I made it! Today I graduate from the University of Southern Maine with a Bachelor of Science in nursing. It is time to begin vigorously studying for the NCLEX and to find a job. There are so many things that have interested me. Now that I have finished my clinicals I am most drawn toward mental health and neurology.

One of the biggest challenges with nursing is connecting everything together. It’s difficult not to get caught up in the minutiae and consequently missing out on the big picture or other significant details. Throughout nursing school we have been assured that with time and experience, we will move from being task-oriented and routine-focused to seeing everything as an interconnected, fluid process, and being able to anticipate and manage rapidly changing non-routine events. I feel that I’ve gained extensive knowledge and learned valuable skills throughout my lectures and labs. However, until interacting with actual patients in a real clinical environment, I could not fully understand, appreciate, and apply all those concepts. My clinicals significantly increased my understanding and have hopefully prepared me for the complexities of nursing practice. I have included some excerpts from my journals of my various clinicals throughout the nursing program:

General Medical-Surgical, Maine Medical Center: R4

One of my clinical days I was assigned to care for a patient who had become paraplegic after falling off a roof. One of the nurses discovered that he needed to have a digital stimulation/disimpaction. Knowing I was a new nursing student, she didn’t expect me to perform this somewhat awkward procedure, but she asked if I wanted to try it. Without hesitation, I said “Sure.” The other nurses and my fellow nursing students looked at me in surprise (I’d like to think admiration and awe), and perhaps some disgust. I double-gloved, and with the guidance of the nurse, I was able to remove his fecal matter. I think my patient was comfortable with it, because during the procedure he was making business calls on his cell phone. I felt a sense of satisfaction that I jumped right in and was able to successfully perform this task.

Mental Health Nursing, Spring Harbor Hospital

I accompanied the kids from the developmental disabilities unit on a field trip to the YMCA to go swimming. It was nice to be with them outside the hospital in a community setting. KP, a 10-year-old girl diagnosed with autism, had witnessed a very traumatic event about 1 ½ years prior to her admission to Spring Harbor. She has a lot of anxiety about any unfamiliar situations. She was very apprehensive about going into the water in the swimming pool at the YMCA. Several staff members tried to coax her and give her different options to entering the pool. KP would dip her toe, lower her legs, or start to descend the steps; then she would immediately pull out in fear. After about 30 minutes of this, she allowed several people to carefully guide her down into the water. When she stood on the floor of the pool everyone cheered. KP was visibly relieved and excited. It was incredibly rewarding and affecting to see this breakthrough! On the next visit to the pool her anxiety and fear were still visible, but it only took about 5 minutes before she raised the courage to step down into the water–much quicker than her previous encounter. She seemed to need the tight grip of several people in order to feel safe and confident. At one point KP said “OK, this is excellent.” Once again, it was wonderful to see her achieve this little success.

Bayside Community Partnership

I look forward to going to the Preble Street Soup Kitchen to take blood pressures every week for our partnership. I hear many different stories from people of different backgrounds in different circumstances, sadly most of whom are going through difficult times. Although many are interested in having their blood pressures taken, I think they simply appreciate our presence there; to have someone listen and provide support.

My wonderful partnership instructors Linda (left) and Su (right), with nursing students at our Bayside health fair.

I always look forward to seeing Gene, a charismatic older gentleman who sits in a chair by the door behind our table every week. He has shared great stories and shown me his amazing sketches. His talent and authenticity are incredibly admirable. It is reassuring to know that Bayside provides so many services to those in less fortunate financial and social circumstances. I have enjoyed working with the community, and I have appreciated the opportunity to interact with many different people who I would not have met otherwise.

Pediatrics, Barbara Bush Children’s Hospital

I accompanied my 11-year-old patient down to interventional radiology for a peripheral line insertion. When she heard music playing in the procedure room, she asked if she could hook her iPod up to the dock with the speakers so she could listen to Justin Bieber, a 17-yr-old Canadian pop singer popular among teens. The radiology staff were happy to comply. My patient enthusiastically began singing along with the songs, and appeared to have every word memorized. As she was going under the anesthesia, her singing was less intense, and she was remembering fewer and fewer words. After she was completely sedated, I think the staff were relieved to have some different background music. I appreciated how this simple thing could affect her disposition, as it was clearly reducing any of her anxiety and apprehension.

Practicum, Scarborough Surgery Center

I went into the operating room one day prepared to observe a vitrectomy (removal of vitreous humor around the macula). When the surgeon invited me over to watch what he was doing, I was surprised to see him cut out the lens and proceed to remove the entire contents of the eye from the socket.

Me at my nursing practicum at Scarborough Surgery Center.

This kind of thing doesn’t bother me; however, I was a little unprepared because it wasn’t what I was expecting. It turned out that he was performing an enucleation (removal of entire contents). A prosthetic would be implanted later. He explained “sympathetic ophthalmia” to me, which has been known to follow ocular trauma or intraocular surgery. The injured eye becomes inflamed first, and the other eye follows (i.e., “sympathetically”). This leads to an autoimmune reaction against the exposed ocular antigens in the injured eye as well as the sympathizing eye. The injured eye is removed to prevent this from happening. I later asked the surgeon about it, incorrectly calling it “empathetic” opthalmia. Jokingly he responded that it would be called “apathetic” ophthalmia if the other eye didn’t care.

I earned my CNA certification a few years ago because I thought it would be a good segway into nursing. During the course I had some memorable experiences, such as having a patient handing me her dentures to hold while she vomited, having another patient defecate on my shoe after I’d given her prune juice for her constipation, and watching a restless and confused patient dutifully and enthusiastically fold washcloths I’d given her to keep her occupied. While I was preparing the groin of a patient scheduled for a procedure, I casually held aside his scrotum with my hand. My instructor pulled me aside afterward to tell me I should have used a towel instead of my hand. If my patient was surprised or uncomfortable, he didn’t indicate it. I encountered another patient in the hallway who was fiddling with the cardiac telemetry leads on his chest. He noticed they were not registering on the telemetry screen in the hall and was attempting to fix them. When I asked him what he was doing and told him he needed a nurse to help, he said “I’m taking care of it. Don’t worry—I’m an electrician.”

I work as a nursing unit secretary which includes answering call bells. The best part about my job is when I have the opportunity to do things for the patients myself. We had only one or two patients at a time in my nursing clinicals, which allowed us the opportunity to give them extra time and attention. Once I begin working as a nurse, I know I will miss having that extra patient interaction.

We’re usually removed from the real world of illness and dying. The nurse sees and participates in things that other people are uncomfortable with. Nursing has become more involved with management, intensive care, and administration. As they become more advanced, they become further and further removed from the patients. The reward, however, is in patient care. Nurses lament that there is not time to do the little things for the patients anymore, the things they enjoy most. When the nurse takes on the responsibility of his/her patients, he/she is accountable for them, advocates for them, and forms a connection with them. The challenge for nurses is to find the compassionate moments with the patients. ~Lori Burnell, RN, MSN

One of the things that made an impression on me from the beginning as a nursing student was the fuller definition of medical care: To cure sometimes, to relieve often, and to comfort always. This has has always stuck with me. The health system is oriented toward the cure of disease; we think of medicine primarily in terms of the interventions we can perform. When overwhelmed by the biomedical needs of the patient and complexities of the treatments, it is difficult to attend to the psychosocial needs of the patient and family.

Hayley models my OR surgical hat and mask.

I am so thankful for the support of my three wonderful daughters who have been incredibly patient and understanding while I have been so busy with school and work. They frequently tell me I’m going to make a good nurse. I cannot adequately express my gratitude and appreciation for my amazing sweetheart and best friend, Brent. He has pushed, encouraged, and supported me throughout it all; always behind me and beside me. Aside from all the hard work, stress, and unavailability, nursing school has been a positive experience overall. I’m definitely ready for the next chapter in my life. I’m looking forward to having more time to spend with my family and to do other things I enjoy. As for putting a “BSN” after my name…that’s pretty awesome too.

I will end with a limerick I wrote for my high-acuity class (thank you, Su) this final semester:

I’ve learned to work hard without rest.
And exercise before each test.
Avoiding conjecture
And vigorous lecture
Show evidence-based practice is best!

My friend Kate B. intrigued me with the storyline of The House of Tomorrow by Peter Bognanni, and recommended that I read it. I’m glad she did, because it truly was a good read.

This is a novel about a teenage boy named Sebastian who is raised in a futuristic geodesic dome by his grandmother whom he calls Nana. She home schools Sebastian under the teachings of the dead, futuristic architect and philosopher Buckminster Fuller. Nana is convinced that Sebastian is destined to save humanity. She also tries to prevent him from uncovering or thinking about the past, particularly in regard to his dead parents. She asks him at the end: “Just tell me how were you supposed to innovate if you were constantly stuck in a past you didn’t even remember?”

But when his Nana has a stroke and is temporarily incapacitated, Sebastian is forced to venture out in the world and befriends a boy his age named Jared, as well as his mother Janice and his sister Meredith.

Jared seems to both fascinate and confuse Sebastian; Jared smokes and cusses, loves punk rock, and is very angry and sarcastic. The way Sebastian tolerates Jared’s sarcasm and rudeness almost seemed masochistic to me. Sebastian soon learns that Jared had recently had a heart transplant. The interaction between the two boys is quite comical. They form an unusual bond and start a band together to perform at a local church talent show. This email Jared sends to Sebastian is a good and humorous illustration of Jared’s character and attitude:

S,
Janice is going out this Saturday night to do something churchy and gay. Now is our chance!!!!!!!!! Come at seven with your instrument.
No excuses or you’re totally out of the band.
Which reminds me, we need a band name. I’ll think of one. Try not to come up with any suggestions. They probably won’t be helpful.
Later,
J
P.S. I hope you’ve been practicing. And I hope you’ve somehow become cooler. That would also help the band.

Sebastian becomes smitten with Jared’s sister, Meredith, who is constantly sarcastic and rude to both Jared and Sebastian. Jared catches Sebastian talking to Meredith and responds:

You don’t have time to chitty-chat with loose women. We have work to do. And you have to save humanity. That’s a lot of shit to get done.

Later Sebastian confronts Meredith about the way she treats her brother. I found her reasoning very thoughtful and touching.

“Why are you so mean to your brother? He’s your family. And he’s�sick. Don’t you understand that?”
“Listen, you chose. Maybe if you knew anything about anything you wouldn’t have to ask such stupid questions.”
“I see the way you treat him.”
“I know you think you’re king of the universe because you have this oddball life and my brother thinks you’re funny, but I’ve lived with him for sixteen years and you’ve known him for weeks.”
“What are you saying?”
“I piss him off because that’s what he likes. I piss him off because that’s how it’s been and if I started being his best friend he’d know it was because of the operation, and he would hate me even more. You get it? I play my part and it makes him think that something is still normal around here.”
“He likes to be angry?”
“Have you ever spent time with him?”
“Okay, maybe sometimes.”
“So don’t tell me, don’t come in here and tell me that I’m making things worse for him because it’s not true. My mom treats him like a five-year-old, and know that’s not right. My dad is never home, and I know that’s not right. So I’m trying something different. I’m treating him like the irritating little shit that he is.”

Throughout all this Sebastian is trying to make sense of a world he never knew existed and soon begins to question the wisdom and philosophy of his eccentric grandmother. He comes to this realization near the end of the book:

The philosophy of Buckminster Fuller and the philosophy of punk rock are not as separate as they may seem to be. Both had a do-it-yourself motto. If something wasn’t out there in the world that needed to be, whether it was a new sound or a new form of housing, you were supposed to do it yourself. It is only those who dared to do something different who made real contributions to life and art. In this very context, it is very possible that Bucky was a punk rocker in spirit. And this was, perhaps, where Nana had gotten it wrong. Instead of allowing me to figure things out for myself, to explore life, she had kept me in a bubble filled only with her ideas. Ideas she had culled straight from Fuller.

I read the entire book in a day. Bognanni does an excellent job portraying how family and friend relationships change. I love how he develops the characters in his book, and his writing style is captivating. The House of Tomorrow is heartfelt, poignant, funny, and gritty. Thank you for the recommendation, Kate. :-)

Neuroscientist David Eagleman proposes in his book Incognito: The Secret Lives of the Brain, that most of what you do, think and believe is generated by parts of your brain to which you have no access. His writing provokes thought and understanding.

The title of this book refers to its theme that we don’t really “know” ourselves. Eagleman describes how most of our thought processes are unconscious and not accessible to us, most of the activity going on without our being aware.

Almost the entirety of what happens in your mental life is not under your conscious control, and the truth is that it’s better this way. When consciousness meddles in details it doesn’t understand, the operation runs less effectively. One does not need to be consciously aware to perform sophisticated motor acts. We are not conscious of most things until we ask ourselves questions about them. The brain generally does not need to know most things; it merely knows how to go out and retrieve the data. It computes on a need-to-know basis. We are not conscious of much of anything until we ask ourselves about it. We are unaware of most of what should be obvious to our senses; it is only after deploying our attentional resources onto small bits of the scene that we become aware of what we were missing. Before we engage our concentration, we are typically not aware that we are not aware of those details. So not only is our perception of the world a construction that does not accurately represent the outside, but we additionally have the false impression of a full, rich picture when in fact we see only what we need to know, and no more. (p. 28)

Perception works not by building up bits of captured data, but instead by matching expectations to incoming sensory data. Neuroscientist Donald MacKay suggested that the primary visual cortex constructs an internal model that allows it to anticipate the data streaming up from the retina. The cortex sends its predictions to the thalamus, which reports on the difference between what comes in through the eyes and what was already anticipated. The thalamus sends back to the cortex only that difference information–that is, the bit that wasn’t predicted away. This unpredicted information adjusts the internal model so there will be less of a mismatch in the future. in this way, the brain refines its model of the world by paying attention to its mistakes. (p. 48-49)

Awareness of your surroundings occurs only when sensory inputs violate expectations. When you first learn to ride a bicycle, a great deal of conscious concentration is required; after some time, when your sensory-motor predictions have been perfected, riding becomes unconscious. You are unaware of how you’re holding the handlebars, applying pressure to the pedals, and balancing your torso. Your brain knows exactly what to expect. So you’re conscious neither of the movements nor of the sensations unless something changes–like a strong wind or a flat tire. Then these new situations cause your normal expectations to be violated, consciousness comes online and your internal model adjusts. This predictability that you develop between your own actions and the resulting sensations is the reason you cannot tickle yourself. Other people can tickle you because their tickling maneuvers are not predictable to you. Interestingly, schizophrenics can tickle themselves because of a problem with their timing that does not allow their motor actions and resulting sensations to be correctly sequenced. (p. 50)

Eagleman shares interesting insight into the way we perceive and accommodate to our differences:

If you are not color-blind, you may find it difficult to imagine yourself as color-blind. But some people see more colors than you do. A fraction of women have not just three but four types of color photoreceptors–and as a result they can distinguish colors that the majority of humankind will never differentiate. If you are not a member of that small female population, then you have just discovered something about your own impoverishments that you were unaware of. You may not have thought of yourself as color-blind, but to those ladies supersensitive to hues, you are. In the end, it does not ruin your day; instead, it only makes you wonder how someone else can see the world so strangely. And so it goes for the congenitally blind. They are not missing anything; they do not see blackness where vision is missing. Vision was never part of their reality in the first place, and they miss it only as much as you miss the extra scents of the bloodhound dog or the extra colors of the tetrachromatic women. (p. 78)

One in a hundred otherwise normal people experience the world with a condition called synesthesia, or “joined sensation.” In synesthetes, stimulation of a sense triggers an anomalous sensory experience: one may hear colors, taste shapes, or systematically experience other sensory blendings. Synesthesia is the result of increased cross talk among sensory areas in the brain. Synesthetes are not driven crazy by the extra dimensions. They’ve never known reality to be anything else. Most synesthetes live their entire lives never knowing that others see the world differently than they do. (p. 80-81)

Nature seems to have invented mechanisms for storing memory more than once. Under normal circumstances your memories of daily events are consolidated by an area of the brain called the hippocampus. But during frightening situations another area, the amygdala, also lays down memories along an independent, secondary memory track. Amygdala memories are difficult to erase and they can pop back up in “flashbulb” fashion. We’re not talking about a memory of different events, but multiple memories of the same event. (p. 126)

I think Eagleman does an excellent job explaining the wiring for our impulses and free will.

Hidden drives and desires can lurk undetected behind the neural machinery of socialization. When the frontal lobe is compromised, people become “disinhibited,” unmasking the presence of the seedier elements in the neural democracy. A common example of this disinhibited behavior is seen in patients with frontotemporal dementia, a tragic disease in which the frontal and temporal lobes degenerate. With the loss of the brain tissue, patients lose the ability to control hidden impulses. These patients unearth an endless variety of ways to violate social norms: shoplifting in front of store managers, removing their clothes in public, running stop signs, breaking out in song at inappropriate times, eating food scraps found in public trash cans, or being physically aggressive or sexually transgressive. (p. 155)

A slight change in the balance of brain chemistry can cause large changes in behavior. People’s brains can be vastly different–influenced not only by genetics but by the environments in which they grew up. Many chemical and behavioral “pathogens” can influence how you turn out. So when it comes to thinking about blameworthiness, the first difficulty to consider is that people do not choose their own developmental path. (162:) How exactly would we assign culpability to people for their varied behavior, when it is difficult to argue that the choice was ever really available? (p. 157)

Eagleman addresses at length the problem of our knee-jerk desire for punishment and revenge for “wrong-doers,” offenders, and prisoners rather than rehabilitation in the interest of improving society as a whole. His ideas of prison reform are astute and thought-provoking:

To help a citizen reintegrate into society, the ethical goal is to change him as little as possible to allow his behavior to come into line with society’s needs. Poor impulse control is a hallmark characteristic of the majority of criminals in the prison system. Many people have a strong retributive impulse: they want to see punishment, not rehabilitation. Often when we hear about a criminal committing an odious act, we are so angry that we want to take vigilante-style revenge. But just because we have the drive for something doesn’t make it the best approach. (p. 182-185)

The current version of the law uses crude divisions: If you’re eighteen we can kill you; if you’re one day shy of your eighteenth birthday you’re safe. If your IQ is 70, you get the electric chair; if it’s 69, get comfortable on your prison mattress. When punishing, what matters is not so much your intuition about blameworthiness but instead about modifiability. I speculate that someday we will be able to base punishment decisions on neuroplasty. Some people have brains that are better able to respond to classical conditioning (punishment and reward), while other people–because of psychosis, sociopathy, frontal maldevelopment, or other problems–are refractory to change. If a particular harsh sentence is meant to disincentivize prisoners from returning, there is no purpose of this punishment were there is not appropriate brain plasticity to receive it. If there is hope of using classical conditioning to effect a change in behavior that would allow social reintegration, then punishment is appropriate. When a convicted criminal is not going to be usefully changed by punishment, he should simply be warehoused. You do not punish or scold a non-housetrained puppy or a young child who shoplifts because you feel they had plenty of options, but instead because you understand the puppy or child to be modifiable. Societies in the future might experimentally derive an index to measure neuroplasticity–that is, the capacity to modify the circuitry. Punitive action may slake bloodlust for some, but there is no point in it for society more broadly. (p. 187-189)

Biological explanation will not exculpate criminals. Brain science will improve the legal system, not impede its function. For the smooth operation of society, we will still remove from the streets those criminals who prove themselves to be over-aggressive, under-empathetic, and poor at controlling their impulses. They will still be taken into the care of the government. But the important change will be in the way we punish the vast range of criminal acts–in terms of rational sentencing and new ideas for rehabilitation. The emphasis will shift from punishment to recognizing problems (both neural and social) and meaningfully addressing them. Further, as we come to better understand the brain, we can concentrate on building societal incentives to encourage good behavior and discourage bad behavior. This will reduce our emphasis on retribution in exchange for proactive, preventative policy making. Suppose we discovered that all serial murderers were abused as children; this encourages us to prevent child abuse, but it does nothing to change the way we deal with the particular serial murderer. We still need to warehouse him and keep him off the streets, irrespective of his past misfortunes. The judge must take action to keep society safe. The concept and word to replace blameworthiness with modifiability, a forward-thinking term that asks, What can we do from here? Is rehabilitation available? If not, will the punishment of a prison sentence modify future behavior? If punishment won’t help, then take the person under state control for the purposes of incapacitation, not retribution. (p. 190)

We see that self-knowledge requires as much work from the outside (in the form of science) as from the inside (introspection). Much of who we are remains outside our opinion or choice. Do we possess a soul that is separate from our physical biology–or are we simply an enormously complex biological network that mechanically produces our hopes, aspirations, dreams, desires, humor, and passions? The majority of people on the planet vote for the extrabiological soul, while the majority of neuroscientists vote for the latter: an essence that is a natural property that emerges from a vast physical system, and nothing more besides. The materialist viewpoint states that we are, fundamentally, made only of physical materials. In this view, the brain is a system whose operation is governed by las of chemistry and physics–with the end result that all of your thoughts, emotions, and decisions are produced by natural reactions following local laws to lowest potential energy. We are our brains and its chemicals, and any dialing of the knobs of your neural system changes who you are. Neurotransmitters (serotonin, dopamine, epinephrine), narcotics and hormones all influence your cognition in addition to genes and viruses. (p. 203-206)

Eagleman shares some interesting ideas about instincts, split-brain patients and brain hemispheres, how your brain interprets your body’s actions, brain rivalry, problem solving, automatism, and emergence.

I apologize for the long-winded review. There was so much in the book I considered significant and interesting. I found Incognito a very compelling read–one of my favorite books, in fact. The book, which is grounded in a massive amount of neuroscience research, is written in a conversational manner with lots of analogies and metaphors that make the information understandable and relevant. Brent actually had the pleasure of meeting and conversing with Eagleman at a Poptech conference last year. I am envious!

OK, so I didn’t read this book thoroughly cover-to-cover. I read Roach’s first book Stiff: The Curious Lives of Human Cadavers, which I really enjoyed. So I figured this book would also be pretty good; and since Brent was going to the NASA Tweetup to watch the final shuttle launch, I wanted to learn more about space flight and behind-the-scenes astronaut life. Although I skimmed over parts of the book (Brent read it too, and he caught me when he tried discussing certain parts of which I wasn’t familiar), I did learn a lot of interesting things and enjoyed Roach’s writing style. She gets actively involved in her research and incorporates humor in clever and unexpected ways. I like how she explains gravity:

Gravity is the prime reason there’s life on Earth. You need water for life, and without gravity, water wouldn’t hang around. Nor would air. It is Earth’s gravity that holds the gas molecules of our atmosphere–which we need not only to breathe but to be protected from solar radiation–in place around the planet. The term “zero gravity” is misleading when applied to most rocket flights. Astronauts orbiting Earth remain well within the pull of the planet’s gravitational field. Spacecraft like the International Space Station orbit at an altitude of around 250 miles, where the Earth’s gravitational pull is only 10 percent weaker than it is on the planet’s surface. Here’s why they’re floating: When you launch something into orbit, you have launched it so powerfully fast and high and far that when gravity’s pull finally slows the object’s forward progress enough that it starts to fall back down, it misses the Earth. It keeps on falling around the Earth rathe than to it. As it falls, the Earth’s gravity keeps its tug, so it’s both constantly falling and constantly being pulled earthward. (p. 86)

The “Space Beauty Treatment” is an interesting phenomenon:

You never think about the weight of your organs inside you. Your heart is a half-pound clapper hanging off the end of your aorta. Your arms burden your shoulders like buckets on a yoke. The colon uses the uterus as a beanbag chair. Even the weight of your hair imparts a sensation on your scalp. In weightlessness, all this disappears. Your organs float inside your torso. They migrate up under your ribcage, reducing your waistline in a way no diet can. One NASA researcher called it the Space Beauty Treatment. Without gravity, your hair has more body. Your breasts don’t sag. More of your body fluid migrates to your head and plumps your crow’s feet. Because blood volume sensors are in the upper body only, your system thinks you are retaining too much fluid and dumps 10 to 15 percent of your water weight. (Then again, I have also heard it called Puffy-Face Chicken-Leg Syndrome.) (p. 103)

If you ever thought jumping up in the air before a falling elevator hits bottom, think again:

Because astronauts are reclining on their backs during touch-down, a space capsule hitting the ocean in calm conditions creates a force on the transverse axis–front to back–by far the body’s most durable. Lying on their backs, fully supported and restrained, they can tolerate three to four times as much G force as they could seated or standing, wherein the more vulnerable longitudinal axis takes the strain. Thus, the best way to survive in a falling elevator is to lie down on your back. Sitting is bad but better than standing, because buttocks are nature’s safety foam. Muscle and fat are compressible; they help absorb the G forces of the impact. As for jumping up in the air just before the elevator hits bottom, it only delays the inevitable. (p. 133)

Roach discusses how gravity (or lack of) affects temperature, blood flow, and the human body. She describes in detail the complications of hygiene, eating, drinking, and eliminating.

Dry, damaged skin flakes off more readily than healthy, lubricated skin and thus disperses more bacteria. It also harbors more pathogens than healthy skin. Most Americans don’t wash often enough to cause skin problems, but they certainly wash more than necessary. Personal hygiene as practiced in the U.S. today is largely a cultural fetish, actively promoted by those with commercial interests. (p. 201)

This book is well-researched and well-written. Roach explores the real-life quagmires of space travel and astronauts–who are real people with real problems.

Dan Ariely previously wrote Predictably Irrational which I read and enjoyed. In this follow-up, Ariely reveals the beneficial outcomes and pleasant surprises that often arise from irrational behavior; he examines some of the positive effects irrationality has on our lives and offers a new look on the irrational decisions that influence our personal lives and our workplace experiences.

What Ariely suggests about our tendency toward hedonic adaptation is compelling:

Hedonic adaptation is the process of getting used to the places we live, our homes, our romantic partners, and almost everything else. It is an emotional leveling out–when initial positive and negative perceptions fade. When we move into a new house, we may be delighted with the gleaming hardwood floors or upset about the garish lime green kitchen cabinets. After a few weeks, those factors fade into the background. A few months later we aren’t as annoyed by the color of the cabinets, but at the same time, we don’t derive as much pleasure from the handsome floors. (p. 168)

One key to changing the adaptation process is to interrupt it. In a set of experiments Leif Nelson and Tom Meyvis measured how small interruptions–which they called hedonic disruptions–influence the overall enjoyment and irritation we get from pleasurable and painful experiences. They found that in general, when asked about their preferences for breaking up experiences, people want to disrupt annoying experiences but prefer to enjoy pleasurable experiences without any breaks. But Leif and Tom suspected that people’s intuitions are completely wrong. People will suffer less when they do not disrupt annoying experiences, and enjoy pleasurable experiences more when they break them up. Any interruption, they guessed, would keep people from adapting to the experience, which means that it would be bad to break up annoying experiences but useful to interrupt pleasurable ones. Results of their experiments confirmed their predictions. They found that a break actually decreases your ability to adapt to a boring or irritable experience, making the experience seem worse when you have to return to it. Here is the trick: instead of thinking about taking a break as a relief from a chore, think about how much harder it will be to resume an activity you dislike. Similarly, if you don’t want to take the plunge and terminate or interrupt a pleasurable experience, consider the joy of returning to or resuming that activity. (p. 176-180)

We can harness adaptation to maximize our overall satisfaction in life by shifting our investments away from products and services that give us a constant stream of experiences and toward ones that are more temporary and fleeting. For example, stereo equipment and furniture generally provide a constant experience, so it’s very easy to adapt to them. On the other hand, transient experiences (a four-day getaway, a scuba diving adventure, or a concert) are fleeting, so you can’t adapt to them as readily. (p. 187)

Ariely explores several important concepts in his book, such as our innate desire for revenge, our tendency to make rash decisions under the influence of emotions, and intrinsic motivation. He uses a nice narrative style with several personal accounts. Although I was familiar with several of the studies from my previous readings, there were some new concepts and perspectives I found fascinating.

Dr. Bill Bass and Jon Jefferson take their readers inside the real Body Farm, recounting how it was created and some of Bass’ more interesting forensic cases in his long career.

Dr. Bass is a forensic anthropologist who founded the University of Tennessee Anthropological Research Facility (aka The Body Farm) where Bass and his colleagues monitor the decomposition of human corpses in various environments. He spent much research on studying human decomposition and identifying human remains. He explains in his book how the bones of the pelvis, knee, and jaw all play a part in determining race or gender while the cranial sutures can determine age.

Warning: The following quotes describe the changes through which the human body goes in a fire:

The human body undergoes dramatic changes in an intense fire. The arms and legs are the first to go. Relatively thin and surrounded by oxygen, they’re like kindling, easy to ignite and quick to burn. At temperatures of only a few hundred degrees, the skin quickly blackens, the fat beneath the skin starts to sizzle, and within a matter of minutes the skin splits open and the flesh begins to burn. Then the limbs begin to move–the hands and feet clench, the arms curl up toward the shoulders, and the legs spread slightly apart with the knees flexed. It’s function of biomechanics and muscle strength: The flexors, the muscles that cause our arms and legs to bend, are stronger than the extensors, the ones that cause our limbs to straighten. As a fire cooks and dries out the muscles and tendons of the body, they shrink, just like a steak on the grill, and the flexors overpower the extensors. The resulting position is very much like a boxer’s stance in the ring; for that reason we call it the “pugilistic posture.” If, on the other hand, the arms are ties or pinned behind the back, they won’t be able to curl up, so finding a burned body whose arms are straight can be an important clue that the victim was somehow confined or restrained. (p. 76)

The other truly dramatic change that occurs is to the head. The skull is basically a sealed vessel, filled with fluid and moist brain tissue. It doesn’t take long for that moisture to reach the boiling point and create pressure in the cranium; the hotter the fire, the greater the pressure. If there’s an outlet for that pressure–for example, a bullet hole in the skull–the pressure vents harmlessly. If there isn’t, the skull can literally burst, fracturing the cranium into numerous pieces. (p. 77)

I will spare all you squeamish readers the details Bass and Jefferson share about differential decay, putrefication, adipocere, autolysis, green bone, or any of the other grotesque terms related to human decomposition. For me, I must admit, it is all very fascinating. :-) It reinforces my desire to study forensic anthropology.

In their book The Grand Design, Hawking and Mlodinow explain the way theories about quantum mechanics and relativity came together to shape our understanding of how our universe (and possibly others) formed out of nothing.

Hawking is eloquent in the way he describes and explains the workings of the universe.

Orbital eccentricity is a measure of how near an ellipse is to a circle. The degree to which an ellipse is squashed is described by what is called its eccentricity, a number between zero and one. The earth’s orbit has an eccentricity of only about 2 percent, which means it is nearly circular. Circular orbits are friendly to life, while very elongated orbits result in large seasonal temperature fluctuations. On Mercury, for example, with a 20 percent eccentricity, the temperature is over 200 degrees F warmer at the planet’s closest approach to the sun (perihelion) than when it is at its farthest from the sun (aphelion). (p. 150-151)

In 1992 came the first confirmed observation of a planet orbiting a star other than our sun. We now know of hundreds of such planets, and few doubt that there exists countless others among the many billions of stars in our universe. That makes the coincidences of our planetary conditions–the single sun, the lucky combination of earth-sun distance and solar mass–far less remarkable, and far less compelling as evidence that the earth was carefully designed just to please us human beings. Planets of all sorts exist. Obviously, when the beings on a planet that supports life examine the world around them, they are bound to find that their environment satisfies the conditions they require to exist. The fact of our being restricts the characteristics of the kind of environment in which we find ourselves. (p. 153)

Hawking also discusses and explains things such as geodesics, the forces of nature, and how all chemical and organic elements were originally formed. I recommend reading this book to fully appreciate and understand how everything fits together.

The Grand Design is fascinating. It was not a difficult read, as it had no confusing mathematical equations, yet it was interesting, detailed, and thought-provoking. It definitely peaked my curiosity further in physics and cosmology.

New York Times columnist David Brooks uses his book, The Social Animal, to assemble his evidence for the causes of success and failure in life, and to draw implications for social policy.

Brooks shares some insight in the way we learn and communicate, which I found interesting:

Automaticity is achieved through repetition, or “reach and reciprocity.” You start with the core knowledge in a field, for example, then venture out and learn something new. Then come back again and reintegrate the new morsel with what you already know. Then venture out again. Then return. Too much reciprocity and you end up in an insular rut. Too much reach and your efforts are scattershot and fruitless. Learning is not merely about accumulating facts. It is internalizing the relationships between pieces of information. (p. 87, 89)

Brooks suggests that we may think that what we believe and do is largely under our conscious control, and we may believe that we should try to increase this control by the conscious exercise of reasoning and will power; however he maintains that this is all wrong. Nondeliberate emotion, perception and intuition are much more important in shaping our lives than reason and will. Knowledge of what makes us tick, Brooks argues, does not come primarily from introspection but must rely on systematic external observation, experiment and statistics.

People overestimate what they know, and what they can know. They overestimate their ability to understand why they are making certain decisions. They make up stories to explain their own actions, even when they have no clue about what is happening inside. After they’ve made a decision, they lie to themselves about why they made the decision and about whether it was the right one in the circumstances. Daniel Gilbert of Harvard argues that we have a psychological immune system that exaggerates information that confirms our good qualities and ignores information that casts doubt upon them. A great body of research finds that incompetent people exaggerate their own abilities more grossly than their better-performing peers. (p. 219-220)

Brooks presents his book in the context of the story about two fictional characters, Harold and Erica, who are used to illustrate his theory in detail. For me this was unnecessary, distracting, and tiresome. These characters don’t seem to add any depth or help with illustrating his points. He continuously refers back to them, which makes his research seem a bit tenuous and makes it difficult for me to take his data and insight very seriously.

The Tipping Point is about social phenomena and change, in which Gladwell presents life as a social epidemic. He explains how ideas and behaviors spread. Gladwell makes an interesting discovery about kids viewing the show Sesame Street:

After holding experiments, researchers discovered that kids were a great deal more sophisticated in the way they watched the show (or TV) than had been imagined. Kids don’t watch when the are stimulated and look away when they are bored. They watch when they understand and look away when they are confused. Psychologist Elizabeth Lorch said, “Children didn’t just sit and stare, either. They could divide their attention between a couple of different activities. And they weren’t being random. There were predictable influences on what made them look back at the screen, and these were not trivial things, not just flash and dash.” (p. 101-102)

Gladwell also discusses a study of how the frequent cleaning of graffiti from railway cars actually reduced the occurrences of vandalism. He explains it with the idea that crime is contagious. He proposes that ideas and behaviors and new products move through a population very much like a disease does.

There is an epidemic theory of crime that says crime is contagious–just as a fashion trend is contagious–that it can start with a broken window and spread to an entire community. Criminologists James Wilson and George Kelling argued that crime is the inevitable result of disorder. If a window is broken and left unrepaired, people walking by will conclude that no one cares and no one is in charge. Soon, more windows will be broken, and the sense of anarchy will spread from the building to the street on which it faces, sending a signal that anything goes. (p. 141)

I found The Tipping Point a well-written, interesting and entertaining read.

I had half the summer off from school, so naturally I took this opportunity to do some leisure reading. I read some interesting books, all covering my favorite subjects: Neuroscience, psychology, forensics, economics, and science in general.

For nearly every book I read, I take copious notes in Evernote so that I can refer back to the most significant and fascinating things I learn and want to remember. I’ve selected some excerpts from my notes for the books I’ve read the past couple of months, and will post them with reviews for each book.

I enjoy reading. I especially love when my reading prompts further questions and inspires me to study a subject further. I still have a stack of books to tackle before classes start. Yes, I’m a book nerd. :-)