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Evelyn Waugh, A Handful of Dust

Dante, The Divine Comedy

Fyodor Dostoevsky, Crime and Punishment

Tara Westover, Educated

The Teaching Company, The Great Minds of the Western Tradition



The contents of this website are for contemplative purposes only. No medical advice will be given, and emails asking for medical advice will be ignored.

Although patient vignettes are based on my experiences with real individuals, I liberally change details to maintain patient confidentiality.

I also reserve the right to change old postings to correct errors, and to delete comments that include obscene language or that I deem abusive to me or other commentators.  If you are looking for a open mind, I suggest you consult a neurosurgeon.

Katrina Blog Project

July 1

Supposedly, July 1 is the worst day of the year to be admitted to the hospital. The first of July is the day everyone in the doctors’ world moves up the ladder: It is the first day of work for interns (brand-new MDs), the first day for residents (just completed intern year), and it is the first day doctors who have just completed residency training begin practicing medicine without supervision.

On July 1 there are more inexperienced doctors at every level than at any other day of the year.

All of that inexperience deserves some advice, and now that I am almost twenty years in, I would like a try.

Dear New Doctors of All Kinds:

Doctors like to complain. They complain about long hours, insurance companies, difficult patients, school debt, and hospital management. They complain about work stress, burnout, and physician suicide. Some of the complaining is legitimate. Some of it is doctors feeling, out of their own sense of self-importance, that the misery of medical work is unique, not understanding that all jobs everywhere have their own griefs.

None of this is to belittle the hardness of the work doctors do. But it is to remind us of two things. First, unhappiness is not limited to physicians. Everyone who has a job has to put up with many of the same problems doctors do, and a lot of them don’t have nearly as much power to fight back. And most do it for a lot less money.

Second, most people in non-medical jobs don’t have a secret resource that doctors do: patients. Unlike other professionals, doctors have human beings in their work lives who will appreciate what they do — if, that is, they do their jobs with care. This is true no matter what the medical malpractice system is like, no matter how badly the insurance companies treat doctors, no matter how unreasonable hospital managers choose to be. The patient is the doctor’s friend.

The doctors I know who get burned out all have one thing in common. They stop caring about their patients. As long as a doctor sees that his patients need him, medicine will never be intolerable. I could quote psychological research but common sense suffices: the happiest people are those who think themselves useful to others. As doctors lose touch and empathy with their patients, seeing patients feels less like usefulness and more like drudge work. Patients become problems, obstacles between now and the trip home, the afternoon off, or the three day weekend. The patient becomes the enemy. The moment a doctor thinks of patients as enemies, as a drain on time and energy he or she would rather spend elsewhere, all is lost. I have, in my time, known many lost doctors.

This doesn’t mean doctors don’t have a right to personal time. They do. A physician has a right to a private life as much as any patient has, and ought to protect it jealously from the stresses of work. But that, of course, applies to any job in any profession. But it does mean that the patients a doctor sees deserves complete attention. In the exam room, a patient should be the complete focus of work. If we give that to our patients, if we listen to them instead of listening to our own worries, we will always find enough inside us to get up in the morning.

Giving is a gift that mitigates many sorrows. Medicine is one of the few careers in which giving to others is built into the job, every day. Not just serving, as a waiter serves a person a meal or a banker serves a the finanical needs of a client, but true giving -- healing illness, according support and dignity to the suffering, walking with the dying in their final days, providing life-saving advice and counsel. True gifts. The doctor who fails to take advantage of that giving is on the path to depression and burnout.

The Second Book of Kings tells the story of how the prophet Ellijah was inspired by God to go out into the wilderness to seek divine guidance. He saw a powerful wind blow, but God was not in the wind. An earthquake came, but God was not in the earthquake. Next there was a great fire, and God was not in the fire. Finally, after the fire, there was a stillness. God was in the stillness.

Even someone not religious can see the value in this wonderful parable. God is an ethical force. God is truth. Ethics and truth cannot be found in the fire-and-earthquake drama of the doctor’s life. Truth is a gentle voice in the stillness, and it speaks only to those who stop and listen. That voice can be found in the words of patients. The voice of a patient can bring a doctor back to the purpose of work, no matter how miserable and unfair the rest of it may seem to be.

The doctor who remembers this will never go too far astray. I say that from experience.


EtOH Goggles

"I have found," the old man said, "through long experience, trial and error, that when I drink, I gain weight. When I don't drink, I am able to maintain my weight.

"The writing is clearly on the wall, and as soon as I am sober I will be able to read it.'


The Fox's Secret

[The fox said,] "Here is my secret. It's quite simple: One sees clearly only with the heart. Anything essential is invisible to the eyes."

-- Antoine De Saint-Expuery, The Little Prince, Richard Howard tranlation.


Book Catechism: The Bullet Journal Method, by Ryan Carroll


Track the Past, Order the Present, Design the Future.

How did you come upon this book?

I am a Lifehack dabbler, always looking for something to make life easier. One of my interests is time organization methods. I have tried many of them, to little effect, because they are too complicated. During an internet search I found a video about the Bullet Journal method, and from there arrived at Ryan Carroll’s website. His organization method is simpler than most, and it can expand in complexity as needed. I liked that about it, and that got me started with Bullet Journaling.

I bought the book to have a paper reference for the method, and to see if there were any tips or tricks that would improve my game.

Also, I felt a tad guilty that I was using his method and he wasn’t getting a dime. All my money was going to the Moleskine and Traveler’s Notebook companies.

So what is the Bullet Journal Method?

It isn’t complicated, but I don’t want to completely explain it here. There are enough websites doing that already. A Bullet Journal centers around a daily list of todo items (called the Daily Log) and a system of symbols that either mark the items as to-be-done or direct them to another list where they wait to be done. It is a hierarchy of lists, starting at long-term and drilling down to daily. An item can be migrated to the Daily Log if it is to be done today. If it can wait, you can move it to the monthly list, or even a longer-term list called the Future Log. The key to the system is the migration, which keeps items moving from one list to another until it gets done or is archived somewhere for later reference.

And for things that aren’t strictly todos, or for special todos like grocery lists or things to buy for a camping trip, you can assign them to special lists called Collections. Collections are indexed for easy reference later.

The point is that there is a Daily Log that allows you to organize your day, and other lists that allow for everything else. You index these lists as you go, so they are easy to find when you need them.

Sounds like sliced bread just got displaced from the greatest thing list.

Sure. It’s not everything and it isn’t for everyone. But I like its flexibility. You pick up a notebook, any notebook, and you start on page one. When you need a new list you turn the page and continue. Unlike most systems, where you create a set of cubby holes to sift data into (such as tabbed sections of a notebook or separate files for different subjects), with a Bullet Journal you just keep adding to the end. You keep track of what you add by maintaining the index.

But the whole thing is free form. Some months I don’t have a lot to do and I may only generate a few bullet lists. Other months will be very busy and I will have pages and pages. That’s what is nice about it. It expands to fit the project rather than the other way around.

Ok, fine. It's a good system. How is the book?

The first 100 pages or so lays out the system, and were fine. The last 200 pages Carroll jumps into the Zen of Bullet Journaling, about how it will change your life.

First of all, I don’t need a personal organizer that changes my life. I need a personal organizer that reminds me to take out the garbage on the right day. My view of personal organization is purely utilitarian. When Carroll starts getting into the Zen of it, it wears on me quickly.

You have something against Zen?

Oh, no. I like Zen. But Zen is a practice all in itself that does not need Bullet Journals to make it complete. Carroll is trying to make a todo list into something more than it is. This is a common ploy in self-help books. How tidying your house will cure your problems. How running will wipe away your depression. How getting your finances in order will perfect your life. 

It’s all hogwash. Religion and philosophy perfect your life. Keeping a todo list is a tool to free you up to find personal peace, but it is not inner peace itself.

Since you brought it up, what is inner peace?

It may be different for different people. But inner peace is a profound experience, rooted in the transcendental. It is an end in itself, not a means. Personal organization is not an end, it is only a means. You organize so you can move on to inner peace. 

Organization is not the goal that provides joy. It is only a step on the path, and nowhere near the end. When Carroll starts spewing advice about how to solve life’s problems, he loses me. Nothing about the Bullet Journal is important enough to bring me to a state of joy. 

Can you give us an example of taking it too far?

“We can’t always control what fate drops in our lap. In the moments where we do have a choice, we must be vigilant about what we let into our days because we don’t have life to spare...We ask ‘what is vital’ and ‘what matters’ to help us filter our distractions from our lives....Adding this lens of impermanence to your Reflection can provide clarity by reminding you of what’s at stake. We remember death so we don’t forget to make the most of our time alive” (p.182).

Wow. Pretty heavy for a book about managing your todo list.

Exactly. What he says isn't wrong. I just prefer my grocery list not be delivered with a dose of Henry David Thoreau.

Gotcha. So you don’t like the book.

I like the book fine. The pages about how to organize a Bullet Journal are good. But the attraction of the Bullet Journal is its simplicity, not its function as the doorway to nirvana. I suppose if you had never heard any of this mindfulness/carpe diem stuff before, if you had never listened to a Sunday sermon or a graduation address, it might be a place to start. But if you are looking for a philosophy of life, there are better places to look.


Notre Dame de Paris

Notre Dame, Paris, rear view. Photo by the author, 2015.Our first and only trip to Paris was in 2015. As is true for most Americans traveling to France, we left on a connection flight from New York to Paris in the late afternoon. With the seven-hour time difference and eight-hour flight time, the flight landed us at DeGaulle Airport the next morning.

Since we arrived at our hotel many hours before check-in time, we left our bags at the front desk, and, having nothing else to do, made our way straight from Place de la République to Notre Dame. (I recommend this, by the way; when you travel to a foreign city, always go to your number one destination as soon as you get there. The longer you stay in a place like Paris, the more things you find to do. You never have more time to linger than before you make plans.)

We crossed Seine river via the St-Louis bridge and approached the famous church from the back. It was a cool and wet summer morning and the sky was a ponderous gray that would later yield to a parfait French bleu. Here I took the very first picture I would take in France, in a little park with a green lawn and pebble walkways behind the Cathedral. The rays of flying buttresses looked like Notre Dame, but not really; approaching the church from the back is like seeing the back of Mount Rushmore before coming round to the front. It only looks like the place because you know what’s on the other side.

One of the things that impresses about Notre Dame, as with many gothic churches, is the detail. The sides of the church, as you walk around it, are a forest of gables, buttresses, minor spires, gargoyles, and sunburst stained glass windows that look dark from the outside. The details from every angle, including in recesses not easily seen from the sidewalk, suggest the craftsmanship not of construction crews paid by the hour, but by artists who were prepared to spend a lifetime on a building for the ages. Every person who worked on Notre Dame in the Middle Ages was in his mind creating something that would last a thousand years, at least. Today, I doubt there are many builders who give a thought to their work lasting even to the end of this lifetime, much less a millennium.

Now days, we think of an 80 year-old building as ancient. When Notre Dame was finished, the foundations were already a century old, and at least two generations of builders, probably more, had expended their lives on it. If how much you get out of a work depends on how much you put into it, the builders of Notre Dame must have put faith and love into every tap of the chisel, because if the building itself was not everlasting, it certainly fooled tourists like us into thinking it was.

The cathedral inside was everything I expected it to be. It was dark, as gothic cathedrals in my experience tend to be. Although we all read in school that flying buttresses create a support network that allows for vast walls with large stained glass windows, the reality is that flying buttresses can only do so much, and stained glass only allows in a limited amount of light. Even in full daylight, the inside of Notre Dame was cool and relatively dim.

The famous Rose Window in the north transept, which I read has survived the fire, was a masterpiece. I knew it from the pages of many Catholic texts I have read though out my life — it, like the Statue of Liberty, is so representative of the beliefs that undergird it that it is often reproduced, without explanation, as part of theological writing. I stood for a long time just to one side of the main altar and basked in its transcendence. Because it is so high up it can be observed from a distance away, which sets it apart from many of Paris’s great works of art (I’m talking about you, Mona Lisa) where one must compete with huge crowds to look at it. At a distance I could linger over it it as long as I wanted to, without interference. There is nothing I am more certain of than that the builders of Notre Dame designed the window precisely for that purpose, so anyone could spend as much time with it as he or she likes, in apprehending silence. Even eight centuries ago, they were thinking of sleep-deprived travelers like me.

Notre Dame, Paris. Photo by the author.The Rose Window’s glass cast red and yellow and blue resplendent shards of light on the marble floor. I don’t know if the builders thought they were creating an earthly imitation of heaven, but if heaven is a peaceful place, this was captured perfectly. Although Notre Dame stands at the center of one of the busiest places on earth, central Paris, it shut the noise of the world out more effectively than any secular building I have been in. Dark, cool, cavernous, silent, with puzzles of colored light in crossing beams from one end to the other, nothing in this world could say God any better.

Notre Dame is one of the most well-documented buildings on earth. It has been photographed and measured from every possible angle. Reconstructing it after the recent devastating fire will not be a problem. It will eventually look the same, feel the same, and possibly even smell the same as the church it once was. And I will be eager to see it again.

I have experience with reconstructed buildings. The Rotunda, the Thomas Jefferson-designed 1822 building that sits in the heart of the University of Virginia, was gutted by fire in 1895. It was completely restored in 1976 to its original specifications, and for the most part looks like its original self. France will do even better with Notre Dame, which I fully expect will be recreated in every detail, and, if you like things like electircity, running water, and sprinker systems, it will in some respects be better when it re-opens than it was the day before the fire.

If you are a materialist, and you believe that atoms are just atoms, that there is no God or transcendent meaning, the new Notre Dame will be the old Notre Dame. If one atom is as good as another, reconstructing it with new materials physically identical to the old will create the same old building. Wood, after all, is just wood, and rock is just rock. Glass is glass. One brick is as good as another. Perfect imitation is perfect re-creation.

If however, you are like me and believe in transcendence, you will believe that the new church will be worthy and beautiful, but not quite the same as the old. The new church will be built by secular carpenters, masons, and architects who are mainly interested in imitating the lost elements of an injured building. They will not be working with the same intent as the original carpenters, masons, and architects who built the cathedral in the thirteenth century. The original workers were not recreating an old idea; they were expressing their faith in God. The question is, can the new building be an expression of belief as well, and if so, what kind of belief?

For me, this is the heart of it: Will the new Notre Dame be the same building or not? This is a question not of exactitude, but of faith.