self_made_human
Kai su, teknon?
I'm a transhumanist doctor. In a better world, I wouldn't need to add that as a qualifier to plain old "doctor". It would be taken as granted for someone in the profession of saving lives.
At any rate, I intend to live forever or die trying. See you at Heat Death!
User ID: 454
An Indian Abroad in the UK
There's a Union Jack flying outside my window, juxtaposed against a generally dismal sky, lead gray and swollen with cold rain, just yearning to ruin the aspirations of fresh-faced visitors who would love to picnic in the back garden.
I suppose that's as good a mood as any for writing this post, having spent a week settling in, staring wide-eyed at the way the odd billion or so first-world denizens spend their lives, even in a country that's in genteel decline from its glory days.
Long-time readers here might recall my previous posts from my time in India, as I went from a fresh-faced intern to a cynical, bitter survivor of what passes for medical care there. For those who don't have an encyclopedic knowledge of all moderately-decent posts ever posted on /r/TheMotte, here's a link to my repost on /r/Medicine, since Reddit's abominable search function makes it impossible to dredge up the original, which had one of the few comments Scott makes in these parts on it, still a highlight of my Reddit career:
https://old.reddit.com/r/medicine/comments/j30vj2/my_experience_as_a_frontline_doctor_in_a_3rd/
At the time of writing, I was still yearning for escape from India, a squalid, small-minded and parochial place (although, if I had really wanted to, I could have mostly insulated myself from the worst of it, all that takes is tons of money and a willingness to ignore the human shit and suffering in-between expeditions from one enclave to anotjer).
And I'm not entirely home free, so far, I've passed one of the two licensing exams I need to practice in and emigrate to the UK, but pass that one I did, after studying harder than I ever have in my life (because I cared goddamnit, unlike all the times before when I was coasting through simply because it was expected of me), and in an example of positive reinforcement, it paid off, and I'm spending over a month in the UK, prepping for the second, which can only be given in-country because it's OSCE based.
But I've actually left India, and spent enough time here that I can collect some of my thoughts and musings while the awe has yet to wear off.
You know the first thing I noticed after landing here?
How fucking clean London was. No, really, some Indian cities have tried to clean up their act, but the sheer neatness and tidiness of the place was deeply disconcerting to me. I felt as if I was intruding somewhere I wasn't meant to be, a place kept lovingly clean with the devotion given only to private property back home.
The airport experience wasn't particularly different, most countries take pains to set high standards for their international terminals, being the place where many foreigners make their first and only impressions.
But having boarded the tube, still clutching our luggage close, I stared intently at everything around me, how clean and well-maintained it all was, the drastic improvement in the quality and grammar of all the text I could read, the superior typography of all the advertising.
Relatives who had been in the country had also instilled paranoid notions of how run-down and dangerous the neighborhood (full of immigrants) I was going to live in was. Either they were completely ignorant, or simply clinging to an outdated perception of the place, but it was a sleepy, pretty place, only the skin colors of the locals and endless arrays of convenience stores touting their "afro-caribbean" meats and spices that reinforced that. Still plenty of happy families and expensive cars parked outside, so I quickly dismissed their paranoia.
Oh, and closely tied for second place in terms of things that leapt out at me is how utterly multicultural the UK is. I certainly had heard about it, it would be lax of me to plan to move over without doing my research, and I was somewhat concerned about being buttonholed with other South Asians, but the sheer ease and comfort with which people of grossly different ethnicities interact was cool to see!
Third, but certainly not the least, was how streamlined and easy to use the public transport system was. The London tube certainly seemed intimidating with its half a dozen different lines, but once I examined the maps more carefully, I was able to get the hang of it quite quickly.
The buses run on time, with minimal hassle, and just while the prices certainly seemed steep to my Indian sensibilities, they make sense in context. Not seeing people crushing each other or arguing with a conductor about stops was a shock, leaving aside the fact that the buses themselves didn't drive like maniacs haha.
And London is goddamn empty, no seriously, even if I'm staying in a relatively sleepy part of the place, Central London was practically deserted I'm comparison to the metropolitan cities I'm used to. Traffic seemed minimal, and pedestrians were hardly the crushing mass I expected. Perhaps I need to visit New York again in order to dispel my uneasiness..
And people are generally law abiding. My girlfriend and I probably jaywalked and gave some of the local drivers an aneurysm before we realized that people actually cross the streets in an organized manner, whereas zebra crossings are more of a suggestion than a rule back home.
Oh, and nobody let loose on their horn at us, in fact, I hardly hear them at all! This is fucking alien to me, in India, horns are considered to be an extension of the driver, and the first and last resort for self expression.
Driving fast? Toot.
Driving slow? Toot.
Feeling annoyed? TOOT
Just want to express your sheer gratitude for existence and having a motor vehicle? A little toot for the road.
That sheer cacophony is the Cosmic Microwave Background Noise as far as I'm concerned, and its absence is unsettling haha.
On top of that, people seem quite polite and considerate, albeit that's been my experience with people in general. I guess I look too intimidating to fuck around with, but plenty of people offered helpful unsolicited advice when we ran into issues due to our ignorance as tourists, and it was all deeply appreciated.
We did a round of the local supermarkets, and I was absolutely blown away by the sheer variety on offer, like goddamn, you lot have better Indian cuisine than we do! And it's so convenient, everything comes nicely packaged, you can just buy freshly prepared tandoori chicken without needing to mix up half a dozen spices at home. I can empathize with Gorbachev, the West really does things better.
Also, being a couple is absolutely stress free. My girlfriend and I have been extremely risqué even back home, doing absolutely Bollywood-tier stunts like kissing on a moving train while I was on the platform. Thankfully, nobody made a fuss about it then, barring some dirty looks, but the fact of the matter is that nobody cares about us here, I can kiss her and hug her out in the streets or in the bus without a single fuck given (which I can't say about back in our room ;) )
There's hardly any dust to speak of, I could barely open my windows back home without ending up with noticeable coatings, whereas it's been a week and we don't even need to vacuum or dust.
There's also a notable lack of crushing poverty, it's hard to tell at a glance who is working-class, struggling, or quite wealthy. No signs of any homeless, not that the winter would be kind to them.
But you know what I miss the most, something ubiquitous in India?
Bidets.
Toilet paper is absolutely barbaric. Like seriously, what quirk of history made it so that wiping your ass with paper of all things is taken for granted? How does anyone keep their ass remotely clean?? At this point, the modern Western fetish of eating ass is probably the largest health hazard I can think of hahaha. That's the first thing I'm going to get when I find a place of my own, mark my words.
(This paragraph ought to elevate my post to the level of Culture Warring, if nothing else does haha)
But throwing some heavy shade on my happiness is the slow-motion implosion of the NHS, my employer-to-be for the foreseeable future. The situation is getting pretty bad, elective lists for surgery were already backed up for 2 weeks, now there's serious thought being given to simply unloading patients in the parking lot from the ambulance given the lack of room indoors. People spending a dozen hours in the A and E is commonplace, and even a day or more is a distressingly common occurrence. There are plans to strike in Jan, which I'm not able to participate in, but you bet your ass I would if I could. Things are rapidly becoming untenable, with either a massive shakeup (or more likely a collapse of the NHS followed by privatization) being on the cards.
And you know what? If the NHS did fail, it would still be superior to conditions back home. Please, read my previous post if you want to know what healthcare looks like for a billion odd people, with maybe a couple hundred million able to receive care to a standard that wouldn't provoke a lynch mob in the West.
And the UK is far from the richest part of the West. Americans have significantly more wealth, and salaries are pathetic compared to their US counterparts.
So what if it's in (debatable) decline? As painful as it must seem, there's just so much room before you even approach Third World conditions. Like seriously, you guys have no idea how much worse things can get before it gets that bad.
At any rate, I'm just grateful that the end of my time in India is in sight, and I'm studying my ass off for my last exam, motivated by my sheer dissatisfaction at home, and even more by the absolute utopia that the UK is in comparison. (My girlfriend wishes to add that in her absence I'd be eating microwaved meals and hardly studying, so much love to her 😘)
Here's to things not getting as bad as home, and may I not have to refer to India as that any longer!
self_made_human
Kai su, teknon?
1yr ago
Dr. GPT will see you now
I've often noted around these parts that GPT-4 is a really good clinician. It would be hard for it not to be one, I'd be bloody amazing too if I had quasi-eidetic memory of most relevant diagnostic criteria and guidelines. That being said, just the guidelines alone are next to useless, you need to have the crystalline intelligence to apply it in a specific context.
I'd go so far as to say that it's a better, more competent doctor than the majority of human ones, even if it isn't outright superhuman (I've seen some ridiculously good human ones). I read with some humor an article about how it was tested by some bigshot hospital in the US (Harvard Med?) as a clinical adjunct, but by the end of it, the Clinical Director was praising its bedside manner, in the sense that it was kind, compassionate, patient and understanding, and outright suggested human doctors try and emulate that(!).
However, I have one resounding advantage over it namely that thanks to decades of regulatory bullshit, I have a certificate saying I can legally prescribe meds and it can't. L Bozo 💅, as the kids these days say haha.
Still, it would be remiss of me not to make use of it to improve my own skills while that's still relevant, so of late, I've tried using it to hone my own clinical skills. I have it write clinical vignettes that I solve, and then it grades me on my performance.
So far, it's done an excellent job, and funnily enough, I feel a tingling of pride when it says I did a good job. Why wouldn't I? It's a smarter and more decent entity than most humans I've had the displeasure of meeting.
Here's an example:
Clinical Vignette: A 42-year-old male patient presents to the emergency department with sudden onset severe, colicky pain in the right flank and lower abdomen that began 6 hours ago. He also reports nausea, vomiting, and an urgent need to urinate. The patient has a history of hypertension, which is controlled with medication. His vital signs are: blood pressure of 145/95 mmHg, pulse rate of 100 bpm, respiratory rate of 20 breaths/min, and temperature of 99.1°F (37.3°C). Upon physical examination, there is tenderness to percussion on the right side of the lower abdomen and right flank, and the patient appears restless, frequently shifting positions.
What is your diagnosis and treatment plan?
My response:
My diagnosis is a case of a stone in the right ureter.
In terms of management, I'll start IV fluids and insert a catheter. IV antibiotics are to be started according to hospital guidelines.
IV morphine should be given as pain control, along with IV antiemetics.
An Xray KUB or USG should be ordered to identify the size of the stone, and then further treatment depends on said size. A wait and watch policy is appropriate for sub 2mm stones, while larger ones might need surgical removal.
Assessment:
Grade: A
Your response demonstrates a strong understanding of the clinical presentation and management of ureteral stones.
Diagnosis: Your diagnosis of a stone in the right ureter is appropriate given the patient's sudden onset severe, colicky pain in the right flank and lower abdomen, nausea, vomiting, and urgency to urinate. The physical examination findings, such as tenderness to percussion and restlessness, also support this diagnosis.
Treatment Plan: Your plan to start IV fluids and insert a catheter is appropriate for initial management, monitoring, and providing relief to the patient. Initiating IV antibiotics may not be necessary unless there are signs of infection or sepsis; however, following hospital guidelines is always a wise choice.
Administering IV morphine for pain control and IV antiemetics for nausea and vomiting are essential parts of the treatment plan.
Ordering an X-ray KUB (kidneys, ureters, and bladder) or ultrasound (USG) is appropriate to confirm the diagnosis and determine the size of the stone, which will guide further management. As you mentioned, a conservative approach of observation and pain management may be suitable for small stones (less than 5 mm) that are likely to pass spontaneously, while larger stones may require surgical removal or other intervention, such as extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy.
Overall, your response demonstrates excellent clinical knowledge in identifying and managing a patient with suspected ureteral stone. Well done!
Honestly, as a pedagogical tool for medical education, it's unparalleled. I paid a great deal less attention in med school than I should have, from the month of anatomy classes I can't remember because I was getting frisky under the bench, to the period where I was severely depressed and barely dragging myself to class. I used to be very insecure about my knowledge base, but I did pull together and single-handedly teach myself most of the things I'd glossed over while preparing for the PLAB.
I've tried a similar method on GPT-3.5, and it was inadequate to the task. It made a lot more errors, and ended up confused often enough to be annoying. Till date, I haven't seen 4 fumble the bag once. I'd put their competency around the marks of a decent final year student versus a competent postgraduate resident
self_made_human
Kai su, teknon?
1yr ago
So there is the minor problem that I have with YIMBY people - why do you think that building more will actually solve the problem with unaffordable housing? We have been adding lanes to highways since time immemorial (aka the 50s) and the congestion is still here.
Ah, good old "induced" demand. Or, to put it more properly, plain old demand.
If a 4 lane highway was fully congested, such that X number of people could travel on it, and it was expanded to 8 lanes keeping commute times equal, that's 2X the number of people traveling that route.
Those people don't appear from a vacuum, they're primarily composed of those for whom the marginal cost of travel has dropped to the extent that they are now willing to take that route by car, instead of an alternative means of transportation, or even simply not traveling at all. Given their revealed preferences, they have to be getting some utility from the change, or they wouldn't bother.
Similarly, even if more housing was built, and prices didn't drop by much, that would still be additional people finally able to purchase the home of their dreams, at a price they're evidently willing to pay for. That price may seem stiff to you, or you simply might not share their priorities, but at the end of the day, people are getting what they want, namely a house with the amenities of a big city.
self_made_human
Kai su, teknon?
10mo ago
What the hell is going on in Russia?
I've been following the Russo-Ukrainian war since the livestreaming of the first tank that spooked some poor border guard, and frankly speaking the whole affair has been great for calibrating my epistemics.
Did I expect the "3 days to Kiev" thing to work out? Yes. I thought Ukraine was fucked.
I was also wrong about the duration of the war, for reasons little more than vibes going off war exhaustion, I expected the fighting to wrap up in a year. Still going.
Did I expect the UA counteroffensive to be a success? Yes, I was sufficiently inundated with pro-Ukrainian memes and their anti-Russian counterparts that I thought the Russians would fold to a stiff breeze.
Turns out that attacking is a lot harder than defending, especially when the offensive was widely telegraphed and even your relatively incompetent adversary had plenty of time to prepare accordingly.
My takeaway from the above is that forecasting something as anti-inductive as war is incredibly difficult, and that's it far too easy to fall for a cheerleader effect. I wanted Ukraine to win, and badly, and not only was this desire reflected in the sources of news I peruse, but the sheer hatred for the Russian side was sufficient to bury most evidence of them ever doing anything right. The Just World fallacy is hard to avoid personally if all your sources of information fall prey to it.
On /r/CombatFootage, anything remotely pro-Russian, or even depicting their success without obvious bias, gets buried. While I'm fond of /r/NonCredibleDefense, its NAFO sympathies make a honest calibration impossible, and as the name suggests, its members aren't particularly focused on academic rigor or epistemics.
But with that said, the whole Wagner affair confuses me.
Prigozhin managed to get within 2 hours of Moscow, prompting a panicked evacuation, and then suddenly stopped and took his ball home.
What the fuck? In normal circumstances, I'd say he just signed his death warrant, is Putin really going to forgive him for his quasi-coup? Wagner shot down around 7 Russian aircraft in the process!
And there I was thinking Lukashenko was largely a lap dog, unable to exercise agency except when it came to desperately avoiding sending Belarusian troops to Ukraine since it would upend the only thing keeping his dictatorship going. How did he become powerful enough to mediate a truce between Prigozhin and Putin?
It's not like the dust has settled, even leaving aside more questionable rumors, I've seen footage of the VDV cartel-killing one of their own for expressing sympathies for Wagner. Even if Prigozhin himself manages to avoid most consequences of his actions, his men are going to be making their pants desert-camo'd.
So far, I've only come up with one model that I think reasonably fits the evidence, albeit it's more consistent with the era of warlords and medieval feudalism than what I expect to see even in a failed state today:
Prigozhin is actually loyal, or at least he thinks of himself that way, and came to believe that Putin, like the well-meaning Emperor kept in the dark by a coterie of eunuchs (Shoigu and Co), simply wasn't involved in the attempts by the Russian MOD to swallow up Wagner whole.
Thus, he embarked on his crusade more as a demonstration of his ability to perform a coup, rather than a genuine desire to do so. Like an indecisive general crossing the Rubicon, shaking his fist in the direction of Rome and then high-tailing it back.
Cause some chaos and embarrassment, but stopping before what he thinks the red lines are, namely an occupation of Moscow.
I'd also wager that Lukashenko has more agency and freedom than most suspect, or rather Putin's power has declined relatively, such that he can credibly offer to shelter Prigozhin and fend off the dogs.
As far as I can tell, his gambit only partially worked, because Shoigu hasn't gone anywhere, and Prigozhin ended up like a dog that finally caught that damn car but isn't sure what to do with it.
"Sure, let's try and Thunder Run to Moscow, I'm sure we'll run into some real resistance along the way, and we can both rattle sabres at each other and go home."
"Huh. This is awkward, everyone is just giving up and letting us walk right past them. Might as well shoot down a few helicopters, they're the only things that have directly engaged us."
"Uh.. We're about two hours away from Moscow. Now what?"
I'm not going to weight my assessment heavily since I claim no particular expertise, but I'm outlining it here for the more knowledgeable to poke at.
I'd like to see everyone at least attempt to make concrete predictions about the near future. Does Prig make it out of this alive and with his power base intact? Does Putin slip him some unusually heavy and radioactive teabags?
self_made_human
Kai su, teknon?
1yr ago
Apparently sticking out your tongue is actually a greeting in Tibet. I imagine that the quip about sucking on it was entirely in jest, blown way out of proportion by the usual pedo-panickers in the West.
self_made_human
Kai su, teknon?
7mo ago
Trudeau accuses India in killing of Sikh leader on Canadian soil
First of all, I want to state that my epistemic status is huh, rather an informed opinion, but I struggle to think of anyone in a better position on The Motte to discuss this, so bear with me.
India has had its share of irredentists, separatists and good old fashioned terrorists over the years. You have the Maoists still lurking in the north east, playing hot and cold with the government via their jungle boogaloo. Islamic terrorism was a serious issue in 2010s, though it's died down. There were the Tamil Tigers down south, who proved a severe PITA for a decade or so, and then the Khalistanis, who have been largely neutered in-country but find refuge in the numerous, prosperous Sikh diaspora abroad.
The last two have had the dubious distinction of getting confirmed kills on two Indian Prime Ministers (relatives to boot).
Khalistan is the supposed homeland of the Sikh peoples, largely surrounding Punjab in the west. Unable to get it during the original Partition of India, they waged a brutal war against the Indian government for decades, peaking in the 70s and 80s. There were quite a few pogroms and riots, with Hindu on Sikh violence in the rest of India, and vice versa in their population centers.
These days, the movement is moribund within India itself, most young Sikhs don't really pay it any heed, and the older aren't the demographic to go planting bombs for the large part. Sikhs are well integrated into Indian society, and haven't had that consistent friction that the Muslims have had with their Hindu co-ethnics.
Not that you'd know this abroad. Much like IRA sympathizers hanging around in New Jersey bars, the exodus of Sikhs in the 70s and 80s ossified in amber a large migrant population with a grudge to bear against the Indian government.
I'd draw a distinction between these first-wave migrants, and a more recent influx of Sikhs who are drawn more by the prospects of making it big in Canada, or the West in general, rather than any real grievance.
While Khalistan is dead in the water, it's a popular rallying cry there, with Western governments treating it with a mixture of bemused tolerance and kid-gloves for fear of pissing off the strong Sikh voting bloc. Speaking ill of them is, from what I've heard, a surefire way of losing a narrow election, but they're otherwise model citizens and nobody wants to press the issue.
Now, Modi stands accused of the shooting of this dude sometime in June, when he was shot by unidentified gunmen in the parking lot of a gurdwara in Surrey. If there's more substance to the accusation, they haven't been made public, but the heads of state have met to hash it out.
From what I can tell, Modi's response was "we didn't do it, but if it happened, he had it coming", strongly protesting the accusations while demanding Canada be less lenient in harboring terrorists.
Modi also stands accused of the assassination in Lahore of another Khalistan leader, not that anyone particularly cared at the time, and that's just the usual India-Pakistan bhai-bhai at play.
That's the gist of it, on one hand, we have the fact that India has largely refrained from extraterritorial assassinations, certainly not to the degree that the US, Russia or Israel are fond of. I struggle to think of a single example, not that I'm an expert.
On the other, who the fuck else has a motive to whack the dude? I don't think relations between India and Canada are bad enough for the latter to make entirely unfounded accusations, and they've even roped in a few other countries like the UK and US to bring diplomatic pressure to bear. The Head of Foreign Intelligence for India was kicked out from Canada, and some bloke named Oliver Sylvester was the tit to that tat.
I'd wager 50% odds that India was responsible based on the balance of evidence, and I wonder if this will be a flash in the pan that peters out when the Sikhs are mollified, or if Canada really wants to pick a fight with an otherwise neutral/positively inclined major nation.
But if you're curious, this means zilch in terms of impact on Modi's popularity of home, you think supporters of a strongman are going to be mad when he strongmans? Even the libs over at /r/India who foam at the mouth at the sight of Modi are of the opinion he had it coming.
There are few places on the internet I've got more disdain for than RationalWiki. It's a cesspit, on the same tier as /r/Sneerclub. Even rdrama is at least funny and not nearly as malicious.
And it's also squatting on a perfectly good name for a wiki that could deal with actual rationality for one.
self_made_human
Kai su, teknon?
9mo ago
Race is far too predictive for me to give this real credence. I'm only racist because I seek to understand reality, and unfortunately reality is racist as hell.
It's rare indeed that a rational agent is worse off with additional Bayesian evidence, and as mentioned, race is very strong evidence.
It's certainly not everything, as even most HBD-ers would accept, but goddamn do theories for why the world looks the way it does fail utterly without considering it.
As far as I'm concerned, the policy of acknowledging both race and additional information you have about a person is strictly superior to doing the same but ignoring race. I'd be more concerned if a black doctor was treating me since I know about how much AA they receive, I'd be less concerned if the doctor publicized his SAT score or had other objective markers for performance like a specialization in a field where his race counts for nothing (I doubt that's the case in the US, but I could be wrong). This is where AA in general taints by association, said doctor could absolutely be someone who managed to get in without not so subtle nudges, but since they usually lack a way to prove it, they're automatically discounted in the eyes of a rational agent with no additional information.
To use your example of running into a young male in a hoody at night, yes you should be significantly more concerned if he was black, the stats don't lie. Certainly you should avoid being in that situation in the first place, but feel no shame about crossing the street well in advance.
self_made_human
Kai su, teknon?
3mo ago
Ah, good old gain of function research, the gift that keeps on giving.
Why did we have to end up in the dystopia (well, maybe) where most of the useful biotech/genetic engineering like germline editing, gene drives and the like are either stifled in the crib or slowed down to a crawl while something as insanely risky and largely useless like GOFR for lethality is legal and far too easy to do for even just CV padding?
The funniest part about this particular debacle is that the paper in question had a paragraph on ethical issues/IRB clearances, and the only thing it included was assent, from a Chinese military hospital, that the mice in question were treated humanely.
Right.
That's by far the biggest concern. The only concern worth noting.
I'd bash my head against a wall, but I'm already short on neurons to spare.
An Indian Abroad in Thailand
After a pretty enjoyable time in Phuket and Pattaya, I find myself on the highway heading back to Bangkok, and ended up deciding to pen some of my observations along the way.
To wit, I visited Thailand while being quite ignorant about it. As a holiday destination, it's become quite cliché as a haunt for upper middle class Indians, and my residual snobbery kept me from really looking into the place or culture.
If I had been asked about my knowledge before the journey, I'd have scratched my head and gone, "Uh, ladyboys, beaches, Buddhist temples? Weren't they once conquered by some of the more entrepreneurial South Indian kings? (🇮🇳 Jai Hind!)"
Which isn't wrong, per se, but hardly comprehensive.
Since I don't want to bore you with the travelogues of a homebody, I'll stick to simply listing things that surprised my preconceived notions:
Firstly, I was taken aback by how fair Thai people tend to be. I thought they'd be swarthier, akin to Malaysians or Indonesians, but quite a large fraction could easily pass as Caucasian if not for their facial features. The ones who are really tanned seem to be people who work out under the sun, having skin tones I expect.
I find this rather perplexing, given that Thailand is at a latitude lower than the bulk of India, and their counterparts are unapologetically brown.
Secondly, they're piss poor at speaking English. In my entire time here, I have yet to encounter one person fluent in the language, even at places catering to tourists, including at the 5 star hotels I lounged at. The majority only understand a few words or key phrases, about enough to herd tourists or figure out if you want a taxi or a handjob.
I reckon this is due to colonialism, or rather a lack of it. Thailand is practically unique in SEA in never having been conquered by a European power, which usually inculcates more interest or tradition in speaking English or other tongues. Certainly the modal Indian speaks a great deal better English than the Thai do. I'd have expected to be doing somewhat better, but I guess they're getting by with tourists, so kudos to them.
On the topic of tourists, there are loads of Indians here. I mean tens of thousands at the minimum, while Phuket was more cosmopolitan, Pattaya's beaches are 50:50 Indian to local Thai. This translates to about 20 Indian restaurants in spitting distance of my hotel, and tour guides so used to wrangling Indians that they picked up some Hindi and play Bollywood playlists on boats.
Another fixture are the hordes of Russian tourists, to the extent that most of the signage in the cities include Cyrillic. I'm given to understand that a large fraction are draft dodgers laying low in a low COL locale, while sipping cocktails and getting good head. Plenty of families too, either in toto or just vacationing. (A question to @DaseindustriesLtd, what is it with Russian men and the most unflattering buzzcuts?)
Thailand is really clean. Now, as an Indian I admittedly have low standards, but I did spend a while in the UK, so I have a fresh benchmark to judge by. The streets are spotless, the beaches largely free of rubbish, which is a surprise because Indian tourists aren't known for their civic sense, at least back in India.
The roads are in great condition, to the extent that I need reminder that I'm not in a First World country. People keep their cars in great condition, and love ricing them out out too. Traffic is quite civil, and people are quite loathe to use their horns, whereas that's the microwave background radiation of Indian cities.
But the most perplexing thing is the sheer number of pickup trucks here. Seriously, I thought I ended up catching a flight to Texas, a quarter of the cars here are pickups, and I have yet to see the majority being used as utility vehicles. It's not like they're lugging anything of note around, most of them seem to be people carriers and nothing more. (One can argue that's the case back in the States too, at least I haven't seen any truck nuts!)
When it comes to culture, well, I've never seen a more permissive society in my life! Sex work is absolutely normalized, and I find myself scratching my head as to how this state of affairs arose when the country lies so close to significantly more conservative societies to the west and east.
I managed to ditch my parents back at the hotel, and went on a walking tour of the red light district literally next door to where we were staying (an upscale place mind you). There was a street about 300 meters long jam packed with titty bars, strip clubs and miscellaneous hangouts for ladies of the night. Far from the bars being a front for prostitution, the prostitution was a front for the bars. It was like a buffet table of women beckoning you over to grab a slice of ass, they're just sitting on bar stools and trying to outdo each other, or taking turns dancing (rather shittily) on the streets. Now, my parents would probably disown me if I took a hooker back to my hotel room next to theirs, not to mention I have a girlfriend, so it was all look and don't touch for me. I did get a hoot out of seeing several pairs of Russian women scrambling to get through the street, probably on the way back to their hotel. They were blushing so hard you could grill a steak on their cheeks.
Funnier still were the morbidly obese Western sexpats trying to hire a bike to drive them back, when they got on the back behind the tiny Thai drivers, the vehicles often threatened to rear up in fright.
Weed's been legalized here since 2019, but apparently smoking it anywhere in public is a crime. Given that I can never be arsed to roll joints myself, and I could get bhaang for about a hundredth the price of edibles there, I didn't really bother.
If you check my post history, you'll find my tale of attending a cabaret show, one run by ladyboys. And I genuinely couldn't tell that they weren't real women, despite straining my eyes trying. Is there something about the Asian physiognomy that makes it easier for them to pass? The closest thing I found to a tell was the waists, but even then they were well within the range for natal women. The railway community in the West take note, that's how you pass with flying colors.
A lot of the country seems really familiar to Indians. The vegetation is largely the same, albeit we haven't been graced with durian (which doesn't smell nearly as bad as I've heard, not that I tried it). It's funny to see Westerners fawn over elephants, monkeys and sedated tigers, when I was yawning hard at the idea. It was supremely funny to have a tour guide stop our boat to show off mudskippers, as if "walking fish" were a big deal. You can get some mild deja vu from seeing the clear influence of Indian culture in Thailand, though the vocabulary has diverged so far from the old Pali and Sanskrit roots that it's not really legible. Their Buddhist and Hindu syncretic religion is recognizable at the least, but they don't really seem all that religious.
Overall, I've been quite impressed with the place, and I can only hope that Indian cities resemble their Thai cousins. That's still quite an ask, since Thailand is nowhere near as crowded as India, there's room to breathe. But they're far better positioned to appeal to tourists, and I wager that it's only the massive injections of cash into their economy that allow them to have such a higher standard of living.
I'd be tempted to live here, if there was anything to do outside cater to tourists, and it wasn't abominably hot and muggy throughout the year, not to mention that you can't really get by with English alone. Still, I see why it's so popular with Western expats, and Chang beer is certainly everything /r/5555555 hyped it up to be.
self_made_human
Kai su, teknon?
7mo ago
This move to use Bharat in internationally visible context can be seen as normalizing and laying the ground work to a full-on name change. The motivation behind is by some commentators impugned to be Hindutva, the ideology of, in the opinion of these commentators, of "othering" non-Hindu groups. The logic being that India being an English word privileges English speaking-Indian, but since they lack an Asabiyyah, this isn't as dangerous affirming the Hindu name, empowring Hindus who do not lack it.
Instead of framing this as a Hindus vs Everyone Else kind of deal, in my eyes it's more emblematic of another major cultural divide in India, namely the North vs the South.
North India is majority Hindi speaking, whereas the southern states speak Tamil, Telegu and the like instead.
The latter have long been peeved about the BJP government's* tendency to name new projects/initiatives with Hindi terms, or outright rename the old commonly established English ones. This is seen as a form of cultural imperialism or at least chauvinism, since it alienates people from the south who might not be fluent or even conversant in Hindi.
*To be fair, the INC did plenty of Hindi-washing too, the BJP just leans into it more and unapologetically so.
English, while a foreign language, is still the lingua franca for educated Indians, and while Hindi has become far more common in the youth born of non-Hindi speaking parents, many prefer to use a "neutral" language instead of one that implicitly preferences one regional language, which despite what some might claim, is far from universal.
Of course there's a bit of the 'ol alienation of Muslims afoot, but this is a topic that pisses off even the orthodox Hindu majority down south.
As far as I'm concerned, Bharat just sounds way worse than India, and there's no real reason for a switch beyond inflating Modi's ego.
This strikes me as extremely unlikely, verging on outright nonsense.
Let's look at the diseases in question, the initial cluster, namely the ones that Sarno isn't alone in suspecting are psychosomatic, share one commonality that they don't have signs but have symptoms, a bit of medical jargon that simply means that they have no visible-to-outsiders characteristics barring what the patient themselves report and feel. The only exception is joint hypermobility here.
This is reasonable enough, practically every doctor alive, especially in psychiatric practise, has seen such cases, and so have I. It's not much of a stretch to think that the human mind can create something as entirely subjective as pain by itself, in a myriad of different presentations. And invasive tests usually find little to no organic changes that could plausibly cause said symptoms.
Now, the ones Sarno thinks are psychologically induced go way beyond the plausibility of the above, for reasons that might not be obvious to non-medical people. So I'll take a crack at why this makes little sense:
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First and most obviously, they have physical signs and large changes in a consistent and syndromic fashion. I doubt the brain has the ability to cause sudden histamine release and hive outbreaks no matter how stressed someone is.
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Gluten sensitivity is characterized by a testable and obvious change, namely the production of tissue transglutaminase antibodies that are detectable in the blood, prior to confirmation by a biopsy from the intestines. It makes absolutely no sense that the manifestation of anxiety and depression would be the sudden onset of an autoimmune disease with obvious markers! And why to gluten of all things??
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Hell, IBD/Crohns are comorbid with depression because they're extremely annoying and debilitating diseases that cause a massive drop in QOL, I'd certainly be sad if not depressed were I diagnosed with that!
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Herniated discs?? You can literally see them on MRI most of the time, how exactly is the brain buck-breaking the spine??
All of these diseases have clear non-psychiatric pathologies, and obvious objective changes, and unless someone manages to dig up Sarno's figures and at least 3 or more studies confirming its individual claims, I would toss this in the trashcan without further debate.
Edit: I confused IBS and IBD, there's some debate on whether or not the first has psychological links, and there isn't any obvious etiology that I'm aware of.
I MADE IT
FUCK THE HATERS
Ahem. Sorry. Got a bit too hyped up, but I've gotta be my own hype man, it's 11 pm at the hospital.
@Throwaway05, @TheDag, @AhhhTheFrench, @faul_sname, @whoeveritmayfuckingconcern (there's a lot of people who've egged me on over the years, I'll get to you all):
I got a match offer in psychiatry! While Scotland might be a little bit on the dreary side, well, endless exams are even drearier.
I was in an awkward position. If I'd done a lot better, I'd be confident in an offer. If I'd done way worse, I could have washed my hands of it and resolved to grit my teeth to prep yet another year of my short life. But I did well, but not so good that I wasn't on tenterhooks.
Most British doctors don't match on their first try, barring the least craved options like GP.
But psychiatry went from having a competition ratio lower than 1, to 9:1.
The exam got ten times harder since I began planning for it. Doubled in the span of a year. Yet I beat it. Beat all the bastards.
No more wannabe psychiatrist, upgraded to shrink-in-training. Then, barring an act of Satan, a bona fide shrink and not a LARPer
I might hold the current offer in the (mildly vain) hope that I get an upgrade to somewhere less rural, but I'll still take it. (Hmm, it seems that the hold window is already over, it seems to be take it or leave it, but I'll still ask around)
Fuck yeah. Gonna drink a lot of scotch and fuck a lot of bitches. I'm getting out.
Now, it's shame I've got 9 hours left at work, and while its going to be a slow night, I'd rather not lose my Indian license by drinking on duty. That can wait till the morning.
I've been thinking about Indians today.
I guess someone has to.
What is going on in India with their leadership? Why are Indians so bad in India but ones that come hear and get a taste of American corporate structure so good? I know this is probably a best fit for the questions thread, but this legitimately puzzles me.
Filtering. Filtering. Almost there.. No, you've still got coffee grounds left over. Keep at it champ.
The average Indian who arrives in the US is not representative of a random sampling of the native population. I'd know, I am one (Indian that is, I haven't been in the States since the NY skyline was a tad bit different).
The number of would be immigrants is far larger than the number that get through. You're filtering for IQ, conscientiousness and a million other things, leaving aside differences in drive that can motivate someone to cross a couple oceans and establish themselves far from home. That's before even getting into sociocultural aspects.
Leadership is certainly a part of it, at least if you're imagining just taking the same group of people and transplanting them under new management. Indian managers, in India, suck ass. They're mostly stick and little carrot, when they're not sodomizing you with it. Our societal norms and governmental system, while not outright dysfunctional, are still glaringly suboptimal in many regards. Being an entrepreneur is god knows how many times easier in the States, and so is relying on talent and work ethic to pay dividends.
The worst part of India, as most Indians who've escaped would tell you, is all the other Indians. The systemic failings are so coup-complete that the best recourse for a talented Indian is to take his talent elsewhere.
This strict system of skimming off the top is how a country that has, the last time I checked reliable figures, an average IQ in the upper 70s or low 80s, manages to contribute the single most successful ethnic group in terms of average income in the US.
There are plenty of other HBD-related factors, IQ here is not distributed as it would be in a homogenous population. I have good reason to believe that the upper caste/Brahmins are smarter on average, and I'm not one myself, just a cut above what would count as so underprivileged that I'd get AA in India. Millennia of strict endogamy and self-selecting for intellectual pursuits does funny things, just look at the Jews (though they were forced into their role more than willing adopters). And these upper caste people are disproportionately likely to be immigrants to the US. Sadly the matter isn't remotely as well researched as HBD in the US, not that I'm not convinced by available evidence.
Presumably this also answers @sickamore 's question, so I'm not going to duplicate it.
self_made_human
Kai su, teknon?
1yr ago
Even with my minimal interest in being there, I'm always happy when I see the untamed corners of the internet flourish, or at least live to fight another day. Seeing actual unfiltered human output, even if 90% of it is painfully juvenile, is a breath of fresh air. May the agrarians Down Under And To The Side stay online even in the face of perfidy and outrage haha
I spent a distressingly long amount of time thinking that the US and the EU were peers, or that most people can be truly equanimous between them.
Then I saw that an electrician in the US often outearns a UK professor/doctor/senior engineer, owns a bigger house, has more cars, and can enjoy the breadth of half a continent, and a proper continent at that.
So what if the Euros have socialized healthcare? At least in the UK (not EU, I know), the NHS is absolutely swamped and gasping for breadth, with elective surgeries having waitlists months long, and if I wanted to have my ADHD diagnosis ratified, I have to settle for a two year waiting period for an NHS shrink, or spend upwards of 800 GBP like 2rafa said was typical for even a teleconsult from a private consultant.
Everything is smaller, and often just a bit shabbier there. Even I, someone who lives somewhere barely acceptable to modern sensibilities, can clearly see that and plan accordingly.
self_made_human
Kai su, teknon?
1yr ago
A lot of sputtering disgust, and not much in the way of rational argument that I can see.
I am a doctor, my life's work is healing people, extending their healthy lives and keeping sickness and death at bay. I'm just less fundamentally incoherent than people who can perform such a duty and still not be explicitly transhumanist.
I applaud surrogacy. As far as I'm concerned, two people making uncoerced positive sum (to them) transactions is something eminently desirable, and if I find a specific case reprehensible, that's no grounds for me to stick my nose into their business. Someone suffering from infertility (or simply unable or unwilling to childbear) gets the gift of parenthood, and someone with a functional uterus gets a big chunk of cash, and a baby ends up with devoted and well off parents who are immensely motivated to care for it. Neither you nor I have any grounds to meddle, and I feel the same visceral disgust at your disgust as you do for people not harming you in the least.
If my libertarian tendencies weren't obvious enough, I also fully support people doing whatever the hell they want with their bodies, to the extent it doesn't outright harm others. You want to chop off your balls? Go ahead fam. Replace your nipples with subwoofers and your bones with titanium? Fuck my shit up. Not my business, not that I'd want to say no in the first place.
Despite my transhumanism, I don't endorse the modern transgender movement! Most of it appears to be pure social contagion in the mentally unwell, and even the best modern surgical and pharmaceutical interventions are far too crude to make you but a superficial mockery of the other sex.
But that's today's failure, not an indefinite moratorium on sex transition. If we had the technology to safely (ideally reversibly) transition people to the opposite sex at a cellular level, such that they were functionally indistinguishable from someone assigned the same gender at birth, then I see no reason to object! I wouldn't fuck a transwoman today, but I would fuck this hypothetical one, because all of my current objections such as the uncanny appearance, smell, texture, hormonal imbalance, infertility etc become utterly irrelevant.
At any rate, I don't expect to successfully argue you out of your aesthetic objections, I simply don't see a better reason for them than that you simply don't like it. That's perfectly fine, your utility function is yours and brooks no argument, but that should at least be obvious to others without such conditions.
self_made_human
Kai su, teknon?
3mo ago
I have little regard for the pedo-panic in the first place, and this is even more weaksauce compared to that.
If you're at the point where children doing entirely innocuous things, in modest clothing, is somehow a bad thing because you're worried some pedo will use it as jerkoff material, then we're at about the point where audio-visual recording of just about anyone and anything is off the table, and maybe even a ban on thinking about the children, you creep.
It also is entirely pointless to forbid it now, even for the ever illusive concerns of it ending up in AI training data. You don't think there's enough out there that people aren't making photorealistic artifical CSAM, in both photographic and video form? The cat is out of the bag, and while I'm sure there are some pedophiles who have a fetish for jailbait/"real" children, barring about 99.99% of parents from recording their kids and sharing it is so grossly overkill it's demented. You take a video of your daughter jumping on a trampoline and upload it on Insta? Well, about 6 frames can be construed as an "upskirt" shot, enjoy your ban. Discord is already banning people without recourse, including entire discord servers, if a single still image (that bald dude munching popcorn used as a reaction image), is shared, because their heuristics recognize it as a frame shared with a flagged CSAM video.
The reasonable solution, as far as I'm concerned, is to not care, or at least find something more concrete to worry about.
self_made_human
Kai su, teknon?
1yr ago
My grandpa has absolutely skewed my understanding of what a "normal" old person is supposed to be like.
He was performing surgeries himself till he was 80, assisting in them till he was 85, seeing patients in his clinic till he was 91 and the pandemic hit, and now he's 94 and still largely in control of his faculties even as his cognitive functions have obviously declined.
I see a doddering old fool and immediately assume he's something like 90, only to be embarrassed when they're a ripe young age of 75, hard to remember that people mostly end up senile by their late 80s!
self_made_human
Kai su, teknon?
9mo ago
Nevertheless, it’s evident the author himself is skeptical. He spends a lengthy section of the book detailing how JBP himself collapsed into a highly dysfunctional and disorganized existence
Reality is not a morality play, it's perfectly possible for someone to vocally endorse the optimal strategy and yet have it fail them (or him fail it).
The benefits of low hanging fruit like working out, good grooming and fashion are so blatantly obvious that one man's failures do not derail them. I'm sure the author doesn't hold Jordan as the sole argument, but I still can't see it being true.
Improvement is the other strategy which deserves a response; and my response is that I’m far from convinced. The few instances in which I’ve had success with women have had an almost random quality to them, and have been seemingly unrelated to any obvious self-improvement project. Lately I’ve greatly improved both my wealth and general status, and yet success has been sorely lacking.
Scott drew attention to a semi-serious analogue to micromorts, micromarriages, as in an action that has a 1/millionth chance of getting you married. I posit that it's obvious that microfucks are a useful concept too, and that while you any individual act of self improvement cannot be guaranteed to lead to getting laid, they tend to add up over time if you're being diligent.
Handsome people are already born with a lot of (micro)fucks to give, but for the rest of us, we have to work to earn them. Very little guarantees getting laid, short of paying for it in cold hard cash, but it's still worth trying.
In my reply to Cjet, I elaborated on why, despite being significantly above average (at least compared to my peers), I have immense sympathy for incels and incel-adjacent people.
As such, while I wouldn't go as far as to call myself a Chad, I'm certainly further on that end of the spectrum than the other. I still have immense sympathy for incels/average dudes, because I had to deal with raging, all consuming libido for years, and still had dry spells afterwards. I look at the latter, and think "there but for for the grace of God go I". The Chads (and women) simply don't understand what torture that is, how corrosive it can be to your self esteem, even if most of your peers are in similar straits.
Frankly, if you’re having trouble with women as a young man – and I speak as a young man who has had much trouble with women – the problem is likely to get worse with age.
Others have already pointed out that women tend to prefer older men, at least in the age range when men are still desperately horny.
Last but not least, a question to open further discussion: what is the optimal strategy, both in general and in more detail (i.e. should you improve, and what aspect of yourself or your dating approach is most fruitful to improve?).
Firstly, you have to at least try at the "improvement" category. Go to the gym, dress better, get a nice haircut.
If you're extremely unlucky, then yes, this may not suffice, but I feel no qualms about endorsing it in general.
You are far less likely to improve things like height/intelligence/charisma. Some of that isn't outright impossible, since you can always do limb lengthening or keep on hitting the field till you brute force a pickup strategy that works. It's simply not productive.
That being said, it really is a numbers game. If you never try you'll never know, and modern men have a degree of shame and fear that is blatantly counterproductive when you don't have to live in a tribe with the same dozen women your entire life, who gossip about your pitiful failure to court them all. Hit on women goddammit!
Finally, avoid the apps, unless you're in the lucky 10% who get all the goods, in which case my advice isn't for you. For the majority of men, it's a painful, soul sucking process that only dents your self-esteem.
I am unusually good at both in-person flirtation and sliding into DMs, but the advice is still true for the average man. Women are far less picky face to face, and you get far more than a fleeting moment of her attention.
That about sums it up when it comes to general purpose advice, everything else must be tailored to your individual needs.
Addendum:
I'm not being facetious, but my (sweet and loving) girlfriend was looking over my shoulder while I write this post (of all the hundreds I've written lately!).
She would like to make the following statements, written by her own hand on my phone:
Do not listen to anything he said. Doesn't apply to most women. If I slide into her DM, don't expect to get anywhere. My boyfriend vastly overestimates his prowess in the matter of flirtation. He is a very nice man, and that is the 1sf and most important thing g. Women have a radar in detecting fake vs real. I was the one who asked him out, yes that does happen, but it was not because of the flirtatious attitude. Tbh, It was painful. Be yourself. Not everyone is suited to everyone. I can assure you, I like him way before he started flirting. Cause I thought we had a genuine connection and I cud talk to him. That is what we want I the end, someone to talk to, make a life with. Had I not liked him before, his flirting wud have been construed as creepy. So, find out what u like in a woman, and stick to that. Don't slide into peoples dm'z. I assure u, that is a full proof way of getting blocked.
Addendum to the addendum:
Thank you sweetie, of course you're right :*
(Quick, she's looking away!)
Ahem, I would like to add another point to my list of general advice.
Do not take dating advice from women.
I was actually the one who started flirting with her weeks before she even noticed, even if she was the one to ask me out on a date and the one who pulled me in for a kiss. Her mom called me handsome the day the two of them first saw me 😉
That's about it, I don't want to get too saccharine haha.
I am in two minds on the matter.
Primarily, I have strong libertarian sympathies. I would prefer, for myself, the absolute right to choose any procedure for any reason (personal finance and avoidance of externalities allowing), and my standards for informed consent are "I explained to you, quite simply, that there's always a potential for things to go wrong, and now that they did, that's unfortunate, but you knew what you were getting into".
Unfortunately, this does have negative consequences. I am mostly willing to accept that, but all else failing, I would at least hope for a formal certification of a person as a "sophisticated patient", in much the same way that the FTC declares certain people sophisticated investors and allows them them to indulge in high risk (and high reward!) activities that they deem too dangerous for gullible proles.
In practise, this is a de-facto standard doctors extend to other doctors under their care. The gynecologist we saw would normally refuse to insert an IUD in a nulliparous unmarried woman, but when my girlfriend and I could argue UKMEC guidelines with her and point out that the benefits outweighed the risks (even if not as much as oral contraception), she happily went for it. Similarly, I disagree with the old adage that "doctors make the worst patients".
Bullshit. Sure, a few people are inclined to think they know better than their treating physicians, but the majority, having both referred and been referred to, understand the limits of their competence and can also be relied on to actually know what you mean when rattling off the standard boilerplate, which usually makes normal eyes glaze over.
But this shouldn't be something winked-nudged for other doctors and allied health personnel. If I encounter someone who has done their research and seems generally intelligent, I sincerely wish I could hand out a pass that both indemnifies me from some medicolegal risk if they were to take less than ironclad advice, and also lets them access more experimental therapies without the headache of FDA waivers in terminal cases and so on.
A lot of people from these parts would qualify. Much of the griping about paternalism from doctors here and in adjacent parts of the internet arise from intelligent, often UMC people not realizing that they're not typical in terms of what a normal doctor encounters, and our default priors are heavily biased against accepting it when a patient excitedly advocates for an experimental therapy they read about online (in your case it might be legit, but it is more often a misreading of WebMD or, shudder a Tumblr blog for alternative medicine).
Usually, your doctor does know better. Though a good one should also recognize an informed patient.
I had a terrible day. Overworked, underpaid, but what was most painful was seeing a poor lady with metastatic gall bladder cancer that was all but 100% confirmed. Severely jaundiced and anorexic, multiple distant mets including to the spine, and unlikely to be worth anything but palliation.
Her family was adamant that the diagnosis be kept from her. In the UK, that would be flat out illegal unless I fastidiously document that the patient themselves declined to learn more about their diagnosis. But in India, and many other Asian countries, family members usually handle such matters, especially for old, poorly educated people who are unlikely to take the knowledge of their impending demise well.
"Is it a gallbladder stone?" She asked me hopefully while her family was off haggling with my supervising consultant. I was about to go into a painstaking explanation about her cancer, and did get well into it, but I was rapidly grabbed by her son and daughter and told to please not tell her she was about to die, and certainly not from cancer.
Luckily for me, I doubt she understood half of what I said, especially since my Hindi is only passable, and soon enough, I was tip-toeing around the sudden change in surgical plans and why, a patient with "cholecystitis" was going to be have both an ERCP and an FNAC of a supraclavicular node.
"But my neck is fine doctor! And my back hurts." The PET-CT showing avid uptake disagrees. Maybe the back pain was from a fall a few months back, her daughter prompts. Sure. Maybe. Maybe it's also the mets causing fragility fractures, I don't say.
"Is she going to get better? What does chemotherapy mean?" I get asked by the family, who have processed about 10% of what the senior surgeons have told them. Well, at least I don't have to lie that the sudden pivot to an ERCP will improve her jaundice and QOL if not her life expectancy by much. And you'd hope after 6 months here I'd know how to explain how chemo works. She developed SOB after the OP, ?PE, and I watched the bacon being made as my surgical consultant grabbed a passing CCM doctor (who made the mistake of walking through the ward) and they haggled over what tests met very strict criteria for cost-effectiveness. No ABG for you, a CXR and ECG? Yeah, they can afford it. She got better till she inevitably gets worse.
To add insult to injury, I had a mandatory communications training course that day. Aced it, of course, but I had to chuckle and groan at how divorced from reality much of it was. And then I face-palmed when the final quiz began asking questions about HIPAA, which is not a thing in India and not covered in the course itself, strongly suggesting the material had been designed by ripping off a US source, or perhaps the latter hadn't localized it particularly well. All the actual citations and foot notes should have made me sus in the first place.
Some people are dumb, or simply won't understand no matter how much you dumb things down. We avoid this truth, except where formal diagnosis of mental incompetence lets us firmly but gently usher demented grannies back into the chemo ward, and most importantly that this is true even for seemingly functional members of society.
That's about it. Any wonders I wish we could all be smarter so my chosen preference of letting everyone decide, for better or worse, about their health, would cost less in bodies and money? I'll still pay with mine.
self_made_human
Kai su, teknon?
3mo ago
Sigh. It seems it was inevitable that I'd have to get around to doing the unpleasant part of being a mod at some point, namely enforcing the rules and using my discretion in ambiguous situations. But I did sign up for it.
Please consider this a request, and a mild warning, not to speak this way.
So far, your comment has received 3 reports for being antagonistic, which it clearly seems to be to me. To an extent, antagonism is a forgivable sin, and I certainly plead guilty to being less than maximally polite on occasion.
However, what does draw my attention is that this, to me, represents an example of "waging the Culture War". There's no strict line in the sand here, the people discussing CW in the CW thread are almost always at least modest opinionated on the matter, and advocacy for one's beliefs is in no way disbarred.
I don't even particularly care that you call them trannies, I'm not one to police vocabulary where the word is entirely synonymous with more polite equivalents, even if it's pejorative. If someone insisted on calling Jews "Blood-drinking vampires", then I'd consider that to be an obvious infraction. Some of the other mods may well disagree, but I'm only me, and I have a degree of leeway here.
It might surprise you to learn that I happen to largely agree with you. I consider transgenderism, if not an outright mental illness in the strictest sense, to be highly comorbid with it. I wouldn't balk at calling many of them insane like you did. I have a soft spot for Kiwi Farms, Rdrama and the other untamed corners of the internet, and I'm glad they live to fight another day in an increasingly homogenous internet where the edges are sanded down and a relatively small but vocal minority tyrannizes the rest of us and slides the French Overton Window as fast as the rails allow.
That being said, I would prefer you be less antagonistic. You are allowed to be happy that attempts to deplatform a site that makes fun of transgender people backfire. You may enjoy schadenfreude. You may, assuming the rest of your comment doesn't continue to not contribute to the atmosphere/culture we seek to cultivate here, also call people trannies (or at least I won't mod you for that reason alone).
But the gestalt impression conveyed by your comment? Bad. Not conducive to the (ideal) spirit of even-tempered discussion of contentious topics. The problem with culture war fervor, schadenfreude, and pithy pejorative labels for the outgroup is that they tend to crowd out everything else, or at least foster a negative spiral if left unaddressed that leads to everyone else doing the same, and those looking for more polite and high quality debate crinkling their nose and leaving. We aren't rdrama, this is what we are trying to avoid here, and by including all three and not much else, this comment is not helping.
I'll leave it at that, it would take a trivial restatement of your comment to make it slip under the high threshold I hold for formal mod action, if not a reprimand. If you wish to consider this an attempt at censorship (and how can mod action not be?), then it's of tone and not content.
self_made_human
Kai su, teknon?
4mo ago
By pidgin do they mean the annoying tendency of the NZ government to sprinkle in Maori words in press releases?
self_made_human
Kai su, teknon?
7mo ago
Every few hours, when I get tired of sneaking a cheeky vape in the millions of bathrooms and liminal stairwells that litter my hospital, I'll head over to the back of the building, in a secluded, roped off area that's the de-facto smoker's haunt of the place.
An ankle height chain dangles at the approach, as do signs for, among other things, no parking, and an enjoinder against loitering because there's construction ongoing up above.
It might say something about the nature of the universe that the tripping hazard produced by that chain far outweighs that of the falling debris, when it exists. Not the prohibition on smoking, of course, but since you can't quite see the signs from there, everyone pretends they don't exist.
There's a quiet camaraderie at play, doctors huddling together for a chemical pick-me-up after a grueling day at work, a good chunk of which was spent admonishing their patients for the same indulgence they're engaging in.
Did I mention this is an oncology hospital, or at least department big enough to be a standalone one? I suppose that's relevant too.
You can see a combination of quiet guilt, resignation and combativeness in their eyes. Yes. We know this is bad for us. We know you know. What are you going to do about it? Not smoke? Perish the thought, and pass me another. How's that patient with COPD doing? Yeah, he won't quit, even if it kills him, and given that he's got end stage lung cancer with brain mets, we're half a mind to wheel him out, nebulizer in tow, for a couple to greet the last dawn of his life, and just the start of another for us.
I stand there puffing on my vape, experiencing an exceedingly mild, almost homeopathic sense of smugness and superiority. Look at them, burning out their lungs, huffing and puffing when I pass them on the stairwells, and for what, the same nicotine I get, without the stink and almost all of the drawbacks beyond a nicotine dependency?
The vape ban in India has been a disaster, and these are the consequences. I muse on the black comedy that is existence with a black coffee in hand, that the tobacco lobbyists in here got a final swing in by banning the cheaper, healthier alternative.
I ignore the occasional curious glance at my little electing facsimile, the incongruity of a cigarette with an usb port. I'm probably the only one. In turn, I ignore the shifty consultants who don't meet my eye, still harboring in their heart of hearts the feeling they need to do better and set an example for us all. I hear the promises, the whispered pacts to cut down together. They're still they're next week.
There's a bimodal distribution there, you can tell seniority both by how quick, hurried and clandestine their puffs are, all flash and smoke blown into dark corners, and then the blatant ones, the big shots without who the hospital would grind to a halt of PGs, Associate Consultants and RMOs left rudderless when the buck stops with them. They challenge each cig and any mildly curious passersby. Fuck you, even cancer thinks twice about taking me on, at least on the hospital premises.
And then the phones ring, cigarettes burn out, the last dregs of chai and coffee are downed. Paper cups laden with ashes find more corners to marinate in, and stubs are crushed by shoes beneath scrubs and we all go our merry ways. If there's hell to pay, at least we can afford it.
Apologetics for America
I'm a big fan of the United States. It's a big country. It's a safe country. The people are wealthy, kind, industrious, and have done more than their fair share of upholding the Pax Americana under which the majority of the world prospers, including those who would tear it down.
I would go so far as to say that I'd be significantly happier if I had been so lucky as to have been born in a counterfactual universe where my parents had emigrated there, even keeping all my myriad flaws like ADHD and depression.
It's a country that holds multitudes, and has had such a good track record of making good on its promise of embodying:
And then achieving the minor miracle of making the vast majority of them upstanding proud Americans regardless of caste and creed.
(To such an extent that it has lost the memetic immune system needed to assimilate some of the people who meet that criteria but are resilient to anything but force)
It is gorgeous. Even after the visiting the UK, a nation that even in its sclerosed and ailing state is significantly better than India, I found myself grossly disappointed at how small and dull the place was, compared to what I've seen of the States.
I count myself lucky to still have the memories of when I visited as a toddler, some of my earliest, a period I enjoyed so much that I came back home speaking English with an American accent when I hadn't even been conversant in the language when I left.
I stare at the reels and pictures posted on Insta by my friends studying there with ill-concealed envy. It looks so huge, so clean, so vibrant, so picturesque and unspoiled. Still a land where someone with innate talent, having landed with but a penny to his name, can ennoble himself through hard work, or at the very least his descendants.
If it were not for the fact that I'm currently ineligible to give the USMLE today, for no fault of my own, I'd bid adieu to my current aspirations for practising and settling in the UK. The latter is still better than India, but do you really need me to tell you how low a bar that is to beat?
I'm about as pro-American as it gets without driving a pickup truck with the stars-and-stripes hanging off it!
The people eat great food. They live in huge houses that appear outright intimidating to the rest of us. They can afford to waste gigaliters of water on a modestly appealing perennial grass and mostly not begrudge the expense.
They can travel visa free to most of the world, and act the fool there (can, not necessarily do, the worst I can say about most American tourists I've met is that they were rather underinformed about where they'd ended up), content in the knowledge that none but utter pariah states would dare raise a hand at them out of fear of Uncle Sam.
They earn salaries that make us all look like paupers. The median wage for a doctor in the US is $250k, fresh out of residency, whereas a senior consultant in the UK might be content to make half that. Indian doctors can only weep, especially lowly ones like me. Even my father, so talented in his surgical field that he'd be nationally famous if he was more fluent in English (instead just being regionally famous), makes only $50k PA at the very peak of his career, after a life of suffering and hustling so his sons would have to suffer and hustle just a bit less.
Even that seemingly colossal sum of money does not achieve the QOL a naive purchasing power calculation would suggest. Even billionaires here must be content to have their money only buy quick trips with their windows rolled up from only upper class enclave to the next.
The world, somewhat more multipolar than it once was, still wobbles unsteadily if you try and make it rotate around an axis not centered on America.
I'd give a lot to be there. I really would.
That is why it so severely vexes me that my girlfriend, a smart, intelligent and hard working woman who makes for an enviable partner to have at my side, holds a view of it so jaundiced you don't know whether to cry or laugh.
Like many Americans, she has had her perception of the States clouded by sheer propaganda that is more interested in cherrypicking out all of America's real problems, and when even all the real ones no longer suffice, concoct ones out of half-truths and whole-cloth to terrorize a broken primate brain that only notices the bad and becomes inured to the good, such that it no longer bears a resemblance to how fucking good they have it.
She stares at me like I'm mad when I tell her I've always wanted to live there, and the few warts on the face of the nation can't hide its timeless beauty.
She believes that abortion has been banned. When I protest otherwise and say that it's only a few states putting restrictions on it, and even then, just a few, she shakes in existential terror at the idea that there's a seething crowd coming for the rights of women, eager to snatch them all away. She thinks racism is a serious concern for hardworking and talented immigrants who speak fluent English, whereas you could put me in a room with a Confederate flag and I'd find a way to end up drinking beers and shooting AR-15s before dawn.
Did I mention she's terrified of gun violence, even if she could live a dozen lives in parallel and not get shot?
She categorically refuses to follow me if I wistfully make plans to find some route to make it there, be it fighting tooth and nail with my med school and the ECFMG to give me the right to at least try my luck, so that I can show them I meet even their high standards.
I'm at the point that I am seriously debating abandoning clinical medicine as a career, to upskill myself in medical ML, so that I have an easier route to the States that isn't gated behind a professional licensing exam I'm not allowed to give. I am still young. I am allowed to dream.
She's rather be middle class in the UK, unable to afford air-conditioning, living in a tiny house, watching our salaries erode into nothingness, and then, if Sunak successfully makes doctors into a thin wrapper for GPT-5, potentially resign ourselves to a life of mediocrity, or worse, come back to India with our tails between our legs where we'd have to settle for working shit jobs with longer hours and worse pay.
She's scared of paying the medical bills, when the kind of comprehensive coverage that two professionals making 500k together buys care beyond the dreams of the NHS. Perhaps not value for money, but value.
I criticize America all the time, but only because I love it. I want to gorge myself on cheeseburgers with ridiculous portion sizes, because even if I die fat, I die happy.
I cherish what the Founding Fathers built, a shining city built on a hill of negentropy and abundance, rising out of a swamp wherein dwell the majority of us, only a generation or two removed from near-Malthusian conditions. I would die to keep the barbarians away from the gates, if only because I want to cross them myself, as an esteemed guest if nothing else, hopefully to be one of their own.
I set out to write a post somewhat glorifying (fairly) America, and to invite others to submit arguments that would let my girlfriend see reason. It would seem I've inadvertently done all the heavy lifting, if not for the fact that I've marshaled all these arguments before her and still found them wanting.
I don't want to jump to the conclusion that the two of us are moral mutants who can never reconcile our preferences. I prefer to think that she's wrong about her fears, or weighs the wrong facts too heavily and the right ones not at all.
Help me convince her. I will find it hard to live with myself if I fail.
Oh, and Happy Fourth of July to you all, ye sons and daughters living several decades in the future, hailing from the nation from whose physical and mental toil most of the good things in the world come.
Wait, is it a bit late for that? Um, I blame timezones, pernicious and insidious things that they are.
Don't think I don't see the cracks in the pristine facade, the erosion of the meritocracy that made your country glorious. I simply think that if America wakes up and patches a few holes, it can earn the right to slumber again in peace for centuries hence.
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