It’s Always Your Fault

I came across this brief article (“It’s Always Your Fault“) from 2016 by DHH, who–among other things–was the creator of the web application framework Ruby on Rails and co-founder of Basecamp/37Signals:

There’s a system in place that caused this to happen, and you’re part of that system. Shit never happens in a vacuum. The vast majority of it is a predictable consequence of the way things are. Even if it was “just somebody’s fault”, others put or kept that person there.

The goal is to change the system, and to change the system, you have to change its parts. Have the courage to start with yourself. Absorb as much blame and responsibility you can for what happened, and hopefully some of that introspection will rub off on the other parts of the system. But even if it doesn’t, you’ve still done your bit to improve matters.

In Medicine, we seem to oscillate between blame-game individual-at-fault finger-pointing and Just Culture the-system-is-the-problem.

It’s true we shouldn’t go around punishing people who are trying to learn and doing their best, and equally true that we need to always be looking to address system flaws. It’s also critical to keep in mind how many people working in healthcare are second victims of those mistakes, which prevents healthy introspection in favor of guilty misery.

But I also found his point just a little refreshing. As usual, it’s not either/or, it’s both.

 

Coffee at Work

The coffee at work has been—for most locations of my training and attending career—terrible. From the burnt “Parks and Coffee” drip sitting for hours on the hot plate during residency to the cheapest K-cups at the imaging center. It doesn’t matter what sweetener or creamer you might add, it was rare to finish the cup once it was cold enough to taste. I’m not a coffee snob. I’m really more of a pragmatist. I don’t have the time or inclination for a long ritual even when working from home let alone the desire to do anything elaborate at work. Walking to the hospital Starbucks is slow and expensive. It’s a treat on the way for an early call shift morning but not something I enjoy doing routinely.

One of my residents shared Cometeer with me. It’s a variation on a coffee subscription (which is itself a variation on the incredible number of subscriptions available these days). I generally don’t like these sorts of things (who wants to remember to pause or cancel?), but I enjoyed the one I tried at work so I gave it a try.

The twist is that it’s a small recyclable cup of liquid-nitrogen flash-frozen coffee concentrate. Add your liquid of choice, hot to the frozen puck or cold after thawing, and you have instant coffee that isn’t, well, instant coffee. I predominantly use it as an espresso shot equivalent for making ice lattes, and for this purpose, it is effective and efficient. And it’s easy to slip in my bag and use on-site. On the enjoyment scale, I put it way above Starbucks’ regular iced coffee and just underneath their shaken iced espresso.

 

 

I honestly don’t know if I will continue to subscribe in the future, because it’s not the cheapest. You can cancel at any time and thankfully it’s also easy to spread out deliveries and pause them for months, because there’s no way I would want tons of coffee piling up in my freezer at any given time. I just don’t drink that much. With a $25 new member coupon, the per cup cost is $1.20 per pod (just a bit more than Nespresso pods) and cheaper than what I get at the coffee shop (but also more expensive than nothing, free tea, or the burnt brown caffeinated sludge otherwise available).

So, if you happen to be in the market for a new caffeine source and are interested in trying something new, you can try Cometeer and get $25 off (and subsidize my coffee consumption by the same amount!). Note that this is not a sponsored post; I just wouldn’t mind having cheaper coffee in the future. Also, note that I have literally never done a post like this in this site’s 13-year history. And finally, note that I can only use one referral bonus per order, so alas no matter how many of you choose to buy some I won’t be getting any coffee for free.

Always Something to Learn

From the very pleasant small corner (seriously, just check out the comments!) of the internet that is author George Saunders’ substack, Story Club, answering a question about finding a mentor:

One of the things I’ve come to love about this Story Club community is its generosity. From where I sit, it feels like people show up here with the right attitude for any artistic endeavor, which is, “I bet there’s something for me to learn here.” This doesn’t mean that the person doesn’t already know quite a lot. But she has reverence for the importance and difficulty of the task and knows at some level that showing up in a curious, humble, friendly spirit, she’s more likely to return home with something of value.

If that’s not wisdom for approaching just about anything, I don’t know what is.

A lopsided fig

Jason Kottke, a true OG blogger, on taking a sabbatical:

Does what I do here make a difference in other people’s lives? In my life? Is this still scratching the creative itch that it used to? And if not, what needs to change? Where does kottke.org end and Jason begin? Who am I without my work? Is the validation I get from the site healthy? Is having to be active on social media healthy? Is having to read the horrible news every day healthy? What else could I be doing here? What could I be doing somewhere else? What good is a blog without a thriving community of other blogs? I’ve tried thinking about these and many other questions while continuing my work here, but I haven’t made much progress; I need time away to gain perspective.

I love good curation. With my two young kids, personal wants and need, and professional demands, I don’t personally have the bandwidth to really produce a filter+share site myself, but I really appreciate when someone can steadily put a high-quality narrative or personal spin on *waves hands vaguely in the air* all of this.

Kottke is an excellent blogger, and he’s been doing it since 1998.

Wanting Less

Some highlights from the essay “How to Want Less” by Arthur C. Brooks in The Atlantic.

Homeostasis keeps us alive and healthy. But it also explains why drugs and alcohol work as they do, as opposed to how we wish they would…It’s why, when you achieve conventional, acquisitive success, you can never get enough. If you base your sense of self-worth on success—money, power, prestige—you will run from victory to victory, initially to keep feeling good, and then to avoid feeling awful.

My thought: Like the two factory theory of motivation and hygiene, success (especially monetarily) may help you be less dissatisfied (being impoverished is hard), but the absence of dissatisfaction is not satisfaction.

“The nature of [adaptation] condemns men to live on a hedonic treadmill,” the psychologists Philip Brickman and Donald T. Campbell wrote in 1971, “to seek new levels of stimulation merely to maintain old levels of subjective pleasure, to never achieve any kind of permanent happiness or satisfaction.”

Professional self-objectification is a tyranny every bit as nasty. You become a heartless taskmaster to yourself, seeing yourself as nothing more than Homo economicus. Love and fun are sacrificed for another day of work, in search of a positive internal answer to the question Am I successful yet? We become cardboard cutouts of real people.

We become cardboard cutouts of real people is an amazingly clear description of what the current form of meritocracy, conventional “acquisitive success,” and social media has wrought.

In truth, our formula, Satisfaction = getting what you want, leaves out one key component. To be more accurate, it should be: Satisfaction = what you have ÷ what you want

Our mental state rests in the balance between reality and expectation/desire.

It is the wanting, for which there is always more, that binds us to the Sisyphean futility of the hedonic treadmill.

And getting off is hard.