Mix Tape Mastery

I miss the days of mix tapes. CDs were fine too. Yes, I know you can still do playlists, but the skill of the mix tape master was to optimise the content within the limited amount of playtime. As soon as the playtime limits are removed the skill of curation was lost.

I wasn’t particularly good at it really, but I had a few people I knew that were excellent. A mix from them would give you more than just listening to some good songs. The songs would flow from one to another. There’d often be some sort of theme connecting them. They always introduced me to new artists. I didn’t necessarily like all of them, but when I did (and most often I did) I would then go off and explore their other offerings and expand my musical library.

I listened to the Maria Popova interview on the Tim Ferris podcast this morning and she shared a similar story about how she views literature. She described books as being the original internet. How authors referencing other texts and writers was like a hyperlink. New areas of knowledge to be explored that you might not otherwise have come across.

I think that’s a good position for a writer, particularly a non-fiction writer, to take.  To consider; how can I distil all that I have learnt from these different information sources into something that incites curiosity in the person that reads my work. So that they can expand their intellectual and humanistic library.

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Know better, do better

I’ve been struggling a little bit recently with the concept of regret. So often you hear people say they don’t believe in regrets. One of my favourite Beth Orton songs has a line “What’s the use in regret? They’re just things we haven’t learned yet”. But there are some things that I regret. Personal things. Mostly about how I behaved in a situation, or interpreted something and missed an opportunity for a better connection.

Yesterday I was listening to Rising Strong audiobook by Brene Brown and she shared a quote from Maya Angelou “Do the best you can until you know better. Then when you know better, do better”. She also challenges you to start considering others through the assumption that people are doing the best they can with the tools they have. This resonated with me. Particularly regarding my reflections and the guilt that I was feeling, shame, I don’t know what, about my contributions to what was a pretty toxic work environment that I was in some time ago. And how hard I’d judged one particular individual who was always putting himself out there and who I’d considered very touchy feely. For a number of years I considered him to be my nemesis, in that he was so obviously the polar opposite of me that it was hard for us to collaborate effectively.

I went and had a great meeting with my supervisor and was on my way back to the car, inspired by the thought provoking conversation and keen to get back to work when I heard someone call my name. It was the man I’d been thinking about. I hadn’t seen him for over 5 years. 5 years ago I probably would’ve tried to get away with him thinking that I hadn’t heard him, or shut him down as quickly as possible. Yesterday I took the time to talk to him. I knew better and I did better.

Still not sure about the regret thing, but I’m not hung up about it so I figure that’s ok.

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Fix-it Felix

Fix-it Felix spends a lot of time fixing windows. He’s very good at it. He’s invested a lot of time and effort into being the best window fixer he can be. Uses tools that are proven to be the best, the most reliable. He is the only one available to fix the windows. The residents need him. He is very busy.

Here’s an idea Felix, why don’t you talk to Ralph why he’s breaking the windows?

Tell me Felix, do you want to take a risk and try to build a world with less broken windows or do you just want to be kept gainfully employed doing what you know you’re already good at?

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Difficult conversations

I started my day with a difficult conversation with another parent at school drop off. It came onto my radar yesterday afternoon and was one of those things that I knew I couldn’t let slide. It was something that just didn’t align with the values we’re trying to establish in our family. The annoying good thing about kids is that they bear witness to these types of things meaning you’ve got a live-in accountability partners. The details don’t matter, but the action did. I lost sleep over it last night, felt nervous about it this morning, and felt uncomfortable while I was doing it, but I did it anyway and I’m glad I did.

I followed that up with watching Atul Gawunde’s Google talk on being morning during a morning indoor rowing session rather than the run that I was supposed to have. The content wasn’t really anything new to me, but it was a good reminder of what got me on the path that I’m currently on.

In October 2011 I attended a lecture given by Eric Cassell. I had just started in a completely new role as a Pharmacist in a regional palliative care team. It may have even been my first week. Definitely during my induction. I had no idea who this old man was, but he spoke with that kind of New York accent that immediately feels more entertaining and worth listening to (at least when you’re from Adelaide). His content lived up to my superficial assessment. Surpassed it. It was a life changing moment for me.

It was very similar to what I listened to today. It challenged my perspective on sickness, and forever changed my perception of our roles as health care providers. I checked the notes and reflection I wrote following the session.

  • We need to change our definition of sickness
    • Not disease but something that impairs the patient from achieving their goals and purpose
    • Palliative care helps patients get the most out of what remains of their life
    • People don’t wake up in the morning wanting to survive, they want to live, i.e. heartbeat doesn’t equal life
  • In terms of Pharmacy, this philosophy could also apply to assessing appropriateness of medicine, side effects etc.
  • Health isn’t just about the body, but also mental, social etc.  Therefore sickness and dying also isn’t just about the body.  Doctors think of dying as the time from which no cure is possible, but patients and families consider it to be when that person ceased being able to be who they really are
  • How can we as pharmacists assist patients with the dying process?
    • Identifying goals of treatment for that patient that are real to that patient
    • Recognising adverse effects and things that are impairing the patient’s life that don’t necessarily have to

It also made me think about one of the Pharmacist interviews that I’ve been analysing and interpreting this week. Pharmacist 14 put it perfectly, I think:

If we’re not brave enough to talk about death, it’s very hard to talk about multimorbidity and co-morbidities in the context of cancer. Because we can’t then say you probably don’t need a statin because you’re unlikely to be alive in 5 years. I think that pharmacists are inherently scared…

…a lot of people are uncomfortable with talking about death and therefore would not be comfortable having those conversations to allow good pharmaceutical care

If your motivation as a pharmacist is to fulfil work duties and feel comfortable and secure, then you won’t have these conversations and your impact and value will be limited. If you are a Pharmacist that is driven to do important work for people who care, you will embrace the opportunity to be vulnerable, respectfully engage in difficult conversations, and make people’s lives better as a result.

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Sia and Beyonce

Both are amazingly talented musicians. If I was looking for someone to headline an epic performance I’d probably go with Beyonce. If I was wanting someone to collaborate with another artist and write a song for them I’d go for Sia.

That’s not to say that either of them are not capable of doing the other. Sia might not choose to perform but she’s certainly capable of doing it to a very high standard. And Beyonce is known for her collaborative approach to songwriting, even if they’re songs for her to sing. In fact, the two have worked together (there’s some crazy internet conspiracy theory about Beyonce kidnapping Sia).

Who is more successful? If you define success as being able to live a life where you can make good art, then comparison is irrelevant. More relevant is the idea that one of the keys to their success is their openness to collaboration with others and the evolution of their ideas.

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EBM snobbery

Prior to finding myself as a freelancer (that’s what I’m calling myself this week), I spent a bit over a decade working in hospitals. There are lots of really great things about spending your early career in hospitals. It is an amazing learning environment. But over that decade I started to get the impression that it was a bit of a mono-culture. Part of that I think is to do with the industrialisation of hospital services that grew in response to the medication safety movement. This created a shift (at least in pharmacy) from having a workforce which valued clinical decision making to one that relied upon policies, procedures and meeting KPIs. Alongside this was the rise to dominance of evidence based practice.

I’m not for one minute saying that EBM is not important. I think it’s essential to form the foundation for effective health policy. I just think many people have made it out to be synonymous with best evidence (scientific studies, usually confined to quantitative RCTs) and forgotten the other bits. And those other bits, patient preferences, clinical judgement, and ‘lower quality evidence’ like qualitative studies, are vitally important to effective clinical decision making.

This morning I was reading about the challenger disaster (in Range by David Eppstein). Narrowly focusing on the quantitative data, discounting the qualitative data and available expertise resulted in the death of seven people. There existed a culture that discouraged problem identification, and failed to build environments that encouraged discourse. A culture where sticking to the defined procedure, even when it might not be appropriate, seemed more defensible than risking looking foolish to upper management by discussing the ‘soft’ data and human concerns.

This reminded me a lot of the hospital environment. I bet a lot more than seven lives have been cut short because of the same issues.


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Don’t forget the fiction

I’ve been pretty full on with my non-fiction reading lately, in various formats. The more I’m exposed to, the bigger my to-read list. This week’s obsession reminded me not to forget the fiction. Make time for it. Value it.

It was listening to the Tim Ferris interview with Neil Gaiman that sparked this train of thought. I’m becoming increasingly fascinated with different people’s approaches to the creative process, in whatever field they may be working (although be warned if you listen to it, there is a very lengthy discussion about fountain pens that I could’ve done without). I’ve got to admit, I didn’t actually know who this guy was before, so I’m not even sure why I chose that episode. Or, more accurately, as it turns out I was aware of quite a bit of his work, but didn’t know it was him. And never made the connection that American Gods, Coraline and Good Omens shared an author. That’s pretty broad. That afternoon I used the excuse of a sleeping baby to sit down to read more of Range (David Eppstein). Who does he use as an example of a generalist author, but Neil Gaiman.

There are a few things I needed to remind myself of in terms of the importance of reading fiction. First of all, its good to get out of your head. Despite that though, there’s such opportunity to learn from fiction. You get a chance to get an insight into other people’s lives. To empathise. Reading This is How it Always Was lead me to completely reexamine my approach to issues relating to transgender children and adolescents. A Little Life made me look at suicide and intractable suffering in a new light also. Of course, there are others, but these are two that really confronted me emotionally.

The other thing is storytelling. Regardless of how you’re presenting information, be it a novel, a powerpoint presentation, a paper in a scientific journal, story matters above all. In a youtube video of Neil Gaiman at MIT (told you he was this week’s obsession) he gives his definition of a story as “anything that keeps someone watching or reading and doesn’t leave them feeling cheated at the end”. I think that’s something I need to practice doing more.

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Sunk costs

Yesterday my mum took my daughter shopping to get some tap shoes. She started a dance class at the start of this year and this coming semester they are going to do tap dancing as part of it. They weren’t cheap. There is a risk (likelihood?) that in six months time they won’t fit or she decides she doesn’t even like tap dancing. At that point they appear to be a sunk cost. But what fun would it be without them, right?

She wore them the whole day yesterday. Last night she put on a long winded concert and practised auditioning for the voice (maybe Australia’s got talent would be a better choice if she ends up being any good at the dancing). Regardless of where she ends up in six months time, they’re going to enrich her experience, and that’s what childhood is all about. There’s no such thing as sunk costs when it comes to positive childhood experiences.

Likewise, there’s no such thing as sunk costs in personal learning and development. I’ve had to come to terms with this with the whole PhD thing. I often feel judged by others about my decision to pursue a PhD. I know a lot of people think it’s a waste of taxpayers money to fund people to look at issues unless they are going to contribute an outcome that betters society. But they miss the point about the learning experience that individual undertakes. That people who are committed to lifelong learning and invest in personal development make society better. I think that’s one of the best outcomes we could hope for.

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Collective responsibility

I just got back from my morning run after dropping my son at childcare. It was a difficult drop off after a difficult start to the morning and a difficult run as I’m still recovering from a perpetual cold. I was really enjoying the opportunity to listen to a podcast – the Goodlife Project episode with Brene Brown. It’s a great episode and it was really getting me fired up for my work day.

As I traveled along the path by the river I passed a little boy in the shadows of the underpass. He was about three years old with a balance bike. He was standing by the fence watching the river flow by. I figured his parents or someone was probably following closely behind and expected to see them as I went up the hill, but there wasn’t anyone there. I turned back and I could see the boy had move on. Oh fuck, now I felt responsible. If he continued on, he’d be past the fenced off area and could be into drowning territory very quickly.

So I turned around, ran back and called out to him using the most carefully selected, non alarmist and non confronting language I could think of. I asked him if he’d gone too far ahead of his mum or dad and said I thought it was probably a good idea if he wait in one spot for them until they showed up. I told him I’d sit with him (at a comfortable distance) and wait for them to show up.

I felt surprisingly very vulnerable. I didn’t know how it was going to turn out. Sure, in my mind I was preventing this boy from a potential accident. But what was whoever was looking after him going to think? I mean, this little kid was left to his own devices on a bike with no helmet along a flowing river for crying out loud. I took this as an indicator that we probably didn’t necessarily share the same value. And what was I supposed to do if they didn’t show up?

It was a good three and a half minutes until I saw some feet appear in the distance (I know because I had my watch recording my now interrupted run). That might not seem like a long time in the general sense, but having worked in the paediatric ICU, and having a neighbour who lost a child in a backyard drowning, I know that it doesn’t take long for bad things to happen to little kids. Along came his grandparents who looked mildly concerned and commented on how fast he is on his bike. I smiled and took off promptly.

Sometimes, often times, we have to do what is right, not what is most comfortable. As humans we have a collective responsibility to look out for each other and do what we can. Always.


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Today’s post is occurring late in the day. My day did not go as planned. Its school holidays, my husband’s out of town and my daughter was supposed to be going to vacation care. She did not want to go. “I feel really tired”. “I don’t feel good”. What is one to do in this sort of scenario?

I guess part of it depends on context. My plans didn’t involve having to be anywhere else today so it wasn’t a big deal if she stayed home so long as she didn’t expect me to play with her all day. But was it ok to say she could stay home just because it was easy? Was I supposed to make her go because we’d already paid for it and she needs to understand the value of money? Was she really telling the truth or was she just trying to manipulate me into letting her spend the day with me? Would she be doing this if Chris wasn’t away and she wasn’t going to be staying the night at my Mum and Dad’s tonight?

Then I stopped for a moment and did what I’ve been learning and thinking about so much lately. I listened. Either she was actually starting to feel unwell, or she felt like she needed me close. That’s not being manipulative, that’s being a kid. And I think that’s what she needed and I’m happy that I gave that to her. It’s not about being right. It’s about doing your best, and showing the people that you care about that you’re listening to them.

In my head, it links to how we as pharmacists listen to (or don’t) to what the people we are providing care for are saying. Understanding what they’re saying and why they’re saying it rather than taking them at face value and with judgement.

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