This May Hurt a Bit

Did you know that many surgeons play music during operations? It was going so smoothly that we were humming along to “Who Says You Can’t Go Home?” It was during the bridge of the song that your blood pressure suddenly dropped. The anesthesiologist called it out. I looked at the monitor and saw numbers flashing in red.

There was a lot of red, actually. Blood in the wound, blood in the suction container, blood in transfusion bags, bloody footprints on the floor. No more than with any other patient. But I think somewhere along the way I learned to take the sight of liters of blood for granted.

I was scared. I stopped watching them stitch and stared at the monitor, which suddenly seemed like my closest connection to you. They called out the medications they were giving you to raise your blood pressure.

After a few minutes, it worked. Your blood pressure slowly climbed to green numbers. I was still shaking as I silently willed the numbers to stop bouncing around.

But the numbers stubbornly drifted down. Even though they were keeping up with the fluids. Even though you were on medications that force your blood vessels to clamp down and your heart to beat harder.

The red returned and was unrelenting. Your blood pressure was too low, your heart rate too high, the tracing of your heart rhythm irregular and non-shockable.

“We can be done in ten minutes,” the surgeons said.

I’ve never seen surgeons work so fast. They’re usually so particular about their stitches, getting the perfect angle and length for each one.

I’ve also never seen so many anesthesiologists at the head of an operating table.

I’ve never seen an ICU bed booked so quickly.

I’ve never seen someone lose their carotid pulse.
 

From Shara Yurkiewicz, a fourth-year student at Harvard Medical School, at her blog This May Hurt a Bit at Scientific American.

I Never Learn

Really love this new album from Lykke Li.

Why cutting government is dangerous

Lots of people seem to think that A) government is very inefficient, and that therefore B) we can make society more efficient by cutting the size of government. But actually, (B) doesn't follow from (A). And in fact, the very thing that makes government inefficient in the first place might make cutting it a bad idea!

Why is government inefficient? Because of incentives. Companies generally make hiring and investment decisions based on a marginal cost/marginal benefit calculation (though corporate institutions can of course get in the way of that, and if there are externalities then it's not efficient, etc. etc.). But government makes its decisions based on some other kind of cost-benefit calculation entirely. Sadly, we don't have a good understanding of government decision-making, and this is an area that could use a LOT more research attention than it is getting.

Anyway, because government doesn't make decisions on a monetary cost/benefit margin, it tends to be inefficient. But because of that, if you take a hacksaw to government, starving it of funds, or demanding that it fire workers and close divisions, these firing and closing decisions will not be made on a cost/benefit margin. If you force a corporation to downsize, it will usually lay off the least productive workers first. But if you force a government to downsize, it very well might lay off the most productive workers while retaining the least productive ones!

The very thing that makes government inefficient can make cutting government inefficient!
 

More here.

Specifically, the government entities that tend to survive a purge are most likely to be entrenched interests, and those are often entities that serve a narrow but politically motivated minority.

As in other fields, the inability to measure productivity accurately across different units of government means great inefficiency in funding allocation. So many problems can be reduced to inaccurate measurement.

The decline of Mission Chinese Food

Michael Bauer has dropped Mission Chinese Food in SF down to a food rating of 1.5 stars.

Many favorites are a shadow of what they were when I initially reviewed the restaurant as well as when I updated it 18 months ago, about six months after Bowien started spending the bulk of his time in New York. On that visit, the food had lost a bit of luster but still showed his vision.

My all-time favorite dish - salt-cod fried rice ($12) with Chinese sausage and confit mackerel - shows how the cooking has devolved. On my recent visit it was as dry as sawdust, although there were glimmers of what I had loved in the interplay between land and sea.

Another favorite, ma po tofu ($12), which used to be thick with ground pork, seems to have been reformulated. It now has a greasy broth with too-large cubes of tofu and a one-dimensional heat that masked the earthy shiitake and aged chile sauce.
 

I agree. My recent few deliveries from MIssion Chinese have been so disappointing: the beef in the broccoli beef brisket was overcooked, as were the Chongqing chicken wings. Westlake rice porridge lacked the usual comforting flavor blend of salt and brine. It was just bland. The market greens, which have always been braised baby bok choy for as long as I've been ordering from them, have been successively less and less flavorful, lacking both salt and garlic.

Bauer theorizes the decline in the food quality at Mission Chinese Food may be due to the absence of Danny Bowien from the kitchen. Bowien is off in NYC working on Mission Cantina and searching for a new location for his NYC branch of Mission Chinese Food; the initial location was a hit but was closed by the Department of Health for pest-related issues last November (yikes).

With a much longer commute than I had in LA, a dearth of street parking throughout San Francisco, and the scarcity of good restaurants in SOMA near my apartment, I have come to depend on restaurant delivery for more meals than at any point in my life since my years in NYC.

The SF food delivery scene is, to be blunt, a desert. I'm not counting the possibility of using Postmates to expand the delivery options to include more restaurants that offer takeout; that's a fairly hefty price premium that I hesitate to resort to except when I'm desperate.

Obi Wan Bowien, come back and whip that kitchen into shape! You're our only hope.

The zeitgeist in verbal tics

Blame the English major in me, but at any given time some spoken or written tic causes me to cringe. For a while, it was really common for me to hear people say "I'm wanting to" instead of "I want to." To my relief, that seems to have faded.

The two phrases that I hear so often now, perhaps because they're so common in business settings, are “at the end of the day” and “the reality is.” I'll be in a meeting and hear both phrases used multiple times, everyone one-upping each other with each successive "at the end of the day" or "the reality is," each successive occurrence marching us closer to the true end of the day and some greater version of reality.

When someone drops an "at the end of the day" on you, the presumption, whether explicit or not, is that whatever you've said is not bottom line enough. You haven't been seeing the big picture, you've been in the weeds.

Something similar occurs when someone hurls "the reality is" at you, but it feels worse, doesn't it? What have you been doing, dealing in unreality?

At the end of the day it doesn't matter. But the reality is it does matter. At the end of the day. Not before then. At lunch, just after dinner, but before the day has ended, it doesn't matter. But later, closer to 10pm in your time zone, maybe after you've brushed your teeth and you're about to end your day, then, and just then, it matters a lot.