Live Together, Die Alone

As a follow up to my previous post on the Regrets of the Dying, a reader who worked in pallitive care wrote in to share an interesting anecdote: patients where she worked always seemed to die during the very brief moments when a family member or care worker stepped out of the room. This post on a Chicago Tribune blog contains similar anecdotes from a different hospice center:

In the 1990’s, Twaddle [chief medical officer at a pallittative and hospice center] and her colleagues noticed a strange phenomenon. "Families would be in vigil for days by a bedside, finally go to get some dinner, take a shower, and when they left, the person would die,” she said. "Then, racked with a sense of guilt, self-flagellation ensued as family members said 'I shouldn’t have left.' "

So they conducted an informal study and found that more than 80 percent of the time, Moms died alone. Dads, on the other hand, seemed to wait until everyone was there and died in the midst of the gathering, Twaddle said.

“Even when the family was in vigil, it was when they left that Mom died,” Twaddle said. “What does that perhaps indicate about 'wanting someone there?'”

Twaddle knows the study was scientifically flawed, but here's her larger point: “If there is a piece that is volitional in the death process, could it sometimes be in waiting for space, quiet, and aloneness for some?

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Here's Robin Hanson's skeptical take on list of regrets I linked to (emphases my own):

Deathbed folks are usually far from their analytical peak – they are often in great pain, and rather muddle-headed. So why would we think their comments especially insightful? I suspect we attach unrealistic significance to deathbed words because we are terrified to think about death, and eager to show our devotion to the dead and dying.

But if deathbed regrets are less than reliable descriptions of reality, where might they come from? One theory is that they are like the famous interview question “What is your main fault?”, which evoke answers like “I work too hard” or “I’m too much of a perfectionist.” These are obviously attempts to brag about a good feature, but call it a “fault.” All but regret #4 above fit this directly – they basically say “I sacrificed so much for you people.” Regret #4 similarly declares how much the dying cares about others.

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If all this talk of death is getting you down, here's a song from Glee that gave me goosebumps, and another one featuring Gwyneth Paltrow that got stuck in my head the moment I heard it. (You've been warned.)

Best Sign at the Rally for Sanity

This wins the award for the best sign (among many hilarious mock-signs) at Jon Stewart's political Rally for Sanity last weekend in Washington D.C.:

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How Seinfeldian: it identifies an issue everyone thinks about but rarely analyzes. Why do Mexican restaurants not provide more than three or four tortillas with a fajitas order? Order fajitas and you inevitably run out of tortillas before the meat and veggies are eaten.

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Last week I met with a friend who subscribes to this blog via Kindle. He pulled up to our meeting place, got out and stood in front of his car, and waved me over. He popped open the trunk. I looked. He had just come from picking up groceries. Plop in the middle was a full rotisserie chicken. I asked, "You read my post?" He smiled and nodded. I had a quiet moment, and reflected. To think my blogging has had that kind of impact — to know that more supermarket rotisserie chickens have made their way into the homes of hard working men and women, to know that said men and women will be enjoying not only warm chicken right away but also cold chicken leftovers for days to come…goosebumps, goosebumps. (Thanks to Jackie Danicki for turning me on to the wonders of inexpensive supermarket rotisserie chicken.)

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Here's my post on bread baskets, menus, and waiter eitquette. I talk about fish oil and supplements here. Here's my ode to the rice cooker. Paul Graham thinks the number of restaurants in a city that require men to wear a jacket and tie is an indicator of that city's potential as a tech center. Here are Michael Pollan's nine rules of thumb for good nutrition.

How to Cook Restaurant-Quality Food

Last year the always worthwhile Adam Gopnik wrote a great piece about cookbooks. Delightful reading for anyone unusually interested in cooking. For the rest of us, there was one big overarching practical nugget:

…hyper-seasoning, and, in particular, high salting, is a big part of what makes pro cooks’ food taste like pro cooks’ food….

Mark Peel, in his Campanile cookbook, comes near to giving the game away: “We chefs all lie about our mashed potatoes,” he admits. “We don’t tell you we’ve used 1½ pounds of cream and butter with 1¾ pounds of potatoes. You don’t need to know.” (Joël Robuchon, the king of his generation of French cooks, first became famous for a purée that had an even higher proportion of butter beaten into starch.)…

After reading hundreds of cookbooks, you may have the feeling that every recipe, every cookbook, is an attempt to get you to attain this ideal sugarsalt-saturated-fat state without having to see it head on, just as every love poem is an attempt to maneuver a girl or a boy into bed by talking as fast, and as eloquently, as possible about something else.

I've learned a bit about cooking over the past several months. Below, I add two points of advice to Gopnik's:

1. Add salt.

2. Buy rotisserie chickens from the supermarket.

3. Buy a rice cooker.

Why Have I Not Done Drugs? And Should I?

I am an entrepreneurial, adventurous person hungry for new experiences. I enjoy experimenting. I am above-average in my appetite for risk. Why have I not done a single drug in my life? Why no weed, cocaine, LSD, cigarettes, mushrooms, etc?

I am not sure. I know a few other people who are in a similar position and they are also genuinely perplexed.

Some possible reasons:

1. Not doing drugs when young actually was the risk-taking behavior. Most people around me were smoking at least marijuana. There was a lot of social pressure to do drugs. By choosing not to, I risked social alienation while also signaling independence and free spiritedness.

2. Early on I became known as the guy who "doesn't smoke" and therefore a no-drugs attitude became part of my identity. Once an identity forms, it's hard to act in ways that contradict it.

3. My first exposure to drugs was in high school and the people who did a lot of drugs, including marijuana, tended to be the stupidest in terms of raw horsepower and work ethic. I associated weed with those people, and I did not want to be those people.

4. I am unusually health-conscious and I perhaps unfairly lump all drugs together when assuming they harm physical and/or mental health.

5. I am deferential to the law (though I often challenge the authority structure in other situations). I have never been arrested or in jail. While I drank alcohol when under-age, alcohol would soon become legal at age 21 so it seemed less-bad than smoking marijuana, which is always illegal no matter the age.

6. At this stage in life I do not know where I would buy drugs, how much to buy, how it works, how to verify purity, and so on. There is a non-trival logistical barrier.

7. The benefit of drug use is unclear and since I cannot calculate it, I would rather spend my money on other things.

8. I fear addictions. This explains, by the way, why I do not drink coffee.

9. I like to be in control of most situations and I fear relinquishing that control if high on a drug.

Note that I am pro-marijuana legalization from a policy perspective. I could be convinced that we should legalize or decriminalize other drugs. I do not think less of adult professionals who smoke pot from time-to-time though I inexplicably find pot-smoking a turn-off when pondering the sexual attractiveness of women.

Here is a long reflective piece on the experience of smoking cactus, via Nathan Labenz, and it is pieces like this which pique my curiosity.

I am already a pretty happy person with plenty of friends (I don't need them for social life) and while the temptation for new experiences exists it's not strong enough to get me to move the status quo. My main question about drugs, then, revolves around personal utility. Could they improve my relaxation habits when not on the drug? Could they help me focus or concentrate when not on the drug? I am saying "not on the drug" because I have heard that the experience on the drug opens new dimensions that stay with you. Could they improve my ability to introspect? Would being high on cactus for one day, for example, inspire me to think big thoughts while on the high that I could remember and think about post-high?

These are honest questions, and I suspect Vince Williams, among others, will have answers in the comments section.

Why Nassim Taleb Walks

Nassim Taleb, of Fooled by Randomness and Black Swan fame, has a new-ish essay up on his site called Why I Do All This Walking, or How Systems Become Fragile. He ponders health and fitness strategy by thinking about our ancestors. Our ancestors walked aimlessly a lot and occasionally had to sprint if we were being chased or doing the chasing. Plenty of idleness, he says, some high intensity. He questions the modern obsession with regular exercise and discusses his own effort at sporadic weight lifting sessions followed by several weeks of being totally sedentary. At the end he links it back to his larger ideas around systems theory.

The footer says “do not quote” the piece, so I won’t excerpt here, except by providing a link to the free PDF. Thanks Seth Roberts for the pointer.

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At the bottom of Taleb’s homepage he posts his email address and invites readers to contact him. With some qualifications:

Concise messages are much preferable (say a maximum < 40 words) as I will not be able to read long letters. Please do not 1) send me your papers or other “interesting material” to read, 2) ask finance questions (not my specialty, 3) make me to rewrite sections of my books (I write books, not emails), 4) ask for a list of “other interesting books to read”, 5) ask me to provide career or educational advice, 6) send me passages from Tolstoy or the Ecclesiast on luck and randomness, 7) send me the list of typos in my drafts. Note that I almost always reply (but ONLY to short messages), time permitting (but once) –even to nasty emails. Finally, note that, thanks to my new keyboard, I sometimes reply in Arabic, particularly to academics. [Also please please refrain from offering to “improve” my web site].

He opens his piece on walking by noting that thanks to the “exposure” of his books he came onto theories about fitness by two authors. I imagine this happend by a reader writing in and sharing “interesting material” of the sort he says he does not want. I have never emailed Taleb, but I don’t take his qualifications seriously. It is, in fact, a very naked way to signal busyness and importance.

Working Out With Nothing but a Floor

When you're on-the-go, finding a gym can be hard and going for a run outside is always fraught with the risk of getting lost.

So I now pack two good exercise tools in my suitcase that allow me to do a workout anywhere, anytime:

1. Jump rope – A jump rope is light, compact, and use-able anywhere. Because you stay in one place, you can simply take one step outside your hotel building and get after it.

2. Ripcords – I discovered these when their CEO, a blog reader, emailed and offered to send me a box. They're awesome. You can do many types of exercises with resistance bands.

Another blog reader, Adam Gilbert who's CEO of MyBodyTutor.com, emailed me a workout plan that requires nothing but a floor:

1. Jumping jacks – Do 4 sets of 50

2. Body Weight Squats – Do 3 sets of 20 (shoulder width)
(http://www.youtube.com/watch?v=zqj1qjIA6E0 – Great video to watch for form)

3. Wall Sit – 2 sets of 1:30 each
(http://www.youtube.com/watch?v=tDjKeOCgisw – Good video to watch for form)

4. Calf Raises  – 4 sets of 25 each

5. Push ups (shoulder width) – 3 sets of 20 each (Go slow and steady.)

6. Push ups (close grip) – 3 sets of 20 each (Go slow and steady. Again, own the exercise!)

7. Lying Torso Raise – 3 Sets of 15 each

Directions: Lie face down on the floor and place your hands loosely behind your head. Slowly raise your upper body until your chest is a few inches off the floor. You should feel your lower back muscles contracting as you rise up. Hold the top position for two-seconds then slowly return to the starting position and repeat.

8. Crunch – 3 sets of 15 each
(http://www.youtube.com/watch?v=TKg_cdwq9l4 – Good video on how to do them. Most importantly crunch your chin up towards the ceiling. Look up! And hold!)

9. Bicycles – 3 sets of 30 each (Every time you touch a knee it counts as one)
(http://www.youtube.com/watch?v=vPKXFarXbys – Very good video with great form!)

10. Plank (Hold for 2 minutes or as long as you can. 2 minutes is the goal though.)
(Perfect form – http://www.youtube.com/watch?v=9Ar2iRusnnc)

Back Pain Made Simple: Just the Facts

The Cleveland Clinic Journal of Medicine has a helpful, authoritative review of back pain, its causes, and advised treatments. Back pain is the second most common reason for doctor visits (after the common cold). I recommend sending it to anyone dealing with back pain.

Some of the key points:

  • Most back pain has no recognizable cause and is therefore termed “mechanical” or “musculoskeletal.” Underlying systemic disease is rare.
  • Most episodes of back pain are not preventable.
  • Confounding psychosocial issues are common.
  • A careful, informed history and physical examination are invaluable; diagnostic studies, however sophisticated, are never a substitute. Defer them for specific indications.
  • Encouragement of activity is benign and perhaps salutary for back pain and is desirable for general physical and mental health. Evidence to support bed rest is scant.
  • Few if any treatments have been proven effective for low back pain.
  • Low back pain should be understood as a remittent, intermittent predicament of life. Its cause is indeterminate, but its course is predictable. Its link to work-related injury is tenuous and confounded by psychosocial issues, including workers’ compensation. It challenges function, compromises performance, and calls for empathy and understanding.

I would highlight the fact that exercise is helpful. (You should also exercise when you have the common cold, by the way.)

The last point about empathy and understanding rings true. Last October I woke up one morning with searing, unexplainable lower back pain. It dominated my existence for a couple weeks and I was able to do almost nothing else. I grew more understanding of what some must deal with on a daily basis.

Also, I never do exercises in the gym that come anywhere close to hurting my back. This includes squats. Unless you're extremely well instructed on how to use the weights, avoid back-related movement and stick with bodyweight exercises.

(h/t Andy McKenzie for the pointer)

The Keys to Life: Running and Reading

Will Smith, one of my favorite actors and rappers, tells the audience at the 2005 Kid's Choice Awards that the keys to life are running and reading. The two minute YouTube clip is embedded below. Running because when you run you get tired and want to quit and have to train yourself to fight through the pain and be resilient, and reading because through books you can learn from the people who have lived before you. It's inspirational to hear this message delivered by Smith to a rap beat and interspersed with some riffs on hard work.

(hat tip: Max Marmer)

Three Things I’m Doing to Become Healthier and Smarter

1. I take four Kirkland Natural Fish Oil Omega 3 pills a day. Each pill has 1000 mg of total fish oil with 300 mg of DHA and EPA each. 1200 mg/day seems to be a good target amount. Here's a page comparing fish oil to flaxseed oil. Here are all of Seth Roberts' posts on Omega-3. Here is Tyler Cowen on his flaxseed oil supplement which he calls "good for his heart, brain, and gums" and says "the Omega-3 ingredient has a scientific consensus in its favor, with no evidence for negative side effects."

2. I'm tracking personal metrics. I'm starting with sleep and exercise. I record in Excel when I went to bed, when I woke up, and how many minutes I exercised. See the article titled You Are Your Data to learn about the burgeoning Quantified Self movement. I hope to track nutrition soon. And maybe one day I will be able to carefully track my time spent on different activities.

3. I'm interviewing local neuro-psychologists to see if they can help me understand how I learn. I am still unsure how I process information best. People with learning disabilities work with these folks. I don't think I have a learning disability but I do think I could do a better job at taking in information in ways that are optimal for my cognitive makeup. I'm also researching SPECT scans, but these have its critics and are expensive.

I'm not a self-improvement maniac. But I am on the lookout for ways to become healthier, happier, and smarter, and all these things seem likely to help in one or all of these fronts.

Thanks to Seth Roberts, Andy McKenzie, Tyler Cowen, and a Child of the Kemp for their direct or indirect advice.

Bodyweight Exercises and Perfect Pushups

Growing up, exercise equaled sports. I played tennis, baseball, basketball, football, ping-pong, roller-hockey, home-run derby, and others. I eventually realized that if I wanted to get good I had to focus on one and I chose basketball. I started playing year-round, participated on elite traveling teams, dragged my ass out of bed at early hours to do agility and plyometric exercises, and worked near-daily on improving all aspects of my game. Playing basketball I learned a tremendous amount about teamwork, giving and receiving feedback, the importance and limits of hard work, channeling competitive instincts toward a firm goal, and mental focus. After my senior year season of high school I felt burnt out and stopped playing for a couple years.

With the built-in structure and commitment of basketball gone, I had to think about physical fitness in a context other than team sports. It’s not uncommon for athletes to stop exercising altogether when the whip of a coach is absent, but I had no problem jumping into a new self-designed program that would keep me in shape. I went to the gym every day and pursued various cardio and weight exercises. Here’s my post on diversity in your workout routine. Here’s my post on pushups and crunches.

For exercise I think about two things: cardio and strength training. For cardio I do 10-15 mins on the bike (I read light fiction or magazines) and then 20-25 mins on the treadmill (I listen to music and try to just chill out). My strength training is more experimental. Since I’m no longer playing basketball there’s no external need to build muscle mass, so my motivation / interest fluctuates. On its own, increased strength just feels good, lifting weights uniquely relieves stress, and there are aesthetic / attractiveness benefits, too. Due to my frame and biology, I can put on significant upper body muscle mass within a few months if I keep a routine. But it can be a hassle screwing around with the machines.

A few months ago I started up a more vigorous strength training effort. However, instead of going into familiar free weights and machines, I focused exclusively on pushups, crunches, and pull-ups: bodyweight exercises. Because of my weight, these types of exercises have always been hard — ie the more you weigh, the more weight you’re pushing up. My question was: Can I actually get bigger this way or will I just maintain current strength?

My goal was to do 100 pushups a day, every day, and as many crunches and pull-ups as I could do. Within a few weeks I was doing three sets of pushups (35, 35, 30) in 10-15 mins and within a couple months I could do 50-60 pushups consecutively no problem. (There’s a whole movement around doing 100 pushups consecutively.) I felt / observed significant gains in upper body muscle mass. Most important I had no problem doing them daily because anytime I had some time to kill and a floor I could drop down and get it done. Much harder to invent excuses not to do it!

For Christmas my brother got me Perfect Pushup — two circular disks with handles that you put on the floor and they twist as you go down and push up. It stresses slightly different muscles and supposedly is better for your elbows. At the least using them keeps the basic pushup interesting. Again — avoid boredom by introducing variety into your workout.

Nutrition-wise, my basic operating principle is as it’s always been: “Eat as much food as I can.” I’m always hungry. I try to pre-eat before restaurant meals, I try to go to restaurants with known small eaters so I can finish whatever they don’t eat, and I snack / eat Clif bars throughout the day. So quantity hasn’t changed but quality has. Specifically, I have tried to eat more cottage cheese and nuts (solid sources of protein) and move my PB&J’s to wheat instead of white bread (if you eat PB&J every day like me this makes a difference).

So, after three months of a pushup-centric workout routine combined with a little more focus on my intake, I feel as fit as ever. The numbers bear it out. When I stopped playing ball my weight crept up to 220, even 225 pounds, which at 6′ 4″ I could manage but it still felt a little heavy. Now I’m down to 215 lbs which feels more comfortable. My physique is more cut. This involved no weight machines! Granted, bodyweight exercises will only take you so far — to re-introduce variety and push above my weight, I’m for the moment moving back to machines and free weights — but for the casual fitness person I strongly recommend keeping it simple and doing push-ups, crunches, and pull-ups.

Bottom Line: I highly recommend bodyweight exercises if you want a simple, easy, anywhere way to increase overall strength.