Happiness and Success: Chicken or Egg

The rapidly growing field of positive psychology seeks to turn long held conventional wisdom on its head.  Since early childhood we are taught that focus, discipline and hard work leads to success - which ultimately brings happiness.  What if the opposite is actually true?  It is a happy individual who is more likely to be successful.  This is the message of Shawn Achor's work - who is a professor at Harvard and published a few books on happiness.  He has glib arguments to persuade you into believing his view - which, I concede is backed by research.  I randomly came across an audio version of his book, Before Happiness, while on a transatlantic flight. It made for compelling listening.  Many of the experiments listed on this site were conducted with graduate and medical students.

Physician poets

The nature of our work attracts individuals who are to a varying degree poets and writers at heart.  We were at a faculty dinner after a long day of lectures when Mike brought up the question - why medicine?  Some on the table had known their destiny from early on while others became healers by accident.  Everyone had a remarkable tale to tell.  Mike himself was maybe 11 or 12 years old, growing up somewhere in middle America.  His summer job as a newspaper boy saw him bicycling his way through the neighborhood every morning - tossing rolled newspapers into manicured front yards.  One day he was about to turn onto a main street when he heard a loud crash. Then he saw it; two mangled vehicles that had collided head-on,  smoke billowing from one of the car's radiator.  Both the drivers were slumped forwards in their seats, unconscious.  Those were the days when seat belts were not considered fashionable.  As people quickly gathered and someone called Emergency response, Mike watched paralyzed with fascination.  The driver of the smoking vehicle was pulled out, his neck grotesquely hanging; twisted at an unnatural angle such that even a child's brain could register it as being incompatible with life.   Next the paramedics got to the gasping occupant of the other vehicle, who expired after a few minutes of futile attempts at resuscitation.  The scene was seared into Mikes brain.  He did not know it then, but he had make the decision to become an Emergency Physician so that maybe someday he could do better for similar trauma victims.

Check Mate

My daughter has developed an interest in chess.  Recently we were visiting friends in San Diego who have kids the same age.  We played some chess and I was trying to recall the checkmate trick in 5 moves from my own childhood.  We looked up youtube and came across this video.  Every thing was going well till this surprise ending......

Adjusted Cat Score

We have an unwritten rule in the observation unit.  Having more than 3 cats makes you ineligible for admission to the unit.  Whenever we go against our better judgement and accept someone with a cat score of >3, it always ends badly.  Problems compound, complaints are filed and unit operations grind to a halt.  
Over many years of doing this, we have been fooled by people with less than 3 cats who have not done well in our observation unit.  So I have devised an adjusted cat score to capture this demographic.  Having more than 3 drug allergies, a diagnosis of fibromyalgia, chronic lymes disease or gall bladder dyskinesis gives you one cat each.  You may actually have someone with no cats but has an adjusted cat score of 3.
All this is a bit tongue-in-cheek but sadly speaks to our culture; always in overdrive - destroying peace and turning us into basket cases.

Selective Amnesia

On rounds this morning we talked about the potential of selective amnesia.  Mike mentioned how great golfers tend to forget the lousy shots and only remember the good ones. Something similar happens to people who grow older and are able to remain happy - they loose all memory of the bad events in their lives.

A story I wrote for my daughter's birthday.....

“The Strange Case of Logomania at Camp”

(Logomania - excessive interest in words)

Chapter 1

Away to Camp

Ariel was a perfectly normal 8 year old girl.  She had a pretty freckled face, curly black hair, shiny brown eyes and a button nose.  She made friends easily and laughed a lot.  She fit in with everyone at her all-girls school.

Ariel had two older brothers.  Matt was 10 and Mike was 12.  She loved them both dearly but they could sometimes be very gross - the way only boys can be.  For example, they would sometimes dig their nose and fling the boogers at her!!  Matt loved to read and you would always find him in a corner with a book.  Mike was more of an outdoor person who made friends with all sorts of animals.  To his parents horror, he would bring in a rat or a toad as a pet and insist on showing it to the family at dinner time.

Ariel’s parents were professors at a big university.  Her father, Paul was an English teacher, while her mother Tanya, taught Law.  The family enjoyed solving riddles and playing word games.  Paul was always trying to introduce new words to kids.  He used to say, “ happiness is words”.  Even though the three children always groaned “oh no - not again” whenever he came up with the word of the day,  secretly, they appreciated how much effort he put in them.  The parents were not rich and had to work very hard to send the three kids to good schools and to summer camps in the mountains.

This was the first summer the children were going away to camp for seven and a half weeks.  Paul was excited for them.  But at the same time he worried that they would not be learning any new words.  Dad would not be there to force them.  The children did not seem to mind this one bit.  It so happened that Paul’s mother  - that is, the kids grandmother, whose name was Nana, had a secret.  When she was a little girl, her father had sent her away to study at the Paranormal Academy, which was kind of a school to study the art of magic.  There, she had learned some basic elements about creating tonics and potions.  Depending upon the type of tonic, if you mixed it in someones food, you could make them do whatever you wished.  For example, you could make a tonic to stop kids from watching too much TV.   It took a lot of practice to make the potion just right.  Otherwise the effect  would only last a few minutes.  Or sometimes, the tonic would have the exact opposite effect and the child would leave everything else and  watch TV all the time.  For this reason, only the very best students were allowed to graduate from the school and given permission to practice the art of potion making.  Unfortunately, Nana was not one of them.

Paul was unable to sleep the night before his children were due to go to camp.  He was tossing and turning in bed when he had an idea.  He got up and tiptoed into Nana’s room.  “I am sorry to bother you Nana, are you awake?”  he said.  Nana was about to drift off to sleep when she heard Paul and said, “Paul, is that you?  What on earth are you doing up at this hour?”.  

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Chapter 2

Nana’s Experiment

Paul apologised again and explained, “Nana, I can’t seem to go to sleep.  As you know, the kids are off to camp soon and I am worried they may not learn any new words while away for such a long time”.  Nana was well aware how Paul adored new words and wanted to instill ( which means to create a habit or establish an idea) a love of reading and writing in his children.  He was convinced that it was essential (important) to be a good reader and speaker to be successful in life.  She also knew that without Paul’s daily coaxing (persuading), the children will not have the motivation to seek out new words.  

Paul said, “I think you can help me”.  Nana was not sure how she could help but allowed Paul to proceed with his idea.

“Nana, if you agree to concoct (meaning to make something by combining various ingredients) a magic potion which will make the children learn one new word a day, I will mix it in their milk at breakfast tomorrow and viola!  we will have kids hungry for new words!!”.  He was visibly excited and pleased with himself.  Nana thought about this for a minute, took a deep breath and sighed.  “I am not sure this is a good idea” she said.

“Why do you say that”, asked Paul.

“Well, for one, I do not have the secret recipe book.  Our teacher, Wizard Wally (WW), gave the book to only six children in the whole school - the ones who made it through the finals”.  The rest did not pass the test.  It was so very long ago.  Nana was only ten years old at that time - she was almost 80 years old now.  She still remembered the final exam like it was yesterday.   After a whole year of training and countless hours in the Paranormal academy mixology lab, it was time to meet the challenge.  That Tuesday morning on a glorious spring day, three hundred girls and boys gathered in the big auditorium next to the playground.  It was 8:30 AM.   All the children had butterflies in their stomach as they awaited WW to hand them the task that would make or break them.

Wizard Wally appeared at the stage to address the gathering.  They would be given 45 minutes to prepare a potion that would grant the power to fly to anyone who drank it.  The effect of the potion would wear off when the clock struck midnight.  They would each get one pan, four cups of water and a small stove to cook.  They could take any of the vast collection of herbs in the school garden and other knick knacks from the large pantry to prepare the magic mixture.  The big school bell rang to signal the start of the competition and everyone ran to gather whatever they thought they would need.  Since there was no recipe taught to them during class for power to fly, everyone had to use their best guess to come up with the new idea and make it work.  Nana felt quite confident she could do this. She had paid attention during the potion making class but had not bothered to take notes. She put 2 cups of water in the pan and set it on the stove to medium heat.  In the meantime, she plucked 3 sprigs (meaning:  twig of a plant) of thyme, one leaf of the deadly nightshade plant, a thimbleful (meaning small quantity or pinch) of white pepper, a one inch piece of dried tail of a chinese rat, a strawberry, a teaspoonful of fish sauce and a tablespoon of vinegar.  She threw it all into the pot, just as the water was coming to a boil.  As the mixture thickened, she poured in the remaining two cups of water and covered the pot, and turned the heat down to let it simmer.  The other children were similarly cooking at their stations.  The air was thick with strange and sometimes not so pleasant smells of exotic ingredients getting combined in various proportions.  Things were not going well for some kids.  There were scattered explosions as some of the pots burst into flames.  Luckily, the school required every kid to wear face and eye protection  and nobody got hurt. Some kids watched helplessly as colorful, thick smoke came out of their pots. They knew their potion was not going to work as intended.  One of the cardinal (important) rules of potion making was that it should never smoke.  Nana’s thought her pot smelled a bit funny.  It was probably the fish sauce.  She could have done without it, but now it was too late - oh well!. Maybe it would still work.  If you could fly and smell like a fish, that would still be considered the power to fly. The bell rang once more at the end of 45 minutes to signal the end.  Everyone stopped what they were doing and gathered in front of their pots.  A few kids had triumphant (meaning: victorious or feeling of joy) smiles but most looked gloomy.  Wizard Wally now had a surprise announcement.  All the kids would form pairs and have to taste each others potion to see if it worked.  Many hands immediately went up -  all had the same question:  What if the potion had an undesirable effect?  They knew too well stories of children who had turned into toads or  going crazy, clucking like a chinese chicken after drinking an erroneous (meaning: wrong or incorrect) concoction.  Everyone was deeply worried.  Wizard Wally allayed (meaning: put to rest) their fears by telling them in a calm voice that he had the power to reverse any ill effects with his magic wand.  He was the most respected Wizard there ever was and could work any magic with his wand.  Reassured, they made pairs and holding a ladle in one hand, dipped it into their partners broth, pinched their noses tightly using the other hand’s thumb and forefinger, squeezed their eyes shut and on the count of three, swallowed the vile (meaning extremely unpleasant) stuff.

Chapter 3

A spectacle like no other

Now you have to remember that Wizard Wally had been head of the Paranormal (meaning: supernatural) Academy for almost two decades (a decade is 10 years long).  He had seen it all.  Of all the school days, it was the final exam he enjoyed most.  It was the day when not only the skills of his students but also his own skills were tested.  When things went horribly wrong, as they always did, he had to be ready with his trusty wand to reverse the spells.  Exactly five seconds after the children gulped down the potion, all hell broke loose.  Ariel, who was Nana’s best friend, gave a loud, ear piercing shriek when she noticed her arms had turned into the wings of a vampire bat.  She flew up to the chandelier and hung upside down, swinging. This was not exactly the power of flight she was hoping for. The naughtiest kid in the class found himself jumping from table to table, for he had been transformed into a chimpanzee.  Of the three hundred, only six were able to fly at will from drinking the potion that was brewed just right.  Nana was hoping hers was the winning formula, but alas, her partner, instead of getting the ability to fly, started glowing a horrible pink color.  Nana herself did not do much better, for she had become a centipede.  But the most strange transformation was that of Ivan, the school bully, who, by some twist of cruel fate was now a pot bellied swine!  To add insult to injury, he was not a normal looking swine either.  He had enormous, condor like wings, which moved every time he oinked and made him bounce up and down like a pogo stick. Most other kids had fared even worse.  There were cockroaches, lizards, snakes, deer and an occasional lion or two.  It was approaching lunchtime and as would be expected, natural predators started eyeing each other as food.  

Wizard Wally had to work with lightening speed to reverse the unintended effects of the potion ASAP (as soon as possible).  It would be very hard to explain to Johnny’s parents that he had been transformed into a deer after consuming the wrong stuff and had been eaten up by Michael, a very hungry lion.  Long story short, Wizard Wally worked like a madman, furiously waving his wand, chanting in galic (an old language), till all the strange creatures were back to their original form.  The fortunate six were awarded the coveted (highly desired) degree of Bachelor of Magic (B.M) and were encouraged to return next semester for the advanced masters degree.  Meanwhile, the rest of the dejected (sad and depressed) bunch were reassured by WW (that is Wizard Wally) that even though they may not be going home with the B.M, the lessons they had learned in the past year would help them throughout their lives.  He also cautioned them against any further pursuit of the magic craft, as it was most likely to end badly.  When Nana grew up, on many occasions later in her life, she was tempted to brew a potion or two - but resisted the temptation.  Painful memories from the test day always came back.

Chapter 4

Nana Gives In

Paul listened attentively as Nana recounted (tell someone about something) her story from the Paranormal Academy.  When she finished, Paul said, “Nana, even though you did not graduate, I am sure you can concoct the right mixture if you give it a shot (which means to try something).  After All, making children want to learn new words should be a much easier task than giving someone power of flight.”  Nana was not so sure.  Even if she agreed to Paul’s crazy idea, she would have to track down one of the graduates from yore (long ago) and convince them to loan her the secret recipe book.  Then she would have to gather the right ingredients and mix them in exact proportions.  Assuming she was able to do all that, there were still no guarantees the potion would work.  The children were leaving at noon tomorrow and Paul was getting increasingly desperate.  He was clutching at straws (trying to find a way to succeed when nothing you choose is likely to work).  Nana took one look into her son’s pitiful eyes and her heart melted.  Against her better judgement, she gave in and agreed to the insane plan.  She warned him, “I will try my best, but there are no promises of success.  Are you prepared for the consequences if thing go wrong?”.  Paul eagerly nodded his head up and down, signaling a “yes”.

There was little time to loose - mother and son got to work at once.  Nana went to the website of the Paranormal academy and tracked down the email addresses and phone numbers of all six graduates.  She began to draft an email when she realized it would be too late by the time she would get a response back.  So, despite the late hour, she took a chance and started calling them one by one.  The first number she dialled was that of Harry, the class joker.  As a kid, he was always playing tricks and making everyone laugh.  Harry’s wife Barbara picked up the phone.  She informed Nana that sadly, Harry had died two years ago of natural causes at the age of 78.  Nana was sorry to hear this.  She gently asked if Barbara knew where Harry kept his childhood things and if would be possible get hold of the magic recipe book.  Barbara had poor eyesight and walked with a cane. She did not think she would be unable to locate the secret recipe book in the attic where all of Harry’s stuff was stored, even if she did manage to climb up there.  She would have to wait for her son to come to her house in the morning to help her.  Time was one luxury Nana did not have, so this option was out. She politely thanked Barbara and hung up. Next on Nana’s list was a girl named Mary. The second phone call woke up a cranky old Mary.  She was never very social in school and had mostly kept to herself.  Nana recalled that at the Paranormal Academy, Mary could invariably (almost always) be found sitting under the huge oak tree at the center of school, her nose buried in “Magic 101” or “the complete manual of contemporary wizardry”.  With age, Mary’s hearing had deteriorated (gone bad) and she had refused to get a hearing aid.  Nana said, “Hi Mary, I am sorry to wake you up, but I desperately need a favor”.  What Mary heard was “Hail airy, eye am lorry to shake you........” and got really mad.  It was impossible to communicate with Mary and after a couple of minutes, Nana gave up.  

Paul was starting to get nervous as the third number on the list was disconnected when Nana called it.

Chapter 4

Fingers Crossed

Fourth time lucky!  It was good old Jake who answered the phone.  He had been number four on the list.  Nana remembered Jake as a tall, serious kid with mischievous eyes.  After his B.M degree, Jake had gone on to do his M.M (Masters in Magic).  When he finished, the second World War had broken out and he was drafted to fight for his country.  One of the reasons he probably survived the war was thanks to his training at the Paranormal Academy.  He had been selected to join a group of special individuals with unusual skills who could be used to fight the enemy by unconventional (unique) means.  Jake had spent many a happy hour absorbed in making potions in a secret underground laboratory located in the Black Hills of South Dakota.  He never saw any real combat.  Most of his magic potions did not work since it was so difficult to find the exotic (strange) ingredients called for.  Though he did hit a home run (was successful) with one of his concoctions that made soldiers impervious (meaning resistant or not affected by) to bullets. It was responsible for winning the war.  Jake was awarded the Purple Heart for his efforts and went on to become a prominent senator.  He was now retired and had continued to dabble (kid around) in magic for personal amusement.  He stayed active with biking, hiking and sailing and was in excellent shape for an 81 year old man.

Jake listened patiently as Nana explained Paul’s predicament (meaning: situation).  Normally, he would have refused to help with their request as he no longer made potions for controlling the behaviour of other people. He thought it was morally wrong to do so.  But it so happened that he too, like Paul, loved words.  Jake had two sons, who were now grown men.  Jake’s work as a Senator had kept him so busy that he never had the time to give his kids the love of words when they were little.  Now that they were grown up, they had not done too well in life.  One son dropped out of college and sold used cars in a sleazy dealership while the other son did not even make it to college and cleaned windows for a living.  Nothing wrong with these jobs but unfortunately, the sons were not happy adults as they never read any books.  Jake did not want Paul’s kids to turn out the same as his own children, so he agreed to help.

This was going to be tricky business (meaning difficult task).  Jake located his precious recipe tome (meaning: textbook), looked up “potions for controlling kids” in the index and opened the book to page 357. The good news was most of the ingredients would be easy to find and the potion would not have a strong taste.  It could be mixed in milk without the kids noticing the difference.  Jake read out the recipe to Nana.  It called for lavender, honey, pink sea salt, 5 drops of lemon and one, freshly plucked wild blueberry.  Luckily, Paul lived next to the blueberry mountain in the Adirondacks and wild blueberries had just started blooming.  While Nana gathered rest of the ingredients, Paul ran up the mountain to get the one blueberry.  Nana followed Jake’s instructions carefully as she slowly stirred the ingredients into boiling water.

Finally, the potion was ready and she took it off the stove to let it cool.  It was way past midnight when they got done.

Next morning, a bleary eyed Paul woke up at  6AM to the sound of the alarm.  He had slept only 4 hours but had to get up before the kids to make breakfast and mix exactly eight drops of the potion to a glassful of milk for each of the kids.  He crossed his fingers and woke his excited kids at 630 AM.

Chapter 5

It worked! (only too well)

As Paul was loading the van with Kids duffels, Nana woke up.  She came down to the kitchen where she found the kids just finishing the breakfast and gulping down their milk.  They greeted Nana with a hug, put on their shoes and ran outside to help Paul.

Suddenly, Ariel stopped and looked Paul in the eyes.  “Aren’t you forgetting something Dad?”, she exclaimed.  

“What would that be darling?”, replied Paul.

“Word of the day!!!, you have not told us yet and I am dying to know?”.

“Yes, what is the word of the day?”  chimed in Matt and Mike.

Paul could hardly believe what he was hearing.  He looked at Nana, who had come out to the driveway.  Both were grinning ear to ear.  The midnight toil (effort) had paid off.

The day’s word was antipodes - a word that meant two places situated on opposite sides of earth.  Also, it was a word used to refer to Australia and New Zealand.

Paul dropped off Ariel at the girls camp and the boys off at a nearby all-boys camp.  Interestingly, instead of saying plain old goodby, the kids said “adios, sayonara and buona sera” to Paul.  They could not figure out why Paul could not stop smiling.

Ariel ran to greet and hug her friends.  By evening, the camp was a zoo with hundreds of kids, happily chatting, running, singing.

Sue, who ran the camp, was a very astute (sharp) woman.   She immediately noticed a very strange phenomena.  All the kids in the camp were talking in impeccable (meaning: faultless) english.  She did not hear a single “like” or “awesome” muttered.  What was even more surprising, gone was the horrible mumbling speech that had become so common among school kids now a days.  Everyone was speaking clearly and concisely (Expressing much in few words).

It seemed that the potion had worked too well!  The desire to learn new words had spread like a disease from kid to kid by physical contact.  And now everyone had logomania.

This changed everything.  Every morning Sue would have to start the day with a new word.  This was the most eagerly awaited event.  Children competed with each other to see if they already knew the word or its meaning and attempted to use the word in their daily conversation.  Another thing that changed was the institution of the reading hour after lunch.  A favorite of everyone.  The children devoured (to eat up greedily) classics and modern literature alike.  Everywhere you looked, children were reading Moby Dick, Treasure Island, War and Peace and the like.  You could not find “Diary of a Wimpy Kid” anywhere - for the children held a particular disdain (consider it beneath oneself) for colloquial (informal or conversational) literature.

On visiting day, Parents were astounded (astonished) by their kids language skills.  Soon, the word spread (pun intended) and the camp became the most sought after in all of USA.  Sue could not keep up with the requests and there was a five thousand long waiting list to get in.

And Paul was a happy man.

Return of the Physical Exam?

Much has been written about the erosion of physician physical exam skills.  Reliance on technology has made many exam techniques either redundant or obsolete.  Abraham Verghese  elegantly argues on the importance of the human touch in the practice of medicine.  The ritual of physical exam achieves much more than gleaning disease clues.  It helps foster a physician patient relationship that is necessary to initiate the healing process.  He writes:

"The bedside evaluation, consisting of the history and physical examination, was once the primary means of diagnosis and clinical monitoring. The recent explosion of imaging and laboratory testing has inverted the diagnostic paradigm. Physicians often bypass the bedside evaluation for immediate testing and therefore encounter an image of the patient before seeing the patient in the flesh. In addition to risking delayed or missed diagnosis of readily recognizable disease, physicians who forgo or circumvent the bedside evaluation risk the loss of an important ritual that can enhance the physician-patient relationship. Patients expect that some form of bedside evaluation will take place when they visit a physician. When physicians complete this evaluation in an expert manner, it can have a salutary effect. If done poorly or not at all, in contrast, it can undermine the physician-patient relationship. Studies suggest that the context, locale, and quality of the bedside evaluation are associated with neurobiological changes in the patient. Recognizing the importance of the bedside evaluation as a healing ritual and a powerful diagnostic tool when paired with judicious use of technology could be a stimulus for the recovery of an ebbing skill set among physicians."
In my recent interaction with medical students, I am happy to report a resurgence in interest in the physical exam.  I think that rapid advances in simulation and its increased use in Medical schools and residency programs may be partly responsible.  Stanford has an online program highlighting some basic exam skills.

Delhi Dengue

 It is especially hard to see the frailty of aging parents; since you tend to remember them while growing up as energetic adults, providing love and security - your heroes. So seeing my Dad in the ICU looking half his size was gut wrenching. My trained physicians eyes immediately looked at the overhead monitor -relieved with what I saw.  His vitals were stable. Dengue had sapped all his strength. His voice was a bare whisper. I spent the next 10 days seeing him discharged home and starting to recuperate.  The newspapers were confirming rising dengue cases. I doused myself with more DEET than I have in a lifetime. I often say, if you need proof of the existence of god, all  you need to do is visit India.  The common man battles death at every corner. Humbled and frightened into submission - he becomes a slave to the ubiquitous superstition.  Men and women have hands laden with cheap rings on every finger.  Each ring has a different stone to ward off a particular evil spirit.  Also commonly seen are orange and red colored prayer threads, wrapped many times over an individuals wrist like bracelet and worn for added good luck, prosperity and even a bit of manly vigor. Not even my educated parents or for that matter I, were immune to this terror.  Habitually peppering our statements with "touch wood" and "gods grace".  Nothing like living in India to bring your mortality into sharp focus.  back to the hospital, I was completely taken by this service and dedication of the nurses from Kerela (a state in Southern India). These girls, mostly in their 20s and early 30s exuded a quiet determination. But above all of, what struck me most about their work was an aura of peace and joy.  And work tirelessly they did.

Irritable Bowel Syndrome (IBS)

With increased levels of stress, altered sleep patterns and a preponderance of processed foods in our diets, I am seeing more and more patients with the diagnosis of IBS.  Most have varying degrees of abdominal pain, diarrhea or constipation.   A few of my patents have told me about their success stories with treating diarrhea predominant IBS.


Step 1 - Probiotics:  Start with twice a day combination of probiotics.  1 pill each of Saccharomyces boulardii and Lactobacillus GG in the morning and evening.  There are many commercial over-the-counter preparations to choose from.  Once symptoms resolve, continue this combination once a day.  This is unlikely to work if you continue to have stress and do not get enough sleep.


Step 2 - protein intake:  If the above fails to do the job, increase certain types of protein in your diet.  My patients recommend fish.   I have another person who swears by a combination of one scoop of Gold Standard Natural Whey powder and one scoop of Amazing Grass superfood (for antioxidants), mixed in soy milk or water.


Ultimately, what ails us all is the lack of time, so aptly said by Davies:

W. H. Davies

Leisure

WHAT is this life if, full of care,
We have no time to stand and stare?—No time to stand beneath the boughs,
And stare as long as sheep and cows:
No time to see, when woods we pass,
Where squirrels hide their nuts in grass:
No time to see, in broad daylight,
Streams full of stars, like skies at night:
No time to turn at Beauty's glance,
And watch her feet, how they can dance:
No time to wait till her mouth can
Enrich that smile her eyes began?
A poor life this if, full of care,
We have no time to stand and stare.

Pawan Suri Method of removing water from your ear

The Pawan Suri(tm) method of removing water from the ear: I discovered this method when I was 7 years old and would occasionally get water in my ear after swimming. Tilt your head to the side with the affected ear facing up. Now drip a small amount (5-10 drops) of water into the affected ear (from a cup or the palm of your hand). As the water enters your ear canal, you will feel a "give" as it breaks through the "air-lock" that is trapping the water. Now tilt the head the other way and let all the water drip out....you ear is now clear. This always works.

The Genius of Marketing

(Click on the title above for the Onion hyperlink)

It never seizes to amaze me how clever marketing is able to dupe even the usually cynical, educated demographic. I came to work today to find a nearly empty bottle of water sitting at the workstation. The contents of this bottle had been consumed by my colleague who would be shortly signing out to me. This colleague happens to be a highly intelligent woman with post doctoral education, great personality and what I would consider flawless skin.

Now to the bottle of water - what caught your eye immediately was the name: "BORBA" SKIN BALANCE WATER in Ariel 32 font, an appealing light gray on white background. Things get better from here. An image of exotic Lychee fruit tastefully decorated the front followed by this information: REPLENISHING, Designed to diminish skin's Dryness.Sensitivity.Roughness.....HIGH IN ANTIOXDANT VITAMIN C & E, ZERO CALORIES.

And wait, there is more on the back (this is worth the read)

BORBA
Nutraceuticles (don't know what the hell that is, but sure sounds impressive)
__________________________________

HEALTHY SKIN FROM WITHINTM
_________________________________________________________


BORBA SKIN BALANCE WATER REPLENISHIG contains a revolutionary cultivated bio-vitamin complex along with nutrients from the lychee fruit, which are intended to boost moisture, keeping skin smooth and supple while aiding in its hydration. BORBA SKIN BALANCE WATER is formulated to work with your body's chemistry to promote healthy skin. This on-the-go skin care infused beverage combines simplicity and nutrition with the goodness of water. Its water with benefits. (are you thinking what I am thinking)
__________________________________________
the next section goes on to elaborate on the miracle of Lychee fruit, I will not bother to reproduce it, but what follows is important in case you forgot how to consume water:



DIRECTIONS FOR USE: Shake well, Twist, Sip, Thrive. Enjoy cold. Drink BORBA Skin Balance Daily to enhance skin care from within. (I think this is an obvious typo, since I would urge the prospective imbiber to drink my concoction three times a day instead of  Daily)

And this goes on and on..... as long as you don't look closely at the ingredients that for some inexplicable reason include dyes like FDC yellow etc and sucralose - I guess you have to balance all that goodness with a touch of poison.

icing on the cake? The miracle water's inventor is:

SCOTT-VINCENT BORBA,
Founder and Licensed Esthetician

I suspect Mr Borba after a series of highly successful careers as a used car salesman, bail-bondsman and investment banker with GS has now reached the pinnacle with his new venture.

Wintergreen

Less than 2 hours away from Richmond, Wintergreen resort has become one of our favorite weekend getaways in the Blue Ridge Mountains. Developed as an all season resort, it offers a variety of accommodation options ranging from hotel rooms at the mountaintop lodge to private vacation home and condo rentals. This time we stayed at the beautiful home of Kathy and Dave Witt, http://www.vrbo.com/39572. My parents, who are visiting from India were surprised how someone can trust and open their home to strangers. They particularly enjoyed the hot tub. My mother is convinced her varicose veins look much better after the dip. The children's play area, Devil's knob golf course, tennis and great hiking trails make for a full day. Just in case you are in the mood for some quality beach time, Lake Monocan ( http://www.wintergreenresort.com/activities/lake_monocan.aspx) in the valley is a short 20 min drive and offers superb swimming, sandy beach and golf.

Isla Mujeres - the dissenting view

Long averse to doing the touristy thing, when we planned our visit to Cancun, we wanted to stay away from the infamous Zona Hotelera. Instead, we booked a vacation rental home on Isla Mujeres, a small Island off Cancun reached by a 20 min ferry ride. Dubbed as a laid back island that offers a more authentic Mexican experience, we decided to rent the two bedroom “casa crystal”, enticed by the beautiful pictures on the Internet (www.vrbo.com/88875). First the good – the island definitely has a slower pace of life and a local feel to it when compared to Cancun, and there is some great snorkeling/diving around the island. The people are wonderful. There seems to be a basic honesty that I have found missing in some other developing countries.

Now the bad – terrible food and pollution. If you want to cook your own food like us, there is one moderate sized supermarket in the middle of town that sells conventionally grown, tasteless produce. It is hard to even find decent bread. Most restaurants are average to bad. The concept of recycling is non-existent and the island is teeming with gas powered golf carts and taxis that pollute the air. It is hard to swim in the ocean and not think about all the sewage being dumped in the water. Also, like cancun, the Isla unfortunately has its tourist traps like the Garrafon Park and Dolphin Swim - both of which we were able to avoid.
We would not be in a hurry to go back.

Killer habanero Guacamole

Ingredients:

4 ripe avocados
1 clove garlic
2 green onions
3 Key limes (or 1 large lime)
1 Habanero (can substitute thai bird chillies or Serrano peppers)
1/2 bunch fresh cilantro
1 tsp ground cumin
1 wedge of orange
salt to taste

Finely chop the cilantro, habanero, garlic and onions. Add the avocados and juice of key limes and orange,cumin and salt to taste. Use a fork to mix everything together (I like the chunky consistency - but you can make a finer paste if you prefer). If you like it really hot - add an extra habanero. Can serve with corn chips, sliced baguette or anything else you can think of.....no matter how much you make - it is never enough!

Best Dim Sum in Washington DC

Whenever I eat Dim sum, there is always a nagging doubt in the back of my mind about the quality of meat being ingested. Regardless, I am periodically drawn to the unbeatable pleasure of a weekend dim sum feast. Having eaten this cuisine all over the world I would have to rate Hong Kong's dim sum the best. Though I hear lately they are trying to discourage the locals from indulging in the fried variety for health reasons.
We recently ate at China Garden in the Washington area and would rate it a 7/10.
The place is big, waiters are appropriately rude and 80% of the clientele is oriental. I loved the green chili hot paste (Lachio) that I have not seen elsewhere - but you have to ask for it. We usually go for the steamed dim sum and always try the Chinese broccoli (Guylan). As I write the Pavlov reflex has been triggered and I am already thinking of the next dim sum adventure - maybe something in Orlando where I will be visiting this weekend.

Soccer Moms

"Soccer Mom" though not outright pejorative, is also not considered a complimentary term. Having spent most of the week juggling work and my two small kids ( since my wife is out of town) has convinced me that "Soccer Mom" is the highest calling of mankind. I am unable to fathom how the suburban blond housewife can raise three well behaved kids, look good, play tennis, cook AND keep the husband happy (regardless of the generous doses of Zoloft/Prozac). Upbringing? Faith? Genes?

Curly Endive and pork pasta

One of my favourite things to do is cook. I will often improvise on existing recipes to create my own signature dishes. Few days ago I ended up buying curly Endive (by mistake) instead of red lettuce. Since I am not a big fan of endive and it was organic and expensive, I looked up some recipes and created this amazing dinner. The idea was to get rid of the mild bitterness of endive while preserving its crispness.

Curly Endive and Pork Pasta

3 pork chops (boneless, 1.5" thick)
One large head of curly endive
1 packet penne pasta
3 medium roma tomatoes
3 cloves of garlic
2 tablespoons Black bean paste (available at any major grocery store)
3 tablespoons Worcestershire sauce
2 tablespoons pure honey
sea salt and fresh ground black pepper to taste
3 tablespoons olive oil
3 small hot green chillies (available at the Indian store) or substitute 1 habanero (omit if wimp)



Boil pasta according to directions (al dante , put a teaspoon of salt in the water)
Cut pork chops into 2 inch strips and add honey, black bean paste, Worcestershire sauce, salt and pepper and marinate for 15 minutes
In the meantime, chop the endive into bite size pieces and chop tomatoes into cubes.
Heat the oil in a large wok or pan. Add garlic and fry for a few minutes till it starts to turn brown and releases aroma. Add the marinated pork and cook on high heat for 5 to 7 minutes till all the pork is opaque and cooked through (do not overcook). Add curly endive over the pork and cover the wok/pan. Reduce the heat to medium and cook for another 5 minutes or till all the endive is blanched. Add tomatoes and green chillies (optional).
In a large mixing bowl or Corning dish, layer pasta and pour the pork over it. Mix the pasta and pork and serve with your favourite wine.

Welcome!

After much debate, I have decided to create a blog for a variety of reasons..........having always fancied myself as a writer and never really getting the time and motivation to get down to it, creating a blog seems like a good place to start. Who knows, my great American Novel may emerge from these random thoughts.

Even though the title of this blog points to my profession as an Emergency Physician, besides my observation of the human condition in the Emergency Department, I will document my everyday journey with the final goal for finding the meaning of life and everything......the answer to which according to Douglas Adams is 42.