I think part of the problem is that there is nothing like an MTV/radio that can push a specific music video or style of music anymore - everyone finds their own stuff, and only the super watered down main stream actually gets pushed out to people. The internet fragments us.

There should be a sift just for music videos; that'd be sweet.

I really wasn't a fan of Nirvana when they came out. I was heavily into metal (Iron Maiden, Metallica, Sepultura, Slayer, etc) and Nirvana just sounded like a boring watered down version to me.

It wasn't until much later that I realised I was looking at it from the wrong direction. Nirvana were a pop band who used heavy guitars, and that was kinda cool.

I don't believe we will ever see another band with their influence again. Mainstream music today is much more fragmented, so even if someone came along and radically altered hip-hop, for example, the influence would be felt far less in other genres.

Ok, I would point-out that everything this puppeteer does so well is based on his stringing-of one cliched phrase to another while using not-so-subtle words to trigger responses. Notice how his carefully-crafted script should he be distracted from it (in this case by a heckler who is not only about to be the brunt of a joke, but probably arrested, detained, bullied, released and followed for weeks and he'll most likely get an IRS audit in his mailbox soon) goes to shit, and he can't improvise a sentence fragment or turn of phrase.

Making the guy the brunt of a joke, then hustling him out of the casino for a work-over. Capone would be proud.

Simple, emotionally-loaded pre-scripted words in every speech, every prepared statement.
He touches his face too much, pretty sure that's a liar's tell, very irritating and one of the most flagrantly insulting heads of state in the history of the office of President.

People, are becoming so overtly programmed to respond to such obvious bullshit....Kill your fucking TV's please people, before Complete Cognitive Warpage occurs...

Your video, Tempered glass yields to a fragment of a spark plug, has made it into the Top 15 New Videos listing. Congratulations on your achievement. For your contribution you have been awarded 1 Power Point.

You can sign me up @bareboards2. If there were some broad agreement on terminology I would switch to gender neutral language instantly. Fucking sick of it.

Coincidentally I was thinking about this just this afternoon, because luckily I have nothing better to do at work than stand around contemplating gender politics; pleased and proud as I am of genderqueer crusaders trying to wrestle pronouns into shape, I've been generally unwilling to join them. For fuck's sake, I spend enough time every day arguing about the excess syllable in the number sev, I can't afford to multiply that by every sentence with a person in it.

Singularising plural pronouns is offensive to me on a practical and aesthetic level, Spivak's no damn good, you've got your zes and your hirs and your hens, it's a pain in the ass but as soon as we get some consensus and momentum it's going to be cool.

Can't see that feminism really has anything to do with all this, well, I have trouble seeing that feminism has anything to do with anything. Not to go all Trancecoach here with male world problems but they're similarly told that to be professional they have to knot a piece of cloth around their neck for no reason or slice the hair off their face every day for no fucking reason. The situation is that we have a bullshit tribal culture with endless absurd customs and arbitrary rituals which is perpetuated by morons.

So we should always be rationalising - language, culture, behaviour, expectations.

Gender neutrality is obviously the way to go. If you get shoved in a box you don't become the champion of the box and work to make your box the best box it can be; you break out and start beating your captors over the head with box fragments.

I don't give a fuck about women's problems; I don't give a fuck about women, but I'm glad to consider anyone who stops wearing makeup a part of my team because I don't wear makeup for the same reason I don't shave my stupid face.

Anyway that was my choggie impression for the day. Too much caffeine, not enough sleep, not enough time spent bathing in the blood of my enemies.

Little orphans in the snow
With nowhere to call a home
Start their singing, singing
Waiting through the summertime
To thaw your hearts in wintertime
That's why they're singing, singing

Waiting for a sign
To turn blood into wine
The sweet taste in your mouth
Turned bitter in its glass

Israel, in Israel
Israel, in Israel

Shattered fragments of the past
Meet in veins on the stained glass
Like the lifeline in your palm
Red and green reflects the scene
Of a long forgotten dream
There were princes and there were kings

Now hidden in disguise
Cheap wrappings of lies
Keep your heart alive
With a song from inside

Even though we're all alone
We are never on our own
When we're singing, singing

There's a man who's looking in
And he smiles a toothless grin
Because he's singing, singing
See some people shine with glee
But their song is jealousy
Their hate is clanging, maddening

In Israel
Will they sing Happy Noel
In Israel, in Israel
Israel, in Israel
In Israel
Will they sing Happy Noel

OMG nostalgia! I lived not even 20 minutes from there when I was a kid. I almost got killed in the parking lot there on the 4th of July once when a firework exploded right after launch and sent fiery fragments out into the crowd (one of them smashed the windshield of the car next to me). I also remember totally wanting to go on the Cannonball loop but my parents wouldn't let me (in hindsight probably a good decision on their part).

Motorworld there was awesome--it was across the street from Action Park and I think run by the same people. They had these cage-enclosed go-karts tanks equipped with compressed-air tennis ball cannons and sensors that stopped the tanks temporarily if they got hit by a tennis ball. You could pay to drive the tanks around inside an enclosed arena or you could also shoot at the tanks from the outside of the arena using air-cannon turrets that required quarters to operate. Tons of fun.

Mostly, though, I went to the water park, which according to Wikipedia had the most casualties. I got a fair amount of scrapes from the waterslides and I can totally see how people could get seriously injured on some of them.

Also it's very important that we mobilize and get angry about this sort of thing when it hits the fan or we won't organize. Nothing will progress, and we'll stay a fragmented society that's completely controlled by it's government and propaganda.

Ignore the apologists and the jaded cynics. Move the Country Forward.

The universe is "just right"? Instead of too hot or too cold? Your tiny lifespan in this tiny fragment of the cosmos is only possible because the local conditions happen to be just right to sustain human life for the time being. That's easier to believe than some all-powerful sky-wizard waving a wand and creating stuff.

@newtboy

What we do know is they did not know, or even have any evidence that they had returned to Boston after the shootout..."

What?!?! How in the fuck do you know that? Did you read that on Infowars? It's expected that a paranoid nutter as yourself would take hold of that bit of info and accept it without any evidence at all, but it's unfortunate that others here, who come here primarily for relaxation or entertainment and may read VS comments with a less-than-critical mindset, might gloss over it and have it slowly infect and then fester in their brains as fact instead of the unmitigated, unsubstantiated bullshit that it is. Evidence that the cops did not know or think the suspects could be in Boston or specific areas searched in Boston after the shootout or STFU. I'm assuming your only evidence they even conducted searches there at all is the YT description you mention, but it doesn't matter to me one way or another if they did or didn't. It shows, however, how easily you collect and incorporate any ethereal fragment of the English language that you feel will support your idiotic narrative.

Seen plenty of open ended hoses like this around britain, most people i know keep the end off. I think the answer is that overnight it will freeze, but when it warms the next day it is obviously the outer part of the ice which will warm and melt first, meaning it's nicely lubricated to move. I dunno how the ice became so fragmented but maybe he just stomped on it a bunch to break it.

Windows 8 reminds me of Apple-style arrogance. Like charging $29 for an adapter, and foisting Apple Maps on users, Microsoft foisted Metro on users.

Having used it on my sister's computer, it's clearly not sufficiently consolidated with the desktop option. It doesn't offer any usability improvements to the extent I've used it. As the video points out, accessing menus is confusing and is immediately obvious to any power user who wants to set it up as they like.

Their intentions are clear. Consolidate desktop, tablet and to a lesser extent phone to a similar UI and thereby gain an advantage over Google/Apple which are relatively fragmented.

Problem is, they're approaching it by foisting it on people. As mentioned Metro/Desktop bridging is half baked. Rather than removing the start key, they should have made Metro optional, and incentivised people onto it through usability benefits.

The interface for desktop mode is not ready. In keeping it optional, they could have given themselves breathing space on top of the Windows 8 release to make integration far more seamless.

The point of full screen is clear from a productivity point of view. Clear all distractions and get the job done. Problem is, instead it is acting as a barrier to usability through confusion menu navigation.

While the video creator has exaggerated the problems I think his points are spot on.

Murder is a difficult thing to get away with most of the time, and there's a level of sophisticated social engineering required before you can really rack up a count, otherwise you'll get caught around the 2 to 10 mark, like most people serving prison sentences that aren't drug or theft related.

But in all honesty, murder is not lucrative unless you're commander and chief to an army. The real money maker is hacking -- why doesn't EVERYONE hack? People on the internet are just slinging their credit card info and personal information around willy-nilly.

If you're a homeless person, here's what you do: (this is assuming you are so poor you have no money and little education beyond your street smart observation)

1. Steal someone's smartphone.
NOTE: If you are unsure what a "smartphone" is, just look for the people that are walking around, seemingly lost, looking at their phone the whole time. If you feel in control, ask them if they're lost. If they reply with a fragmented sentence about "GPS" or "Google maps", you have found your mark. If you're proficient with this style of conversation, find a way to lead them down an alleyway -- you know what to do after that. Example: They say they know that their destination is "somewhere around here, they just can't find the entrance", tell them that's because "the place is using a side entrance down this convenient alley."
2. Steal a second person's smartphone.
NOTE: Hopefully at least one of them isn't password locked. If both are, keep stealing until you have one that isn't.
3. Setup a free email account at Gmail and then go to Craigslist and sell the first device.
NOTE: Or Hotmail or Yahoo or Mailinator or whatever.
4. On the second device, find someone on Craigslist who will help you reset the first device so that no one can trace it back to you.
5. Use Google to learn how to hack, or better yet, just learn how to create phishing emails.
6. NOW HACK (or phish)!
7. You probably gave up on life a long time ago, so if you've figured out a foolproof way to steal smartphones, keep doing that, because people with smartphones are pretty dumb and hacking is actually kind of hard.

Special thanks to Google, Craigslist, smartphones, and the blind entitlement of your victims.

http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=all

One October afternoon three years ago while I was visiting my parents, my mother made a request I dreaded and longed to fulfill. She had just poured me a cup of Earl Grey from her Japanese iron teapot, shaped like a little pumpkin; outside, two cardinals splashed in the birdbath in the weak Connecticut sunlight. Her white hair was gathered at the nape of her neck, and her voice was low. “Please help me get Jeff’s pacemaker turned off,” she said, using my father’s first name. I nodded, and my heart knocked.
Related

Upstairs, my 85-year-old father, Jeffrey, a retired Wesleyan University professor who suffered from dementia, lay napping in what was once their shared bedroom. Sewn into a hump of skin and muscle below his right clavicle was the pacemaker that helped his heart outlive his brain. The size of a pocket watch, it had kept his heart beating rhythmically for nearly five years. Its battery was expected to last five more.

After tea, I knew, my mother would help him from his narrow bed with its mattress encased in waterproof plastic. She would take him to the toilet, change his diaper and lead him tottering to the couch, where he would sit mutely for hours, pretending to read Joyce Carol Oates, the book falling in his lap as he stared out the window.

I don’t like describing what dementia did to my father — and indirectly to my mother — without telling you first that my parents loved each other, and I loved them. That my mother, Valerie, could stain a deck and sew an evening dress from a photo in Vogue and thought of my father as her best friend. That my father had never given up easily on anything.

Born in South Africa, he lost his left arm in World War II, but built floor-to-ceiling bookcases for our living room; earned a Ph.D. from Oxford; coached rugby; and with my two brothers as crew, sailed his beloved Rhodes 19 on Long Island Sound. When I was a child, he woke me, chortling, with his gloss on a verse from “The Rubaiyat of Omar Khayyam”: “Awake, my little one! Before life’s liquor in its cup be dry!” At bedtime he tucked me in, quoting “Hamlet” : “May flights of angels sing thee to thy rest!”

Now I would look at him and think of Anton Chekhov, who died of tuberculosis in 1904. “Whenever there is someone in a family who has long been ill, and hopelessly ill,” he wrote, “there come painful moments when all timidly, secretly, at the bottom of their hearts long for his death.” A century later, my mother and I had come to long for the machine in my father’s chest to fail.

Until 2001, my two brothers and I — all living in California — assumed that our parents would enjoy long, robust old ages capped by some brief, undefined final illness. Thanks to their own healthful habits and a panoply of medical advances — vaccines, antibiotics, airport defibrillators, 911 networks and the like — they weren’t likely to die prematurely of the pneumonias, influenzas and heart attacks that decimated previous generations. They walked every day. My mother practiced yoga. My father was writing a history of his birthplace, a small South African town.

In short, they were seemingly among the lucky ones for whom the American medical system, despite its fragmentation, inequity and waste, works quite well. Medicare and supplemental insurance paid for their specialists and their trusted Middletown internist, the lean, bespectacled Robert Fales, who, like them, was skeptical of medical overdoing. “I bonded with your parents, and you don’t bond with everybody,” he once told me. “It’s easier to understand someone if they just tell it like it is from their heart and their soul.”

They were also stoics and religious agnostics. They signed living wills and durable power-of-attorney documents for health care. My mother, who watched friends die slowly of cancer, had an underlined copy of the Hemlock Society’s “Final Exit” in her bookcase. Even so, I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims.

Things took their first unexpected turn on Nov. 13, 2001, when my father — then 79, pacemakerless and seemingly healthy — collapsed on my parents’ kitchen floor in Middletown, making burbling sounds. He had suffered a stroke.

He came home six weeks later permanently incapable of completing a sentence. But as I’ve said, he didn’t give up easily, and he doggedly learned again how to fasten his belt; to peck out sentences on his computer; to walk alone, one foot dragging, to the university pool for water aerobics. He never again put on a shirt without help or looked at the book he had been writing. One day he haltingly told my mother, “I don’t know who I am anymore.”

His stroke devastated two lives. The day before, my mother was an upper-middle-class housewife who practiced calligraphy in her spare time. Afterward, she was one of tens of millions of people in America, most of them women, who help care for an older family member.

Their numbers grow each day. Thanks to advanced medical technologies, elderly people now survive repeated health crises that once killed them, and so the “oldest old” have become the nation’s most rapidly growing age group. Nearly a third of Americans over 85 have dementia (a condition whose prevalence rises in direct relationship to longevity). Half need help with at least one practical, life-sustaining activity, like getting dressed or making breakfast. Even though a capable woman was hired to give my dad showers, my 77-year-old mother found herself on duty more than 80 hours a week. Her blood pressure rose and her weight fell. On a routine visit to Dr. Fales, she burst into tears. She was put on sleeping pills and antidepressants.

My father said he came to believe that she would have been better off if he had died. “She’d have weeped the weep of a widow,” he told me in his garbled, poststroke speech, on a walk we took together in the fall of 2002. “And then she would have been all right.” It was hard to tell which of them was suffering more.

As we shuffled through the fallen leaves that day, I thought of my father’s father, Ernest Butler. He was 79 when he died in 1965, before pacemakers, implanted cardiac defibrillators, stents and replacement heart valves routinely staved off death among the very old. After completing some long-unfinished chairs, he cleaned his woodshop, had a heart attack and died two days later in a plain hospital bed. As I held my dad’s soft, mottled hand, I vainly wished him a similar merciful death.

A few days before Christmas that year, after a vigorous session of water exercises, my father developed a painful inguinal (intestinal) hernia. My mother took him to Fales, who sent them to a local surgeon, who sent them to a cardiologist for a preoperative clearance. After an electrocardiogram recorded my father’s slow heartbeat — a longstanding and symptomless condition not uncommon in the very old — the cardiologist, John Rogan, refused to clear my dad for surgery unless he received a pacemaker.

Without the device, Dr. Rogan told me later, my father could have died from cardiac arrest during surgery or perhaps within a few months. It was the second time Rogan had seen my father. The first time, about a year before, he recommended the device for the same slow heartbeat. That time, my then-competent and prestroke father expressed extreme reluctance, on the advice of Fales, who considered it overtreatment.

My father’s medical conservatism, I have since learned, is not unusual. According to an analysis by the Dartmouth Atlas medical-research group, patients are far more likely than their doctors to reject aggressive treatments when fully informed of pros, cons and alternatives — information, one study suggests, that nearly half of patients say they don’t get. And although many doctors assume that people want to extend their lives, many do not. In a 1997 study in The Journal of the American Geriatrics Society, 30 percent of seriously ill people surveyed in a hospital said they would “rather die” than live permanently in a nursing home. In a 2008 study in The Journal of the American College of Cardiology, 28 percent of patients with advanced heart failure said they would trade one day of excellent health for another two years in their current state.

When Rogan suggested the pacemaker for the second time, my father was too stroke-damaged to discuss, and perhaps even to weigh, his trade­offs. The decision fell to my mother — anxious to relieve my father’s pain, exhausted with caregiving, deferential to doctors and no expert on high-tech medicine. She said yes. One of the most important medical decisions of my father’s life was over in minutes. Dr. Fales was notified by fax.

Fales loved my parents, knew their suffering close at hand, continued to oppose a pacemaker and wasn’t alarmed by death. If he had had the chance to sit down with my parents, he could have explained that the pacemaker’s battery would last 10 years and asked whether my father wanted to live to be 89 in his nearly mute and dependent state. He could have discussed the option of using a temporary external pacemaker that, I later learned, could have seen my dad safely through surgery. But my mother never consulted Fales. And the system would have effectively penalized him if she had. Medicare would have paid him a standard office-visit rate of $54 for what would undoubtedly have been a long meeting — and nothing for phone calls to work out a plan with Rogan and the surgeon.

Medicare has made minor improvements since then, and in the House version of the health care reform bill debated last year, much better payments for such conversations were included. But after the provision was distorted as reimbursement for “death panels,” it was dropped. In my father’s case, there was only a brief informed-consent process, covering the boilerplate risks of minor surgery, handled by the general surgeon.

I believe that my father’s doctors did their best within a compartmentalized and time-pressured medical system. But in the absence of any other guiding hand, there is no doubt that economics helped shape the wider context in which doctors made decisions. Had we been at the Mayo Clinic — where doctors are salaried, medical records are electronically organized and care is coordinated by a single doctor — things might have turned out differently. But Middletown is part of the fee-for-service medical economy. Doctors peddle their wares on a piecework basis; communication among them is haphazard; thinking is often short term; nobody makes money when medical interventions are declined; and nobody is in charge except the marketplace.

And so on Jan. 2, 2003, at Middlesex Hospital, the surgeon implanted my father’s pacemaker using local anesthetic. Medicare paid him $461 and the hospital a flat fee of about $12,000, of which an estimated $7,500 went to St. Jude Medical, the maker of the device. The hernia was fixed a few days later.

It was a case study in what primary-care doctors have long bemoaned: that Medicare rewards doctors far better for doing procedures than for assessing whether they should be done at all. The incentives for overtreatment continue, said Dr. Ted Epperly, the board chairman of the American Academy of Family Physicians, because those who profit from them — specialists, hospitals, drug companies and the medical-device manufacturers — spend money lobbying Congress and the public to keep it that way.

Last year, doctors, hospitals, drug companies, medical-equipment manufacturers and other medical professionals spent $545 million on lobbying, according to the Center for Responsive Politics. This may help explain why researchers estimate that 20 to 30 percent of Medicare’s $510 billion budget goes for unnecessary tests and treatment. Why cost-containment received short shrift in health care reform. Why physicians like Fales net an average of $173,000 a year, while noninvasive cardiologists like Rogan net about $419,000.

The system rewarded nobody for saying “no” or even “wait” — not even my frugal, intelligent, Consumer-Reports-reading mother. Medicare and supplemental insurance covered almost every penny of my father’s pacemaker. My mother was given more government-mandated consumer information when she bought a new Camry a year later.

And so my father’s electronically managed heart — now requiring frequent monitoring, paid by Medicare — became part of the $24 billion worldwide cardiac-device industry and an indirect subsidizer of the fiscal health of American hospitals. The profit margins that manufacturers earn on cardiac devices is close to 30 percent. Cardiac procedures and diagnostics generate about 20 percent of hospital revenues and 30 percent of profits.

Shortly after New Year’s 2003, my mother belatedly called and told me about the operations, which went off without a hitch. She didn’t call earlier, she said, because she didn’t want to worry me. My heart sank, but I said nothing. It is one thing to silently hope that your beloved father’s heart might fail. It is another to actively abet his death.

The pacemaker bought my parents two years of limbo, two of purgatory and two of hell. At first they soldiered on, with my father no better and no worse. My mother reread Jon Kabat-Zinn’s “Full Catastrophe Living,” bought a self-help book on patience and rose each morning to meditate.

In 2005, the age-related degeneration that had slowed my father’s heart attacked his eyes, lungs, bladder and bowels. Clots as narrow as a single human hair lodged in tiny blood vessels in his brain, killing clusters of neurons by depriving them of oxygen. Long partly deaf, he began losing his sight to wet macular degeneration, requiring ocular injections that cost nearly $2,000 each. A few months later, he forgot his way home from the university pool. He grew incontinent. He was collapsing physically, like an ancient, shored-up house.

In the summer of 2006, he fell in the driveway and suffered a brain hemorrhage. Not long afterward, he spent a full weekend compulsively brushing and rebrushing his teeth. “The Jeff I married . . . is no longer the same person,” my mother wrote in the journal a social worker had suggested she keep. “My life is in ruins. This is horrible, and I have lasted for five years.” His pacemaker kept on ticking.

When bioethicists debate life-extending technologies, the effects on people like my mother rarely enter the calculus. But a 2007 Ohio State University study of the DNA of family caregivers of people with Alzheimer’s disease showed that the ends of their chromosomes, called telomeres, had degraded enough to reflect a four-to-eight-year shortening of lifespan. By that reckoning, every year that the pacemaker gave my irreparably damaged father took from my then-vigorous mother an equal year.

When my mother was upset, she meditated or cleaned house. When I was upset, I Googled. In 2006, I discovered that pacemakers could be deactivated without surgery. Nurses, doctors and even device salesmen had done so, usually at deathbeds. A white ceramic device, like a TV remote and shaped like the wands that children use to blow bubbles, could be placed around the hump on my father’s chest. Press a few buttons and the electrical pulses that ran down the leads to his heart would slow until they were no longer effective. My father’s heart, I learned, would probably not stop. It would just return to its old, slow rhythm. If he was lucky, he might suffer cardiac arrest and die within weeks, perhaps in his sleep. If he was unlucky, he might linger painfully for months while his lagging heart failed to suffuse his vital organs with sufficient oxygenated blood.

If we did nothing, his pacemaker would not stop for years. Like the tireless charmed brooms in Disney’s “Fantasia,” it would prompt my father’s heart to beat after he became too demented to speak, sit up or eat. It would keep his heart pulsing after he drew his last breath. If he was buried, it would send signals to his dead heart in the coffin. If he was cremated, it would have to be cut from his chest first, to prevent it from exploding and damaging the walls or hurting an attendant.

On the Internet, I discovered that the pacemaker — somewhat like the ventilator, defibrillator and feeding tube — was first an exotic, stopgap device, used to carry a handful of patients through a brief medical crisis. Then it morphed into a battery-powered, implantable and routine treatment. When Medicare approved the pacemaker for reimbursement in 1966, the market exploded. Today pacemakers are implanted annually in more than 400,000 Americans, about 80 percent of whom are over 65. According to calculations by the Dartmouth Atlas research group using Medicare data, nearly a fifth of new recipients who receive pacemakers annually — 76,000 — are over 80. The typical patient with a cardiac device today is an elderly person suffering from at least one other severe chronic illness.

Over the years, as technology has improved, the battery life of these devices lengthened. The list of heart conditions for which they are recommended has grown. In 1984, the treatment guidelines from the American College of Cardiology declared that pacemakers were strongly recommended as “indicated” or mildly approved as “reasonable” for 56 heart conditions and “not indicated” for 31 more. By 2008, the list for which they were strongly or mildly recommended expanded to 88, with most of the increase in the lukewarm “reasonable” category.

The research backing the expansion of diagnoses was weak. Over all, only 5 percent of the positive recommendations were supported by research from multiple double-blind randomized studies, the gold standard of evidence-based medicine. And 58 percent were based on no studies at all, only a “consensus of expert opinion.” Of the 17 cardiologists who wrote the 2008 guidelines, 11 received financing from cardiac-device makers or worked at institutions receiving it. Seven, due to the extent of their financial connections, were recused from voting on the guidelines they helped write.

This pattern — a paucity of scientific support and a plethora of industry connections — holds across almost all cardiac treatments, according to the cardiologist Pierluigi Tricoci of Duke University’s Clinical Research Institute. Last year in The Journal of the American Medical Association, Tricoci and his co-authors wrote that only 11 percent of 2,700 widely used cardiac-treatment guidelines were based on that gold standard. Most were based only on expert opinion.

Experts are as vulnerable to conflicts of interest as researchers are, the authors warned, because “expert clinicians are also those who are likely to receive honoraria, speakers bureau [fees], consulting fees or research support from industry.” They called the current cardiac-research agenda “strongly influenced by industry’s natural desire to introduce new products.”

Perhaps it’s no surprise that I also discovered others puzzling over cardiologists who recommended pacemakers for relatives with advanced dementia. “78-year-old mother-in-law has dementia; severe short-term memory issues,” read an Internet post by “soninlaw” on Elderhope.com, a caregivers’ site, in 2007. “On a routine trip to her cardiologist, doctor decides she needs a pacemaker. . . . Anyone have a similar encounter?”

By the summer of 2007, my dad had forgotten the purpose of a dinner napkin and had to be coached to remove his slippers before he tried to put on his shoes. After a lifetime of promoting my father’s health, my mother reversed course. On a routine visit, she asked Rogan to deactivate the pacemaker. “It was hard,” she later told me. “I was doing for Jeff what I would have wanted Jeff to do for me.” Rogan soon made it clear he was morally opposed. “It would have been like putting a pillow over your father’s head,” he later told me.

Not long afterward, my mother declined additional medical tests and refused to put my father on a new anti-dementia drug and a blood thinner with troublesome side effects. “I take responsibility for whatever,” she wrote in her journal that summer. “Enough of all this overkill! It’s killing me! Talk about quality of life — what about mine?”

Then came the autumn day when she asked for my help, and I said yes. I told myself that we were simply trying to undo a terrible medical mistake. I reminded myself that my dad had rejected a pacemaker when his faculties were intact. I imagined, as a bioethicist had suggested, having a 15-minute conversation with my independent, predementia father in which I saw him shaking his head in horror over any further extension of what was not a “life,” but a prolonged and attenuated dying. None of it helped. I knew that once he died, I would dream of him and miss his mute, loving smiles. I wanted to melt into the arms of the father I once had and ask him to handle this. Instead, I felt as if I were signing on as his executioner and that I had no choice.

Over the next five months, my mother and I learned many things. We were told, by the Hemlock Society’s successor, Compassion and Choices, that as my father’s medical proxy, my mother had the legal right to ask for the withdrawal of any treatment and that the pacemaker was, in theory at least, a form of medical treatment. We learned that although my father’s living will requested no life support if he were comatose or dying, it said nothing about dementia and did not define a pacemaker as life support. We learned that if we called 911, emergency medical technicians would not honor my father’s do-not-resuscitate order unless he wore a state-issued orange hospital bracelet. We also learned that no cardiology association had given its members clear guidance on when, or whether, deactivating pacemakers was ethical.

(Last month that changed. The Heart Rhythm Society and the American Heart Association issued guidelines declaring that patients or their legal surrogates have the moral and legal right to request the withdrawal of any medical treatment, including an implanted cardiac device. It said that deactivating a pacemaker was neither euthanasia nor assisted suicide, and that a doctor could not be compelled to do so in violation of his moral values. In such cases, it continued, doctors “cannot abandon the patient but should involve a colleague who is willing to carry out the procedure.” This came, of course, too late for us.)

In the spring of 2008, things got even worse. My father took to roaring like a lion at his caregivers. At home in California, I searched the Internet for a sympathetic cardiologist and a caregiver to put my Dad to bed at night. My frayed mother began to shout at him, and their nighttime scenes were heartbreaking and frightening. An Alzheimer’s Association support-group leader suggested that my brothers and I fly out together and institutionalize my father. This leader did not know my mother’s formidable will and had never heard her speak about her wedding vows or her love.

Meanwhile my father drifted into what nurses call “the dwindles”: not sick enough to qualify for hospice care, but sick enough to never get better. He fell repeatedly at night and my mother could not pick him up. Finally, he was weak enough to qualify for palliative care, and a team of nurses and social workers visited the house. His chest grew wheezy. My mother did not request antibiotics. In mid-April 2008, he was taken by ambulance to Middlesex Hospital’s hospice wing, suffering from pneumonia.

Pneumonia was once called “the old man’s friend” for its promise of an easy death. That’s not what I saw when I flew in. On morphine, unreachable, his eyes shut, my beloved father was breathing as hard and regularly as a machine.

My mother sat holding his hand, weeping and begging for forgiveness for her impatience. She sat by him in agony. She beseeched his doctors and nurses to increase his morphine dose and to turn off the pacemaker. It was a weekend, and the doctor on call at Rogan’s cardiology practice refused authorization, saying that my father “might die immediately.” And so came five days of hard labor. My mother and I stayed by him in shifts, while his breathing became increasingly ragged and his feet slowly started to turn blue. I began drafting an appeal to the hospital ethics committee. My brothers flew in.

On a Tuesday afternoon, with my mother at his side, my father stopped breathing. A hospice nurse hung a blue light on the outside of his hospital door. Inside his chest, his pacemaker was still quietly pulsing.

After his memorial service in the Wesleyan University chapel, I carried a box from the crematory into the woods of an old convent where he and I often walked. It was late April, overcast and cold. By the side of a stream, I opened the box, scooped out a handful of ashes and threw them into the swirling water. There were some curious spiraled metal wires, perhaps the leads of his pacemaker, mixed with the white dust and pieces of bone.

A year later, I took my mother to meet a heart surgeon in a windowless treatment room at Brigham and Women’s Hospital in Boston. She was 84, with two leaking heart valves. Her cardiologist had recommended open-heart surgery, and I was hoping to find a less invasive approach. When the surgeon asked us why we were there, my mother said, “To ask questions.” She was no longer a trusting and deferential patient. Like me, she no longer saw doctors — perhaps with the exception of Fales — as healers or her fiduciaries. They were now skilled technicians with their own agendas. But I couldn’t help feeling that something precious — our old faith in a doctor’s calling, perhaps, or in a healing that is more than a financial transaction or a reflexive fixing of broken parts — had been lost.

The surgeon was forthright: without open-heart surgery, there was a 50-50 chance my mother would die within two years. If she survived the operation, she would probably live to be 90. And the risks? He shrugged. Months of recovery. A 5 percent chance of stroke. Some possibility, he acknowledged at my prompting, of postoperative cognitive decline. (More than half of heart-bypass patients suffer at least a 20 percent reduction in mental function.) My mother lifted her trouser leg to reveal an anklet of orange plastic: her do-not-resuscitate bracelet. The doctor recoiled. No, he would not operate with that bracelet in place. It would not be fair to his team. She would be revived if she collapsed. “If I have a stroke,” my mother said, nearly in tears, “I want you to let me go.” What about a minor stroke, he said — a little weakness on one side?

I kept my mouth shut. I was there to get her the information she needed and to support whatever decision she made. If she emerged from surgery intellectually damaged, I would bring her to a nursing home in California and try to care for her the way she had cared for my father at such cost to her own health. The thought terrified me.

The doctor sent her up a floor for an echocardiogram. A half-hour later, my mother came back to the waiting room and put on her black coat. “No,” she said brightly, with the clarity of purpose she had shown when she asked me to have the pacemaker deactivated. “I will not do it.”

She spent the spring and summer arranging house repairs, thinning out my father’s bookcases and throwing out the files he collected so lovingly for the book he never finished writing. She told someone that she didn’t want to leave a mess for her kids. Her chest pain worsened, and her breathlessness grew severe. “I’m aching to garden,” she wrote in her journal. “But so it goes. ACCEPT ACCEPT ACCEPT.”

Last August, she had a heart attack and returned home under hospice care. One evening a month later, another heart attack. One of my brothers followed her ambulance to the hospice wing where we had sat for days by my father’s bed. The next morning, she took off her silver earrings and told the nurses she wanted to stop eating and drinking, that she wanted to die and never go home. Death came to her an hour later, while my brother was on the phone to me in California — almost as mercifully as it had come to my paternal grandfather. She was continent and lucid to her end.

A week later, at the same crematory near Long Island Sound, my brothers and I watched through a plate-glass window as a cardboard box containing her body, dressed in a scarlet silk ao dai she had sewn herself, slid into the flames. The next day, the undertaker delivered a plastic box to the house where, for 45 of their 61 years together, my parents had loved and looked after each other, humanly and imperfectly. There were no bits of metal mixed with the fine white powder and the small pieces of her bones.

Katy Butler lives in Mill Valley, Calif., and teaches memoir writing at the Esalen Institute in Big Sur.

Tired of that $2.6 Million Program that Teaches Chinese Prostitutes to Drink?

by John Ransom


Liberty is about a lot of things; it’s a deep topic. But at its core liberty can be summed up in one simple and reciprocal concept. That concept is respect.

You know the 2010 last election was about many things, but it was mostly about respect.

It was about starting to restore the respect that people have in government, by getting the government to restore the respect that they show to you…by taking liberty seriously.

If you are like me, you think that many of our elected officials from both the right and the left truly believe that what they think of you is much more important than what you think of them.

If you’re like me you’re tired of a trillion dollars in so-called stimulus spending that went to mob-connected asphalt contractors rather than the pockets of working families who own businesses and pay taxes and do all the working and dreaming in this country.

If you’re like me, you’re tired of a $2.6 million program that teaches Chinese prostitutes to drink more responsibly while unemployment soars across the country.

If you’re like me, you're tired of an arrogant federal government which pays out $47 billion in fraudulent claims in Medicare every year while they lecture the rest of us about healthcare economics.

If you are like me, you’re tired of the US Postal service wasting $30 million on a program that pays 1100 employees to do nothing. Yes, today, the US Post Office sat 1100 employees in empty rooms, as they do every day, and literally paid them to do nothing. They can’t play cards; they can’t watch TV, in fact they can’t do anything at all. To the tune of $30 million per year.


Yet this very same federal government comes to us now and proposes to manage our healthcare, our retirement, the education of our children, the auto industry, the oil industry, pharmaceuticals, the mortgage industry and lectures the American people that they are under-regulated.

If you’re a middle American like me, from the grassroots, I bet you know someone who owns their own business; if you’re like me you probably know someone who has paid employees of that business on time every week, but hasn’t been able to pay themselves a dime. Yet these very same people who provide half the new jobs in our economy, who have lost money over the last few years, still owe the government tens of thousands of dollars in taxes every year. People wonder where our jobs have gone? They’ve been crushed by a system that doesn’t honor job creation; by a system that doesn’t honor liberty; a system that gives no respect.

And if you are like most of the voters I speak to, you are tired of insiders from Washington and Wall Street on both sides of the aisle, and their wasteful spending schemes that don’t even propose to solve the very issues facing Main Street and working families.

Let’s suppose global warming is real; I don’t think it is, but let’s say it's so for the sake of argument. Show me please how the Renewable Electricity Standard-- which will cost American families $1800 per year-- please show me how it’s going to lower the earth’s temperature. They can’t because the Renewable Electricity Standard wasn’t created to combat global warming and it won’t lower the earth’s temperature.

Ok, so let’s suppose the issue is carbon emission; that carbon is really bad and we have to get it out of our atmosphere. Show me please how the Renewable Electricity Standard is going to reduce the amount of carbon in our atmosphere. They can’t. It wasn’t designed to do that and it won’t do that.

The government doesn't write legislation with solutions in mind, but rather with power and control of your very lives. And it is inside of your lives where you will wrestle back that control.

I’m often reminded that it’s with readers just like you where many of the seminal events of our country happened. It’s in rooms just like you’re in right now that a small group of patriots in Massachusetts planned the Boston Tea Party; it’s in groups just like you are a part of today that was born the Mayflower Compact; it’s in the free association of our citizens, for the common good and with common respect, that the greatness and goodness of our country will always be found.

And as long as people like you, freely associate for the common good and meet in respect, our country will always remain both great and good.

But ordinary people are paying attention, actually reading the Constitution; people are actually asking questions about the 10th Amendment, asking: What kind of power does Washington really have over us?

Unfortunately, there aren’t enough people who have been awakened to that yet, that’s why readers like you are so important. Each individual reading this is so incredibly important because the job you have this year as a citizen has never, ever, ever been more important. The 2012 election is going to determine what it’s like to live in this country for a long time. It’s going to be people just like you, having conversation just like this, in rooms across America that are going to make a difference.

This is the chance to turn the tide. The chance we have today is to bury that last vestiges of big government in our country; to reclaim our liberty from a new deal and replace it with a true deal.

I’ve been very fortunate because over the last half dozen years I’ve been able to travel all around the country working with grassroots activists just like you. I understand, I think, better than elected officials, what makes the grassroots so special. It's you and your ability to communicate.

We have all these new tools available for citizens to communicate that just a few years ago we didn’t have. A few years ago readers wouldn’t have been as energized and as informed because we didn’t have the ability to communicate as we do now. We have been so fractured and fragmented all around the country and around the nation that we feel like we can’t do anything, that Washington is so big and out of touch that we can’t do anything.

In fact, that couldn’t be farther from the truth. Now is the time we really do have the opportunity. For the first time in our history ordinary citizens have the ability to communicate with one another over the heads of the media in publications like Townhall. We are networked on social media sites, like Facebook and Twitter that expose us to thousands of people for free.

But when I was growing up there were three TV stations and two newspapers in every town that decided what the news was. There were probably a dozen people in any town that picked our news for us.

Those days are over.

This election isn’t about voting for the next person standing in a long line of elites who will rule over us; it’s about what kind of country we want to be in the future.

It’s about preserving the American dream right here right now. Because when they mess with our liberty, they really mess with our ability to dream.

I believe that the ability to dream is worth handing down to our kids.

I believe that it’s our dreams that makes us the most dynamic country in the world.

It’s the dream that brings jobs and prosperity to the US.

It’s a dream that treats promises like they really matter.

And it’s the dreams that are the promise of America.

Because when politicians treat the promises they campaign on like they matter, when they are held accountable to those pledges-- by us-- we will restore the respect they owe us.