Friday, December 31, 2010

Wishing you all a Happy, Prosperous & Productive New Year!

Thursday, December 23, 2010

Fortune cookie: I just realised that if a personality could be a Möbius strip I would be it; there! Now I am fully explained if explicable :-)
"The book belonged to my father, a scientist, and was a favorite of his; in fact he had a large appetite for fantasy. I have wondered if there isn't some real connection between a certain kind of scientific-mindedness (the explorative, synthesizing kind) and fantasy-mindedness. Perhaps 'science fiction' really isn't such a bad name for our genre after all. Those who dislike fantasy are very often equally bored or repelled by science. They don't like either hobbits, or quasars; they don't feel at home with them; they don't want complexities, remoteness. If there is any such connection, I'll bet that it is basically an aesthetic one."

Le Guin
What constraint continually mires a discussion of the general in particulars?

Bent double, like old beggars under sacks,
Knock-kneed, coughing like hags, we cursed through sludge,
Till on the haunting flares(2) we turned our backs
And towards our distant rest(3) began to trudge.
Men marched asleep. Many had lost their boots
But limped on, blood-shod. All went lame; all blind;
Drunk with fatigue; deaf even to the hoots(4)
Of tired, outstripped(5) Five-Nines(6) that dropped behind.
Gas!(7) Gas! Quick, boys! – An ecstasy of fumbling,
Fitting the clumsy helmets(8) just in time;
But someone still was yelling out and stumbling,
And flound'ring like a man in fire or lime(9) . . .
Dim, through the misty panes(10) and thick green light,
As under a green sea, I saw him drowning.
In all my dreams, before my helpless sight,
He plunges at me, guttering,(11) choking, drowning.
If in some smothering dreams you too could pace
Behind the wagon that we flung him in,
And watch the white eyes writhing in his face,
His hanging face, like a devil's sick of sin;
If you could hear, at every jolt, the blood
Come gargling from the froth-corrupted lungs,
Obscene as cancer, bitter as the cud(12)
Of vile, incurable sores on innocent tongues,
My friend, you would not tell with such high zest(13)
To children ardent(14) for some desperate glory,
The old Lie; Dulce et Decorum est
Pro patria mori.(15)

Wilfred Owen
8 October 1917 - March, 1918

Thursday, December 09, 2010

"the natural sequence of an unnatural beginning"
I was angry with my friend:
I told my wrath, my wrath did end.
I was angry with my foe:
I told it not, my wrath did grow.

And I watered it in fears,
Night and morning with my tears;
And I sunned it with smiles,
And with soft deceitful wiles.

And it grew both day and night,
Till it bore an apple bright;
And my foe beheld it shine,
And he knew that it was mine,

And into my garden stole
When the night had veil'd the pole:
In the morning glad I see
My foe outstretch'd beneath the tree.

William Blake
Songs of Experience

Tuesday, December 07, 2010

May you be blessed and abide in a state of Grace;
May The Ineffable preserve your health of body and of mind,
and keep you firmly all the days of your life,
lending you strength in trial and joy otherwise.

Friday, December 03, 2010

Some prose barely misses being poetry; that is an underhanded cruelty....
The first question that has to be asked in an emergency is, "Is there time to think?"

Tuesday, November 30, 2010

Friday, November 26, 2010

Tuesday, November 23, 2010

RP The Future of Medicine

It is not new technologies that we have to fear, but old passions. The ban on human cloning will be lifted at some time with both good and bad consequences most of which are currently unforeseeable.


The future is unpredictable and will become more so. New technologies will continue to proliferate and the average standard of living will continue to rise. Life will become materially easier and psychosocially more stressful. We remain constrained by a very slowly evolving biology.


Welcome to the Future of Medicine.

RP I am Sorry

I am sorry.


I am sorry that you do not have the life that you dreamed of having. I am sorry that you do not have the work you thought you were made for or the partner you believe you deserve. I am sorry that you were mistaken in the options you thought you had.


I am sorry.


I was late learning that saying those three words is not the same as saying that it is my fault. It is my expression of my feeling for you and not an attribution of blame, an acknowledgement of responsibility. Women seem to learn this at an early age. Men often do not.


Most people feel entitled to an apology for numerous unnamed injustices and many walk around with an unacknowledged anger. No-one's life is perfect and no-one cares!


Csikszentmihalyi has an agreeable prescription: forget happiness as a goal, it is a by-product: seek challenge. Goethe offers encouragement too, "Whatever you believe you can do, or dream you can…."


RP Risk Neutral

"If you can make one heap of all your winnings

And risk it on one turn of pitch-and-toss,

And lose, and start again at your beginnings

And never breathe a word about your loss;"


Rudyard Kipling


cannot do that.


I am unusually rational and by that I mean that I tend not to make decisions on the basis of my feelings. I try to be risk neutral which is not always easy and even so, I know I cannot do that: risk everything and bear the loss in silence.


Life is about risking loss. We love despite the risk. We marry and have children despite the risks. We may be blind to the risks; we still take them.


I cannot do that, but I do consider it an ideal to strive for.

Zemanta helped me add links & pictures to this email. It can do it for you too.

Monday, November 22, 2010

“Our inventions are wont to be pretty toys, which distract our attention from serious things. They are but improved means to an unimproved end.”

Henry David Thoreau

Sunday, November 21, 2010

A basic emotion (e.g., interest, joy, sadness, and anger) is a set ofneural, bodily/expressive, and feeling/motivational componentsgenerated rapidly, automatically, and nonconsciously when anecologically meaningful stimulus is sensed or perceived (Izard,2007).
Queueing theory, stochastic limerence, imaginary numbers and a girl called Cindy...

Saturday, November 20, 2010

"It is discomfiting to accept that health care in the emergency department (ED) is basically dangerous, kept from disaster only by the continuous interventions and adjustments of the people working in it."
"comiogenic error"

AMA & Social media

Thursday, November 18, 2010

"The chief result of all this more modern view is the gradually growing conviction that mental life is primarily teleological; that is to say, that our various ways of feeling and thinking have grown to be what they are because of their utility in shaping our reactions on the outer world"
"The best time to plant a tree was 20 years ago. The second best time is now".
"No! Try not. Do. Or do not. There is no try."


Wednesday, November 17, 2010

Hospital based multi-specialty practice as federated. What are the rules of engagement?

Wednesday, November 10, 2010

"In times of peace, we should learn ourselves, and teach others, that which, in troublous times, both they and we must practise"

We are arrested in conviction; deafened with acclaim and facile with facade. Torment knows no preparation and Ecstacy burns it all away.

Good night! Good morn! Good day! Scripted so; and such! Welcome! [Got any LSD?]

Sunday, November 07, 2010

The Proper Study of Mankind
From Alexander Pope. An Essay on Man. As reproduced in Poetical Works, ed. H. F. Cary (London: Routledge, 1870), 225-226.
Know then thyself, presume not God to scan;
The proper study of Mankind is Man.
Plac'd on this isthmus of a middle state,
A being darkly wise, and rudely great:
With too much knowledge for the Sceptic side,
With too much weakness for the Stoic's pride,
He hangs between; in doubt to act, or rest,
In doubt to deem himself a God, or Beast;
In doubt his Mind or Body to prefer,
Born but to die, and reas'ning but to err;
Alike in ignorance, his reason such,
Whether he thinks too little, or too much:
Chaos of Thought and Passion, all confus'd;
Still by himself abus'd, or disabus'd;
Created half to rise, and half to fall;
Great lord of all things, yet a prey to all;
Sole judge of Truth, in endless error hurl'd:
The glory, jest, and riddle of the world!
The evidence is conclusive: homo sapiens sapiens is not designed for thinking; reason is grafted and we named ourselves more in hope than description
Fickle fortune, inconstant Hynos, remitting Morpheus!

Thursday, November 04, 2010

Are you not glad there is no monopoly on idiocy? I am.

Wednesday, November 03, 2010

Why does an assessment of the utility of knowledge exclude superordinate changes of perspective? There are no immutable facts; theories (sic) are just that; opinions are really statements of preference. Wisdom is superordinate.

Here's to the celebration of apparently useless knowledge: may the worlds we live in intersect....

Wednesday, October 27, 2010

"Of all the things that drive men to sea, the most common disaster, I've come to learn, is women."

Charles Johnson

Tuesday, October 26, 2010

Reality is fickle. Ask anyone's perception.
Average a large number of faces and you end up with stunningly gorgeous. Do the same with voices and you end up with something similar.
Subitizing, coined in 1949 by E.L. Kaufman et al.[1] refers to the rapid, accurate, and confident judgments of number performed for small numbers of items. The term is derived from the Latin adjective subitus (meaning "sudden") and captures a feeling of immediately knowing how many items lie within the visual scene, when the number of items present falls within the subitizing range
So what to do with that supercomputer?

Sunday, October 24, 2010

An endorsement. Definitely in favour of information depth....
Simplicity, authenticity, NOW! Desire. Yes! ...Alive? #sixwords

Saturday, October 23, 2010

Wisdom is not the apex of the data pyramid: data is fractal, information 2-dimensional, knowledge conceivably 3-dimensional....

Friday, October 22, 2010

Relationship: discrete, distinguishable, equal and excepted. #sixwords
Obtuse abstruse excuse refuse recuse use.... #sixwords
Come home to me winsome palindrome! #sixwords

Thursday, October 21, 2010

Productivity improvements effectively represent compounded time returns
What shape a coevally annotated life?

Monday, October 18, 2010

"The road of excess leads to the palace of wisdom.
Prudence is a rich ugly old maid courted by Incapacity.
He who desires but acts not, breeds pestilence."

William Blake

Oh! Glory! Glory! Glory! [Me :-)]
Amazon as Big Brother

Thursday, October 14, 2010

"Consciousness is not a complex phenomenon; it is what consciousness is about that is complex."
Passive capture - Recall - Recombination
Systems collapse / fail without feedback. Nuance is multiple length inhibitory feedback loops.
What is a self-referent string of infinite length?

Wednesday, October 13, 2010

(in existentialist philosophy) Relating to or denoting an emotionally appropriate, significant, purposive, and responsible mode of human life
Authenticity is not a property of opacity.
It can scarcely be denied that the supreme goal of all theory is to make the irreducible basic elements as simple and as few as possible without having to surrender the adequate representation of a single datum of experience.

—Albert Einstein,

Monday, October 11, 2010

This language; this language: part breath, part sound, part gesture, part intimation, part desire, part theft , part gift, part ineffable; this is the Word - encompassing CGAT, all its strings, my embryo, my corpse, my ashes, my living - the articulation, shape, movement, thought, feeling, intention and ends - this is the Word defining, describing, delimiting me-I-we-me-us-I... Me

In the beginning was the Word and the Word....
Reminded of the utility of ambiguity

Saturday, October 09, 2010

"By appreciation, we make excellence in others our own property."

Friday, October 08, 2010

Purpose. Meaning. Significance.
How happy is the blameless vestal's lot!
The world forgetting, by the world forgot.
Eternal sunshine of the spotless mind!
Each pray'r accepted, and each wish resign'd ...

Minimum wage data...
Spare me a prayer?

Thursday, September 30, 2010

RP Dispensing with doctors? [Letter to the SAMJ 2003]

To the Editor: South Africans have been fortunate beyond belief in their access to doctors, widespread poverty notwithstanding. They are unaware of their good fortune, taking it for granted, but all good things must come to an end.

Other health care professionals cannot replace doctors at a lower cost. True, the work done by doctors can be divided up among several classes of professionals, but doing so increases the costs of care severalfold - the British and American experiences serve as proof of this.

The South African public does not think of a visit to a doctor as one for information or a diagnosis, but rather as one for treatment. This mistaken belief has meant that many attend doctors inappropriately, but it has also meant that the public has not paid for the true cost of care.

South Africans are about to discover that they cannot afford doctors, and their doctors are about to discover the same. Already highly sought after by developed economies, circumstances will force their flight, however regretfully. South Africa will find itself in the same situation as other sub-Saharan countries with regard to the numbers of doctors in relation to the population. The ratio will be woefully inadequate.

Less than 3% of any age cohort in this country is capable of studying medicine. This group must produce our accountants, lawyers, statisticians, actuaries and engineers, among others. It cannot do so completely, and of all the career options, medicine probably falls at the bottom of the scale. We already produce fewer doctors per year than we did in the past, and that number will only get smaller.

It now takes 22 years of study to produce a doctor in South Africa. Which intelligent person is going to make such a commitment in order to be paid as much as a secretary - and to have his or her place of work and residence decided on by the government? I thought the constitution outlawed slavery? And I thought that the USSR proved conclusively that a central command economy does not work? Even the Chinese
acknowledge this. 

The government is changing doctors' scope of practice while calling it something else. This can only end badly for all concerned if the government fails to listen to an important constituency, viz. doctors in South Africa. Pearl Harbour was not a bolt from the blue, nor was 9/11: in both cases those in authority failed to pay attention to the necessary information until it was too late.

Hegel may have been right that history teaches only that we learn nothing from the past.

E Hassen

Tuesday, September 28, 2010

Thursday, September 23, 2010

Wednesday, September 22, 2010

"the evolution of meaning" - meaning is an adapted construction
Ambrose Bierce was right about the future....
I was just reminded that in this world more important than doing is proof of doing.

Thursday, September 09, 2010

Thursday, September 02, 2010

The parade of my emotions is more interesting for its order than its raiment

Wednesday, September 01, 2010

Sunday, August 22, 2010

Thursday, August 19, 2010

Footprints in grey snow / flickering shadows absent / deny I am here #haiku
Clarity. Consistency. Comity. Consideration. Concentration. Completion. #sixwords
Soup. Too early, too late: mistimed. #sixwords

Monday, August 16, 2010

"as if paranoia were a way of life, not merely a set of reasonable precautions but a religion"

Sunday, August 15, 2010
Book of odds
One is more than twice as likely to die from a vending machine accident than a shark attack :-)
"For sale. Baby Shoes. Never worn." Hemingway. #sixwords
Authors@Google: Clay Shirky
"Publishing is for acting"
Competence: "the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individuals and communities being served."
#sixword Don't tell, show. Telling is showing.

Tuesday, August 10, 2010

"What do you think it is?"
I am arrested in fatigue; it seems self-evident: parsing, what else could it be? Ok. That I can answer = something fairly innocuous and so inconsequential.
I am to be educated? Fatigue is a thick glutinous barrier....

RP Logic vis a vis necessity

Barring Adam and Eve – and perhaps her 13 daughters – Genghis Khan is the biologically most successful individual in recorded history: 1 out of every 200 people alive today is a descendant. I read too, that he was illiterate and uncultured and that his empire was born of rage and no grand vision.


He altered the course of human events.


This is human life: accident, luck, chance.


We do not think statistically. We are not rational; we are people. If 10% of all the people who had ever lived are alive today and that proportion will increase as time passes it means that we have been and are a successful species. Logic then is not necessary to survival.


It seems survival only needs experimentation.


RP Commitments

The irregularity with which I update this blog implies that either this blog is not important or I have difficulty meeting my commitments.


Like life, the truth is neither as stark nor as simple: this blog is important but it is not my first priority and I do have difficulty meeting my commitments to myself but not to others. This blog is written for others, but the readers are an undefined mass. I feel no personal responsibility towards them because I have assured no individual that I will update this blog daily.


I do not know how many have read this blog or have done so more than once. I have been dropping stones into the abyss waiting to hear them hit bottom.


Futile actions have utility on more than one dimension and so are not necessarily futile. It all depends on your point of view.


"Maturation forms the spine to creativity."
In celebration of becoming: a paean to aspiration

Prayer as medicine: how much have we learned?

RP Resolutions

Image representing Wikipedia as depicted in Cr...Image via CrunchBase
I have no new resolutions to offer. Old ones will have to suffice: balance, good habits and small wins.

Two recommendations I'd like to offer: Human Knowledge 2000 by Brian Holtz and the Wikipedia. They are both memes and may they propagate far and wide.

I've suddenly realised that Michael Porter's teaching on strategy is essentially an argument favouring commitment: to commit to one thing is to say "No" to everything else. This is like evolution being about relationship.

The brain operates on massive parallel processing; so does society. We just need freer, more open real-time communication.

This story does not have a beginning, a middle and an end….

Ramadhan Mubarak!

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There is a point at which fatigue becomes hallucinogenic; neurochemistry is given to fickle breakdowns....
...effacing, I am captured, captivated by the ephemeral gossamer....

Monday, August 09, 2010

Friday, August 06, 2010

Thursday, August 05, 2010
Department of Health. Abolition of the four-hour waiting standard in Accident and Emergency. Letter from the Secretary of State to the President of the College of Emergency Medicine. 23 June 2010
Sentiment or feeling? What? No distinction?...

Saturday, July 31, 2010

Wednesday, July 28, 2010

So why would hyponatremia be 6x more common in women than men?

Friday, July 23, 2010

Thursday, July 22, 2010

Thursday, July 15, 2010

To ends; or to means; the righteous are shrouded in means.... Righteous?
"...if you can fill the unforgiving minute with sixty seconds worth..."

Saturday, July 10, 2010

The essential problem with exercise is that it is boring

Wednesday, July 07, 2010

Saturday, June 26, 2010

Monday, June 14, 2010

Friday, June 04, 2010

I learnt tonight that little girls can get drunk on aftershave [90% ethanol]

Thursday, May 20, 2010

Wednesday, May 19, 2010

Reify: to consider the abstract as concrete; or to objectify a subject. There seems a disconnect here....
Tension pneumothoraxImage via WikipediaToday reinforced that chest auscultation is crap: GSW to right upper chest, which by definition has a pneumothorax: sounded ok on auscultation.
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This shape for this life; this pattern for that. Threads, molds, mixed metaphors....
"A story has no beginning or end; arbitrarily one chooses that moment of experience from which to look back or from which to look ahead."

- Graham Greene, The End of the Affair

Tuesday, May 18, 2010
New head of global surgical society aims to keep Africa on the cutting edge

Friday, May 14, 2010

Tuesday, May 11, 2010 Journal Watch Emergency Medicine March 6, 2009 Benefits of Urgent Evaluation and Treatment for TIA and Minor Stroke
Today, I think I would like to be like all those people who sleep EVERY day - when it's dark out....

Thursday, April 29, 2010

Monday, April 19, 2010

I guess my polytrauma patients should be grateful to Boffard...

Sunday, April 18, 2010

“He who loves 50 people has 50 woes; he who loves no one has no woes.” Buddha quotes
...My affections are blissfully unengaged....

Saturday, April 17, 2010

Google Earth helps discover rare hominid ancestor in South Africa
Attitude cannot be taught, only nurtured
"A large literature from behavioral economics
and psychology finds that people often make inconsistent choices, fail to learn from
experience, exhibit reluctance to trade, base their own satisfaction on how their
situation compares with the satisfaction of others and depart from the standard
model of the rational economic agent in other ways."

Daniel Kahneman and Alan B. Krueger

Monday, March 29, 2010

In all the colours and tones and depths of my soul...
In the breadth and brightness and brute of my spirit...
Brilliance is contagious, stupidity less so;
Joy is is contagious, sorrow less so;
Ecstacy is contagious, psychosis less so.....

Saturday, March 13, 2010

Wednesday, March 10, 2010
PAST, n. That part of Eternity with some small fraction of which we
have a slight and regrettable acquaintance. A moving line called the
Present parts it from an imaginary period known as the Future. These
two grand divisions of Eternity, of which the one is continually
effacing the other, are entirely unlike. The one is dark with sorrow
and disappointment, the other bright with prosperity and joy. The
Past is the region of sobs, the Future is the realm of song. In the
one crouches Memory, clad in sackcloth and ashes, mumbling penitential
prayer; in the sunshine of the other Hope flies with a free wing,
beckoning to temples of success and bowers of ease. Yet the Past is
the Future of yesterday, the Future is the Past of to-morrow. They
are one -- the knowledge and the dream.

Ambrose Bierce

Monday, March 08, 2010

The imagining self vs the experiencing self vs the remembering self...

Thursday, March 04, 2010

Tuesday, March 02, 2010

“She used to say, ‘When there are so many problems in life, I should put myself on the scale?’ ”

Monday, February 22, 2010

RP Adversity

Diversity and adversity are necessary catalysts for personal development. We all want to grow, to develop, to become more than we are. None of us want the adversity, but it seems that the development cannot be had without the adversity. The same with diversity: there cannot be change and change without pain – birth pangs of a sort.
No eruption from a chrysalis comes without pain. And yet we are not masochists.
Youth grows through ignorance, but beyond that first flush growth requires courage because we know that it will hurt and we have no joy in pain.
To growth and courage; to Life!

RP Opposites

Success in life requires the embodiment of opposites: to be tough and tender, to be focused and exploratory, to be dissatisfied and accepting, to be exacting and ….
How does unshakeable conviction allow for fallibility? How is passion reconciled with reason?
Are you all of one thing or many things? Do you embrace ambiguity?
I realise now that it does no good simply to ask these questions without also attempting personal answers. I think that you are less interested in the questions that I can raise than in the tentative responses I can make. Not to risk failure is to remove the possibility of admiration. So, I should care and not care all at once.
I think that I am all of many things; that I know much and understand little and that my certainties diminish with each year. To want to be ordinary takes great courage. I do not know if such a desire is admirable. I do not know my becoming self.

RP My brother's keeper

It is not possible to properly judge people; we lack enough information. Social sanction is effective and necessary: I am my brother's keeper.
It is impossible to change another's mind; we lack authority. As with children, example is most persuasive.
It is possible to change ourselves. It is also very painful. Why would you do it?

RP Logic

I have seen women present with hugely ulcerated breasts from breast cancer that had been growing for months. Asked why they had not sought medical advice earlier they would respond that they had hoped it would "just go away". Delay guaranteed an early death. I could never understand it.
There are people at the opposite spectrum: "I sprained my wrist 3 weeks ago. I am still getting the odd twinge. No, it's not painful really. Yes I can move it fine. No, I haven't hurt it again. Why today? Oh, I just thought that I'd make sure, you know, that it's nothing serious. It's fine? Really? Ok. Thank you so much."
People are entirely without logic.
School teaches us about science: Newton's laws, organic chemistry, Ptolemy's triangle. School misleadingly teaches us that things are explicable. People are not explicable. Still, we seek to understand others in the hope that they are less muddled than ourselves.
Apropos relationships: candour actually does work.
Rare events are cumulatively common. Most rare events occur once in a lifetime to an individual. Taking steps to avoid repetition after the event is not rational...
"built to build"

Sunday, February 21, 2010