and becomes a rather bit more complex after that. I wrote it back in 2008. That aging code was sound but needed some updating; actually, I remember walking through Saint Paul, on my way to workout at St. Thomas (at a gym that no longer exists), puzzling through the right way to do nested parsing of template code. I wanted to be able to write these nice clean templates that this chunk of code would then take a look at and replace with content. What I mean is, if you can keep content apart from presentation, you are afforded a lot of flexibility. So, if in the future webpages are written in a completely different language, or if I want to produce an archival version of the site (say, a printed book) in a different format, then this code is the bridge between raw information (content) and final output (presentation).
So, I took the main engine of this site, and refined a few parts of it, adding useful, explicatory comments so 5 years from now I won’t have to again go “how on earth does this work again?”
I enjoyed the brainteaser of retracing my steps from the past, puzzling through a few knotty bits of parsing and using the experience I have gained since to better traverse arrays and clean up the code in a lot of tiny ways.
I love improving the hidden bits, making them better in ways that no one but me sees. Gives me great satisfaction. Unsurprisingly, that’s the part I like about dentistry, too. The patient neither knows nor cares about the precision of the fit of their crown, but I do, and I want it to be not just good enough, but remarkable.
Took out a really really difficult tooth today. #18 (lower left molar), root canal treated, very broken down. Nothing, and I mean no-thing, above bone. Whoa. Elevated a nice flap because I learned the hard way what happens when you do NOT do that… you end up with tissue that looks like hamburger when you are done, and at this point you start to wonder, seriously, that hackneyed phrase from your oral surgery attendings: “if you treat tissue like that, you’re no different than a butcher”. So, yeah, the tissue in this case was in great shape. Good to see. These roots, though, man. They currrrved into bone, down, and down.
Some good pre-op planning paid off, because we had to go through plans A and B before plan C finally delivered the tooth to the outside world.
My patient was spectacular—they really did well, though. We got them nice and numb, and now that the tooth is out, the area can begin healing back to a healthy residual ridge. I’m always happy to be able to do this for folks, and I hope they are happy to have trouble teeth out.
I was running to my car outside the other day, and I planted my left foot to pivot. That foot was on ice, and completely slid out from under me. One moment I was up and running, and you know the way your brain leaves out the details when something painful happens quickly? The next nanosecond I was down on the ground. I laid there for a little while, thankful I had tugged my left leather & wool mitten on the hand that gave the ground a ringing SLAAAP. Up and running, down and not running.
I’m fine, my hand is fine, and actually I don’t share such an anecdote to provide a slapstick image of limited entertainment. Instead, I think it’s a metaphor for life. Sometimes, you get that “maybe not such a good idea” thought in your head, so you half-expect something unforeseen and equilibrium-demolishing is going to happen. Many other times, you just have no idea anything is going to happen; a human’s prescience is limited not only by available knowledge but also by limited scope of focus.
Our prognostications of future events, then, is poor. So, we do our best to enjoy moments when we are up and running, because there will be times when suddenly we are down and not.
I can’t stand that this is what America is; that we trade
our children’s lives for the opportunity to purchase
items specifically invented for killing. I can’t stand
it. It’s pathetic and embarrassing and barbaric.
Publication bias affects every field of medicine. About
half of all trials, on average, go missing in action, and
we know that positive findings are around twice as likely
to be published as negative findings.
His description of the situation was a “disaster” is quite accurate. The business of primary journals combined with the business of funding studies, together they are letting us down.
Philosophy says you can not have good without evil. Which is to say you have no frame of reference, no true way to define “good” if you don’t have it’s opposite. Now, I haven’t the philosophical experience to discuss good’s definition in terms of evil, but I believe it is related to another universal facet of the human experience: joy’s definition in terms of pain.
I took a calc-based physics class freshman year of undergrad taught by exactly the type of man you would expect to teach physics: someone who lived the life of a scientific intellectual, generally unconcerned with the messiness of expressing feelings and discussing emotions. By a peculiar twist of phrasing of which I can’t recall the specifics, he revealed to the class that his daughter was very sick, dying. The reaction was just as surprising, coming from a group of sleep-deprived youngsters just making it through another Wednesday morning class: a subvocal gasp rippled through the class. And one day, his daughter was gone. We knew no details, and our professor’s words gave us nothing but facts: she had been very sick, and suffered no longer. Though his words revealed little, his affect belied a profound relief. I guess I had expected a deep mourning to overcome him, and instead there was an incredible lightness. Over the course of just a week, he seemed to return to his previous self, quicker to laugh, a far more jocular, humorous man. The suffering had been taken away.
• • •
During a proper workout, there should be stretches of time when you wonder if you can push any longer. A good workout should awaken your survival instinct: can I go 30 more seconds? Do I have 3 more reps? Will my lungs burn up if I breathe any faster? Push, push, push. On television shows such as “The Biggest Loser”, such exertion is driven to dramatic heights and nearly reaches parody. But, there truly is drama in a real workout. Thus, afterwards, as the dramatic arc dictates, you experience joy; wow, I’m standing here and it feels so magnificent. I’m just, standing. I’m breathing at a normal rate. Look at the sun, greet it’s warmth. The suffering has been taken away.
• • •
To those incredibly brave mothers who are able to deliver a baby without an epidural (note that I do not disparage those who must use one for innate, unavoidable, physiologic reasons), there is a protracted period of immense pain. Women athletes have muscle tone and endurance helping them through delivery, but they also have something more; the understanding that there’s another phase after the pain. Pain, pain, pain, push, push, suffering — we place a mother’s delivery in many stories because it is true drama. The enormous dopamine rush that accompanies a successful delivery becomes shockingly potent: not only does mother greet a new life, but she delights in the release from exertion. The bond with baby is made even more powerful when it is combined with such relief. Mom is delivered from suffering.
• • •
If I were to jumble up good/evil and joy/pain, I might say I don’t think pain is good. We do not wish pain on our companions, so that they might heighten their sense of joy. But, there pain is, out in the world, always a part of life. Joy doesn’t always spring directly from it, as in the anecdotes above, but joy pulls into clearer focus, a sculpture coming into sharper relief from the carving of the chisel.
I am realizing that I don’t like stuff. Not in a little way, but in a really big way. Having ATVs or a boat sounds like the most awful thing: gas, insurance paperwork, maintenance records, towing trailers… just… yuck. I love to donate things, throw things away, recycle, get rid of worn clothes, throw out stuff I no longer use, and get rid of broken stuff. See, my brain has a tendency to track everything single thing we own and when we get rid of something, it makes that mental list shorter. That’s partly why I want a document scanner. I have giant boxes of school paperwork (literally like over 40 pounds of school papers) that is valuable but unsearchable. Pounds of organized (paid) bills. If I scan all this, it takes up zero space, I recycle of bunch of papers, and all that information is searchable thanks to the magic of optical character recognition.
When people are grocery shopping with headphones on or when they’re totally absorbed in a text message conversation at the gym, I first thought such behavior simply annoyed me. I thought that these people’s disregard for their surroundings bothered me because it put more of what can only be described as dead weight in my path, forcing me to find a passage around inert obstacles that are unaware and unwilling to acknowledge my presence. Then I realized it wasn’t my forced reroute that troubled me but rather that first part—these folk’s lack of awareness.
The majority of people wearing headphones or lost in their phones in spaces where public, social interactions are de rigueur, these people broadcast a certain energy—one that says I have surveyed you, plebs forming my surroundings, and I find you utterly unworthy of my time or my attention. Let me clarify: for the purposes of this essay, I am altogether unconcerned by the changes to various etiquette, norms, and communication standards wrought by the modern technology and gewgaws with which we cocoon and distract ourselves. This is not a “kids these days” thing. My concern is different: the body is present but the spirit is elsewhere.
There is a scene in Pixar’s 2008 film Wall·E aboard a giant interstellar cruise ship. Mary, a human who represents the state of humanity, is blithely, completely unaware of her surroundings until a minor accident disables her heads-up communications screen.
She gazes about in astonishment: “I didn’t know we had a pool!” Pixar was not trying to be subtle here, and it’s a testament to the quality of their filmmaking that this scene played neither abrasive nor preachy.
So that’s all I wish, that the engrossed and distracted could realize the beauty, depth, quality, and vitality of what they are missing when they fixate on a tiny screen.
You probably won’t like your first job very much. My first job was at 3M and its only saving grace was that I met a truly great guy named Chris Rupert. Lacking a car, I was taking extremely long bus trips to work and he was nice enough to give me a ride—he’s one of those people who help out, expecting no overblown credit or glory in return. Just a super nice, stand-up guy. I’m lucky to know him. That’s sort of it from that job, though. I’ll be honest, I did a fair amount of sleeping—3M is where I first learned to sleep sitting up. I’d wear my glasses in the morning, and arrive in the empty, recently sold-off Pharm portion of the 3M building. In a nearly-empty farm of cubicles I’d turn on my computer and then… sleep for about an hour. After that I’d go to the bathroom, put in my contacts, and start my day. During the long afternoons, I taught myself object-oriented programming and wrote large chunks of the software behind this website. None of this, not the sleeping, not the programming, was in any way related to my job. But, I learned the ins and outs of corporate email (send a lot of it, be unnecessarily verbose, CC liberally) and the pure, unabashed joy with which folks greeted “free cake in the breakroom.”
Now, I’m coming to the end of another first job, my first job as a dentist. The owner dentist and I agree on, well, nothing. We don’t agree on anything. I practice in an environment that I could never have even imagined. I never ask my assistant to “go get such and such”—instead, I always ask “do we have such and such?” Sometimes, the answer is yes. I have improved at presenting treatment plans, learned some things about setting patient expectations, learned many technical details of doing the job. And yeah, I’m happy to have learned the things I have, but I’m passionate about not doing good or even great dentistry. I want the products, the physical products of my career, the ones people have in their mouths and use every day of their lives, to be remarkable. It’s time for me to seek out an environment where I can continue working toward that goal. That’s the most important lesson I’ve learned working where I have.
So just remember when you start your job, in your career that you’ve picked, you’ll have big expectations. “This is it, time to shine!” You’ll want to see a sign each day that you picked the right thing. At first, you won’t. Expertise and virtuosity aren’t delivered to you ready-made or fully formed. You have to incubate your nascent skills and interests into your future Power Skills. I made up that term, but it is just a shorthand for the fact that I know you are going to be great at whatever you want to be great at. Your dream matters, so don’t ever take difficulties along the way as a sign that you need a different dream. Be careful not to consider a turbulent start as inauspicious.
Just tie up those shoes, gaze ahead to where road meets horizon, choose your path, and start walking.
