www.thefacesoffacebook.com/ - The Faces of Facebook - All Facebook At One Place

What will you say about an effort that coalesces all the Faces of Facebook? All 1.2 billion of them! This gargantuan effort loads all 1.2 billion profiles' faces on its website. Zooming onto a single portion gives one a more detailed view of the faces and even closer zooming will launch a person's facebook profile.<br /><br />Go to www.thefacesoffacebook.com to see all the  faces of facebook -almost  the cyber world brought together as it is! However as maybe expected the site is taking a long hile to load. That could be an effect of the increased traffic to the site or a conflict of all the diversity brought together ;-)<br /><br />http://www.thefacesoffacebook.com/

facebook profiles facebook profiles pics faces of facebook fce of facebook www.thefacesoffacebook.com/ www.thefacesoffacebook.com/ - The Faces of Facebook - All Facebook At One Place

What will you say about an effort that coalesces all the Faces of Facebook? All 1.2 billion of them! This gargantuan effort loads all 1.2 billion profiles' faces on its website. Zooming onto a single portion gives one a more detailed view of the face…

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The Path to Infinite Leverage (Musical Tribute)

The following chart shows the inverse of the 10-year treasury yield. Why the inverse? At 0%, one could borrow an infinite amount of money and still pay the interest payments in full (without even breaking a sweat). When seen this way, 0% isn't a floor. It's infinity!<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZlS_v14yyJeJ4BHQosbdGhKJo7Sykl0BTeQjqlZF8hTpa4DQGkSpvSPxy1vCHhtTaL77c0TuWPOL4ElVRf78eUhG-7cnRj78SpPsaYwbTLXJXWqoloIyTCwmjXbP-gZRHYKgv3syuZ8g/s1600/The+Path+to+Infinite+Leverage.jpg" imageanchor="1"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiZlS_v14yyJeJ4BHQosbdGhKJo7Sykl0BTeQjqlZF8hTpa4DQGkSpvSPxy1vCHhtTaL77c0TuWPOL4ElVRf78eUhG-7cnRj78SpPsaYwbTLXJXWqoloIyTCwmjXbP-gZRHYKgv3syuZ8g/s320/The+Path+to+Infinite+Leverage.jpg" /></a><br /><span style="font-size: x-small;">Click to enlarge.</span><br /><br />Note that there has been a trend change. As seen in the difference between the red and blue exponential trend channels, the inverse is growing even faster than it once was. What does this mean? Rising interest rate environment my @$$! That's what. Just an opinion of course. Your opinion can and probably does vary.<br /><br />But before you disagree, consider this. Our modern financially innovative over-leveraged society *requires* an exponentially increasing amount of leverage, lest it seize up (again). If not, please provide evidence to the contrary. I'm all ears. Further, an economy seizing up tends to be disinflationary (compared to what it was before it began to seize).<br /><br />If I am right, then we better start learning Japanese economics, because that's where we are headed apparently. Welcome to the era of <a href="http://research.stlouisfed.org/fred2/graph/?g=mQJ">perma-ZIRP</a>. And when I say perma-ZIRP, I do not mean over the next 10,000 years. It could easily be a LOT longer than most people think though. For savers looking for <a href="http://research.stlouisfed.org/fred2/graph/?g=mQM">a relatively safe return</a>, I expect the beatings to continue until morale improves. It's one reason I have not been scared about locking in long-term interest rates whenever <a href="http://news-these-days.blogspot.com/2013/08/19-year-tips-trading-update.html">the opportunity presented itself</a>.<br /><br /><iframe allowfullscreen="" frameborder="0" height="236" src="//www.youtube.com/embed/r00ikilDxW4" width="420"></iframe><br /><div style="color: #666666;"><br /></div><div style="color: #666666;"><i>When you're at the end of the road<br />And you've lost all sense of control<br />And your thoughts have taken their toll<br />When your mind breaks the spirit of your soul<br /><br />Your faith walks on broken glass<br />And the hangover doesn't pass<br />Nothing's ever built to last<br />You're in ruins</i></div><br />This is not investment advice. It's just the opinion of a perma-bear. That said, who honestly believes that the <a href="http://www.forbes.com/sites/afontevecchia/2013/09/26/jcpenneys-contradictions-retailer-announces-equity-offer-hours-after-ceo-ullman-denies-need-to-raise-capital/">hangover is passing</a>? We're not just drinking a <a href="http://en.wikipedia.org/wiki/Hair_of_the_dog">hair of the dog</a> that bit us. We're attempting to drink the whole frickin' dog again. Good luck on that one long-term!<br /><br /><b>Source Data:</b><br /><a href="http://research.stlouisfed.org/fred2/graph/?g=mQG">St. Louis Fed: Custom Chart</a>

The Path to Infinite Leverage (Musical Tribute)

The following chart shows the inverse of the 10-year treasury yield. Why the inverse? At 0%, one could borrow an infinite amount of money and still pay the interest payments in full (without even breaking a sweat). When seen this way, 0% isn't a floo…

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Watch Modern Family @ ABC Online FREE

<b>Modern Family</b> is one hugely popular comedy show on TV. The show reinforced its status and popularity by winning the award for the best comedy series at EMMY's for the fourth time in a row. <br />Get the latest episodes of Modern Family online free streaming at the official ABC website. This is only for viewers in USA.<br /><br /><a href="http://abc.go.com/shows/modern-family">http://abc.go.com/shows/modern-family</a><br /><br />The website has all the Modern Family trivia and is a veritable treasure for the lovers of the show with pics, recaps, bios, news, memes and more.<br /><br />Go to Hulu to watch more archived and <b>latest episodes of Modern family</b> online free. Get to watch the last 5 episodes of the serial. To get the entire current season on HD on computer - one can subscribe to Hulu Plus. Geographical viewing restrictions may apply however. <br /><br /><a href="http://www.hulu.com/modern-family">http://www.hulu.com/modern-family</a><br /><br />

watch modern family abc watch modern family free online watch modern family latest episodes watch modern family online Watch Modern Family @ ABC Online FREE

Modern Family is one hugely popular comedy show on TV. The show reinforced its status and popularity by winning the award for the best comedy series at EMMY's for the fourth time in a row. Get the latest episodes of Modern Family online free streamin…

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'Big Bang Theory': 7 Things to Know About Season 7

<div dir="ltr" style="text-align: left;" trbidi="on"><a href="http://www.hollywoodreporter.com/">http://www.hollywoodreporter.com</a><br /><h2 class="main_article_deck" style="background-color: white; color: #252525; font-family: 'Vonness Bold Compressed', Helvetica, sans-serif; font-size: 26px; font-weight: normal; line-height: 30px; margin: 0px; padding: 0px;">Who's fighting? Who may get intimate? Johnny Galecki, Simon Helberg and Kunal Nayyar dish on what's ahead from the CBS hit.</h2><div class="article_body" style="background-color: white; color: #454545; font-family: Georgia, Times, serif; font-size: 14px; line-height: 23px; margin: 0px; padding: 15px 16px 0px 0px;"><div class="main_blog_image_placeholder" style="float: left; margin: 0px 16px 0px 0px; padding: 0px 0px 12px;"><div class="" style="margin: 0px; padding: 0px;"><center><div class="pinterest-button clearfix" style="margin: 0px; padding: 0px; position: relative;"><img alt="Big Bang Theory Deception Verification - P 2013" class="imagecache imagecache-blog_post_349_width" height="1572" src="http://www.hollywoodreporter.com/sites/default/files/imagecache/blog_post_349_width/2013/09/big_bang_theory_deception_verification_a_p.jpg" style="border: 0px; float: left; height: auto; margin-bottom: 10px; max-width: 349px;" title="" width="1047" /></div></center></div><div class="main_media_credit" style="clear: left; color: #cccccc; font-size: 10px; font-style: oblique; line-height: 13px; margin: 0px; padding: 2px 0px 0px; text-align: right;">CBS</div><div class="main_image_caption" style="color: #959595; font-size: 11px; font-style: oblique; line-height: 13px; margin: 0px; padding: 2px 0px 0px;">"The Big Bang Theory"</div></div><div style="padding: 0px 0px 12px;">Following a sixth season that saw CBS' nerdy comedy <em>The Big Bang Theory </em>reach a creative milestone when<strong>Kunal </strong><strong>Nayyar</strong>'s Raj<a href="http://www.hollywoodreporter.com/live-feed/big-bang-theory-season-6-finale-behind-scenes-set-visit-505624" style="color: #e11a1f; text-decoration: none;">overcame his selective muteness</a>, TV's top scripted comedy among adults 18-49 returns for its seventh year Thursday with back-to-back episodes.</div><div class="recommended_articles" style="clear: both; float: left; line-height: 1em; margin: 0px; padding: 20px 35px 20px 0px; width: 195px;"><div class="header" style="border-bottom-color: rgb(0, 0, 0); border-bottom-style: solid; border-bottom-width: 3px; color: black; font-family: 'Vonness Bold Compressed', Helvetica, sans-serif; font-size: 21px; line-height: 1; margin: 0px; padding: 0px; text-transform: uppercase;">OUR EDITOR RECOMMENDS</div><div class="module_wrap" style="background-image: url(http://www.hollywoodreporter.com/sites/all/themes/thr/images/border_dot_h.gif); background-position: 50% 100%; background-repeat: repeat no-repeat; float: left; margin: 0px; padding: 10px 0px; width: 195px;"><div class="media" style="float: left; margin: 0px 16px 8px 0px; padding: 0px; position: relative;"><div class="thumbnail" style="background-image: none; background-position: initial initial; background-repeat: initial initial; height: 58px; margin: 0px; overflow: hidden; padding: 0px;"><a href="http://www.hollywoodreporter.com/live-feed/big-bang-theory-books-kate-635563" style="color: black; font-weight: bold; line-height: 15px; text-decoration: none;"><img alt="" class="imagecache imagecache-thumbnail_tiny_58x58" height="58" src="http://www.hollywoodreporter.com/sites/default/files/imagecache/thumbnail_tiny_58x58/2013/03/big_bang_theory_the_tangible_affection_proof_a_l.jpg" style="border: 0px; display: block; float: left; height: auto; margin-bottom: 0px; max-width: 648px;" title="" width="58" /></a></div></div><div class="text" style="display: table-cell; float: none; font-family: Arial; font-size: 13px; font-weight: bold; margin: 0px; padding: 0px; vertical-align: middle;"><div class="outer" style="margin: 0px; padding: 0px;"><div class="inner" style="margin: 0px; padding: 0px;"><a href="http://www.hollywoodreporter.com/live-feed/big-bang-theory-books-kate-635563" style="color: black; line-height: 15px; text-decoration: none;">'Big Bang Theory' Books Kate Micucci for Return Visit (Exclusive)<img class="redarr" src="http://www.hollywoodreporter.com/sites/all/themes/thr/images/elements/icon_red_darrow.png" style="border: 0px; display: inline; float: none; height: auto; margin: 0px 0px 0px 3px; max-width: 648px;" /></a></div></div></div></div><div class="module_wrap" style="background-image: url(http://www.hollywoodreporter.com/sites/all/themes/thr/images/border_dot_h.gif); background-position: 50% 100%; background-repeat: repeat no-repeat; float: left; margin: 0px; padding: 10px 0px; width: 195px;"><div class="media" style="float: left; margin: 0px 16px 8px 0px; padding: 0px; position: relative;"><div class="thumbnail" style="background-image: none; background-position: initial initial; background-repeat: initial initial; height: 58px; margin: 0px; overflow: hidden; padding: 0px;"><a href="http://www.hollywoodreporter.com/live-feed/big-bang-theory-cast-eps-609087" style="color: black; font-weight: bold; line-height: 15px; text-decoration: none;"><img alt="" class="imagecache imagecache-thumbnail_tiny_58x58" height="58" src="http://www.hollywoodreporter.com/sites/default/files/imagecache/thumbnail_tiny_58x58/2013/04/bob_newhart_big_bang_theory_a_h.jpg" style="border: 0px; display: block; float: left; height: auto; margin-bottom: 0px; max-width: 648px;" title="" width="58" /></a></div></div><div class="text" style="display: table-cell; float: none; font-family: Arial; font-size: 13px; font-weight: bold; margin: 0px; padding: 0px; vertical-align: middle;"><div class="outer" style="margin: 0px; padding: 0px;"><div class="inner" style="margin: 0px; padding: 0px;"><a href="http://www.hollywoodreporter.com/live-feed/big-bang-theory-cast-eps-609087" style="color: black; line-height: 15px; text-decoration: none;">'Big Bang Theory' Cast, EPs Share Their Season 7 Wish List<img class="redarr" src="http://www.hollywoodreporter.com/sites/all/themes/thr/images/elements/icon_red_darrow.png" style="border: 0px; display: inline; float: none; height: auto; margin: 0px 0px 0px 3px; max-width: 648px;" /></a></div></div></div></div><div class="module_wrap" style="background-image: url(http://www.hollywoodreporter.com/sites/all/themes/thr/images/border_dot_h.gif); background-position: 50% 100%; background-repeat: repeat no-repeat; float: left; margin: 0px; padding: 10px 0px; width: 195px;"><div class="media" style="float: left; margin: 0px 16px 8px 0px; padding: 0px; position: relative;"><div class="thumbnail" style="background-image: none; background-position: initial initial; background-repeat: initial initial; height: 58px; margin: 0px; overflow: hidden; padding: 0px;"><a href="http://www.hollywoodreporter.com/live-feed/big-bang-theory-boss-previews-594416" style="color: black; font-weight: bold; line-height: 15px; text-decoration: none;"><img alt="" class="imagecache imagecache-thumbnail_tiny_58x58" height="58" src="http://www.hollywoodreporter.com/sites/default/files/imagecache/thumbnail_tiny_58x58/2013/05/big_bang_theory_bon_voyage_reaction.jpg" style="border: 0px; display: block; float: left; height: auto; margin-bottom: 0px; max-width: 648px;" title="" width="58" /></a></div></div><div class="text" style="display: table-cell; float: none; font-family: Arial; font-size: 13px; font-weight: bold; margin: 0px; padding: 0px; vertical-align: middle;"><div class="outer" style="margin: 0px; padding: 0px;"><div class="inner" style="margin: 0px; padding: 0px;"><a href="http://www.hollywoodreporter.com/live-feed/big-bang-theory-boss-previews-594416" style="color: black; line-height: 15px; text-decoration: none;">'Big Bang Theory' Boss Previews New Pairings in Season 7<img class="redarr" src="http://www.hollywoodreporter.com/sites/all/themes/thr/images/elements/icon_red_darrow.png" style="border: 0px; display: inline; float: none; height: auto; margin: 0px 0px 0px 3px; max-width: 648px;" /></a></div></div></div></div><div class="module_wrap" style="background-image: url(http://www.hollywoodreporter.com/sites/all/themes/thr/images/border_dot_h.gif); background-position: 50% 100%; background-repeat: repeat no-repeat; float: left; margin: 0px; padding: 10px 0px; width: 195px;"><div class="media" style="float: left; margin: 0px 16px 8px 0px; padding: 0px; position: relative;"><div class="thumbnail" style="background-image: none; background-position: initial initial; background-repeat: initial initial; height: 58px; margin: 0px; overflow: hidden; padding: 0px;"><div class="video-button-overlay" style="margin: 0px; padding: 0px;"><a href="http://www.hollywoodreporter.com/live-feed/big-bang-theory-season-6-moments-525669" style="color: black; font-weight: bold; line-height: 15px; text-decoration: none;"><span style="background-image: url(http://www.hollywoodreporter.com/sites/all/themes/thr/images/sprite_5_22_2013.png); background-position: 1px -332px; background-repeat: initial initial; bottom: 0px; display: block; height: 42px; left: 0px; margin: 0px; position: absolute; text-indent: -9999px; top: auto; width: 42px;"></span><img alt="" class="imagecache imagecache-thumbnail_tiny_58x58" height="58" src="http://www.hollywoodreporter.com/sites/default/files/imagecache/thumbnail_tiny_58x58/2013/05/big_bang_theory_love_spell_potential.jpg" style="border: 0px; display: block; float: left; height: auto; margin-bottom: 0px; max-width: 648px;" title="" width="58" /></a></div></div></div><div class="text" style="display: table-cell; float: none; font-family: Arial; font-size: 13px; font-weight: bold; margin: 0px; padding: 0px; vertical-align: middle;"><div class="outer" style="margin: 0px; padding: 0px;"><div class="inner" style="margin: 0px; padding: 0px;"><a href="http://www.hollywoodreporter.com/live-feed/big-bang-theory-season-6-moments-525669" style="color: black; line-height: 15px; text-decoration: none;">'Big Bang Theory' Cast Shares Their Favorite Season 6 Moments<img class="redarr" src="http://www.hollywoodreporter.com/sites/all/themes/thr/images/elements/icon_red_darrow.png" style="border: 0px; display: inline; float: none; height: auto; margin: 0px 0px 0px 3px; max-width: 648px;" /></a></div></div></div></div><div class="module_wrap last" style="background-image: none; background-position: initial initial; background-repeat: initial initial; float: left; margin: 0px; padding: 10px 0px; width: 195px;"><div class="media" style="float: left; margin: 0px 16px 8px 0px; padding: 0px; position: relative;"><div class="thumbnail" style="background-image: none; background-position: initial initial; background-repeat: initial initial; height: 58px; margin: 0px; overflow: hidden; padding: 0px;"><a href="http://www.hollywoodreporter.com/live-feed/big-bang-theory-at-paleyfest-428530" style="color: black; font-weight: bold; line-height: 15px; text-decoration: none;"><img alt="" class="imagecache imagecache-thumbnail_tiny_58x58" height="58" src="http://www.hollywoodreporter.com/sites/default/files/imagecache/thumbnail_tiny_58x58/2013/03/bigbang.jpg" style="border: 0px; display: block; float: left; height: auto; margin-bottom: 0px; max-width: 648px;" title="" width="58" /></a></div></div><div class="text" style="display: table-cell; float: none; font-family: Arial; font-size: 13px; font-weight: bold; margin: 0px; padding: 0px; vertical-align: middle;"><div class="outer" style="margin: 0px; padding: 0px;"><div class="inner" style="margin: 0px; padding: 0px;"><a href="http://www.hollywoodreporter.com/live-feed/big-bang-theory-at-paleyfest-428530" style="color: black; line-height: 15px; text-decoration: none;">'Big Bang Theory' at PaleyFest: 15 Things You Didn't Know<img class="redarr" src="http://www.hollywoodreporter.com/sites/all/themes/thr/images/elements/icon_red_darrow.png" style="border: 0px; display: inline; float: none; height: auto; margin: 0px 0px 0px 3px; max-width: 648px;" /></a></div></div></div></div></div><div style="padding: 0px 0px 12px;">The first episode will find Sheldon (<strong>Jim Parsons</strong>) and Penny (<strong>Kaley Cuoco</strong>) bonding over missing Leonard (<strong>Johnny Galecki</strong>), who has been at sea on a research mission for Stephen Hawking. Meanwhile, Howard (<strong>Simon Helberg</strong>) helps Raj mend a broken heart after <a href="http://www.hollywoodreporter.com/live-feed/big-bang-theory-books-kate-635563" style="color: #e11a1f; text-decoration: none;">Lucy (<strong>Kate Micucci</strong>)</a> opts to end their relationship.</div><div style="padding: 0px 0px 12px;"><strong><a href="http://www.hollywoodreporter.com/gallery/big-bang-theory-guest-stars-439826" style="color: #e11a1f; text-decoration: none;">PHOTOS: 'The Big Bang Theory's' Nerdiest Guest Stars</a></strong></div><div style="padding: 0px 0px 12px;">The second installment will feature Leonard's early return creating a rift with Sheldon, while Howard finds himself still navigating his overbearing mother.</div><div style="padding: 0px 0px 12px;"><em>The Hollywood Reporter </em>caught up with Nayyar, Helberg and Galecki to get the scoop on what to expect when the series returns.</div><div style="padding: 0px 0px 12px;">1. Just because Raj can now talk to women won't mean he's good at it. "I’m not sure that's a good thing," Nayyar says with a laugh. "He's going to put his foot in his mouth <em>a lot</em>." Raj's goal this season? The same as it has been since season one: to find love.</div><div style="padding: 0px 0px 12px;"><strong><a href="http://www.hollywoodreporter.com/live-feed/big-bang-theory-boss-previews-594416" style="color: #e11a1f; text-decoration: none;">STORY: 'Big Bang Theory' Boss Previews New Pairings in Season 7</a></strong></div><div style="padding: 0px 0px 12px;">2. Episode three will see Raj organize a scavenger hunt that will continue what showrunner <strong>Steve Molaro</strong> previewed would be new pairings in season seven. "They put Leonard and Bernadette (<strong>Melissa Rauch</strong>) together for the first time, which is really fun," Galecki says. "They work horribly together! I hope they use that because we all understand the dynamic of having a best friend with a spouse you might not necessarily get along with."</div><div style="padding: 0px 0px 12px;">3. Galecki notes viewers will see a new side to Bernadette during the scavenger hunt. "When it comes to being competitive, Bernadette is a dragon! She's horrible! It was a lot of fun to film," he says.  </div><div style="padding: 0px 0px 12px;">4. Sheldon and Penny have grown closer -- which could create a problem for Leonard. "They've bonded over missing Sheldon, which is really sweet and wonderful," Galecki notes. "Leonard comes home a bit early and is excited to see Penny, but it takes a while to acclimate to the idea of being around Sheldon again (<em>laughs</em>). There are some complications there."</div><div style="padding: 0px 0px 12px;"><a href="http://www.hollywoodreporter.com/gallery/emmys-2012-on-set-behind-scenes-big-bang-theory-329806" style="color: #e11a1f; text-decoration: none;"><strong>PHOTOS: Behind the Scenes: 'The Big Bang Theory'</strong></a></div><div style="padding: 0px 0px 12px;">5. Speaking of Bernadette, she and Howard will experience some growing pains as they continue to navigate marriage. "There's some fighting going on," Helberg warns. "We're getting into the possessive -- she wants her husband and he wants his friends and video games. There's some spats that happen."</div><div style="padding: 0px 0px 12px;">6. With Howard and Bernadette bickering, he'll turn to his best friend, Raj, for solace -- which will create a very awkward scenario. "Wolowitz crashes at Raj's a bit after a fight with Bernadette and he's having a hard time kicking the habit of video games and male bonding time to be with his wife," Helberg says of the duo's night together. "There could be some cuddling -- our shirts come off at some point, so we'll see!"  </div><div style="padding: 0px 0px 12px;">7. Galecki is cautiously optimistic about Leonard's and Penny's future together after he heads off to sea while the lovebirds are at the healthiest point in their relationship. "I don't think things have ever been better for Leonard and Penny," he says with a laugh. "But I'm afraid to even say that out loud!"</div><div style="padding: 0px 0px 12px;"><em>The Big Bang Theory </em>airs Thursdays at 8 p.m. on CBS. Hit the comments below with what you're looking forward to seeing.</div></div></div>

'Big Bang Theory': 7 Things to Know About Season 7 'Big Bang Theory': 7 Things to Know About Season 7

http://www.hollywoodreporter.comWho's fighting? Who may get intimate? Johnny Galecki, Simon Helberg and Kunal Nayyar dish on what's ahead from the CBS hit.CBS"The Big Bang Theory"Following a sixth season that saw CBS' nerdy comedy The Big Bang Theory…

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Thursday Night Football: After slow start, 49ers pull away for win

<div dir="ltr" style="text-align: left;" trbidi="on"><div dir="ltr" style="text-align: left;" trbidi="on"><a href="http://www.sportingnews.com/">http://www.sportingnews.com</a><br /><br /></div><iframe allowfullscreen="" frameborder="0" height="360" src="//www.youtube.com/embed/v1g9BdvwSrc?feature=player_detailpage" width="640"></iframe><br /><div style="background-color: white; font-family: 'Apres RE', 'apres re', sans-serif; font-size: 1.166666em; line-height: 1.6; margin-bottom: 22px;">ST. LOUIS — Colin Kaepernick threw two touchdown passes, Frank Gore had his first 100-yard game of the season and the San Francisco 49ers' defense stepped up without some of their stars in a 35-11 rout over the St. Louis Rams on Thursday night.</div><div style="background-color: white; font-family: 'Apres RE', 'apres re', sans-serif; font-size: 1.166666em; line-height: 1.6; margin-bottom: 22px;">Anquan Boldin had five catches for 90 yards and a touchdown, and Gore had 153 yards on 20 carries and a 34-yard score for San Francisco (2-2), which was outscored 46-10 the previous two games. Navarro Bowman had two of the 49ers' five sacks with a strip leading to a fourth-quarter scoring run by Anthony Dixon.</div><div style="background-color: white; font-family: 'Apres RE', 'apres re', sans-serif; font-size: 1.166666em; line-height: 1.6; margin-bottom: 22px;"><strong>— </strong><a href="http://www.sportingnews.com/nfl/box-score/20130926014/san-francisco-49ers--st-louis-rams" style="color: #020202;" target="" title=""><strong>Box score</strong></a><strong> | </strong><a href="http://www.sportingnews.com/nfl/play-by-play/20130926014/san-francisco-49ers--st-louis-rams" style="color: #020202;" target="" title=""><strong>Play-by-play</strong></a><strong> | </strong><a href="http://www.sportingnews.com/nfl/story/2013-09-26/phil-dawson-san-francisco-49ers-free-kick-nfl-st-louis-rams-thursday-night-footb" style="color: #020202;" target="" title=""><strong>Unique play</strong></a><strong> | </strong><a href="http://www.sportingnews.com/nfl/story/2013-09-26/nfl-week-4-picks-dolphins-saints-patriots-falcons-bears-lions-steelers-vikings" style="color: #020202;" target="" title=""><strong>Week 4 picks</strong></a><strong> | </strong><a href="http://www.sportingnews.com/nfl/story/2013-09-24/nfl-week-4-power-rankings-seahawks-broncos-bears-saints-patriots-chiefs" style="color: #020202;" target="" title=""><strong>Power rankings</strong></a></div><div style="background-color: white; font-family: 'Apres RE', 'apres re', sans-serif; font-size: 1.166666em; line-height: 1.6; margin-bottom: 22px;">The Rams (1-3) had an overtime win and tie against San Francisco last year, and took the early lead Thursday before falling flat. Greg Zuerlein banged in a 40-yard field goal off the right upright to end a nine-game scoring drought in the first quarter, but the 49ers answered with 28 straight points.</div><div style="background-color: white; font-family: 'Apres RE', 'apres re', sans-serif; font-size: 1.166666em; line-height: 1.6; margin-bottom: 22px;">The 49ers came close to a Super Bowl title in February and regained their footing against the team that gave them the most trouble last season. Minus cornerback Nnamdi Asomugha and linebackers Patrick Willis and Aldon Smith, they quieted a raucous, hopeful crowd, sending all but a few thousand home early.</div><div style="background-color: white; font-family: 'Apres RE', 'apres re', sans-serif; font-size: 1.166666em; line-height: 1.6; margin-bottom: 22px;">Kaepernick had no touchdown passes and four interceptions the previous two weeks and completed fewer than 50 percent of his passes. He was 15 for 23 for 167 yards.</div><div style="background-color: white; font-family: 'Apres RE', 'apres re', sans-serif; font-size: 1.166666em; line-height: 1.6; margin-bottom: 22px;"><strong>— </strong><a href="http://www.sportingnews.com/nfl/story/2013-09-26/peyton-manning-broncos-vs-eagles-offense-tempo-most-consistent-aikman" style="color: #020202;" target="" title=""><strong>Aikman's Hot Reads</strong></a><strong> | </strong><a href="http://www.sportingnews.com/nfl/story/2013-09-26/week-4-nfl-podcast-drew-brees-saints-dolphins-monday-night-football" style="color: #020202;" target="" title=""><strong>Week 4 podcast</strong></a><strong> | </strong><a href="http://www.sportingnews.com/nfl/story/2013-09-25/nfl-mock-draft-2014-bridgewater-clowney-mariota-hundley" style="color: #020202;" target="" title=""><strong>Best in class</strong></a><strong> | </strong><a href="http://www.sportingnews.com/nfl/video/1lko3z228quq61oyacbihlg4ai" style="color: #020202;" target="" title=""><strong>VIDEO: Ross Tucker's picks</strong></a></div><div style="background-color: white; font-family: 'Apres RE', 'apres re', sans-serif; font-size: 1.166666em; line-height: 1.6; margin-bottom: 22px;">Boldin had a monster debut with the 49ers after helping the Ravens beat San Francisco in the Super Bowl, but had been quiet along with the rest of the offense the previous two weeks. He had two highlight catches in the second quarter, a 42-yarder despite Cortland Finnegan getting flagged for holding, and a 20-yard score capped by a dive into the end zone after barely avoiding the sideline.</div><div class="hmedia embed-left" style="background-color: #f0f0f0; float: left; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 12px; line-height: 16px; margin: 0px 20px 14px 0px; width: 330px;"><img class="photo" src="http://dy.snimg.com/story-image/1/59/4527825/181164-330-0.jpg" style="border: 0px; max-width: 100%; vertical-align: middle;" /><span class="caption fn" style="display: block; font-size: 0.916666em; padding: 8px 10px;">Colin Kaepernick was 15-for-23 for 167 yards and two touchdowns in the victory. (AP Photo)</span></div><div style="background-color: white; font-family: 'Apres RE', 'apres re', sans-serif; font-size: 1.166666em; line-height: 1.6; margin-bottom: 22px;">Gore more than doubled his output from the first three weeks and got a lot more work, too, after totaling just 11 carries last week. Four days earlier, DeMarco Murray burned them for 175 yards in Dallas' 31-7 win.</div><div style="background-color: white; font-family: 'Apres RE', 'apres re', sans-serif; font-size: 1.166666em; line-height: 1.6; margin-bottom: 22px;">The Rams have trailed by double digits in every game, making up an 11-point deficit against Arizona in the opener but not gaps of 21 and 24 points against Atlanta and Dallas, and were down by 25 in the fourth quarter against San Francisco.</div><div style="background-color: white; font-family: 'Apres RE', 'apres re', sans-serif; font-size: 1.166666em; line-height: 1.6; margin-bottom: 22px;"><strong>— </strong><a href="http://www.sportingnews.com/nfl/team/25/san-francisco-49ers" style="color: #020202;" target="" title=""><strong>49ers team page</strong></a><strong> | </strong><a href="http://www.sportingnews.com/nfl/team/14/st-louis-rams" style="color: #020202;" target="" title=""><strong>Rams team page</strong></a><strong> | </strong><a href="http://www.sportingnews.com/nfl/statistics" style="color: #020202;" target="" title=""><strong>Statistical leaders</strong></a><strong> | </strong><a href="http://www.sportingnews.com/nfl/story/2013-09-24/dj-hayden-raiders-rookie-scouting-report-cornerback-broncos-redskins-missed-tack" style="color: #020202;" target="" title=""><strong>Rookie report</strong></a><strong> | </strong><a href="http://linemakers.sportingnews.com/nfl/2013-09-24/super-bowl-48-odds-broncos-seahawks-patriots-cowboys-49ers-saints-packers-bears" style="color: #020202;" target="" title=""><strong>Super Bowl odds</strong></a></div><div style="background-color: white; font-family: 'Apres RE', 'apres re', sans-serif; font-size: 1.166666em; line-height: 1.6; margin-bottom: 22px;">They got hit by injuries, too, the worst of them when rookie safety T.J. McDonald was carted off with a leg injury in the second half.</div><div style="background-color: white; font-family: 'Apres RE', 'apres re', sans-serif; font-size: 1.166666em; line-height: 1.6; margin-bottom: 22px;">After mustering just 25 yards in the first quarter, the 49ers took a noisy crowd out of it in the second, averaging more than 11 yards per snap while piling up 176 yards and two touchdowns. Kaepernick was 8 for 12 for 104 yards in the half, all but 11 of those yards in the second quarter.</div><div style="background-color: white; font-family: 'Apres RE', 'apres re', sans-serif; font-size: 1.166666em; line-height: 1.6; margin-bottom: 22px;">The Rams went for it on 3rd-and-1 from the 49ers 34 and Donte Whitner's diving interception in the end zone set up an eight-play, 80-yard drive capped by Gore's 34-yard run on third-and-1 in the final minute that made it 14-3.</div><div style="background-color: white; font-family: 'Apres RE', 'apres re', sans-serif; font-size: 1.166666em; line-height: 1.6; margin-bottom: 22px;">The San Francisco defense took Gore off the hook for getting stripped by rookie Alec Ogletree and a turnover, forcing St. Louis into a three-and-out. Davis, who had been questionable with a because of a hamstring injury, broke open for an easy catch in the left side of the end zone to push the lead to 21-3.</div><div style="background-color: white; font-family: 'Apres RE', 'apres re', sans-serif; font-size: 1.166666em; line-height: 1.6; margin-bottom: 22px;">Boldin entered with 83 career receptions against the Rams, the most of any opponent he has faced.</div></div>

49ers pull away for win Thursday Night Football: After slow start Thursday Night Football: After slow start, 49ers pull away for win

http://www.sportingnews.comST. LOUIS — Colin Kaepernick threw two touchdown passes, Frank Gore had his first 100-yard game of the season and the San Francisco 49ers' defense stepped up without some of their stars in a 35-11 rout over the St. Louis Ra…

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Matt Said Jay Said 8 28 38 49

<div dir="ltr" style="text-align: left;" trbidi="on"><div class="MsoNormal">Matt: Let’s make this quick.<br />Jay: Good plan! Those fish sticks seemed …. “off.” <br />Matt: I didn’t need that shared with me. <br />Jay: I want to share my life with you.<br />Matt: That’s sweet, but don’t. <br />Jay: Hey now! You’ve never hesitated to overshare with me. <br />Matt: That’s different. <br />Jay: Oh. <br />Matt: Good. <br />Jay: Wait! <br />Matt: Oh God, here we go. <br />Jay: How is it different? <br />Matt: It just is. <br />Jay: I don’t think that’s a good enough answer. <br />Matt: I’m known for my oversharing. <br />Jay: And? <br />Matt: You’re not. <br />Jay: So? <br />Matt: Let’s just both stay in our lane. <br />Jay: Ohhhhhhh … Okay. <o:p></o:p></div><div class="MsoNormal"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiF1PjlelyxRClIcT9gWkaCx53LecUAohC1AHmk8yfwOCICyEzjQk1JWWFmf2JqIoci4_9WoklFbwNJJgnrjtxK06HFx8Fan8Vt8XaP_HbYP5JbC5x28fMvRQKHUzr8ICn89fKv9wk-JYkE/s1600/Scarlett+Johansson+Hot+Sexy+Boobs+Cleavage.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiF1PjlelyxRClIcT9gWkaCx53LecUAohC1AHmk8yfwOCICyEzjQk1JWWFmf2JqIoci4_9WoklFbwNJJgnrjtxK06HFx8Fan8Vt8XaP_HbYP5JbC5x28fMvRQKHUzr8ICn89fKv9wk-JYkE/s1600/Scarlett+Johansson+Hot+Sexy+Boobs+Cleavage.jpg" /></a></div><div class="MsoNormal"><o:p><br /></o:p></div><div class="MsoNormal">Jay: Oh hey! <br />Matt: Yes? <br />Jay: We’re gonna introduce a new segment this week!<br />Matt: With a new LIVE correspondent. <br />Jay: Smugly Superior w/ Dana! <br />Matt: The role she was born to play. <br />Jay: Hell yeah. Not much of a stretch for her. <br />Matt: Well, you start with what you know. <br />Jay: True. <br />Matt: Is she gonna dis Breaking Bad?<br />Jay: I’m sure of it. <br />Matt: Good! I’m sick of hearing about that show.<br />Jay: You and me both. <br />Matt: It can’t possibly be THAT good. <br />Jay: I don’t see how. </div><div class="MsoNormal"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuyZv5GkUFSqnRELrywUnymLbqM2iiIiSmOsixt5whyxGYnFhSGIEEL8xS-6M86AHVAHZinnwpzokTaV9vyRm-GfSEBeekm23AHJJG_Xt-XJKpm5lKLmXau2ibioiLW7EHhSdjcQOPt4Yf/s1600/tamron+hall+iws+radio.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiuyZv5GkUFSqnRELrywUnymLbqM2iiIiSmOsixt5whyxGYnFhSGIEEL8xS-6M86AHVAHZinnwpzokTaV9vyRm-GfSEBeekm23AHJJG_Xt-XJKpm5lKLmXau2ibioiLW7EHhSdjcQOPt4Yf/s1600/tamron+hall+iws+radio.jpg" /></a></div><div class="MsoNormal"><br /></div><div class="MsoNormal">Matt: So what else for Sunday?<br />Jay: Another new segment. Tribute to the McLaughlin Group<br />Matt: Ha! I love that crazy old bastard. <br />Jay: He’s the greatest. <br />Matt: Oh! It’s “Confucius Day” <br />Jay: Really? We could work with that! <br />Matt: Especially when is lesser known brother PROfucius shows up. <br />Jay: I bet he’s ALMOST as brilliant as Confucius. <br />Matt: Yeah, ALMOST. <br />Jay: There’s lots of China stuff we can talk about. <br />Matt: Definitely. <br />Jay: What else?<br />Matt: Two words: Ted. Cruz. <br />Jay: HA! Is he still talking? <br />Matt: We’ll check in on Sunday.<br />Jay: I bet he’s reading off inspirational speeches from movie. <br />Matt: And maybe some other crazy-ass stuff. <br />Jay: That’s awesome. <br />Matt: And Paul Piatt<br />Jay: And EVEN MORE Drew Peacock<br />Matt: Schmoop loves him.<br />Jay: I know she does. <br />Matt: She just has a funny way of showing it. <br />Jay: And we’ll throw other stuff in as it comes up. <br />Matt: We can do it! <br />Jay: Oh the show title. <br />Matt: Hmm …. <o:p></o:p></div><div class="MsoNormal">Jay and Matt: <a href="http://www.blogtalkradio.com/im-with-stupid/2013/09/29/cussin-the-egg-rolls" target="_blank">CUSSIN’ THE EGG ROLLS</a>! <o:p></o:p></div><div class="MsoNormal">Jay: Freaking brilliant. <br />Matt: Damn we’re good. <o:p></o:p></div><div class="MsoNormal"><br /></div><br /><div class="MsoNormal">That’s “<a href="http://www.blogtalkradio.com/im-with-stupid/2013/09/29/cussin-the-egg-rolls" target="_blank">Cussin’ the Egg Rolls</a>” this Sunday at 12 Noon ET on IWS Radio. Be there or something really terrible might happen. I mean, probably not, but why risk it? <o:p></o:p></div><div class="MsoNormal"><br /></div></div>

Matt Said Jay Said 8 28 38 49

Matt: Let’s make this quick.Jay: Good plan! Those fish sticks seemed …. “off.” Matt: I didn’t need that shared with me. Jay: I want to share my life with you.Matt: That’s sweet, but don’t. Jay: Hey now! You’ve never hesitated to overshare with me. Ma…

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A New Character

I've wrote this a few times in my head and never seem to quite be able to put it into words.  I've struggled with this - both this for what this is and also whether or not to share it. <br /><br />I'd been planning to avoid the subject completely, basically censoring my own blog.  Or maybe start a second blog as a different person but lose the friendships i have here when i was a wearing the hat of a different person. Oh that doesn't make sense but i think you see what I'm getting at.<br /><br />And i love this community very much and am so so happy to have formed real friendships outside the confines of this blog.  And one of you in particular has really been that extra special friend and probably saved the last bits of my sanity.  Love you!!!!<br /><br />I like writing what's on my mind.  Yeah sometimes i go back a few hours later and ask myself what the fuck was I thinking and delete it.  But other times it's just helpful.  It's a hug.  It's advice.  It's a bit of companionship with a subject i can't discuss with friends out in the real world.  <br /><br />But in the end, this blog is for me, not for you. For me to censor myself or be forced to reinvent a new persona... that just doesn't seem right.  This is my space and a place i like to sort my thoughts.<br /><br />I know i'll be judged for this.  And i think I'm okay with that.  <br /><br />People say life is short.  It is, at least when you're 90 and you're looking back at your life.  You look back and reminisce about good times and you also have regrets.  Some of those regrets are where you went wrong, but many are where you didn't bother to go right.  You lived a good life, you did the safe things.  But what about all those things you didn't get to do?  Now you can't, you're 90.  That's when life is short.  You're out of time.<br /><br />So here's what dawned on me... Life is long, really freaking long.  I'm 38.  I hope i haven't hit the halfway point of my life.  Yet, here i am, looking back at my life with those same regrets.  Bad choices, oh hell, there's a lot of bad choices.  Good and safe choices, yeah got those too.  Regrets of things I didn't do or can't do?  Far too many.  And you know what? I'm not 90.  I don't have to accept never experiencing things i want to.  I have time.  And i'm going to live it.  I refuse to spend the next however many decades wallowing in this state of "I wish I'd gotten a chance to..." for the sole reason that not experiencing things is the right or safe or proper choice.  I guess i've finally realized things that are basically on my bucket list can be taken care of while I'm still young enough to enjoy it (perhaps over and over again) even if it's not proper or safe or right.<br /><br />It's a bit past 11 pm here and i'm alone in bed writing this.  My family had some fun plans for the afternoon and evening, he promised and then it didn't happen.   I know better than to tell the kids anything anymore.  But i know.  He didn't get home until very late and now he's upstairs working out.  Other things take massive priority over me.  It hurts, it just sucks plain and simple.  Will I leave him because he ignores me?  No... but these long evenings alone, stuck in the house because of the little Things a'snooze in their beds... it just gives me more time to reflect upon empty places in my soul.  <br /><br />This post really isn't giving you much information, i know.  And I'm not sure when or if i will.  I just feel like I need to go ahead and get this out of the way so when the time comes to bring it up, it's not shocking news.<br /><br />There's another character to add to my story.  His name is Sir.<br /><br />No, i'm not (and will not <i>ever</i> be) having sex with anyone other than myself, and then my husband when I'm lucky.  This is understood between Sir and i.  Which probably doesn't make any sense either but please just take it at face value that it's the truth.

A New Character

I've wrote this a few times in my head and never seem to quite be able to put it into words.  I've struggled with this - both this for what this is and also whether or not to share it. I'd been planning to avoid the subject completely, basically cens…

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Medicine's Search for Meaning - NYTimes.com

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; " class=""><div id="opinionator" style="color: rgb(0, 0, 0); font-family: Georgia, serif; font-size: 13px; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; " class=""><div align="left" class=""><div class="entry-content"><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Every day, we are reminded that the health care system is in crisis. We are going bankrupt. There are too many lawsuits. We practice defensive medicine. We restrict access. But surveys of doctors indicate a problem that penetrates much deeper than this. Today, almost 50 percent of doctors <a href="http://archinte.jamanetwork.com/article.aspx?articleid=1351351" style="color: rgb(0, 0, 102); text-decoration: none; " class="">report symptoms of burnout</a> — emotional exhaustion, low sense of accomplishment, detachment.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Medicine is facing a crisis, but it's not just about money; it's about meaning.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">We often think of medicine as a science, and many doctors do come to think of themselves as technicians. But healing involves far more than knowledge and skill. The process by which a doctor helps a patient accept, recover from, adapt to, or endure a serious illness is full of nuance and mystery. I was often moved by how much my father-in-law — an actor who died from a form of leukemia — drew comfort and even inspiration from the relationship he had with his hematologist (who requested a Shakespeare recitation at each visit).</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Great doctors don't just diagnose diseases, prescribe medications and treat patients; they bring the full spectrum of their human capabilities to the compassionate care of others. That is why doctors, upon entering the medical profession, speak noble words like the Declaration of Geneva ("I solemnly pledge to consecrate my life to the service of humanity…") or the <a href="http://guides.library.jhu.edu/content.php?pid=23699&sid=190571" style="color: rgb(0, 0, 102); text-decoration: none; " class="">Oath of Maimonides</a>("May I see in all who suffer only the fellow human being.")<br class=""><br class="">Yet by then, considerable damage has already been done. Nearly half of medical students become burned out <a href="http://www.nytimes.com/2008/10/31/health/chen10-30.html" style="color: rgb(0, 0, 102); text-decoration: none; " class="">during their training</a>. Medical education has been characterized as an <a href="http://www.ncbi.nlm.nih.gov/pubmed/2612802" style="color: rgb(0, 0, 102); text-decoration: none; " class="">abusive and neglectful family system</a>. It places unrealistic expectations on students, keeps them sleep-deprived, overstressed, and in a state of fear of making mistakes, and sends the message that doubts or grief should be kept to oneself. While the training formally espouses the ethics of empathy, compassion and altruism, doctors and researchers say that the socialization process — the "<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3173411/" style="color: rgb(0, 0, 102); text-decoration: none; " class="">hidden curriculum</a>" — teaches something <a href="http://www.ncbi.nlm.nih.gov/pubmed/11401802" style="color: rgb(0, 0, 102); text-decoration: none; " class="">very different</a>: stay detached, objective, even a little cynical. Five out of six doctors say that medicine is in decline and close to 60 percent would not recommend it as a career for their children (<a href="http://www.physiciansfoundation.org/uploads/default/Physicians_Foundation_2012_Biennial_Survey.pdf" style="color: rgb(0, 0, 102); text-decoration: none; " class="">pdf</a>).</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">As administrative and documentation burdens have exploded in the past three decades, doctors find themselves under pressures to work as quickly as possible. Many have found that what is sacrificed is the very thing that gives meaning to the whole undertaking: the patient-doctor relationship.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">"These high levels of distress, depression, loss of satisfaction, fatigue, and burnout have big repercussions for quality of care," explains Dr. Tait Shanafelt, director of the Mayo Clinic Department of Medicine's program on physician well-being. It leads to medical errors, substance abuse, and doctors quitting — something that a country with an aging population and a <a href="https://www.aamc.org/advocacy/campaigns_and_coalitions/fixdocshortage/" style="color: rgb(0, 0, 102); text-decoration: none; " class="">shortage of doctors</a> can ill afford.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">How could we help medicine overcome its own illness?</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">That's a question that has occupied Dr. Rachel Naomi Remen for decades. Remen is a clinical professor of family and community medicine at the U.C.S.F. School of Medicine and the director of the<a href="http://www.ishiprograms.org/" style="color: rgb(0, 0, 102); text-decoration: none; " class="">Institute for the Study of Health and Wellness</a>, at <a href="http://www.commonweal.org/" style="color: rgb(0, 0, 102); text-decoration: none; " class="">Commonweal</a>. Over the past 22 years, she has been advancing a powerfully subversive addition to the medical curriculum, a course called <a href="http://www.ishiprograms.org/programs/medical-educators-students/" style="color: rgb(0, 0, 102); text-decoration: none; " class="">The Healer's Art</a>.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">For the first six years, Remen taught it with 10 friends, all community physicians drawn from outside the school. She was half afraid that her dean would discover it and throw her out. But gradually, the course began to spread by word of mouth, to two schools, then four, then 16, then 25. It is now taught annually at 71 schools in the United States (half of the nation's medical schools) and schools in seven other countries.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">More than 1,600 students take the course each year and about 13,000 have gone through it. And while it is described as a simple elective — a 15-hour course given in five three-hour sessions — many of the doctors who teach it, and the students who take it, see it as part of a movement. In evaluations, large majorities of students say the course fills a gap in their medical education. It helps them to feel more committed to medicine, more supportive of their classmates, more confident that they can be good doctors, and more clear about what they can personally offer patients. More than 95 percent of them say they will recommend it to other students.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">"What our students say loud and clear is this course helps to keep their spirits alive as they go through the training," explains Nancy Oriol, dean for students at Harvard Medical School.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Remen's life has been shaped by her own experience living with illness. By her own admission, she has not been well for 60 years. When she was 15, she was diagnosed with Crohn's disease. She underwent nine major surgeries and took large doses of steroids daily for 15 years. "My doctors told me I would be dead by the time I was 40," she says with a laugh. She's now 75 and has been a doctor herself for 50 years.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">After medical school, on her first day in training as an intern, a 3-year-old was brought into the emergency room after a car accident. The doctors were unable to save the child's life. Remen accompanied the chief resident as he met with the parents to inform them that their child had died. When they broke down, the sadness was too much. Remen found herself crying, too.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Afterward, the chief resident took Remen aside and said that her behavior had been highly unprofessional.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">The message stuck. By the time Remen was senior resident, she hadn't cried for years. That year, another child, a baby, was brought into the hospital after drowning unattended in his bathtub. The doctors were unable to resuscitate the baby. This time, Remen was the one responsible for informing the parents that their only child had died — and as they held each other and fell apart sobbing — she stood silently by in her white coat, maintaining her professional distance. After a while, the baby's father, with tears running down his face, apologized. "'I'm sorry, doctor,' he said. 'I'll get a hold of myself in a minute.'"</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">How had she become the person a grieving father apologizes to? This is a common outcome of the hidden curriculum.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">The Healer's Art is predicated on the idea that medicine is an ancient lineage that draws its strength from its core values: compassion, service, reverence for life and harmlessness. When students and doctors connect to these values in a community, they derive meaning and strength, and can "immunize" themselves against the assaults of the medical curriculum and even the health care system itself.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">To help people tap into these deep currents, the course is delivered in an unusual manner. Students and faculty members meet together in small groups in the evenings, participating side by side as equals. There are no experts, no hierarchies, no wrong answers; anyone may speak about his or her experiences or simply listen.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">It begins by reminding people that it is not by chance that they are in the room. "We ask: 'How old were you when you first realized that the needs of a living thing mattered to you?'" says Remen. "For most doctors and students, the impulse to respond to the needs of others, plants, animals, insects, and even people, goes back to early childhood, sometimes as far back as they can remember."</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Remen recalled a student who told the class that his mother used to bathe him in an old claw-footed bathtub. "At the end of his bath, she would pull out the stopper, reach behind him and get a towel, sit him on her lap and dry him. One day he stepped on the drain and it was sharp — there was pain and blood — and his mother said, 'Never stand on the drain again.' A few weeks or months later, as he was waiting for her to dry him, he noticed the water circling the drain as the tub emptied. He remembered how sharp the drain was and worried that the water was being hurt. After that, when his mother pulled the plug, he would drop his washcloth over the drain to protect the water.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">"This is magical thinking. He was probably about 3," said Remen. "Now he is a pediatrician and he brings the same intention to make a difference in pain and suffering to his little patients himself."</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Every culture approves and disapproves of different qualities. As the price of admission, medicine implicitly asks its members to leave aspects of themselves behind. The course explores this idea, what Carl Jung called the "shadow."</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">"Everybody's given a box of crayons and a big piece of paper like in first grade and they are asked to draw a picture of the parts of themselves they feel they can't bring into their work as doctors," explains Joseph O'Donnell, a Senior Advising Dean at the Geisel School of Medicine at Dartmouth, who has taught the course for more than a decade. First-year students do the exercise alongside doctors who have been practicing for decades. "Then everyone holds up their picture. You see 'curiosity,' 'love,' 'compassion,' 'kindness,' 'creativity.' And people say, 'I thought I was the only one experiencing this.' "</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">The session on grief and loss is among the most powerful, adds O'Donnell. "Students and faculty are asked to become still and quiet," he explained. "They're asked to think back to a time when they experienced a loss, and remember the feelings, and think about what someone may have done that was helpful, or unhelpful."</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">They write it down. Then the students are asked to say what was helpful. "You hear things like: They held my hand. Gave me a hug. Brought me food. Sat silently and listened." For unhelpful, you hear things like, "They said, 'I'd better leave you alone" or "You'll be fine in no time.'"</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">When O'Donnell graduated from medical school in 1973, there was no place to discuss such matters openly. "It wasn't safe to say, 'I'm really bothered by what I'm seeing today.' You just took care of it. You read the scientific articles, but you put your heart and soul aside. Here you are allowed to bring those things to the forefront in a valid way with colleagues who are esteemed."</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Dean Parmelee, the Associate Dean for Academic Affairs at Wright State University, who has taught the course for several years, recalled an incident shared by a fourth-year student who had been part of a team when a baby was stillborn.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">The mother was 16 or 17 years old and she was with her boyfriend, he recalled. There were some psychosocial issues. "After the delivery, the student said, shockingly, everyone just left the operating room," said Parmelee. "He was the only person left and the only sound was the air-conditioning and the ventilation." The mom had started to cry; her baby lay still on her abdomen. The boyfriend was crying, too. The student said nothing. He simply reached out and took the mother's hand and with his other hand he reached out and took the father's hand, closed his eyes and stood there with them for a few minutes crying silently together.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">"The student said that if he hadn't taken the course, he would have left the room like everyone else," added Parmelee. "Or he might have said something like, 'You're young, you can have another baby.' "</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">"Instead," commented Remen, reflecting on the story, "he offered them and himself the healing of a common humanity."<br class="">This is not how doctors are accustomed to managing grief and loss. "We intellectualize it, minimize it, become numb to it," O'Donnell said.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">There is an enduring belief in medicine that if you feel strongly it will cloud your judgment. But <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361392/" style="color: rgb(0, 0, 102); text-decoration: none; " class="">research indicates</a> that emotional attunement can improve critical thinking, decision-making, and the ability to act quickly in crisis moments.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Moreover, we need to feel to connect with other human beings. "If patients see that you care, they can trust you enough to tell you the truth and are more likely to follow your advice," observes Remen. Parmelee, who has been an expert witness in malpractice cases, has found that most cases boil down to physicians "not really listening or making themselves available emotionally for a patient."</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">And then there is the simple truth that buried feelings don't just go away. "When I took The Healer's Art, the session on grief and loss brought up a whole period in my life that I must have tried hard to not think about," recalled Parmelee. "I was totally unaware of its continuous impact on me, and how much was still there after more than 30 years."</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">In medical school, students rarely hear their teachers speak this way. Brent Aebi, a third-year medical student at Wright State University, said that hearing veteran doctors speak about their struggles helped him to see a path forward that felt right to him. "I saw that you don't have to become hardened," he said.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">The same holds for peers. The combination of hyper-competition and self-doubt in medical school can work against the development of supportive relationships. "This way of listening to others' stories is not present in the normal medical training," observes Rhianon Liu, a third-year medical student at Johns Hopkins School of Medicine. "And it showed me that the most important protective mechanisms are the relationships we build with our classmates and faculty."</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">Indeed, the importance of listening comes across as one of the course's biggest lessons. "Students comment that they never realized how powerful silence is in communication," said Parmelee.</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">For O'Donnell, who oversees oncology at the Veterans Administration Hospital in White River Junction, Vt., the course has helped him learn to listen more deeply. "I hear themes I might have missed before," he says. "Not just the symptoms, but the story — how scared the patient is that this ache might mean a recurrence. It brings you back to taking care of people. Because the world isn't made up of atoms. It's made up of stories."</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">The Healer's Art is an entry point: an attempt to anchor a cultural shift in medicine. Some students who have taken the course have formed groups so they can continue to uncover the meaning of their work after the course ends. They are building an alternative socialization process. The Institute for the Study of Health and Illness also helps doctors, nurses and other health care professionals form groups dedicated to "<a href="http://www.ishiprograms.org/programs/all-healthcare-professionals/" style="color: rgb(0, 0, 102); text-decoration: none; " class="">Finding Meaning in Medicine</a>."</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">But the course and similar programs need to be given much higher priority if we are going to attack burnout. "Because it has <a href="http://jama.jamanetwork.com/article.aspx?articleid=184612" style="color: rgb(0, 0, 102); text-decoration: none; " class="">strong links to the quality of care</a>," says Dr. Shanafelt of the Mayo Clinic, "promoting wellness is a shared responsibility of individual physicians as well as the hospital or practice group."</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">However, if hospital administrators are going to allow doctors to cut back on "productive" activities so they can take time to focus on self-care, he adds, "We'll need to provide hard evidence for people making financial decisions that this is a good investment."</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class="">For doctors, this investment could mean the difference between succumbing to burnout and finding ways to practice that deepen their sense of purpose. "When doctors learn to read the affective domain, they are shocked to discover that they have gone right past experiences of profound meaning without seeing them," says Remen. "They say, 'I was colorblind.' Medicine offers you a front-row seat on life. Meaning is all around you. When you can see it, it gives you a sense of gratitude for the opportunity to do this work."</div><div style="font-style: normal; color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; " class=""><em class=""><a href="http://davidbornstein.wordpress.com/" style="color: rgb(0, 0, 102); text-decoration: none; " class="">David Bornstein</a> is the author of "<a href="http://davidbornstein.wordpress.com/books/how-to-change-the-world/" style="color: rgb(0, 0, 102); text-decoration: none; " class="">How to Change the World</a>," which has been published in 20 languages, and "<a href="http://davidbornstein.wordpress.com/books/the-price-of-a-dream-the-story-of-the-grameen-bank/" style="color: rgb(0, 0, 102); text-decoration: none; " class="">The Price of a Dream: The Story of the Grameen Bank</a>," and is co-author of "<a href="http://www.oup.com/us/catalog/general/subject/Sociology/SocialMovementSocialChange/?ci=9780195396331&view=usa" style="color: rgb(0, 0, 102); text-decoration: none; " class="">Social Entrepreneurship: What Everyone Needs to Know</a>." He is a co-founder of the <a href="http://solutionsjournalism.org/" style="color: rgb(0, 0, 102); text-decoration: none; " class="">Solutions Journalism Network</a>, which supports rigorous reporting about responses to social problems.</em></div></div></div></div></div><a href="http://opinionator.blogs.nytimes.com/2013/09/18/medicines-search-for-meaning/?src=recg&pagewanted=print" class="">http://opinionator.blogs.nytimes.com/2013/09/18/medicines-search-for-meaning/?src=recg&pagewanted=print</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; " class=""><br class="webkit-block-placeholder"></div>

Medicine's Search for Meaning - NYTimes.com

Every day, we are reminded that the health care system is in crisis. We are going bankrupt. There are too many lawsuits. We practice defensive medicine. We restrict access. But surveys of doctors indicate a problem that penetrates much deeper than th…

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Rush: Quite a ride

<span class="Apple-style-span" style="background-color: white; color: #5e5e5e; font-family: Arial, Helvetica, sans-serif; font-size: 13px; line-height: 18px;"><span class="Apple-style-span" style="font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif;"><b><i>Rush</i> </b></span></span></span></span></span></span><b>(2013) • <a href="http://trailers.apple.com/trailers/universal/rush/" style="color: #27a9c5; text-decoration: none;">View trailer</a></b><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif;"><span class="Apple-style-span" style="font-family: Arial, Helvetica, sans-serif;"><span class="Apple-style-span" style="font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif;"><b> </b><br /><b>Four stars. Rating: R, for profanity, nudity, sexual content, brief drug use and disturbing images</b></span></span></span></span></span></span></span></span><br style="background-color: white; color: #5e5e5e; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;" /><span class="Apple-style-span" style="background-color: white; color: #5e5e5e; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 13px; line-height: 18px;"><b><span class="Apple-style-span" style="font-weight: normal;"><b>By <a href="http://www.blogger.com/profile/12885694730612878577" style="color: #27a9c5; text-decoration: none;">Derrick Bang</a> • </b></span>Originally published in <i><a href="http://www.davisenterprise.com/" style="color: #27a9c5; text-decoration: none;">The Davis Enterprise</a></i>, 9.27.13</b></span><br /><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span> <!--[if gte mso 9]><xml> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings></xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:Zoom>0</w:Zoom> <w:TrackMoves>false</w:TrackMoves> <w:TrackFormatting/> <w:PunctuationKerning/> <w:DrawingGridHorizontalSpacing>18 pt</w:DrawingGridHorizontalSpacing> <w:DrawingGridVerticalSpacing>18 pt</w:DrawingGridVerticalSpacing> <w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery> <w:DisplayVerticalDrawingGridEvery>0</w:DisplayVerticalDrawingGridEvery> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:DontGrowAutofit/> <w:DontAutofitConstrainedTables/> <w:DontVertAlignInTxbx/> </w:Compatibility> </w:WordDocument></xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="276"> </w:LatentStyles></xml><![endif]--> <!--[if gte mso 10]><style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} </style><![endif]--> <!--StartFragment--> <br /><div class="MsoNormalCxSpFirst"><span style="font-family: Arial, Helvetica, sans-serif;">Friends tell you what you want to hear. Enemies tell you what you need to know.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">Director Ron Howard’s <i>Rush</i> isn’t merely the fact-based account of an intriguing sports rivalry; it’s also the most exciting auto racing movie to roar into theaters since 1971’s <i>Le Mans</i> ... which, given Steve McQueen’s passion for authenticity and the superb efforts of cinematographers René Guissart Jr. and Robert B. Hauser — not to mention a team of five (!) editors — is high praise indeed.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhu8tvAbKddeXMFrNvFtjRheetm7NkF_rv5Hi2NSrnh43ydqaADolzc0tPs9z4-AjRgM11TLk2aDBNGX7ygzD6C_4jFI5Fz0qdnPKt4mx_qOK1rhqTNUI7Gd_09waWDzhX8GkjGnhU5Khc/s1600/Rush+blog.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhu8tvAbKddeXMFrNvFtjRheetm7NkF_rv5Hi2NSrnh43ydqaADolzc0tPs9z4-AjRgM11TLk2aDBNGX7ygzD6C_4jFI5Fz0qdnPKt4mx_qOK1rhqTNUI7Gd_09waWDzhX8GkjGnhU5Khc/s400/Rush+blog.jpg" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">The calm before the storm: No love is lost between rival racers James Hunt (Chris<br />Hemsworth, foreground left) and Niki Lauda (Daniel Brühl), each determined to<br />out-drive the other en route to a Formula 1 World Championship. But that isn't the<br />whole story by any means: Their saga is the stuff of sports legend.</span></td></tr></tbody></table><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">No matter. Howard’s collaborators — cinematographer Anthony Dod Mantle and editors Daniel P. Hanley and Mike Hill — are up for the challenge. They’re also given a sensational assist by sound designers Danny Hambrook and Markus Stemler, whose ear-splitting attention to detail delivers everything except the pungent, eye-watering stench of high-octane fuel. Which you’ll probably imagine anyway.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">But while the visceral exhilaration is palpable, it’s mere backdrop; this film gets its emotional heft from the fascinating narrative crafted by British scripter Peter Morgan, whose well-deserved Academy Award nominations for <i><a href="http://derrickbang.blogspot.com/2009/01/frostnixon-battle-royale.html">Frost/Nixon</a></i> and <i>The Queen</i> — not to mention his work on <i>The Last King of Scotland</i>, <i>The Damned United</i> and quite a few others — demonstrate considerable skill when it comes to sketching characters through well-composed dialogue.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">James Simon Wallis Hunt (played by Chris Hemsworth), British to the core, and Austrian Niki Lauda (Daniel Brühl) meet — and immediately clash — as ambitious Formula 3 drivers. They couldn’t be more different: Hunt is a womanizing, hedonistic toff who wears flamboyant aristocratic superiority like a cloak, while Lauda is solemn, remote and blunt to the point of insolence. Hunt is the pluperfect London playboy, Lauda the Teutonic precision; neither apologizes for his behavior, or would think of doing so.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">Hunt loves the champagne-hazed thrill of victory, and is happiest when posing for photographs as he clutches an award. Lauda quite famously gave his trophies to a local garage, as “payment” for having his car washed and serviced.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">But they both take racing seriously, albeit from different sensibilities. Hunt is as bold and reckless on the track as in real life, embracing the challenge for its romantic, death-defying aura; Lauda, meticulous to a fault, calculates odds and works them to his favor. Hunt relies on the largess of sponsors he can impress; Lauda drives mechanics crazy by ordering design changes ... which inevitably prove advantageous.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">As a result, Morgan’s script focuses on the <i>attitude</i> of racing, as much as the sport itself. At a time when drivers were expected to die every season — as Brühl’s Lauda informs us, in his dryly ironic, off-camera narration — professional racers truly were a breed apart. (It could be argued that NASCAR, with its ever-safer vehicles and protective body gear, has stripped some of the rogue spirit from auto racing.)<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><a name='more'></a><br /> <div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">Casting director Nina Gold did a sensational job, as both Hemsworth and Brühl look, sound and move very much like the real Hunt and Lauda. The physical similarities are truly striking, but of course it’s deeper than that. <o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">Anybody who thus far has dismissed Hemsworth as little more than a pretty face, based on bombastic fluff such as <i>Snow White and the Huntsman</i> and his ongoing role as the Asgardian Thor, needs to reassess; Hemsworth nails the blithe insolence of, say, Peter O’Toole in his prime. This portrayal of Hunt is charismatic to the point of bewitchery; we can’t help admiring the man despite his obvious superficiality.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">And yet there’s fire in his eyes, as well. The glad-handing Hunt seems incapable of anything as boorish as genuine temper, and yet we suspect, based on the steel that Hemsworth's performance doesn’t quite conceal, that this guy’s fury would be breathtaking.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">Rest assured, Morgan allows us a highly satisfying glimpse.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">The Spanish-born Brühl is unlikely to be recognized on these shores, aside from his supporting performance in 2007’s <i><a href="http://derrickbang.blogspot.com/2009/09/inglourious-basterds-paths-of-gloury.html">Inglourious Basterds</a></i>, but I suspect that’s about to change. His Lauda displays his ferret-faced features proudly, even defiantly, no doubt operating from the belief that one cannot be teased or humiliated by others, if you pre-emptively remove their ammunition. Lauda is chill psychology and intellectual arrogance, an attitude that Brühl conveys <i>perfectly</i>.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">As a result, although Lauda is equally hard to like, he emerges here as the underdog ... even though, as the two men graduate to Formula 1 racing and engage in the very public antagonism that fueled press coverage during the early 1970s, he certainly doesn’t need the sympathy. When Lauda blasts past Hunt in order to win the 1975 World Championship, it seems a triumph of intellect over emotion. But of course Hunt, finishing fourth, isn’t about to slink off quietly. There’s always another season.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">The rich fascination of Morgan’s script, and the marvelous subtlety of Hemsworth and Brühl’s performances, are best defined by our dawning realization that — somewhere along the line, almost without our awareness — enmity blossoms into respect. As the 1976 season begins, the two men still don’t like each other, but their mutual regard has shifted. Glances toward each other become more reflective, less hostile; clipped conversations are less contemptuous, more ... well ... collaborative.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">Racing fans well remember what happened during that tempestuous 1976 season, and I’ll not spoil the suspense here, for the benefit of viewers lucky enough to come to this story cold. But that’ll be a difficult feat, since Lauda has been highly visible for the past month, and likely will remain so between now and Oscar season. Hunt, sadly if perhaps predictably, died from a heart attack in 1993, at the age of 45.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">The supporting performances are equally strong, starting with this saga's significant women. Olivia Wilde, whose smoldering, come-hither sensuality literally drips off the screen, is well cast as free-spirited professional model Suzy Miller, whose jaw-dropping 1974 marriage to Hunt made headlines around the world. We’re certainly not surprised when this relationship doesn’t last, although Miller’s subsequent husband will raise your eyebrows.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">Despite this, Wilde shades Miller generously, suggesting that she feels deep affection for Hunt, his glaring flaws notwithstanding.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">Romanian-born Alexandra Maria Lara is even more engaging as Marlene, the woman who catches Lauda’s eye during a meet-cute sequence that Howard stages for maximum amusement. If it truly happened this way, you couldn’t imagine a better first encounter; either way, it’s a great movie moment. <o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">Lara gets considerable screen time, and Marlene’s presence clearly changes Lauda. Their most powerful conversation also is the calmest, as Lauda reflectively confesses that happiness may have crippled him; henceforth, every time he squeezes into a race car, he’ll know that he has something to lose. The expression on Lara’s face, at this moment, is heartbreaking; we understand that Marlene suddenly wonders if loving her new husband is such a good thing after all.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">Christian McKay is memorable as Lord Hesketh, the colorful racing enthusiast who bankrolls Hunt’s early career with a large inheritance. (Hesketh later became chief whip in the House of Lords, for John Major’s government.) Julian Rhind-Tutt is wholly convincing in his small role as Anthony “Bubbles” Horsley, Hunt’s chief mechanic; Pierfrancesco Favino delivers an engaging blend of admiration and frustration as Lauda’s Ferrari teammate, Clay Regazzoni.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">Cinematographer Dod Mantle won an Oscar for <i><a href="http://derrickbang.blogspot.com/2008/12/slumdog-millionaire-it-is-written.html">Slumdog Millionaire</a></i>, and his camerawork here is sensational. Quite inventive, as well, with cameras fastened to racers’ helmets, in order to place us, quite literally, in the drivers’ seats. Mantle also cross-cuts between dozens of camera set-ups, in order to convey the raw intensity of the racetrack footage; Howard, in turn, blends these many images for maximum excitement.<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;">Howard has a gift for tackling well-known factual events that lose none of their suspense in his hands, despite our knowledge of what’s coming. I can think of no greater compliment, than the fact that he sends us from the theater wanting to know more about these subjects: the Apollo 13 miracle, John Nash in <i>A Beautiful Mind</i>, James Braddock in <i>Cinderella Man</i> and now this engaging rivalry between James Hunt and Niki Lauda. (Lauda has written five books, and I suspect his sales figures are about to climb.)<o:p></o:p></span></div><div class="MsoNormalCxSpMiddle"><br /></div><div class="MsoNormalCxSpMiddle"><span style="font-family: Arial, Helvetica, sans-serif;"><i>Rush</i> is a solid sports drama about two genuinely fascinating road warriors. Monday evening’s preview screening drew applause as the closing credits appeared, and I’m not the slightest bit surprised.</span><span style="font-family: Times New Roman;"><o:p></o:p></span></div><!--EndFragment-->

2013 Alexandra Maria Lara Chris Hemsworth Christian McCay Daniel Bruhl Four Star Films Julian Rhind-Tutt Olivia Wilde Pierfrancesco Favino Sports films Rush: Quite a ride

Rush (2013) • View trailer Four stars. Rating: R, for profanity, nudity, sexual content, brief drug use and disturbing imagesBy Derrick Bang • Originally published in The Davis Enterprise, 9.27.13 0 false 18 pt 18 pt 0 0 fals…

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Fascinating, One Meeelion Frames Per Second, Bullet impacts In Slow Motion

This is amazing. How in the world do you make a camera that can expose a million frames in one second?!<br /><br />It's fucking mind boggling to ponder.<br /><br />Pretty damn cool results though, see for yourself.<br /><br /><iframe width="560" height="315" src="//www.youtube.com/embed/QfFoMyMoiX4" frameborder="0" allowfullscreen></iframe>

Fascinating, One Meeelion Frames Per Second, Bullet impacts In Slow Motion

This is amazing. How in the world do you make a camera that can expose a million frames in one second?!It's fucking mind boggling to ponder.Pretty damn cool results though, see for yourself.…

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Early morning reflections at Mabry Mill

<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1ynntl7IkyZpwanLakJlLdD-UJ1ErxpVKXhyBo9k2JuUxelq0K6AztO7Zk-mkVotYjdzG8LUlWlL32OfTQ81b4j_FADXLXC-xjG5_mXDFaoG2maWT-5bz7ouxqTcPTsHfGIJaKBkPKl5l/s1600/1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1ynntl7IkyZpwanLakJlLdD-UJ1ErxpVKXhyBo9k2JuUxelq0K6AztO7Zk-mkVotYjdzG8LUlWlL32OfTQ81b4j_FADXLXC-xjG5_mXDFaoG2maWT-5bz7ouxqTcPTsHfGIJaKBkPKl5l/s400/1.jpg" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><span class="fbPhotosPhotoCaption" data-ft="{"type":45,"tn":"*G"}" id="fbPhotoSnowliftCaption" tabindex="0"><span class="hasCaption">I was able to capture the early morning September sun as it shimmered on the tops of trees and was reflected in the mill pond at Mabry Mill on the Blue Ridge Parkway. From visiting as a child to visiting with our own children to visiting post-children, I never tire of this iconic reminder of life as it once was in the Blue Ridge Mountains of Virginia.</span></span></div><br />Photo by Lynn R. Mitchell

Blue Ridge Mountains Blue Ridge Parkway Mabry Mill southwest Virginia tourism Virginia Is For Lovers Early morning reflections at Mabry Mill

I was able to capture the early morning September sun as it shimmered on the tops of trees and was reflected in the mill pond at Mabry Mill on the Blue Ridge Parkway. From visiting as a child to visiting with our own children to visiting post-chil…

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HealthBoards Message Boards

Dealing with a medical condition is often difficult. Connecting with others who are going through the same thing can make a world of difference. HealthBoards.com is where you can make those connections. HealthBoards provides a unique one-stop support group community offering over 200 message boards on various diseases, conditions, and health topics. The HealthBoards community is one of the largest and most dynamic on the Web, with over 10 million monthly visitors, 850,000 registered members, and over 4.5 million messages posted. HealthBoards was rated as one of the top 20 health information websites by Consumer Reports Health WebWatch.<br /><br><br /><br><a href="http://www.healthboards.com/">http://www.healthboards.com/</a>

HealthBoards Message Boards

Dealing with a medical condition is often difficult. Connecting with others who are going through the same thing can make a world of difference. HealthBoards.com is where you can make those connections. HealthBoards provides a unique one-stop support…

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Labor board: Funeral giant SCI broke the law in dispute with Teamsters

Unscrupulous funeral giant SCI broke the law by bad faith bargaining with Teamster employees, threatening them, spying on them and trying to trick members into leaving the union, according to the Chicago region of the National Labor Relations Board (NLRB).<br /><br />The NLRB has also dismissed frivolous and potentially defamatory accusations made by the company against the union.<br /><br /><a href="http://teamsternation.blogspot.com/2013/08/funeral-directors-locked-out.html" rel="nofollow">Service Corporation International (SCI) locked out 59 funeral directors and drivers</a> at 16 Chicago-area funeral homes last month.<br /><br />John T. Coli, secretary-treasurer of Teamsters Local 727, said:<br /><blockquote class="tr_bq">... the company has been merely grasping at straws, trying to shift the blame on the union with their false accusations. In reality, they are the ones violating the law and mistreating their dedicated employees. </blockquote>According to <a href="http://www.teamster.org/content/funeral-industry-giant-sci-committed-unfair-labor-practices-labor-board-says" rel="nofollow">Teamsters Local 727's press statement</a>,<br /><blockquote class="tr_bq">SCI’s numerous unfair labor practices forced the union-represented funeral workers to strike on July 2. Despite an unconditional offer by the union to return to work, the company locked out workers on Aug. 19. Pickets have continued to protest SCI’s bad faith bargaining and other unfair labor practices. </blockquote><blockquote class="tr_bq">The Region of the NLRB now will attempt to reach a settlement with SCI on the charges. Absent settlement, the Region typically issues a complaint, and a hearing in front of an administrative law judge then takes place. </blockquote><blockquote class="tr_bq">“Our fight is not over, but this is a victory for working men and women,” Coli said. </blockquote><blockquote class="tr_bq">Local 727 urges all Chicago-area residents to support community-owned funeral homes as labor actions continue. More than 60 recommended funeral home alternatives can be found online at <a href="http://www.integrityinillinois.com/">www.IntegrityInIllinois.com</a> to aid families in affected communities.</blockquote>We know you still have a ways to go, but congratulations on a hard-fought victory!<br /><br /><div><br /></div>

Chicago funeral directors SCI Labor board: Funeral giant SCI broke the law in dispute with Teamsters

Unscrupulous funeral giant SCI broke the law by bad faith bargaining with Teamster employees, threatening them, spying on them and trying to trick members into leaving the union, according to the Chicago region of the National Labor Relations Board (…

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How Not to Die - Jonathan Rauch - The Atlantic

Dr. Angelo Volandes is making a film that he believes will change the way you die. The studio is his living room in Newton, Massachusetts, a suburb of Boston; the control panel is his laptop; the camera crew is a 24-year-old guy named Jake; the star is his wife, Aretha Delight Davis. Volandes, a thickening mesomorph with straight brown hair that is graying at his temples, is wearing a T-shirt and shorts and looks like he belongs at a football game. Davis, a beautiful woman of Guyanese extraction with richly braided hair, is dressed in a white lab coat over a black shirt and stands before a plain gray backdrop.<br /><br><br /><br>"Remember: always slow," Volandes says.<br /><br><br /><br>"Sure, hon," Davis says, annoyed. She has done this many times.<br /><br><br /><br>Volandes claps to sync the sound. "Take one: Goals of Care, Dementia."<br /><br><br /><br>You are seeing this video because you are making medical decisions for a person with advanced dementia. Davis intones the words in a calm, uninflected voice. I'll show you a video of a person with advanced dementia. Then you will see images to help you understand the three options for their medical care.<br /><br><br /><br>Her narration will be woven into a 10-minute film. The words I'm hearing will accompany footage of an elderly woman in a wheelchair. The woman is coiffed and dressed in her Sunday finest, wearing pearls and makeup for her film appearance, but her face is vacant and her mouth is frozen in the rictus of a permanent O.<br /><br><br /><br>This woman lives in a nursing home and has advanced dementia. She's seen here with her daughters. She has the typical features of advanced dementia …<br /><br><br /><br>Young in affect and appearance, Volandes, 41, is an assistant professor at Harvard Medical School; Davis, also an M.D., is doing her residency in internal medicine, also at Harvard. When I heard about Volandes's work, I suspected he would be different from other doctors. I was not disappointed. He refuses to let me call him "Dr. Volandes," for example. Formality impedes communication, he tells me, and "there's nothing more essential to being a good doctor than your ability to communicate." More important, he believes that his videos can disrupt the way the medical system handles late-life care, and that the system urgently needs disrupting.<br /><br><br /><br>"I think we're probably the most subversive two doctors to the health system that you will meet today," he says, a few hours before his shoot begins. "That has been told to me by other people."<br /><br><br /><br>"You sound proud of that," I say.<br /><br><br /><br>"I'm proud of that because it's being an agent of change, and the more I see poor health care, or health care being delivered that puts patients and families through—"<br /><br><br /><br>"We torture people before they die," Davis interjects, quietly.<br /><br><br /><br>Volandes chuckles at my surprise. "Remember, Jon is a reporter," he tells her, not at all unhappy with her comment.<br /><br><br /><br>"My father, if he were sitting here, would be saying 'Right on,' " I tell him.<br /><br><br /><br>Volandes nods. "Here's the sad reality," he says. "Physicians are good people. They want to do the right things. And yet all of us, behind closed doors, in the cafeteria, say, 'Do you believe what we did to that patient? Do you believe what we put that patient through?' Every single physician has stories. Not one. Lots of stories.<br /><br><br /><br>"In the health-care debate, we've heard a lot about useless care, wasteful care, futile care. What we"—Volandes indicates himself and Davis—"have been struggling with is unwanted care. That's far more concerning. That's not avoidable care. That's wrongfulcare. I think that's the most urgent issue facing America today, is people getting medical interventions that, if they were more informed, they would not want. It happens all the time."<br /><br><br /><br>Unwanted treatment is American medicine's dark continent. No one knows its extent, and few people want to talk about it. The U.S. medical system was built to treat anything that might be treatable, at any stage of life—even near the end, when there is no hope of a cure, and when the patient, if fully informed, might prefer quality time and relative normalcy to all-out intervention.<br /><br><br /><br>In 2009, my father was suffering from an advanced and untreatable neurological condition that would soon kill him. (I wrote about his decline in an article for this magazine in April 2010.) Eating, drinking, and walking were all difficult and dangerous for him. He ate, drank, and walked anyway, because doing his best to lead a normal life sustained his morale and slowed his decline. "Use it or lose it," he often said. His strategy broke down calamitously when he agreed to be hospitalized for an MRI test. I can only liken his experience to an alien abduction. He was bundled into a bed, tied to tubes, and banned from walking without help or taking anything by mouth. No one asked him about what he wanted. After a few days, and a test that turned up nothing, he left the hospital no longer able to walk. Some weeks later, he managed to get back on his feet; unfortunately, by then he was only a few weeks from death. The episode had only one positive result. Disgusted and angry after his discharge from the hospital, my father turned to me and said, "I am never going back there." (He never did.)<br /><br><br /><br>What should have taken place was what is known in the medical profession as The Conversation. The momentum of medical maximalism should have slowed long enough for a doctor or a social worker to sit down with him and me to explain, patiently and in plain English, his condition and his treatment options, to learn what his goals were for the time he had left, and to establish how much and what kind of treatment he really desired. Alas, evidence shows that The Conversation happens much less regularly than it should, and that, when it does happen, information is typically presented in a brisk, jargony way that patients and families don't really understand. Many doctors don't make time for The Conversation, or aren't good at conducting it (they're not trained or rewarded for doing so), or worry their patients can't handle it.<br /><br><br /><br>This is a problem, because the assumption that doctors know what their patients want turns out to be wrong: when doctors try to predict the goals and preferences of their patients, they are "highly inaccurate," according to one summary of the research, published by Benjamin Moulton and Jaime S. King inThe Journal of Law, Medicine & Ethics. Patients are "routinely asked to make decisions about treatment choices in the face of what can only be described as avoidable ignorance," Moulton and King write. "In the absence of complete information, individuals frequently opt for procedures they would not otherwise choose."<br /><br><br /><br>Though no one knows for sure, unwanted treatment seems especially common near the end of life. A few years ago, at age 94, a friend of mine's father was hospitalized with internal bleeding and kidney failure. Instead of facing reality (he died within days), the hospital tried to get authorization to remove his colon and put him on dialysis. Even physicians tell me they have difficulty holding back the kind of mindlessly aggressive treatment that one doctor I spoke with calls "the war on death." Matt Handley, a doctor and an executive with Group Health Cooperative, a big health system in Washington state, described his father-in-law's experience as a "classic example of overmedicalization." There was no Conversation. "He went to the ICU for no medical reason," Handley says. "No one talked to him about the fact that he was going to die, even though outside the room, clinicians, when asked, would say 'Oh, yes, he's dying.' "<br /><br><br /><br>"Sometimes you block the near exits, and all you've got left is a far exit, which is not a dignified and comfortable death," Albert Mulley, a physician and the director of the Dartmouth Center for Health Care Delivery Science, told me recently. As we talked, it emerged that he, too, had had to fend off the medical system when his father died at age 93. "Even though I spent my whole career doing this," he said, "when I was trying to assure as good a death as I could for my dad, I found it wasn't easy."<br /><br><br /><br>If it is this hard for doctors to navigate their parents' final days, imagine what many ordinary patients and their families face. "It's almost impossible for patients really to be in charge," says Joanne Lynn, a physician and the director of the nonprofit Altarum Center for Elder Care and Advanced Illness in Washington, D.C. "We enforce a kind of learned helplessness, especially in hospitals." I asked her how much unwanted treatment gets administered. She couldn't come up with a figure—no one can—but she said, "It's huge, however you measure it. Especially when people get very, very sick."<br /><br><br /><br>Unwanted treatment is a particularly confounding problem because it is not a product of malevolence but a by-product of two strengths of American medical culture: the system's determination to save lives, and its technological virtuosity. Change will need to be consonant with that culture. "You have to be comfortable working at the margins of the power structure within medicine, and particularly within academic medicine," Mulley told me. You need a disrupter, but one who can speak the language of medicine and meet the system on its own terms.<br /><br><br /><br>More ...<br /><br><br /><br><a href="http://www.theatlantic.com/magazine/archive/2013/05/how-not-to-die/309277/?single_page=true">http://www.theatlantic.com/magazine/archive/2013/05/how-not-to-die/309277/?single_page=true</a>

How Not to Die - Jonathan Rauch - The Atlantic

Dr. Angelo Volandes is making a film that he believes will change the way you die. The studio is his living room in Newton, Massachusetts, a suburb of Boston; the control panel is his laptop; the camera crew is a 24-year-old guy named Jake; the star …

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