It’s All a Jumble…

Day 57: Tuesday

Good morning Zak,

“When man wanted to make a machine that would walk he created the wheel, which does not resemble a leg.”

-Guillaume Apollinaire

Descending melody is a universal in world music.  Every culture that we know of has some examples of melodies that generally start high in pitch and end low.  Ethnomusicologists think this is simply due to the nature of our physiology: whenever someone breathes out to sing a melody, they start with a lot of breath and end with very little.  This makes it natural to descend in pitch toward the end of a melodic line.

If I were to indulge myself in speculation about this, I might even take the explanation a step further.  It seems like downward motion is a pretty universal part not only of our physiology, but of all of nature in general.  I mean, here on earth, things pretty much always move downward if nothing stops them.  Water, tree branches, trees themselves…  I guess in that way descending melody is a lot like Cage’s 4’33’’; it’s the sound of nature when people don’t interfere that much.

The so-called “lament meter” in ancient Hebrew poetry is probably an example of this.  Although we don’t have direct evidence of the original melodies, the lopsidedness of the poetic meter itself seems to evoke a diminishing energy toward the end of the verse.  The first part of the verse (the first “colon”) is generally longer then the second.

I feel like there’s something inherently lament-ful about this kind of verse structure.  Isn’t it kind of sad how everything on earth eventually falls back to the ground and dies?  Everything except for some small amount of helium, which, I understand, escapes the atmosphere because it’s so light.

But the really strange thing is how relatively rare this melodic typology is within Western concert music.  Our melodies tend to climax about two-thirds of the way in.  In a sense, you could maybe say our musical tradition is about contrasting the entropy the natural world with the creative energy of human life.

“Right, well, I mean… this piece behind me, I call it ‘The Afous II.’  And, I mean, it’s really about how confusing, you know, society is.  Because, you know, it’s all a jumble, isn’t it.”

-Adam Savage

schermata-2017-02-07-alle-12-39-25

A river or a waterfall might tend to flow downward, but human discourse generally moves the opposite way: I say something, you say something, and eventually we reach some kind of logical consequence… an agreement or a main point or something like that.  Contrary to the entropy of the natural universe, human conversations, or “language games,” tend to snowball, accumulating more energy as logical discourse progresses.

Here’s a a very famous lament, which climaxes, no less, toward the end of each strophe.

God, who created all that comes and goes
and shaped this faraway love,
give me strength, since I already have the intention,
so that I see this love far away
in reality and in a fitting place
so that rooms and gardens
shall seem to me to be new palaces.

-Jaufre Rudel, source

Until tomorrow,

Tim

Costing a leg

Day 54: Thursday

Morning, Tim!

Silly Josephine…

Tim as you well know I work in healthcare. Thinking about healthcare as a business feels kind of grimy at times — you are making money off of those who desperately need help, many times in order to live. That said, having worked with a lot of Catholic hospital systems, the usual saying goes “No margin no mission”. In order to operate, in order to help all of those people, they need to have the financial backing to do so. They certainly have a lot of write-offs each year, essentially donating care back to communities; but it’s no news that in the U.S., healthcare is expensive, and many people are paying all they can afford in medical bills.

I’m not sure how I’m supposed to think about making money off of others’ misfortune. In one hand, I’m helping them extend life; in the other, the cost of that extension is often a poor quality of life, constantly fretting about bills and work.

I recently came across some articles about financially backing legal cases. I asked a friend of mine with a law degree to explain in a bit more detail, but the gist is that there are many wrongs done to people – e.g. abuse, discrimination, etc. – done by a corporation that has quite a bit of money. If the individual were to sue, there are legal ways for the corporation to spend those dollars quickly prolonging and “drowning” the individual, making it effectively impossible to sue in many cases. There are some lawyers who will work on a contingency basis, not getting paid until the individual does — but they typically have caps far smaller than would be necessary to take on a corporation.

The linked article discusses financially backing some of these cases. Now I certainly don’t have enough money to bankroll anyone’s legal case, but the idea still intrigues me. If real harm was done, shouldn’t there be some recompense paid? The same problem we saw above begins to arise, though – in order to operate like this, the financial backer would need some form of compensation, thus taking a portion of what would go to the individual. There’s this feeling of doing good while simultaneously lessening the good done.

I’m not sure there’s any way around it within healthcare. Hopefully make it cheaper to deliver care, I suppose. It’s just unfortunate that there’s a cost to doing good.

Until tomorrow,

Zak

Volcanos and Good (Women) Doctors

Day 34: Wednesday

Morning, Tim!

Today I defend your cacophony of structuralism with (giant [and well drawn…]) earplugs!! I then attack your base (well played) with a giant bottle of vinegar (I contemplated having a man jumping on the bottle to squirt it out as if it were a water blob, but wasn’t able to accurately portray that…). So yeah…take that.

Day 3: Under siege

Sketches Copy - 8.png

My base is defended by earplugs (alternatively it could be headphones and listening to all about that bass…). Your “base” is being attacked by a spritzing bottle of vinegar. 

While fun to draw on my phone, I may need to print out next time…silly big fingers…


One article that has received a fair amount of attention the past couple days calls out disparities in physicians, most notably a quality of care gap favoring female physicians.

“Salaries for female physicians average some $19,879—eight percent—lower than male physicians. At academic hospitals, male physicians receive more research funding and are more than twice as likely as female physicians to rise to the rank of full professor.”

Justified by something, perhaps quality? Nah…

Female physicians actually tend to provide higher-quality medical care than males, according to research released today. If male physicians were as adept as females, some 32,000 fewer Americans would die every year—among Medicare patients alone.

An interesting find. I’m not a clinician, but were I to pursue that route I’d easily be a part of the higher paid statistic – I’m male. Not a part of this study, but I’m also white and tall, each giving me undeserved advantages, privileges. Something isn’t right about that.

But the interesting piece about the article isn’t just the observation that the pay gap is obviously undeserved. At the end of the day, it’s better for patients – they get better results. What is it that brings this about? Is it a communication style? Perhaps an intelligence level of the subset of women self-selecting into the field? Time spent with the patient? Compassion? Less ego?

It’ll be interesting to learn more as they dig in to this.

Until tomorrow,

Zak

Blessed, with Responsibility

Day 30: Friday

Morning, Tim!

Depending on how you count it, we’ve been at it for a month! I figured I’d count it this way so that I could note it before you did (though you could have made a claim regarding “But February only has…” A missed opportunity…).

[…] Close our eyes and imagine somewhere we would like to be if we could be anywhere in the world.  When we opened our eyes he asked if the place anyone had imagined was room 312 YC high school.  I was the only one who raised their hand.  Maybe I was over thinking things, but if I really wanted to be somewhere else, wouldn’t I just get up and leave?

Decisions are a challenging thing. To be fair to your 14 year old classmates, I wonder if they really did have the power to go where they’d like. Perhaps some thought “man, I’d love to be at tacobell!” (depending on the hour of your class, perhaps Starbucks…). But others probably imagined the word Italy (it’s probably hard to imaging if you haven’t gone) or somewhere foreign – and where was a 14 year old to get the means to travel to Italy? Even getting up and leaving wouldn’t get them there. And so of course they sat in class, for that’s what they were told to do, many with the hope that life would be a long conditional. “If I do this [e.g. sit in school like I’m told], I’ll get to do that [e.g. go on vacation where I’d like, or perhaps even live there depending on my willingness to dream…]”

Or you could be an odd boy, realizing this train of thought, and….suggested that this was the place you wanted to be. I was that boy too…

Leaving your work would be an administrative decision that you make about the infrastructure of your life.  We don’t make those kind of decisions on a daily basis.

You don’t state it explicitly, but your discussion of decisions, infrastructure life decisions in particular, seems to lean toward an inability in at least some cases to truly make these changes. There are people who can make them (e.g. Jim Koch founded Sam Adams brewery after being fed up with consulting – but it was precisely because he was a management consultant that he was in a position to quit). In cases such as these, he describes them as scary but not dangerous; not dangerous because the other option was dangerous – looking back at 65 and wondering why he spent his whole life doing management consulting when that’s not what he wanted to do. I can appreciate this line of thought – I have been blessed with opportunities; while I work hard, I also know I’m lucky to be in the position I am.

In other cases, though, it is dangerous to make those infrastructure changes. For a single mom with three kids, there isn’t much room for adventure in the job market, nor to simply “get up and leave” because the consequences mount so high – hungry kids, an unpaid mortgage, utility bills mounting. Or, much worse, someone in a war-torn country who can’t leave because they literally can’t. They have nowhere to take refuge, no country to take them in.

Obviously you know all of this; I’m merely reflecting on decisions, infrastructure choices in particular. Reflecting on the choices I deliberate over…

I feel blessed to be able to even have the options I have in my choices. I also wonder what responsibility comes along with those options…

Until Monday,

Zak

p.s. I hope you chose to join the choir. Also if you do, I’ll anticipate a good picture of you doing some handshaking…

First and best, for 100 years

Day 28: Wednesday

Morning, Tim!

I work with a lot of entrepreneurs. Most of the companies I interact with have been around for less than 5 years, many for only 1, and each are in ongoing development mode. They are passionate about the work they do and, being in healthcare, oftentimes have a personal story about why they do the work they do. It is wonderful work – entrepreneurs have said they want to make a difference, that the current way of doing things wasn’t good enough on it’s own, and that they want to contribute to making it better.

In thinking about what makes at least some of these companies successful as they scale, I’ve been primed to look at Amazon first, and recently received another example in Patagonia that is similar, yet with some key differences. I recognize the immediate thought may (should) be “But Zak…those aren’t startups”. Correct. But they are both led by entrepreneurs who have control and who have established what success looks like for their companies.

Taking Amazon first, Bezos saw Amazon wasn’t great at working internally when one team needed access to what another team was working on. Perhaps the means of getting there are a bit unsettling, but Bezos mandated that teams had to create interfaces to connect with one another, and that all communication must be through these interfaces. For context, Bezos was taking away any shortcuts – it was more work to create these interfaces (particularly backwards, in many cases). When your vision is to be around after 100 years, though, you build it right – no need for shortcuts, you build it to last and to scale. By forcing teams to create this infrastructure to support Amazon.com, they had also built it for the rest of the world – AWS allows for Amazon to build tech infrastructure that others would use, and they know others will use it because they use it. They are their first and best customer (and…it’s nice when your best customer is the largest online retail giant). Amazon has also done this with their distribution infrastructure, figuring out how to fulfill 2-day delivery all across the US. By building it to meet their own needs, they can just as easily meet others (because they intimately know the needs and challenges faced).

Turning to Patagonia, Yvon Chouinard founded the company because he didn’t like the equipment available to him for climbing. Wanting better gear, he made it – realizing others would want it, he made more and sold it. He did the same for clothing, finding that he couldn’t find elsewhere the clothes he himself would want to wear. The jackets not built to last, nor built for quickly changing weather. The shirts were too bland, the shorts not sturdy. As he created, he also brought on others who, like him, did the activities he wanted to create a company to support. Who better to know what the surfer needs than the guy who, rather than be in his job, mostly just wants to surf all day. While not a clean comparison (Patagonia employees aren’t themselves a best customer in the way that Amazon.com is for AWS, not supporting with nearly the same size/scale) and I’m over-simplifying, but the end-result is similar – Yvon created a company that values doing it “right”, as if they were going to be there in a 100 years, and made products that they themselves wanted in order that they might better do their passions/jobs.

I’m not sure what this looks like for healthcare. In advising health systems, it looks like first and foremost creating a system that the individuals themselves would want to go to. Perhaps that means there is more personalization – whether genomics or simply knowing I prefer Zak to Zakary when I come in. Perhaps it’s a focus on making things safer – perhaps by reducing unnecessary variation in supplies so people can become better experts, perhaps by enforcing hand-washing. Perhaps it’s building a workplace that supports its employees – a workplace that clinicians want to go to, even though the work they do every day is physically and emotionally taxing. I’m not exactly sure how to put this into practice for entrepreneurs within healthcare, but it’s something I think about. Perhaps making medical records more accessible, or innovating within chronic disease or mental health is relevant.

Anyway – I like the idea of creating things that will last, not because of “legacy” but because it’s inspiring to act in a way that is rewarding – to “do it right” and feel satisfied in the work done because it wasn’t for short-term gain or one that took shortcuts. It’s admirable to put in the work, having the discipline to do it right – even more so when empowering others to do that work in their daily lives with you.

Until tomorrow,

Zak

Ugh. I hate lines (but…what to do without them?)

Day 22: Tuesday

Morning, Tim!

If my recollection of English is correct, your use of ‘literal’ is mostly a  taunt, valiantly attempting to have me tirade about unusual incorrect usage and usages. I won’t take the bait – just know I’m watching you closely. That said, I’m watching you closely mostly because you got a haircut from a stylist not named Monique, not because of your taunts. Italy is really changing you…

A couple weeks ago I touched a bit on automation, attempting to detail some thoughts on the tech industry’s moral obligation to bring others along with them. Rather than simply displace workers from jobs, the industry as a whole should help think carefully about the society being created when these jobs are gone and how people can not only make a living but also live meaningful lives contributing to societal flourishing.

Amazon announced the soon to be public launch of their Amazon Go store concept. Watch the video below – it’s worth the couple of minutes.

Now to be clear, this is one store that isn’t yet open to the public. But the implications are glaring. There are 3.5 million people working in cashier jobs in the US alone. I’m not sure how it’s counted, but you also have people managing those cashiers and in the case of grocery stores those bagging the purchases. That’s a lot of people to displace.

And to be sure the technology will have some kinks to work out and some frustrations of it’s own. There will need to be a clear way to get assistance if something isn’t coming “off the cart” if you put it back (consumer frustration) or ensure everything is being charged (retailer frustration). But in the long run, if it really is using self-enforcing and learning tech as described, the thousands of data points gleaned every day add up and the experience improves, driving more people to use the service. Moreover, if their massive scale and logistical distribution advantages weren’t enough, the real advantage here comes when looking at costs – investing in the (essentially) fixed costs of running the tech allows Amazon to out-compete others who have to use labor. And as hinted at above, it’s not just grocery that gets impacted – there’s no reason to believe similar technology couldn’t be put into clothing retail, gas stations, convenience stores, etc.

I write this thoroughly torn about how to feel. From a tech innovation perspective, I’m all for it. People unproductively standing in lines is a real problem to be solved – time that could be spent building relationships over tea or writing comics about math (this is the kind of friendship we have, Tim!) or observing the beauty in nature. But there are other real-world implications, meaning people may not have jobs to work to pay their way through school or to support their families or to simply make a few extra bucks so they can go hang out with their friends on the weekends.

And I don’t have any answers. I don’t even have thoughts in the right direction, yet. But being attentive to what is happening and having it sit on the mind, discussing it with friends – that I can do. Let me know when you’ve figured it out, Tim…

Until tomorrow,

Zak

p.s. I really liked your pigeons rummaging.

p.p.s. If the Amazon Go thing comes to fruition, I have serious angst about having to travel back through stores to put groceries back rather than simply placing my unwanted rice bag on top of the canned soup section. And before you say “aww you’re that guy! Put it back yourself” I’ll pe-empt with a “Hey I’m giving someone a job!”…

Stop That Girl!

Day 7: Tuesday

Good morning Zak,

Ever since Friedrich Nietzsche told us that “God is dead,” it seems like a lot of people have taken this to mean that many other things must be dead too.  While that logic may be air-tight, it’s possible we’ve taken the conclusion too far.  I mean, Zak, it’s become almost an obsession for some of us: people have since written that the Author is dead and that Schoenberg in particular is dead; bloggers have blogged that Blogging is dead; more recently Facebook has taken this thing to its ultimate consequence and topped us all… everyone is dead.  I’m not sure why we’re suddenly so into this trend.  Some people are even making comedy podcasts about death.

“The death of the author means the birth of the reader.”  Ronald Barthes

Emily Mandel wants to know why so many books suddenly have the word “girl” in the title.  She’s noticed this happening a lot, and often when the book is written by a man, guess what becomes of the girl in question by the end… she is dead.  Authors all over the English-speaking world are making these decisions, sometimes independently.

But the tropes and symbols that make up the stories we tell are often bigger than any of us; it was only a matter of time before the Girl from these English books leapt free of the imaginations that bore her and set out to explore the world on her own.  Recently I was passing a movie theater here in Italy when I happened to noticed The Girl on the Train, or really La Ragazza del Treno.  Not sure exactly what she was up to back here in the old country.

They say that humans are social creatures.  I guess that’s true enough.  We certainly like to latch on to trends and things.  Maybe that’s why so many authors on the internet came together to participate in the Free Style Writing Challenge (FSWC).

“Come up and be dead!  Come up and be dead!”  Charles Dickens

Zak, I admit, I am happy to hear about the “good weather” you had on your visit (however narrowly you might define that concept). But while I’m on the topic of your last entry, I must opine with no disrespect to your professor that this “rational actor” business is irrational nonsense.

By the way Zak, this is a word cloud representing the frequencies of individual words in the poetry of Cino da Pistoia.

word cloud

Death: the poetry of Cino

The odd thing about the FSWC is that it’s not just a gimmick; when people are pressed for time, their writing doesn’t devolve automatically into irrational nonsense.  It turns out that as people rely on the formulaic idioms and story-telling tropes that come most naturally to them under pressure, they often end up putting out some surprisingly structured work, sometimes even better structured than normal writing.  In general, the results are exquisite and many times very moving.  Consider for example this fine piece about trains, romance, and poop.

It’s a strange and wonderful world we live in, Zak.  If anyone reading this has happened to see the Girl recently, I’d appreciate them letting me know.  I’ve been looking all over for her, trying to catch up for quite a while now…

Until tomorrow,

Tim