. I suspect, however, that McCain's ritual early bedtime won't be disrupted by the need to wait for late results to come in before making the phone call to Obama.



    Current Mood: Hopeful
    Thursday, October 30th, 2008
    8:28 pm
    Let's hear it for early voting

    Here's a crazy notion: how about a democracy where everyone who wants to vote, gets to vote. (Once.)

    It seems like an obvious way to run a representative democracy, but 2008 is looking like one of the first years where that is actually happening. But not in every state. Just the 30-some with early voting.

    Early voting appears to be the solution to the historical mistake of voting on Tuesdays. Lots of people, you know, "real Americans" have jobs (sometimes two or three) on weekdays (and weekends). They often can't make it to a polling place between 7am and 7pm on the first Tuesday after the first Monday of November. In 2000, I asked one of the cafeteria workers at my dorm if she had voted. She hadn't because she had been swiping our meal cards from 6:45 am until 7 pm. Sure, she had breaks, but probably not enough time for her to go back to her precinct and vote. Apparently, her vote wasn't important enough to count. (Actually, since it was Chicago, there's a chance that she did "vote", but that's another story I'll touch upon below.)

    Previously, people like her were told: too bad -- you should have planned ahead and jumped through three hoops to get an absentee ballot.

    But now states are providing early voting. What a concept: Vote when it is convenient for you! There are necessary limitations (a week, or a month, and not after Election Day), but this seems to implement the ideals of our democracy: The People Decide.

    Not just some of the people, or those with jobs that allow time to vote (or those now without jobs). Everyone. (Except ... foreign nationals, people under 18 and those incarcerated. But those are appropriate limitations.)

    Remember photographs of polling places in South Africa during its first open election? I get goosebumps looking at similar pictures from here in the US. And this is during the *early voting*! Will there be anyone left to vote on Tuesday? I hope so, I hope so.

    The concern for voter fraud is, well, a fraud. And here's why: yes, there have been fraudulent registrations turned in by voter drives. And while that creates a hassle for the county to verify or invalidate dead fish, live puppies, or cartoon characters, the vote itself is not disturbed. Unless said dead fish shows up to vote.

    What about people voting multiple times? Yes, it could (and probably does happen ... rarely). Yet, to have a significant effect on the outcome of the election, it would have to be a coordinated effort with lots of people. And by that very nature of having to be large to be effective, it would be easy to detect -- those kinds of efforts tend to leave a paper trail, disgruntled participants, people with loose lips, etc. It would be exceedingly difficult to secretly tip an election by a coordinated effort of multiple voting.

    No, the better way to sway an election is to purge the voter rolls of people with names similar to felons. To supply inadequate quantities of ballots to certain voting locations. To use machines and ballots that are confusing to the average voter. Turn off the "overvote" detection in some precincts but not others. Do you get my drift?

    Everyone who wants to vote, should vote. Period.

    Current Mood: Patriotic

    Saturday, October 25th, 2008
    5:51 pm
    Counting Calories and Carbon

    Between May 1st and November 1st, I estimate that I will have biked to work about 120 times (out of a possible 130 opportunities). At about 10 miles round-trip, that's 1200 miles that I haven't driven. My car gets about 25 miles per gallon in the city, so that's 48 gallons of gas I haven't burned. Gas averaged about $3.60 this summer, so that's about $170 in gas savings. On the environmental side, a gallon of gas produces 19 pounds of CO2, so I've reduced my emissions by 930 pounds of carbon dioxide.

    However ... I don't hold my breath while biking to work. How much CO2 does biking produce? A quick Google search shows that most estimates say that a person exhales about 2.2 pounds of carbon dioxide daily. That CO2 comes from the food we eat, so if we assume 2200 calorie diet, then for every 1000 calories burned, about a pound of CO2 is produced.

    Biking consumes about 500 calories per hour. It takes me 45 minutes to bike to and from work each day (20 minutes in and 25 minutes home -- it's downhill going in and I'm usually tired from rounds when going home). So 120 trips lasting 45 minutes amounts to 90 hours of biking. That's 45,000 additional calories consumed to propel myself to work. (For reference, a single gallon of gas has about 31,000 calories.) At 1 pound of CO2 per 1000 calories, it looks like I'm exhaling about 45 pounds of CO2 on my way to work.

    My primary source of those additional calories is the slice of toast that I add to my breakfast during the summer. A slice of bread has about 100 calories, and there are 24 slices in a loaf, so I eat about 19 loaves of bread to power myself. At $2 per loaf, that's $40 that I spend in groceries for those additional calories.

    So, to summary the savings and expenditures for biking to work:

    • Savings

      • Carbon Dioxide: 930 pounds

      • Dollars: $170

    • Expenditures

      • Carbon Dioxide: 45 pounds

      • Dollars: $40


    • Net savings by biking to work during the summer:

      • Carbon dioxide: 885 pounds

      • Dollars: $130

    • The opportunity to watch the sunrise (and often the sunset) each day as I enjoy the fresh air, the morning quiet and the occasional sighting of deer, foxes and other animals:
      • Priceless.


    Current Mood: contemplative
    Thursday, October 2nd, 2008
    9:48 pm
    That Reagan Quote

    Sarah Palin ended the debate by including a quote from Reagan: "Someday, we will be telling our children, and our children's children, what it was once like in America when men were free."

    I know that quote. In fact, it was a highlight of my Failure of the American Health Care System that I gave as AMSA Legislative Affairs Director.

    Want the full context? Listen to it. Reagan was speaking out against Medicare in the 1960s, paid by the AMA. It gets good starting at about the 7th minute. The quote comes at about 10:50.

    Current Mood: Flabberghasted

    Wednesday, October 1st, 2008
    9:48 pm
    Waiting Eagerly for the Veeps

    I'm excited for the Veep Debate tomorrow night. Much in the way that NASCAR fans are excited about the weekly races - sure the competition can be good, but the spectacular crashes are the real entertainment.

    And oh do we have some potential disasters awaiting us in St. Louis ...

    The expectations for the debate have been dramatically heightened (or lowered) by what seems like the longest interview ever: the Katie Couric interview of Sarah Palin that has come out ... drip, drip, drip ... slowly this week, each installment more flaberghasting than the prior. I need not link to them -- I'm sure you've already seen Gov. Palin meander through catch-phrases on her way to not answering a question, how she was unable to name a single newspaper and/or magazine that she reads, how other than Roe v Wade she can't think of a Supreme Court decision she disagrees with ... all of leads to exceedingly low expectations for her tomorrow night.

    I don't think we're going to have any explosions tomorrow night. Nor any meltdowns. (Question: if Sarah Palin breaks down into tears, would it actually help her?)

    Anyway, I'd like to see a real policy discussion (which I know won't happen), but here are some questions that I'd like to see answered:


    • Dick Cheney has expanded the role of the Vice President in the past 8 years. What is your vision for the Office of the Vice President?

    • The Vice President often visits foreign countries as an emissary of the Administration. What area of the world would you visit first, and what issues would you raise?

    • Do you believe Guantanamo should be closed? If so, what would you do with the detainees currently held there?

    • One of Dick Cheney's first acts as Vice President was to chair a meeting with energy leaders. He refused to make public the names of those he met with, a trend of secrecy which he continued through his terms. Do you think Cheney has been too secretive? Aside from military secrets, what information should be kept secret, and what kinds of information would you release to the public to maintain transparency and trust in the government?

    • If Al Qaeda detonated a non-nuclear bomb in Washington, DC, what would be your administration's first course of action?

    • China currently holds billions of dollars of US Treasury bonds. What would you do to ensure that they do not sell those bonds precipitously, causing the dollar to crash, especially during our current economic crisis?

    • As President of the Senate, what would you do to restore bipartisanship and a sense of working for a common good in the Legislative Branch, and in the government as a whole?

    • The Justice Department is in turmoil over politicized hiring and firing. What would your administration do to restore the Department?


    I look forward to hearing at least some of those issues discussed tomorrow and in the upcoming Presidential debates. If not, maybe we'll be entertained by some spectacular high-speed collisions and gigantic fireballs.

    Current Mood: anticipatory

    Saturday, September 27th, 2008
    7:55 pm
    An area for personal improvement

    I've been running for half of my life. Started at the age of 15 with high school cross country. Figured I'd stop when I got too busy in college, but I kept at it (though only recreationally, as Northwestern did not have a men's cross country team due to a common misunderstanding of Title IX). When I started medical school, I thought I'd not have time for running ... only to discover that I had plenty of time for running during the first two years. (It was a little harder to find the time in the M3 and M4 years.) Residency didn't put a stop to it (though I've notice my times have slowed a touch since medical school -- running when post-call is not conducive to fast times).

    This year I turned 30 and I decided to try something new: a combination of running and biking. It makes sense -- I started biking while in medical school, and I continue to run. Why not combine the two in one event? Like a 5K race, followed by a 19-mile bike ride, followed by a 5K race. There happens to be one such race right next to where I live, so it's crazy not to give it a try.

    Well, it turns out that I have a bit of a deficiency when it comes to this sort of competition.

    In the first 5K, I quickly found myself near the front -- 4th place after about 1/2 mile. I clocked the first mile in 5:55 -- just under my goal of a 6 minute first mile. I hit the second mile mark at 12:30 -- right on target. I did slow up a touch at the end of the 5K, finishing in about 20:00. However, I was still in 11th place overall.

    And then the bike portion started. About the only place on the entire route where I was able to keep up with those around me was on the steep incline near the beginning. On flat areas and downhills? I was being passed like I was out for a stroll.

    I like to think this was an equipment problem -- my bike isn't a racing bike. It's not even a street bike. It's my commuting bike, with upright handle bars and a rear fender. It is most definitely not a racing bike.

    During the entire 19 mile biking portion, I passed all of one competitor - someone who had passed me earlier in the biking route. I felt like a lead weight sinking to the bottom of a fast-moving stream. Even when we turned the corner for home, with a nice tailwind, I couldn't keep up. I was in 24th gear (of my 24 gears), pedaling as fast as I could, and people just pulled away from me on their high-end speedsters.

    Alas, the biking portion came to a close, and I parked my bike (one of the few with a kick-stand) and hopped back on the running course.

    As I did so, I thought popped into my head: "What are Earth are you doing?!?! You've already run a 5K today, you just finished nearly 20 miles of biking, and now you're running again?!"

    However, I was able to make up some ground on the bikers once we were back on solid ground. And in the end, I finished 30th after clocking a 22:00 5K. One of my slowest competitive races ever -- but given that I have never run a competitive 10K, I thought 42:00 minutes for a 10K of running was pretty good.

    But, about that biking part ... well, I checked the results this evening and discovered that while I was 11th in the first 5K, and had the 18th fastest time in the second 5K, I was ... wait for it ... 61st in the biking portion.

    That's right -- I wasn't even in the top half when it came to biking.

    Hmmm ... that appears to be an area for personal improvement.

    But the results yielded an even more entertaining find: I'm pretty fast at the run, not fast on the bike, but I'm really fast in the transition: I was the 3rd fastest transition from running to biking, and the 2nd fastest from biking to running. (I love the fact that they even keep track of that.)

    There's a simple reason for my transition speed: you see, my bike is so pedestrian that it doesn't even have clip pedals. That meant I did the entire race in my running shoes. By not switching shoes, I probably saved an entire minute.

    Tomorrow, I have a feeling I'm going to be pretty sore. But now I have a goal for improvement in next year's race: transition times under 30 seconds!

    Current Mood: diffuse myalgias

    Saturday, September 13th, 2008
    9:16 pm
    Palin's Personal Politics

    In contrast to the blathering drivel about cosmetics on farm animals, the New York Times has published a detailed review of Sarah Palin's political leadership style based on her experience in Alaska.

    Finally, some in-depth research and analysis of how she has approached her role as Mayor and Governor.

    It is worth a read.

    The article takes a critical tact, but that is appropriate. It would have been nice if it had been done concerning the leadership style of our current Veep ... before he took office.

    Governor Palin takes a similar approach to leadership to what we've seen from the Bush administration: loyalty is favored over expertise, disloyalty is punished harshly, and secrecy is paramount.

    We have seen what that approach does to good governance over the past 8 years. Four more years will lead to further fraying of our social covenant with our government.

    The New York Times does have a journalistic bias: in general, they favor openness and transparency because those are important values to journalists (it makes their jobs easier). And there are occasional sentences that belie a secular bias ("The new mayor also tended carefully to her evangelical base. She appointed a pastor to the town planning board." -- so? Ministers are often also leaders in the community). But overall, the piece is well-written and well-researched. And it shows that a Palin Administration would be loaded with friends and loyalists who use political power to exert personal goals (and not just obtaining sexual favors from interns).

    I hope this article stimulates a discussion about what kind of leadership we want from our next administration. We deserve better than another four years of leaders who use political power to advance personal issues. Our government works for us. As a young politician from Illinois once put it, "Government of the people, by the people, for the people."

    Friday, August 29th, 2008
    9:28 pm
    Vice President who?

    Sarah Palin? Really?

    John McCain's selection for Vice President certainly will re-enforce his maverick status. But, really?

    I'm not the first to point out that having her on the ticket completely undercuts the argument that Obama is too inexperienced to be President. The sole purpose of the Veep is to be President at a moment's notice. So, if Governor of the smallest state, and former mayor of a town with as many people as the building I work in - if she's qualified to be President on Jan 22, 2009, then so must Barack.

    The choice just seems so ... appropriate. For a college dorm room bull session with too many PoliSci majors. Sure, she's a woman, but she's not exactly going to win over the moderate and liberal women who supported Hillary during the Democratic primary. Yes, she's a working mother with five kids, including one under 6 months of age, but did people really vote for the person who looks most like them in a mirror, regardless of their politics?

    Here's a scenario I'd like to lay out: after one day, there is a touch of backlash from the conservative pundits. Initially, there was praise for the way Palin changed the discussion, but now there's the morning after. And some folks, like David Frum, are having second thoughts.

    We've seen this story play out before, when President Bush nominated Harriet "Who?" Myers for the Supreme Court. There was surprise, tepid acceptance, but then an overwhelming wave of disapproval from the insiders. In the case of Ms. Palin, I anticipate that a brewing scandal (either known or soon to be discovered) will explode. The GOP and conservative opinion leaders will decide whether to support McCain's choice, or quietly abandon her, leading her to step aside for the betterment of the party.

    And then McCain will choose a more conventional choice (read: Romney), but will get points for being a maverick first.

    In the meantime, we'll get an onslaught of discussions about whether a mother of a toddler is the appropriate person to be mere asystole away from the Oval Office. Let the disparaging sexist undertones resume! (You've missed them since Hillary conceded, haven't you?)

    Current Mood: surprised

    Sunday, August 17th, 2008
    11:10 pm
    Olympic Thoughts
     After a week of watching the Olympics (a bit of a challenge without cable, or even a television), a few thoughts come to mind:

    • Michael Phelps: Wow.
    • Shooting is an Olympic sport? I thought the Olympics were supposed to bring about peace and harmony among nations by bringing the young athletes together every 4 years. And yet, the first medal is awarded by someone's ability to use a weapon.
    • Come to think of it, why are their separate men's and women's shooting events? Shouldn't this be an arena where gender differences are mute? Whether you have a Y chromosome or not doesn't really affect your ability to aim and pull a trigger, right? Though, it occurs to me that the small bore, 3 position competition sounds like it belongs in a porn movie rather than the Olympics.
    • Gymnastics - incredibly athletic, requiring insane amounts of strength and control, but not a sport in my book. Let's call it what it (and it's winter cousin, figure skate) truly is: competitive art. Sure, there are required components, and penalties for falls and stepping out of bounds, but there's also a purely subjective component. What if one judge thinks dancing like a robot is more artistic than smooth, flowing moves? Why is that opinion wrong? Why is another correct? Opinions and style preferences can change.

      Sports should have objective measures: who scored the most goals? Who crossed the finish line first? Who touched the wall first? These are easily recorded, documented and agreed upon. Yes, there are always subjective components (was that a foul?), but the final measure of competition is objective, not subjective and subject to debate. We know Michael Phelps touched the wall first because we can all see it on the replay.

    • Track should use a start system like drag racing with a series of lights. They use something similar in bicycle racing (in the velodrome portions), so why not on the track? It would be better than penalizing those with slow reaction times, and would eliminate the bizarre fact that a runner can be deemed to have a false start even if they leave the blocks after the gun (but sooner than 0.1 seconds after the gun).
    • Beach volleyball? Come on ... how is putting one sport on sand make it a different sport? Beach soccer, anyone? And don't get me started on trampoline (see gymnastics, above). Synchronized diving doesn't come close, either, but it would be more interesting if the divers had to make contact with each other during the dive. (What next, couples trampoline?)

    That's enough for one night. Now back to watching some incredible athletes in action ....
    Saturday, August 2nd, 2008
    7:30 pm
    Leadership

    There are many definitions of a leader, and many different qualities that people expect to see in their leaders. One aspect of being a leader is encouraging and enabling those around you to become better people.

    Think of the lionized leaders in American history: Lincoln, Jefferson, Martin Luther King, JFK -- of the many things that they did as leaders, they all challenged Americans to be better people.

    On the flip-side, we generally don't have statues and schools named for people who encouraged bickering, pettiness and squabbling (unless the particular person strong-armed the funding for the project and had it named after them - see Stroger Hospital).

    At the moment, one Presidential candidate has struck a tone that has resonated with the American people, and the people of the world, in a way that has caused millions to engage in the political process and social endeavors. And the other guy is just cranky.

    Even if the former has a thin resume, and doesn't have solidified policy statements on every issue, I am hopeful that his mere presence and energy will encourage and enable the American people to move into the 21st century. (And stop fighting Vietnam. Please, just stop fighting that war -- we've normalized relations with the former enemy at this point!)

    Obama represents a new generation, one with a different understanding of race, poverty, homosexuality, the information age, and how success should be defined. Are we going to keep driving toward enriching the bank accounts of a few at the cost of the environment, social strife and the destruction of the family? Or is there a role for community and coming together for a bigger, better cause than ourselves?

    I think the biggest challenge Obama will face is that which brings down all great, inspirational leaders: failing to live up to the expectations of their followers. Great leaders have a tendency to encourage others to be better people -- all the while masking their own personal flaws. And while Jefferson, JFK and MLK may have been able to hide their flaws until after their death, in this era of intense media coverage, any speck in the character of Obama will be magnified. Can he manage the expectations of the masses? That may be President Obama's greatest challenge.


    Recently, commentators have pondered why Obama doesn't have a bigger lead in the polls. Americans want change, and he is the candidate of change. So why isn't he farther ahead in the polls?

    Gosh, could it be because he is a black man with a Muslim name?

    This election environment clearly favors the Democrats. I'm glad that we had the opportunity to choose between two Democratic candidates who would each be breaking a barrier as President. This was the ideal year for a non-white man to run for President -- it will take a substantial tailwind for either a woman or a minority to win the White House because there is a steep hill of prejudice to climb. But that is the case this year, and now is a prime opportunity to break the monopoly that pale penis people have had on the Executive mansion.

    So yes, Obama isn't winning as dramatically as he would be if he were a conventional Democratic candidate. But I believe that if the American people select him as our leader, he will inspire us - and the world - to new heights.

    Current Mood: Inspired

    Wednesday, June 25th, 2008
    10:09 pm
    There is only so much time
     My writing here, as well as to the NPA blog has been limited not by a lack of material, but by a lack of time to draft out even half-processed thoughts. Such is the life of a resident.
    But there are so many things I've wanted to comment upon, so let's just run through them.


    Current Mood: busy and nearly overwhelmed
    Wednesday, May 14th, 2008
    8:37 pm
    Ad Entertainment
     The GOP's unfortunate (and borrowed) new slogan: The Change You Deserve

    Current Mood: Highly amused
    Saturday, May 10th, 2008
    2:08 pm
    A primary solution

    As the Democratic Primary Campaign staggers on for another six weeks, there will be much discussion about finding a better way of selecting Presidential candidates (even many in the GOP aren't thrilled with their selection). Granted, after the 2000 Presidential election, there was much discussion about fixing our election system (remember the talk about eliminating the Electoral College?), but nothing really happened. The same is true with the primary system, but there is more precedence for changing the rules there.

    Below is my solution, which I have thoroughly vetted in discussions with myself in the 12 hours since I thought of it. Overall, I think the system should allow for candidates to build support over several months and demonstrate that they can organize a campaign. I also think they should be selected by a direct democratic process - none of this "local delegates choosing state delegates" thing. It should also be based on a system that the average American can understand, so I'm modeling it off of the selection mechanisms utilized by such all-America institutions like "Survivor" and "American Idol".

    I propose a series of Candidate Selection Days: January 15, February 15, March 15 and April 15. The key to this proposal is the fact that all members of the party can vote during each of these Selection Days, and they can change their vote at any time.

    On the first Selection Day, the field is cut to 6 candidates. Those not in the top 6 are given the hook. On the next Selection Day, the field is cut to 3. After the 3rd Selection Day, only two candidates remain so that after the fourth round, there is always a winner. In addition, at any time during the first three Selection Days, if a candidate receives a majority of the votes, the race is over.

    Participants would be able to vote (probably via a secure on-line mechanism) at any time starting on Jan 2, and can change their vote at any time leading up to one of the Selection Days, at which point the votes would be locked until the survivors are declared. This would allow support of candidates to be measured in real-time, but would also give deadlines for "lock-in your vote" campaigns.

    States would still be allowed to hold primaries -- they could choose any of the four Selection Days. Voters who go to the polling places would have that vote supersede any vote they have registered on-line. This would allow non-tech savvy voters the opportunity to participate. Some states would undoubtedly want to go first, to entice candidates to come to their towns to rally voters, but other states may wait until the 3-to-2 cut because the attention would mean more then. But wait until the last Selection Day and ... oops, one candidate might get 53% in the third round and the 4th round is eliminated as unnecessary. Or, it might be the deciding day.

    But if you can always vote on-line, why would the states still hold elections? Because there will be inertia from much of the population that wants to still go to polling places once and be done with it. (Unless they have later regrets and want to switch their vote.)

    This is probably not quite feasible yet (and would require validation of party membership to participate to prevent double-voting), it sure beats the current system.

    Then again, so would Rochambeau.

    Current Mood: problem-solving

    Thursday, May 8th, 2008
    9:35 pm
    Hillary and Health Care

    The Clinton Campaign has a lot of potential to teach us about what is wrong with the American health care system.

    Back last fall, her health slipped just a bit, but that's to be expected as we grow older. She was active, healthy and engaged through the fall and early winter. But then on January 3, she slipped and fell. She landed in the hospital for a couple of days, but quickly bounced back five days later.

    She spent the next several weeks recovering, but ended up back in the hospital by the end of the month with a complication from her earlier hospitalization (you know, like a DVT).

    She was expecting to be discharged and back to her usual state of health by February 5, but unexpectedly took a turn for the worse. Complication after complication arose, and by the end of February she was in the ICU.

    But then on March 4, she rallied. Sure, she was still in the hospital, but she had been transferred out of the ICU back to the floor. She held her own through the month of March, except for a couple of minor set backs. Her family was expecting her to be back in full force again, though the doctors were still expressing caution at her condition - still on oxygen, etc.

    By April, she was rallying again. But despite being up and walking for the first time in months, she was still transfusion-dependent. Nonetheless, her family was making plans to get the house ready for her return.

    And then it all fell apart in May. She was rushed to the ICU, intubated, and placed on pressors. She was suffering from multi-organ failure. But the she continued to insist (during sedation holidays) that everything be done to save her. The family agreed that she would want everything done, even if there was just a slim chance of saving her. And even though it was possible that she might be weaned off of dopamine within a week, the overall prognosis was still grim.

    Regardless, because the patient wants everything to be done, we continue to pour millions into the effort, realizing all to well that it will not effect the final outcome, or improve her quality of life in the final moments.

    In this way, Hillary is like so many Americans -- fighting to the very end, unable or unwilling to accept the reality of what is to come. All the while, tying up resources that could be put to better use. Hillary is modern medicine.

    Current Mood: Aesopian

[ << Previous 20 ]
My Website   About LiveJournal.com

Advertisement