#Hopefully 4th quarter for school goes well
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Yknow what, I might as well see what happens
Gonna do the notes game, just gonna see what happens I dunno (I have a lot of stuff I need to do and no motivation so I’ll use the internet to force me to)
25 notes - I’ll finish reading Good Omens
50 notes - I’ll finish pulp musicals (I started it and got distracted, came back an hour later so damn confused I HAD MY EARBUDS IN AND EVERYTHING)
100 notes - I’ll draw more (both traditionally and digitally, I want to improve)
150 notes - I’ll continue writing a coffee shop au I started last October and never finished (it was like 75 pages and I just stopped :()
200 notes - I’ll listen to Starry
250 notes - I’ll try to get at least a 70% in Spanish this quarter
300 notes - I’ll clean my room
350 notes - I’ll work on eating healthier
500 notes - I’ll spend more time with my friends outside of school
750 notes - I’ll finish listening to all the musicals on my musical watch list (there are so many of them…)
1000 notes - I’ll get back to doing taekwondo
1500 notes - I’ll take a walk every day
2000 notes - I’ll spend more time with my family
2500 notes - I’ll rewrite my really bad Xehaqus fic from 2 years ago and try my hardest not to just delete all of it (I’d be rewriting 183 pages, I dunno I wanna see how I’d write it now without changing the entire plot)
3000 notes - I’ll actually start to study for school and not just wing it
4000 notes - I’ll stop being such an asshole to my parents Jesus Christ how do they deal with me
5000 notes - I’ll come out to my mom as trans
Try and reach the goal before uhhhhh I dunno April 16th
I may add more later, depends on how fast yall go through the goals, I have a lot of things I need to do (mainly because I need to start caring about my health and how I treat other people). I dunno, let’s see how this goes
Edit kinda did the “come out to my mom” thing soooooo idk I’ll figure something out for 5000 (maybe)
#note game#Yall im so bored#And I need motivation#And also I need to start being like… a decent person#Idk man#I probably shouldn’t be needed to do some of these things but also peer pressure is a wonderful thing#And I’m just kinda a mess rn#Hopefully 4th quarter for school goes well#Fingers crossed?
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New Year, New Requests!
However, requests are closed until January 8 :(
I think I’m going to make a choice that might not be popular but with the new year here, I think I’m gonna delete the requests I have and sort of start over. I mean sort of because I’d be willing to do requests that had been requested and continue some of the wips I started but only if the requester comes back and lets me know that they’re still around and wanting the fic. I’m doing this because, you know, new year new requests and I haven’t posted a fic in a long time thanks to my blog being hidden for 3 months. I know I have a lot of requests that I’m scraping and I’m sorry about that but it’s very overwhelming and I hope you understand <3
That being said, I’m putting the requests below the cut for those who requested them to remember which ones are theirs and to let me know! I’m headed back to school hopefully tomorrow for a quarter that starts on the 4th so I might be a little busy to start excepting requests right away but I will soon!
Thanks for sticking around with me guys and I hope this year brings you more content from me :)
*If you do not see your already requested fic on this list and would like me to write it still pls send me an ask and I’ll add it to my list!
Luke Patterson:
Can we get a cutesy/maybe angsty Luke x reader fic based off the scene/look Luke gives Julie when she asks him to “tell her mom she loves her” when they cross over. But it’s the reader planning to tell Luke how she feels & he gets that giddy smile (the band has been hyping her up/but second guesses herself) then they have the performance & reader returns with Julie expecting the boys to be gone but they aren’t & tries to convince them to go to Caleb but Luke says no & she goes to kiss him??
Hey I love your writing!!!!!!! I have a request for a Luke x reader. So basically this is an alive Luke fic where he is dating the reader. The reader is a little insecure of Julie because she keeps overheating how amazing those two are together and how they should start dating or how he’s probably cheating on her with Julie. So one day she goes to surprise him with lunch and she sees them kissing. Luke sees her but she runs away and he runs after her. Do it very angsty with a happy ending where it was Julie who initiated the kiss because she likes Luke but he doesn’t like her and chooses the reader. Sorry it it’s so complicated.
Can i request a Luke x reader based on the song "She Will Be Loved" by Maroon 5💚
Luke Patterson x reader - Friends by Ed Shareen
Luke Patterson x reader please? Maybe with song Style by Taylor Swift? Or just any Taylor Swift song in general? Better than Revenge? All Too Well? Cordelia Street?
Can i request a luke x reader for all too well by taylor swift?
Luke x reader? Nobody Compares? By 1D?
Oooo Luke x reader - either Fallin’ All in You/Mutual/Queen or Like to Be You kinda vibe by Shawn Mendes??? I LOVE ALL YOUR WORK! 💞
Omg what about a Luke Patterson x Mercer!reader with the song Accidentally in Love by Counting Crows from Shrek sksks
could I request luke patterson x reader - remember the mornings by clinton kane 💚
Could I request a luke x reader with girls like us by zoe wees! love your fics
Luke x Reader Upside Down by Austin & Ally?
hi!! I saw you were doing song requests ages ago, but I just thought of one now, pretty new song but it hits you right in the feels 🥺🥺 it’s chicken tendies by Clinton Kane (the name is very misleading 😂)
Can you do "Sex" by The 1975 with Luke you dont have to put smut (maybe implied) just Luke pining after the reader with a happy ending💕
Omg! Hi! So idk if you are still taking song fics but I was folding my laundry at 2 am (you know... gotta love that college life) and The Vamps song Can We Dance came on and I was like Ahhhhh! The perfect Luke x reader song... especially if like set at a party or something... but I’d just thought I would suggest it! Everything you write is so incredibly good PSA!! 💞
Reggie Peters:
hiii! i was wondering if your accepting prompts could write reggie x reader (who is alex’s younger sibling) and they’re kinda sneaking around. Thank you 💛
hiiiii! can i request some mercer sibling x reggie pleasee! really interested to see your take on alex as a big brother!! Xx
Jatp:
ah hi !! heard you needed songs for requests or something? sorry if you don't but idk any other jatp pages if that makes sense. young love by btr could work really well for any ghost member x ghost / living reader?? anyway take with that what you will !! have a good day and much love
Could you do something with the song Amnesia by 5sos? Maybe the reader literally has to move. A happy ending twist? (I don’t remember the character requested :( let me know pls)
Peter Parker:
I was thinking maybe Peter Parker x Cheerleader!Reader? Where they both secretly pine after eachother but due to Peter's shyness reader thinks he's intimated by her popularity and uncomfortable around her and she avoids him because of it. But Peter's shy and awkward because he thinks no one like her would like someone like him because they're so different from one another. And then they get paired together for a project or something and their feelings grow stronger and they start getting even more awkward around eachother and they get in an argument where they both think they've done something wrong and in the heat of the moment they both confess their feelings. Idk I feel like its too detailed of a request so I'm not gonna be upset if you decline it. If you do want to write it feel free to take any artistic liberties you want! Totally up to you.
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About places, heritage and memory
When I first came to Beirut in the year 2000, I immediately felt a connection between Beirut and Berlin, the city where I had been living for 10 years before coming to Lebanon. I had experienced the years of freedom, change and some anarchy during the process of reunification and reconstruction in the heart of Germany in the 1990s. I found a similar spirit in Beirut where I arrived in the year 2000. Both cities had suffered from a conflict, both cities had been divided and carrying with them deep scars. Also, in Berlin and in Beirut, I was drawn to architectural ruins – old villas, buildings, cinemas, factories. It would inspire me and let me dream about the life that had filled these ruins in times long gone.
Coming to Beirut and living here for 20 years has been emotionally challenging. So many beautiful old villas were abandoned and at the brink of destruction. My first story I filmed for German TV was in Beit Beirut about the divisions of Beirut and Berlin and the difficult process of reunification. A few years later, I filmed the story of my husband and myself in the “egg”, in Khiam prison or what’s left of it, and in Saufar’s old castle. In my first year in Beirut, I shared an apartment with German students who were urban planners. They would go to Zokak al Blat, the part where I live now, and study the urban fabric of this area, recording in detail the old villas, streets, shops, and social fabric, and their master thesis would deliver recommendations for safeguarding this old part of Beirut. But living in Zokak al Blat for the last 13 years or so, I had to experience how “developers” demolished a big portion of the old heritage over the years. Every day I used to walk my daughter to school – a school which still has an old villa and a beautiful garden as part of its campus – I would swear at the wild west capitalism, the greed and ruthlessness of the owners who sold their heritage for money and the construction companies that built soul-less concrete blocks, I would swear at the lack of political will (not the lack of legislation) that gave room to demolish these beautiful old villas and gardens to be replaced by massive, ugly, brutal high-rises. I cried and was depressed.
It is possible that the small high-rise where I currently live was also built on the ground where once an old villa or a garden had been in place. When we moved in, we had a view on downtown, the port, and from the balcony we would look down to a traditional Lebanese house with red tiles, being surrounded by oleander bushes and bougainvillea and trees. My daughter was born in this apartment, while feeding her or putting her to bed, I would peek out of the window of her room, see the city at night and the sunrise over the mountains. This view wouldn’t last long, as in Beirut no one is entitled to have a beautiful view, because a Saudi or Kuwaiti developer destroyed the old house, ripped out the oleander bushes and trees and built a high-rise right in front of our noses. I cried and was depressed.
It is ironic that this very building, which was robbing us of the remainders of Lebanese heritage and a beautiful view, would somehow protect us during the explosion on 4th August, except for the old baby room where my daughter would normally sit on her bed, read or chat with her friends. The explosion destroyed all of our windows and doors and if we had been home during the blast, for sure my daughter would have been sitting in her favorite spot in her room and would have been injured by broken glass which landed on her bed. Thank God we weren’t home. Nevertheless, I cried and was depressed.
The landscape of Beirut has changed drastically over the years. More high rises, more office buildings, less sky, less greenery. Sarcastically, I would comment that in Beirut, “everything old and everything green has to go”. That was the mentality, it seemed. But the mentality of whom? Of the Beirutis who were disconnected from the history of this place, or the mentality of real-estate developers, the mafia ruling post-war Lebanon? Sometimes I’d feel that it would even be better to destroy the entire remaining heritage and make Beirut a complete concrete city. At least then we would no longer be reminded of how beautiful Beirut had been before, we would no longer cry over the loss of heritage because it would have been totally erased from our memories.
As a good old European, who cherishes everything old, I would find some consolation first in Monot street, then in Gemmayzeh and later in Mar Mikhael, the only parts of town where entire quarters were still intact with heritage buildings. I would feel that the soul of Beirut was still preserved and very much alive in these areas; I would be happy to see that a mix of restaurants, pubs, galleries would mingle with little grocery and craftsman shops that had been there long before the hipsters arrived; I’d appreciate a mix of old and young, local and international folks, conservative and crazy ones living side by side. And most importantly, at least, the heritage seemed to be safe!
These areas are no more since 4th August – or at least they’re highly endangered and much of the heritage has vanished. And the real estate developers are already waiting around the corner, knocking on people’s doors – people who have lost their homes, their businesses, their galleries and workshops and living rooms; people who had put a lot of effort in maintaining their heritage buildings, in renovating them and turning them into something beautiful and alive; people who are now homeless and devastated – the real estate sharks are around the corner, abusing people’s suffering and vulnerability of this cruel moment in history, to buy off the lands for a cheap bargain, to knock down the last remainders of Beirut’s history and soul, in order to replace the heritage by ugly, massive, brutal high rises. Their greed and ruthlessness and lack of empathy disgusts me. I cry and I am depressed. If this heritage goes, then I am gone, too. If Gemmayzeh, Mar Mikhael are no longer, I will leave Beirut and never return.
Beirut is at a turning point: Either it will be saved – and with it its heritage, memory and soul – or its soul will be gone. It is heartwarming to see how thousands of young volunteers help the inhabitants and business owners to clear the rubble, collect the broken glass and save what can be saved. There are numerous initiatives like Save Beirut Heritage, AUB Neighborhood Initiative and others who are fighting for save-guarding Beirut’s last heritage. I wonder if some reasonable real estate developers exist which appreciate Beirut’s heritage and are willing to rebuild these destroyed neighborhoods while respecting the people’s will, maintaining the social fabric and the heritage.
And there is the Forum for Memory and Future, a network of Lebanese NGOs, academics and international organizations which deal with Lebanon’s complicated and painful past. This network should expand its mission – (heritage) places and the collective memory of a nation are interconnected. This Forum had as aim to Deal with the Past of the Lebanese civil war. Parts of Beirut who were severely affected by the blast – Monot street, the port, Gemmayzeh for example – were important locations during the war years. This Forum should not focus on the Lebanese civil war only, but become broader and more inclusive in its approach and focus now on lobbying to safeguard Beirut’s heritage which was destroyed on 4th August. It also should lobby to safeguard the ruin of the wheat silo which was destroyed in the explosion and turn it into a memorial site. Because when heritage sites are lost, Beirut’s soul will be gone and with it its memory.
In Berlin, in the hype of the reunification years in 1989 and after, the Berlin wall – symbol of a painful division – was almost totally demolished. The young generations no longer know where the wall was, they do not feel the inhumane character of the wall and the death strips – some even don’t know that Berlin was once divided. Heritage sites and locations are deeply connected to the collective memory of a nation. In Berlin as well as in Beirut. That’s why it is so important to safeguard physical heritage. The memory has a chance to live on, from generation to generation, when sites are kept. And why should the Lebanese remember only the painful past of the civil war? Why not remember the beauty of old Beirut, the 1900s, the 1920s; the heydays of the 1960s when the international jet set would come for holidays? This is also part of the complex and often contradictory collective memory of Lebanon!
I no longer want to cry and be depressed. I hope that the Beirut blast will be a turning point in Beirut’s history and that something positive will come out of this horrible disaster: A rebirth, but with the participation of its people, giving room for a deep connection between the Beirutis and their city, a strong and emotional one. I hope that there will be a new political will to safeguard Beirut’s heritage, and a deep appreciation of this heritage, the history and collective memory which weighs more than dollars.
I no longer want to cry, because I ran out of tears. I no longer want to feel depressed, because the emptiness in my heart has given room to a new, hopefully better beginning.
Christina Foerch 23 August 2020
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Presenting Complaint: Social Injustice
By ANISH KOKA, MD
Bobby
It took some doing, but I had finally made it to Bobby’s home.
It was a rowhome tucked into one of those little side streets in the city that non-city folks wouldn’t dream of driving down. As I step in, I’m met by the usual set up – wooden steps that hug the right side of the wall leading up to the second floor. Bobby certainly hasn’t made it up to the second floor in some time. At the moment she is sitting in her hospital bed in the living room. The bed is the focal point to a room stuffed to the gills with all manners of stuff. At least three quarters of the stuff seems to be food. Cinnamon buns, Doritos, donut holes, chocolate frosted Donuts, crackers, Twinkies. The junk food aisle at Wawa would be embarrassed by the riches on display here.
Bobby weighs in at four hundred pounds, 5 foot 5 inches. She has a tracheostomy from multiple prior episodes of respiratory failure that have required ventilatory support. I’m here at the request of a devoted primary care physician that still makes home calls. I’ve looked through the last number of hospital stays. The last few discharge summaries are carbon copies of each other. Hypoxemic respiratory failure related to pulmonary edema complicated further by morbid obesity. Time on the vent. Antibiotics. Diuretics. Home. Return to the hospital 2 weeks later. The last echocardiogram done was 3 admissions ago. A poor study. Not much could be seen due to ‘body habitus’.
I sit on the side of the bed trying to acquire my own images of her heart. I talk to her as I struggle. Bobby is 58, the youngest of three sisters, and the only surviving member of the family. Her elder sisters died of respiratory complications as well. They both died with tracheostomies. The conversation is circular. The problem according to Bobby is the tracheostomy. Everything was fine before that. I explain that a prolonged period of time on the ventilator on a prior admission prompted the tracheostomy, and that the multiple recent admissions to the hospital that required a ventilator seemed to validate that decision. She doesn’t waver. Both her sisters died shortly after they got tracheostomies. Bobby thinks the physicians taking care of her sisters had a hand in their demise. “They didn’t care”. “We told them they were sick.”
Perhaps.
The picture on the nightstand suggests Bobby was the smallest of the three sisters.
It doesn’t take much to get Bobby talking. Her favorite holiday is July 4th because she makes the family favorite tuna casserole, and her favorite niece, April, helps her with the casserole every year.
Meanwhile, the echocardiogram shows a large right side of the heart. Her pulmonary pressures are elevated, and she seems to be fluid overloaded. Review of her bloodwork from the hospital also strongly suggests her weight may be hampering her ability to expel carbon dioxide. She really needs to be on a ventilator nightly. In other more normal contexts there are additional diagnostic steps to take, but trust won’t be built in a day. She’s heard variations of these recommendations before. She is adamantly opposed to any other invasive tests.
But a small victory. She agrees on the higher diuretic dose.
Bobby is black. I’m brown. We hail from very different zipcodes. She clearly harbors a deep mistrust of the medical system. But I’m hopeful to make some inroads. It doesn’t seem to matter to Bobby that I’m brown, or that I was born in Delhi, or that I reside in a much different zipcode than her. At the moment, I’m just another caregiver in her living room.
I sense a thaw. As I pack up, she asks me when I’ll see her again.
Hopefully soon, Bobby.
Mr. Chalhoubi
Hussain Chalhoubi is in the office with one of his three devoted daughters. It’s a different daughter every week and I can never keep their names straight. I met him after he had suffered a stroke that leaves him frustratingly aphasic. He enjoys food and drink, and like clockwork would appear in my office in the early years frequently with swollen hands and feet days after a dietary indiscretion. He always had a sheepish look on his face as his exasperated daughters would tattle on him.
At some point I learned there was little point to piling on. Scolding only gets you so far. Instead, I asked him about Syria. Boy do those eyes light up. His family had fled shortly after Syria had been plunged into civil war.
I’m curious who he blames for the mess. Assad, the dictator who the US has held responsible? He vigorously shakes his head. His daughter chimes in.
“We are Christians.”
Not much more needs to be said. Assad may be the boogie-man to many, but he is an Alawite, a minority sect of Islam in a sea of Sunni Muslims that makes up the Levant in the Middle East. The rebellion against the Alawite Assad is of the behead-first-ask-questions-later extremist Sunni kind that scares the Syrian Christian minority much more than the ruling dictator accused of his own share of atrocities.
As the conversation comes back to the medical, he forwards through his daughter that he has been trying to flush out his kidneys by drinking copious amounts of water. I try to explain to him that his kidneys and his heart don’t function normally, so they can get overwhelmed.
No flushing.
Over time, he’s started to listen more. He doesn’t skip his medications, avoids drinking too much. He used to be in the office monthly, but now every 3-4 months for routine visits.
Serving patients, or populations ?
It is now a rather quaint idea that outcomes for patients are best improved one doctor-patient relationship at a time. I understand the sentiment. For most patients the outcome is decided well before their encounter with me. Your zipcode seems to be a lot more important to your outcome than your doctor, and unsurprisingly a movement to address matters that have traditionally lived outside of the health care system has gained steam
In an earlier era the doctor’s mission was to recognize and manage diseases. Medical students were taught to hear the severe aortic regurgitation that was causing the progressive shortness of breath. The advances in the management of disease over the last half century have been nothing short of magical. Crack open a chest, arrest the heart, replace an aortic valve, bring the heart back to life. The power of medicine realized was to change the natural history of disease for the ill patient that arrived in distress seeking help.
And here the very reasonable human desire to address systemic inequities in society found synergy with a darker current of thought within medicine that felt the resources expended to care for the very ill are resources poorly spent. The focus, the theory goes, should be on preventing illness in the much larger healthy population. The scope of keeping the healthy well, of course, extends well beyond the medical, and puts everything in play. Sanitation, transportation, air quality, climate change, access to the means to pay for healthcare are just the start of a long list of priorities for those in charge. These programs need scarce budgetary dollars, and so it was only a matter of time after the government started paying for healthcare that politicians and the public health gurus they empowered to manage the health of the population began to voice their disdain for the care of those deemed “too ill”.
The tension here is that medicine’s greatest strides in the last half century have come in those with afflictions that brought them to death’s door. The inroads in this group of unfortunates have come by way of super-specialists far removed from the concerns of the worried well. Richard Lamm, the former governor of Colorado famously derided the work of Thomas Starzl, the father of organ transplantation, questioning the great surgeons use of public health resources to attempt to save individual patients at death’s door. These were the early days of transplantation, when successes were a far cry from the results enjoyed today. As the passage of time made transplantation success rates north of 90% and the public watched children destined for death skipping down hallways, Lamm’s cold calculus came to easily be rejected.
Yet in 2000, writing for Health Affairs, Lamm doubled down.
“Colorado’s doctors were constantly reminding me that in medicine, ‘cost was never a consideration.’ But health care was the fastest-growing segment of my budget, demanding increasing amounts of public funds for the medical school, for new equipment at the hospital, and for Medicaid. Daily, if not hourly, hospitals in my state would effectively appropriate state funds for a high-risk, low-benefit procedure, while I knew that those funds could easily save more lives elsewhere in the health care system or outside of it, say, by buying three new teachers, fixing a broken sewer main, or adding two police officers to a high-crime area for a year. How could cost not be a consideration in making a public budget?”
“How can patient advocates feel so good about the system they work in when I, as public advocate, feel so guilty for having so many people without even basic health care?”
It never strikes Lamm that the citizens he is so desperate to ‘cover’ with health insurance may want to choose not to die and opt to receive an organ transplant. What good is a health insurance plan that doesn’t pay for life saving therapy when you actually need it? This would be akin to paying for a fire suppressing sprinkler system, but not paying to have firefighters come to battle a structure threatening blaze.
The kinder, gentler, smarter society the ideology Lamm represents is a society that turns its back on the tangible, acute needs of the sick for hypothetical needs of the well. In a perfect world, perhaps one could do both. Unfortunately, when it comes to interventions for the worried well, controversy abounds for how exactly one accomplishes this. Does one advocate for zoning and tax policy to allow fresh produce and groceries to be sold in poor zip codes to address ‘food deserts’ so Bobby has more healthy options? Should we advocate for sin taxes on alcohol, tobacco and sugar containing products that by their very nature are meant to be regressive taxes that affect the behavior of patients like Bobby? Does caring for Mr. Chahloubi mean taking a position on US foreign policy interventions in that country, or perhaps advocacy for immigration for asylum seekers?
In an age not so long ago, it was easily recognized that the answers to these questions were to be wrestled with well outside the purview of the medical field. That a growing number in the medical community think medical training gives us special expertise to solve these problems speaks to a self-important medical echo chamber that believes society’s values should mirror its values.
We would be wise to heed the words of C.S. Lewis – “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies… those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.. This very kindness stings with intolerable insult. To be “cured” against one’s will and cured of states which we may not regard a disease is to be put on a level of those who have not yet reached the age of reason or those who never will; to be classed with infants, imbeciles, and domestic animals.”
Bobby and Mr. Chalhoubi aren’t particularly interested in my views on sugar taxes or my feelings about Bashar al-Assad. They want someone invested in them, not in some abstract population. Advocacy by physicians has its place. Its just not in the exam room.
Anish Koka is a physician in private practice in Philadelphia.
The post Presenting Complaint: Social Injustice appeared first on The Health Care Blog.
Presenting Complaint: Social Injustice published first on https://venabeahan.tumblr.com
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Presenting Complaint: Social Injustice
By ANISH KOKA, MD
Bobby
It took some doing, but I had finally made it to Bobby’s home.
It was a rowhome tucked into one of those little side streets in the city that non-city folks wouldn’t dream of driving down. As I step in, I’m met by the usual set up – wooden steps that hug the right side of the wall leading up to the second floor. Bobby certainly hasn’t made it up to the second floor in some time. At the moment she is sitting in her hospital bed in the living room. The bed is the focal point to a room stuffed to the gills with all manners of stuff. At least three quarters of the stuff seems to be food. Cinnamon buns, Doritos, donut holes, chocolate frosted Donuts, crackers, Twinkies. The junk food aisle at Wawa would be embarrassed by the riches on display here.
Bobby weighs in at four hundred pounds, 5 foot 5 inches. She has a tracheostomy from multiple prior episodes of respiratory failure that have required ventilatory support. I’m here at the request of a devoted primary care physician that still makes home calls. I’ve looked through the last number of hospital stays. The last few discharge summaries are carbon copies of each other. Hypoxemic respiratory failure related to pulmonary edema complicated further by morbid obesity. Time on the vent. Antibiotics. Diuretics. Home. Return to the hospital 2 weeks later. The last echocardiogram done was 3 admissions ago. A poor study. Not much could be seen due to ‘body habitus’.
I sit on the side of the bed trying to acquire my own images of her heart. I talk to her as I struggle. Bobby is 58, the youngest of three sisters, and the only surviving member of the family. Her elder sisters died of respiratory complications as well. They both died with tracheostomies. The conversation is circular. The problem according to Bobby is the tracheostomy. Everything was fine before that. I explain that a prolonged period of time on the ventilator on a prior admission prompted the tracheostomy, and that the multiple recent admissions to the hospital that required a ventilator seemed to validate that decision. She doesn’t waver. Both her sisters died shortly after they got tracheostomies. Bobby thinks the physicians taking care of her sisters had a hand in their demise. “They didn’t care”. “We told them they were sick.”
Perhaps.
The picture on the nightstand suggests Bobby was the smallest of the three sisters.
It doesn’t take much to get Bobby talking. Her favorite holiday is July 4th because she makes the family favorite tuna casserole, and her favorite niece, April, helps her with the casserole every year.
Meanwhile, the echocardiogram shows a large right side of the heart. Her pulmonary pressures are elevated, and she seems to be fluid overloaded. Review of her bloodwork from the hospital also strongly suggests her weight may be hampering her ability to expel carbon dioxide. She really needs to be on a ventilator nightly. In other more normal contexts there are additional diagnostic steps to take, but trust won’t be built in a day. She’s heard variations of these recommendations before. She is adamantly opposed to any other invasive tests.
But a small victory. She agrees on the higher diuretic dose.
Bobby is black. I’m brown. We hail from very different zipcodes. She clearly harbors a deep mistrust of the medical system. But I’m hopeful to make some inroads. It doesn’t seem to matter to Bobby that I’m brown, or that I was born in Delhi, or that I reside in a much different zipcode than her. At the moment, I’m just another caregiver in her living room.
I sense a thaw. As I pack up, she asks me when I’ll see her again.
Hopefully soon, Bobby.
Mr. Chalhoubi
Hussain Chalhoubi is in the office with one of his three devoted daughters. It’s a different daughter every week and I can never keep their names straight. I met him after he had suffered a stroke that leaves him frustratingly aphasic. He enjoys food and drink, and like clockwork would appear in my office in the early years frequently with swollen hands and feet days after a dietary indiscretion. He always had a sheepish look on his face as his exasperated daughters would tattle on him.
At some point I learned there was little point to piling on. Scolding only gets you so far. Instead, I asked him about Syria. Boy do those eyes light up. His family had fled shortly after Syria had been plunged into civil war.
I’m curious who he blames for the mess. Assad, the dictator who the US has held responsible? He vigorously shakes his head. His daughter chimes in.
“We are Christians.”
Not much more needs to be said. Assad may be the boogie-man to many, but he is an Alawite, a minority sect of Islam in a sea of Sunni Muslims that makes up the Levant in the Middle East. The rebellion against the Alawite Assad is of the behead-first-ask-questions-later extremist Sunni kind that scares the Syrian Christian minority much more than the ruling dictator accused of his own share of atrocities.
As the conversation comes back to the medical, he forwards through his daughter that he has been trying to flush out his kidneys by drinking copious amounts of water. I try to explain to him that his kidneys and his heart don’t function normally, so they can get overwhelmed.
No flushing.
Over time, he’s started to listen more. He doesn’t skip his medications, avoids drinking too much. He used to be in the office monthly, but now every 3-4 months for routine visits.
Serving patients, or populations ?
It is now a rather quaint idea that outcomes for patients are best improved one doctor-patient relationship at a time. I understand the sentiment. For most patients the outcome is decided well before their encounter with me. Your zipcode seems to be a lot more important to your outcome than your doctor, and unsurprisingly a movement to address matters that have traditionally lived outside of the health care system has gained steam
In an earlier era the doctor’s mission was to recognize and manage diseases. Medical students were taught to hear the severe aortic regurgitation that was causing the progressive shortness of breath. The advances in the management of disease over the last half century have been nothing short of magical. Crack open a chest, arrest the heart, replace an aortic valve, bring the heart back to life. The power of medicine realized was to change the natural history of disease for the ill patient that arrived in distress seeking help.
And here the very reasonable human desire to address systemic inequities in society found synergy with a darker current of thought within medicine that felt the resources expended to care for the very ill are resources poorly spent. The focus, the theory goes, should be on preventing illness in the much larger healthy population. The scope of keeping the healthy well, of course, extends well beyond the medical, and puts everything in play. Sanitation, transportation, air quality, climate change, access to the means to pay for healthcare are just the start of a long list of priorities for those in charge. These programs need scarce budgetary dollars, and so it was only a matter of time after the government started paying for healthcare that politicians and the public health gurus they empowered to manage the health of the population began to voice their disdain for the care of those deemed “too ill”.
The tension here is that medicine’s greatest strides in the last half century have come in those with afflictions that brought them to death’s door. The inroads in this group of unfortunates have come by way of super-specialists far removed from the concerns of the worried well. Richard Lamm, the former governor of Colorado famously derided the work of Thomas Starzl, the father of organ transplantation, questioning the great surgeons use of public health resources to attempt to save individual patients at death’s door. These were the early days of transplantation, when successes were a far cry from the results enjoyed today. As the passage of time made transplantation success rates north of 90% and the public watched children destined for death skipping down hallways, Lamm’s cold calculus came to easily be rejected.
Yet in 2000, writing for Health Affairs, Lamm doubled down.
“Colorado’s doctors were constantly reminding me that in medicine, ‘cost was never a consideration.’ But health care was the fastest-growing segment of my budget, demanding increasing amounts of public funds for the medical school, for new equipment at the hospital, and for Medicaid. Daily, if not hourly, hospitals in my state would effectively appropriate state funds for a high-risk, low-benefit procedure, while I knew that those funds could easily save more lives elsewhere in the health care system or outside of it, say, by buying three new teachers, fixing a broken sewer main, or adding two police officers to a high-crime area for a year. How could cost not be a consideration in making a public budget?”
“How can patient advocates feel so good about the system they work in when I, as public advocate, feel so guilty for having so many people without even basic health care?”
It never strikes Lamm that the citizens he is so desperate to ‘cover’ with health insurance may want to choose not to die and opt to receive an organ transplant. What good is a health insurance plan that doesn’t pay for life saving therapy when you actually need it? This would be akin to paying for a fire suppressing sprinkler system, but not paying to have firefighters come to battle a structure threatening blaze.
The kinder, gentler, smarter society the ideology Lamm represents is a society that turns its back on the tangible, acute needs of the sick for hypothetical needs of the well. In a perfect world, perhaps one could do both. Unfortunately, when it comes to interventions for the worried well, controversy abounds for how exactly one accomplishes this. Does one advocate for zoning and tax policy to allow fresh produce and groceries to be sold in poor zip codes to address ‘food deserts’ so Bobby has more healthy options? Should we advocate for sin taxes on alcohol, tobacco and sugar containing products that by their very nature are meant to be regressive taxes that affect the behavior of patients like Bobby? Does caring for Mr. Chahloubi mean taking a position on US foreign policy interventions in that country, or perhaps advocacy for immigration for asylum seekers?
In an age not so long ago, it was easily recognized that the answers to these questions were to be wrestled with well outside the purview of the medical field. That a growing number in the medical community think medical training gives us special expertise to solve these problems speaks to a self-important medical echo chamber that believes society’s values should mirror its values.
We would be wise to heed the words of C.S. Lewis – “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies… those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.. This very kindness stings with intolerable insult. To be “cured” against one’s will and cured of states which we may not regard a disease is to be put on a level of those who have not yet reached the age of reason or those who never will; to be classed with infants, imbeciles, and domestic animals.”
Bobby and Mr. Chalhoubi aren’t particularly interested in my views on sugar taxes or my feelings about Bashar al-Assad. They want someone invested in them, not in some abstract population. Advocacy by physicians has its place. Its just not in the exam room.
Anish Koka is a physician in private practice in Philadelphia.
The post Presenting Complaint: Social Injustice appeared first on The Health Care Blog.
Presenting Complaint: Social Injustice published first on https://wittooth.tumblr.com/
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Hiatus?
My phone finally messed up. Took it long enough. For those that don't know (AKA most/all of you), I’m bad at holding things and keeping things on my person, so, naturally, I dropped my phone out of its case onto the road and basically destroyed the screen. It worked well enough for me to continue using it. I dropped it during 4th quarter last school year. I just had to use google to go from app to app since the buttons stopped working. Now though, the screen shut down and I can’t turn my phone on anymore. Therefore, I won’t be on any form of social media for longer than a minute at a time. This is a hiatus that’ll last hopefully no more than a week. I’ll get something together to say ‘oops sorry’ when I come back.
This goes for @accidently-happens too.
#life update#lol#i just got my second blog running too#X'D#see yall later#miss ya already#really am sorry though#i've been on and off discord for the last few days but#my phone = my internet#:/#my art blog is super quiet#i'll try to check in tomarrow?
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It’s an old-school SEC matchup!
In case you didn’t know, Auburn and Tulane kick off tomorrow at Jordan-Hare Stadium. In case you didn’t know it, Auburn and Tulane also used to be members of the same conference.
I’m sure there are plenty of people who remember the last time these two teams met — it was 2006, and Auburn won 38-13 — but are there any people around who remember the time before that?
It was 1955, and it would be the final time that Auburn would see the Green Wave for more than 50 years. Tulane was a member of the SEC from 1932-1966, but the Tigers and Wave met every year from 1921-1955. Even worse, Tulane still owns a 17-14-6 record over Auburn, and who knows when we’ll be able to tie it up or take the lead. Atrocious!
Still, we should be able to get one game closer tomorrow. See how we think it’ll end up below!
Auburn (-19.5) vs Tulane (O/U 49.5) - Jordan-Hare Stadium - 6:30 pm CST
The Green Wave visit Jordan-Hare Stadium led by LSU transfer QB Justin McMillan looking to improve upon an impressive showing against a horrible FIU team. Winners of the Cure Bowl a year ago, Tulane has improved in each of the 3 years since Willie Fritz took over. Make no mistake, Auburn can’t sleep walk through this game. Tulane’s offense is getting a lot of attention after putting up 42 points a week ago, but it’s their defense that has me concerned. I went back and watch some highlights of the FIU game, and it looks as though FIU was simply overmatched. So why am I concerned?
Emotional letdown game after the heroics of last week
A true freshman quarterback who is still going to do true freshman things
Special teams coverage
An offensive line that took a while to get going on the ground against an underrated defense
That being said, I’m not worried about Tulane’s offense. I think they want no part of what Kevin Steele puts on the field and I think our defensive line will feast on Saturday.
Keys to winning this game the right way:
Establish the run early and impose your will on Tulane’s defense. Let them know early it’s not their night.
Try to utilize more from the H-Back position in the passing game, giving Nix the underneath to avoid freshman forced throws down field
NO. ONE. GET. HURT. ON. EITHER. SIDE. OF. THE. LINE. (We really need to stay healthy for A&M in 2 weeks)
Give DJ Williams enough reps to prove he can help us play winning football later this month
See if you can get away with little blitzing so that our second level on defense can grow in coverage
Find another outside receiver to step up so Seth Williams can find more 1 on 1 matchups (would love to see more of Matthew Hill or Shedrick Jackson)
This game, like Oregon, is about us. We dictate victory and how we win it. Early mistakes let teams like this linger. Crush them early. Run the football. Protect the football. Then rest your legs late. Auburn 34 Tulane 13
-Josh Black
Tulane is certainly no pushover as they have steadily improved under Willie Fritz. In their opener, they rushed for 350 yards in a 42-14 win over Florida International. The Green Wave also feature former LSU QB Justin McMillan under center who threw for 199 yards last Thursday night and 2 TDs. After a big win over Oregon, it’s reasonable to think the Tigers may not start off as good as we all would like and I wouldn’t be surprised if this game is close at halftime. But despite the big win last week, there was a lot of things to improve upon this week and Coach Malzahn, while happy with the win, certainly wasn’t satisfied with how a lot of things went this past Saturday. But we saw flashes of the potential Bo Nix has, as that was a legendary last drive he had against the Ducks. I would like to see the Nix-Williams combo more, especially considering how many deep shots Nix took in Arlington last Saturday. Boobee was a warrior Saturday night gaining over 100 yards on 24 carries and he really sparked the offense midway through the 3rd Quarter. I’d like to see Kam Martin, Malik Miller, Harold Joiner and the other RBs more involved this weekend. Above all else, Auburn needs to try and stay healthy as several players got a bit banged up last week but hopefully will be good to go Saturday. I think it’s a 1 score game at halftime but Auburn pulls away in the 2nd half. Auburn 34 Tulane 10
-Will McLaughlin
I know there’s some concern about a letdown game here, but I just don’t see it. Sure, Tulane looked awesome running the ball down FIU’s throats last week, but FIU’s defense ranked 111th against the rush last year. The solid play of the Auburn’s defensive tackles against Oregon makes me feel pretty good about that matchup. The only way this doesn’t go well is if Bo NIx and the offense try and force things early and it ends up in turnovers. The Tulane defense was average last year, finishing 65th in the country last season, but they had similar issues to Auburn - they were super efficient, but got killed by the big plays. If Bo connects on a few big passes, this one is a rout. I think he and Seth Williams carry the game winning touchdown chemistry into a big game against the Green Wave. 42-13 White-Outs.
-Ryan Sterritt
I’m more nervous about this game than I should be. We are 19.5 point favorites for a reason. The casinos in the desert didn’t build themselves, they were built by dummies who thought they could outsmart the oddsmakers. I am not one of those dummies. Auburn is going to pound the rock early, put Nix in good situations, and then go deep on play action. I think auburn burns the wave a few times on deep throws in the first half and then is able to get some backups in the game by the fourth quarter. It comes down to not beating ourselves in this game. Yes, Bo Nix can play like a true Freshman at times, but he also has the steely-eyed reserve of a kid who was born for the moment. I don’t remember an Auburn freshman who played like he NEEDED the ball in his hands like this kid does. He’s a lot like Freshman Jared Harper. He is going to do things that are going to make you crazy, but he will also remind you that he has more talent than anything you’ve had at his position in a while. That said, if Auburn turns the ball over in the first half a few times, Jordan-Hare might get restless. I don’t think the Tigers will do that. I’m looking forward to a big win and maybe white uniforms at home. Auburn 41, Tulane 21.
-Son of Crow
How does a young Auburn team handle success? The spotlight? The cameras? Luckily, Tulane comes to town tomorrow. You’d be a fool to sleep on Tulane completely. Willie Fritz is a wizard. They’re a physical team that has all the ingredients of a giant-killer if their opponent sleep-walks through their preparation.
However, there is too much on the line for Auburn to sleep-walk through their Tulane prep. Auburn made a lot of mistakes Saturday. We, the fans, may forget/forgive most of them, but the team has a lot to work on.
This won’t be your standard San Jose State early season blowout. Auburn won’t win this by 45 points. Tulane is too good…defensively. I believe Auburn’s defense is head and shoulders superior to Tulane’s offense, and it will be obvious from the opening kickoff. Auburn 42, Tulane 13
-Josh Dub
I don’t have a great feeling about this one. Tulane can move the ball well enough to make us sweat a bit. Their defensive line appears to be AAC-level nasty. I still think Auburn pulls away, but idk if we can cover the number. I do think we slide into the over though. Auburn 34, Tulane 17
-James Jones
Tulane is a good football team. That’s not just me trying to be nice. As AU fans well know, the top teams in the AAC are solid programs very capable of handing out an L if you aren’t ready. The Green Wave have a former LSU signee at QB, a former OKST WR who had 1,800+ yds for the Cowboys and a VERY good front 7. After the emotional win of Saturday night, an offensive line that has been inconsistent at times and a true freshman QB, it would not at all surprise me if we are shifting uncomfortably in our seats following the first quarter of the first half.
But I expect Auburn’s depth and talent to win out. An explosive 3rd quarter leads to Joey getting some series late in the 4th. AU wins 41-13
-AU Nerd
Auburn covers and the over. Well hopefully this game won’t have me chewing Tums like they are Mentos. On paper and to the lay person this should be an easy win for the Top 10 Tigers. However, as has been adequately covered by my colleagues above. I think this game will be closer than we all want at half (17-10 or 24-13 area) but an adjustment filled halftime and settling in a bit more leads to a comfortable final score. Auburn 44-16
-Drew Mac
I think this one ends up being a lot like Arkansas State in 2010. Our new QB gets to stretch his legs against a solid, but not too challenging opponent and shines while doing so. Auburn 43-13
-AU Chief
There’s no reason for me to believe that our offense isn’t going to get much better after the win over Oregon, unless we’re just so flat after the emotional win that it takes a long time to get it together. I’d worry about that if this was a morning kickoff, but the crowd should be pretty good at night and the team will feed off of that.
Thankfully Tulane plays into our strength in that their offense isn’t going to score much, if at all. They put up some good numbers against FIU, but I think we’ll get some solid pressure on Justin McMillan, and the Green Wave won’t have as much success if they try to neutralize our defensive line as Oregon did.
With the development of Bo Nix, we should be able to hit some big plays, which eluded us for the most part against the Ducks. Tulane allowed 11 plays of 10+ yards to FIU, and if we have Will Hastings and Anthony Schwartz playing more minutes, then our propensity to hit the deep ball goes up.
In the end, we’ll likely be frustrated for a bit with a close game and a possible slow start, but we’ll exert our dominance with talent and depth and pull away late. If Auburn comes out and runs out to a 21-0 first quarter lead, though... watch out, because this team is way more mature than I thought they’d be. Auburn 34, Tulane 6.
-Jack Condon
from College and Magnolia - All Posts https://www.collegeandmagnolia.com/2019/9/6/20852124/staff-picks-10-auburn-vs-tulane
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Financial Samurai 2018 Year In Review: Almost A Fantastic Year
Although 2018 ended on a down note with the stock market selling off, I feel good about how things unfolded. I’ll take the ratio of three good quarters to one bad quarter any year.
Believe it or not, my theme for 2018 was: back to early retirement life. I pushed myself to the point of burnout in 2017. But the funny thing about hard work is that it’s over. I only remember bits and pieces of how difficult 2017 was.
At year-end, it’s easy to forget our accomplishments and our failures. With this post, I’m excited to relive the good and the bad in the following categories: Finances, Family, Health, Business, and Odds & Ends.
This post is like a 4-for-1 special. It needs to be thorough so I can prove to my son his old man wasn’t a deadbeat when he inevitably starts rebelling or when I’m no longer here to defend myself.
2018 Year In Review
Finances – 2.5 Out Of 5 Stars
At the beginning of the year, I predicted we’d see a slowdown in coastal city real estate, a 10-year bond yield under 3%, and a stock market that would have one last hurrah with a 10% return. I was almost three for three with the stock market up ~8% in September. Too bad it gave up all its gains and then a whole lot! At least I got more defensive starting in March.
My net worth is roughly made up of:
30% in stocks/bonds = -3%. After writing Your Risk Tolerance Is An Illusion in the Spring, I reduced my stock allocation in my House Sale Fund to roughly 52% from 70%. As bonds began to outperform stocks coupled with further profit taking, my end allocation is roughly 40% stocks / 60% bonds. Owning a bunch of equity structured notes in my other main fund has helped minimize volatility. But clearly I wasn’t defensive enough and should have taken more profits during the summer.
My House Sale Fund portfolio was up around 13% at one point until I gave all the gains up in the 4th quarter. Right now, it’s holding onto a tenuous 5.4% gain, after the huge rally on Dec 26. Overall, my public investment portfolio is slightly down, which violates my rule of never losing money post retirement. I plan to update this performance daily due to the volatility.
I’m disappointed with my public investment performance. This goes to show that no matter how concerned you are about an asset class or the economy, greed can override logic.
Here’s a good chart that shows how the Vanguard Long-Term Bond Fund has outperformed the S&P 500 since 1999. The next time I start feeling greedy, I need to remind myself that slow and steady wins the race, especially if you’ve already passed the finish line.
6% in cash/CDs = +2.3%. Thanks to rising short-term rates, you can now get around 2% in a money market and 2.5% in a 12-month CD. It’s wonderful to earn something from our risk-free investments now. Cash and short-term CDs have been 10%+ outperformers against the S&P 500. Hopefully, folks will no longer badger me about the risks of underperforming inflation when the real risk is losing absolute dollar value. Unfortunately, I should have had closer to 15% of my net worth in cash and CDs.
30% in real estate = -5%. The online estimates say my real estate holdings have gone up ~6% YoY, but I doubt it now that the stock market has sold off so aggressively from the peak. Online price estimates and public data are always lagging estimates. Prices did continue to go up until about January 2018, but began falling for the remainder of the year. The chart below shows data months before the 4Q2018 stock market correction. Therefore, I’ve manually inputted -5% from +6% for a 11% swing.
Even though my real estate holdings are down, I thankfully feel no stress compared to my stock holdings, which is one of the reasons why I prefer real estate over stocks. One rental property has no mortgage since 2015, my primary residence is providing utility every day by sheltering my family, and my vacation property is generating a positive cash flow. I can’t wait to bring my boy up to Lake Tahoe to touch his first snow in March!
It’s unfortunate that I reinvested $600,000 of the $1,800,000 proceeds from my house sale into the stock market. I should have just stayed super conservative. But I suspect the best I could get now for the house is $2,600,000 today versus the $2,740,000 sale price in 2017. My house was on a busy street next to the busiest street in all of San Francisco. Fringe location properties, even in a good neighborhood, tend to underperform during a market softening.
8% in alternative investments = +5%. My alternative investments in venture debt and real estate crowdfunding seem to be doing well, to the tune of a 11% – 20% IRR. But these figures are probably too aggressive as well, so I’ve assigned a +5% performance instead. REITs and rental property have outperformed all year as rents are stickier than stocks. I remember back in 2009, my rents stayed flat because by the time the lease was over a year later, the recession was over.
25% in my online business = 0% – 150%. My business is the trickiest to value. Revenue and profits are up 20%+ YoY. Therefore, one might conclude that its value should also be up by 20%+. However, valuations have probably compressed since the stock market sell-off. The good thing is that a peer site with about 35% less traffic sold for 2X the value I assigned for my business in my net worth calculations. Therefore, there’s a possibility my site could be worth 2X – 2.5X my assigned value if we normalize for traffic.
From an estate planning perspective, I want my business to be valued as low as possible. It’s the same way you want your house to be valued as low as possible to pay less property tax. To prepare for hard times, I’ve kept my business at 0% growth in my net worth calculation.
Net Worth Growth
Here’s my 2018 net worth progression chart according to Personal Capital. The chart is a little chunky because of cash recognition delays. But overall, it was doing pretty well until the end of the year.
2018 Net Worth = +6.5%
The main reasons why my net worth is up ~6.5% in 2018 are business cash flow and aggressive savings. I continue to save over 70% of my after-tax income. If I didn’t aggressively save, my net worth would have been flat. As my net worth has grown, it’s harder to move the needle as much.
6.5% is OK, but at one point I was up ~11%. Hence, it feels a little disappointing. 10% YoY growth has always been my minimum net worth growth target since graduating from college. Despite the disappointment, I’m glad my net worth didn’t go in reverse.
If you’re feeling bummed out, it helps to look at how far your net worth has come over the past five or 10 years. When I left work in 2012, I was comfortable with what I had. Otherwise, I wouldn’t have left. Having another six years of growth, excluding 2018, has really been a blessing post early retirement.
The key is to not lose all your gains to a bear market.
Related: Recommended Net Worth Allocation By Age Or Work Experience
Family & Fatherhood – 4.7 Stars
I could not have tried harder to be a great stay at home dad. I only have one shot, so I did everything to educate myself about parenthood. I also spent as much time as possible with my son as a stay at home dad.
My greatest moments of joy all year came from seeing my son’s milestones. He started waddling with help at around 11 months and slowly started to walk unassisted at 12 – 13 months. By 18 months he was able to count to 30, say all letters of the alphabet, and identify eight different colors.
His favorite words and phrases at 20 months old are “hot dog, ketchup, yum, yum, yum” “double wide garage door,” “walk with daddy,” “knock knock,” “verde,” “voila,” and “da hai bao (big seal in Mandarin).” He’s also just begun to sing a couple lullabies, one in Japanese and one in French. We try to talk to him in multiple languages as supposedly that helps brain development. He’s hilarious and full of determination. Oh boy is he determined.
When I’m not working on Financial Samurai or managing our investments, I pretend I’m a pre-school teacher and occupational therapist. Because he has a vision issue, I’ve been helping him track objects, work on his depth perception, and hand-eye coordination. So far he can walk up stairs no problem, but he still needs assistance going down stairs.
Now we’re focusing more on his fine motor skills, like drawing, holding a pencil, brushing his teeth, playing piano keys, and using scissors. The duties are never-ending, but it’s been a blessing to care for him every day and watch him grow.
He is a determined boy
My greatest sorrows have also all come from my son. Between 11 – 15 months old he would fall frequently or accidentally bonk his head on something hard or sharp. I felt his pain each time and admonished myself for not doing a better job protecting him.
As a result of his accidents, I ended up padding everywhere around the house and padding every wall and table corner. Interior design be damned! Thank goodness we live in a modest size house. The padding has saved him from injury numerous times, including on Christmas, when he stumbled on a package and hit his head on our coffee leg corner which was padded, hooray!
It turns out that toddlers between 12 – 19 months fall about 17X an hour on average according to one study of 120 toddlers. Only until about age 4 do most toddlers fully master their walking and running skills. That made me feel a little better, but it still made me so sad whenever he hurt himself. Taking him for a walk with a harness has helped tremendously. I’m teaching him to look both ways before crossing the street.
It’s also interesting it takes up to 24 months before a toddler’s fontanel closes. Therefore, we as parents might as well be as diligent as possible in trying to protect his head before his skull gets to full strength. So much about parenthood the first several years is about survival – from preventing suffocation while sleeping to making sure they don’t walk off a ledge.
The better our boy sleeps and the more he is able to communicate his desires, the more rewarding parenthood has become. Because he is so strong-willed, his temper tantrums are also quite a challenge.
One of my concerns is that he will hurt himself during these temper tantrums by banging his head on something hard or arching his back and hurting himself on the floor. Doctors say temper tantrums peak by around 24 months, subside, and then rise again at around 36 months. Here’s where I need to demonstrate maximum patience as a parent for the next 18 months.
Before my son was born, there was never any whining or crying around the house. But once he arrived, I have heard crying and whining every day, multiple times a day for 20 months in a row. Unfortunately, there is no logical reasoning with a young boy, except to use a technique called “caveman speak” while voicing what we think he wants to calm him down. Adjusting to this new scenario has been hard.
It’s also difficult to write, record a podcast, or mentally relax when there is so much noise. Being able to more easily find a quiet space is one of the benefits of upgrading to a larger house. As a result of needing to find quiet time, I often had to wake up between 4am – 5am to get things done. But I’m proud to say I’ve never lost my temper around my boy.
I’ve still got to improve my patience with my wife and not let business stress or stock market stress hurt our relationship. We operate at different paces, and I need to do a better job slowing down. The whole point of financial independence is to be free from money stress to live your best life.
Given my wife is a full-time mom and absolutely does more of the caregiving, the pressure is on me to make sure our finances never go in reverse. As the stock market melted down in 4Q2018, my stress level definitely increased.
Our goal is to both stay full-time parents for at least our son’s first two years of life and ideally try to be full-time parents for five years before he attends kindergarten. Fatherhood is the hardest thing I’ve ever had to do.
Related: How To Survive The Pressures Of Being A Sole Income Providing Parent
Health & Fitness – 3.2 Stars
I’m the same weight as I was in 2017, which is OK. But I gained 5 lbs in 2017, which was not OK. I need to get down to 162 lbs from 170 lbs. At least I exercised 3X a week on average plus took light walks with my son 5X a week on average. Given my goal is to live until 75, or whenever my son can establish himself and find a life partner, it’s important for me to stay in mental and physical shape.
Luckily, I’ve had no serious injuries or medical mishaps this year. I did catch some flu-like virus that knocked me out for 1.5 days in October, but that was it. We did have our first emergency room visit for my son at 5am because he seemed to have come down with a similar virus I had a month later. We also went to an after-hour care facility for some inflammation. Luckily, things got better after 24 hours.
At 41, I still haven’t sprouted any grey hairs, which is a surprise since I first got several grey hairs at 33, the year before I left my day job. The only reason I can imagine for this phenomenon is that not working a full-time job is less stressful. It’s one thing to say how much better life is after achieving financial independence. It’s another thing for the body to show us.
My most fun physical addition has been joining a softball meetup group that plays every Saturday it doesn’t rain. I must have played over 30 games in 2018. Ah, now I remember sustaining a left knee bone contusion that hurt for six months. My personal highlight was drafting and captaining a 4th of July softball tournament and winning. Curiously, it was one of my most satisfying life moments!
Finally, I found out in December I wasn’t getting bumped down to 4.5 in USTA tennis from 5.0. I did poorly in 5.0 league at the beginning of the year and was hoping to get bumped down after three seasons. When I didn’t, I appealed and got denied.
5.0 level tennis is brutally tough. From an ego perspective, it does feel good to be in the top 1% of all tennis levels. Other players give you respect as you puff out your chest and start thinking you’re the shiznits. But after you start repeatedly getting beaten by players younger than you, it starts to get demoralizing! Therefore, I always try to make fun of myself to others by saying the computers must have malfunctioned to keep me at 5.0.
Business – 4.8 Stars
I could not have tried harder to build Financial Samurai either. Here are some of the accomplishments:
Published three posts a week on average
Published three pages a week on average
Published one newsletter a week on average
Improved my short-form writing skills with the newsletter
Produced over 40 podcasts
Did several podcast interviews on other platforms
Launched the Financial Samurai Forum with 1,300 members thanks to my wife who set everything up over a year
Got mentioned in Business Insider, CNBC, MarketWatch, MSN, Apple News, Forbes, and Yahoo
Updated How To Engineer Your Layoff with a new forward for 2019
Increased overall traffic by 20% YoY, with 50% YoY traffic growth between August 11 – December 27
The 50% YoY traffic surge since August 11 seems like an anomaly. It’s like suddenly turning into a speedboat after being a cruise ship. But traffic has been elevated for almost four months so far, with December being the highest traffic all year. For years, December has always been a quiet month due to the holidays. Perhaps the traffic increase is due to a combination of more production, search algorithm changes by Google, and content syndication.
Overall, I’m just really happy there’s been a correlation with effort and reward. That’s all I’ve ever wanted, hence part of the reason why I left work in 2012. Every year since the birth of Financial Samurai in 2009, Financial Samurai has drastically outperformed the S&P 500 and the San Francisco real estate market. As a result, blogging has surpassed real estate as my favorite asset class to build wealth.
For poops and giggles, here’s another net worth chart if I manually input a business value based on recent comparable sales. The 30% spike is nice, but is also dangerous because it brings a false sense of complacency. It’s best to stay motivated as the economy softens. Just know that creating next level wealth is all about owning growth equity over the long term.
Net worth including market value of business = +30% YoY
Life’s Odds & Ends – 4 Stars
In May, I helped coach my high school boys varsity tennis team to the Northern California Sectional championship. This was the first championship in the school’s entire 40+ year history. This victory was particularly sweet because we had come so close my first year in 2017 only to lose in the finals to a school 3X our size. This was another incredible life moment that had nothing to do with money. I only got paid $3,500 for 3.5 months of work. The relationships I developed with some of the parents were a nice bonus.
My dad came to visit three times and my mom twice. My mother-in-law also visited twice and my father-in-law once. It is always great to see them, and I hope they continue to visit us more often. My dream has always been to have three generations spend as much time together as possible. Unfortunately or fortunately, all our grandparents want to remain independent and live in their respective cities. It’s hard to change the older you get, which is why I’ve been trying so hard to move to Hawaii.
I further strengthened a couple friendships. This is huge because as a stay-at-home dad, it’s often hard to make new friends or deepen friendships. There are simply less social events to attend e.g. happy hour. I love having a good buddy to shoot the shit with. I also developed a new in-person relationship with an FS reader, who also so happens to also be a professional athlete on my favorite team. Pretty neat!
I did some decent home maintenance projects this year: caulked the top of our living room window sill to prevent leaks, varnished all our wood planter boxes, rooted the upstairs sink that was clogging, re-roofed the leaking light well, maintained the yard, and fixed a leaky faucet at my rental. Man, I forgot about all this stuff until my wife reminded me. Thank goodness I sold the other rental.
Finally, we finalized our will and revocable living trust. My wife also led the charge getting us through this cumbersome and complicated process. There were so many documents to gather and questions to ask the estate planning lawyer that she estimates the whole process took her about 40 hours. But after we finally signed all the documents on December 20, I felt a huge sense of relief that I could die knowing that my wife and son wouldn’t have to go through probate court.
2018: 3.8 Out Of 5 Stars
Although I didn’t decide to take it easy per my 2018 goal, I have no regrets staying consistent with Financial Samurai. I don’t think I’ll ever change my work ethic until my body starts breaking down. The joy of writing is so tangible because it is an identifiable product that can be eternally consumed.
It’s been hard to accept no longer making a positive return on my public investments after nine years of up, up, up. I’ve got to do a much better job at not letting financial loss negatively affect my mood and my relationship with my wife. Not taking unnecessary risk will help.
During downturns, I envy those in professions that have nothing to do with the stock market. For example, when I asked my estate planning lawyer about what she thought about the stock market collapse in December, she said she had no idea because she outsources all her financial planning to someone else. What a blessing.
I also have zero regrets being a stay at home dad all year. Yes, the days were long and there were many moments of frustration, but just hearing his squeals of joy made full-time fatherhood worthwhile. All I want to do is squeeze and kiss him 100X a day! I’m so thankful my wife has been an amazing mother and partner all year.
Family and Financial Samurai are my two great loves. Everything else comes in a distant second. There was a point where we thought we’d never have a child. So we say a prayer of thanks every evening. Financial Samurai has been a part of me since the bottom of the last financial crisis in 2009. It’s like an old friend that has stuck with me in the worst of times.
The key is to not let my two loves collide, but to let them be synergistic. My family gives me motivation to write, while Financial Samurai is a creative outlet that helps ensure we remain stay-at-home-parents until we decide otherwise.
There’s always a silver lining to a downturn too.
For Financial Samurai, it’s increased traffic as more people are paying attention to their finances. Book sales on how to negotiate a severance are also increasing as savvy employees are trying to get ahead of the layoff curve. Finally, our passive income has also increased due to higher interests rates and my shift towards higher yielding assets like cash, bonds, and CDs.
For family life, it’s being less tempted to go back to work because the return on effort has declined. When all is in shambles, why bother dealing with a commute, company politics, difficult clients, and a declining company stock price.
I hope if my boy one day reads this article that’ll he’ll be proud of his dad. Although 2018 wasn’t a fantastic year, it was filled with many positive milestones.
I’ll be sharing my 2019 outlook and goals next. In the meantime, I’d love to hear some of your hits and misses for 2018!
Related: The Best Financial Samurai Posts For 2018
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Financial Samurai 2018 Year In Review: Almost A Fantastic Year
Although 2018 ended on a down note with the stock market selling off, I feel good about how things unfolded. I’ll take the ratio of three good quarters to one bad quarter any year.
Believe it or not, my theme for 2018 was: back to early retirement life. I pushed myself to the point of burnout in 2017. But the funny thing about hard work is that it’s over. I only remember bits and pieces of how difficult 2017 was.
At year-end, it’s easy to forget our accomplishments and our failures. With this post, I’m excited to relive the good and the bad in the following categories: Finances, Family, Health, Business, and Odds & Ends.
This post is like a 4-for-1 special. It needs to be thorough so I can prove to my son his old man wasn’t a deadbeat when he inevitably starts rebelling or when I’m no longer here to defend myself.
2018 Year In Review
Finances – 3 Out Of 5 Stars
At the beginning of the year, I predicted we’d see a slowdown in coastal city real estate, a 10-year bond yield under 3%, and a stock market that would have one last hurrah with a 10% return. I was almost three for three with the stock market up ~8% in September. Too bad it gave up all its gains and then a whole lot! At least I got more defensive starting in March.
My net worth is roughly made up of:
30% in stocks/bonds = -2%. After writing Your Risk Tolerance Is An Illusion in the Spring, I reduced my stock allocation in my House Sale Fund to roughly 52% from 70%. As bonds began to outperform stocks coupled with further profit taking, my end allocation is roughly 40% stocks / 60% bonds. Owning a bunch of equity structured notes in my other main fund has helped minimize volatility. But clearly I wasn’t defensive enough and should have taken more profits during the summer.
My House Sale Fund portfolio was up around 13% at one point until I gave all the gains up in the 4th quarter. Right now, it’s holding onto a tenuous 5.4% gain, after the huge rally on Dec 26. Overall, my public investment portfolio is slightly down, which violates my rule of never losing money post retirement.
I’m disappointed with my public investment performance. This goes to show that no matter how concerned you are about an asset class or the economy, greed can override logic.
Here’s a good chart that shows how the Vanguard Long-Term Bond Fund has outperformed the S&P 500 since 1999. The next time I start feeling greedy, I need to remind myself that slow and steady wins the race, especially if you’ve already passed the finish line.
6% in cash/CDs = +2.3%. Thanks to rising short-term rates, you can now get around 2% in a money market and 2.5% in a 12-month CD. It’s wonderful to earn something from our risk-free investments now. Cash and short-term CDs have been 10%+ outperformers against the S&P 500. Hopefully, folks will no longer badger me about the risks of underperforming inflation when the real risk is losing absolute dollar value. Unfortunately, I should have had closer to 15% of my net worth in cash and CDs.
30% in real estate = -5%. The online estimates say my real estate holdings have gone up ~6% YoY, but I doubt it now that the stock market has sold off so aggressively from the peak. Online price estimates and public data are always lagging estimates. Prices did continue to go up until about January 2018, but began falling for the remainder of the year. The chart below shows data months before the 4Q2018 stock market correction. Therefore, I’ve manually inputted -5% from +6% for a 11% swing.
Even though my real estate holdings are down, I thankfully feel no stress compared to my stock holdings, which is one of the reasons why I prefer real estate over stocks. One rental property has no mortgage since 2015, my primary residence is providing utility every day by sheltering my family, and my vacation property is generating a positive cash flow. I can’t wait to bring my boy up to Lake Tahoe to touch his first snow in March!
It’s unfortunate that I reinvested $600,000 of the $1,800,000 proceeds from my house sale into the stock market. I should have just stayed super conservative. But I suspect the best I could get now for the house is $2,600,000 today versus the $2,740,000 sale price in 2017. My house was on a busy street next to the busiest street in all of San Francisco. Fringe location properties, even in a good neighborhood, tend to underperform during a market softening.
8% in alternative investments = +5%. My alternative investments in venture debt and real estate crowdfunding seem to be doing well, to the tune of a 11% – 20% IRR. But these figures are probably too aggressive as well, so I’ve assigned a +5% performance instead. REITs and rental property have outperformed all year as rents are stickier than stocks. I remember back in 2009, my rents stayed flat because by the time the lease was over a year later, the recession was over.
25% in my online business = 0% – 150%. My business is the trickiest to value. Revenue and profits are up 20%+ YoY. Therefore, one might conclude that its value should also be up by 20%+. However, valuations have probably compressed since the stock market sell-off. The good thing is that a peer site with about 35% less traffic sold for 2X the value I assigned for my business in my net worth calculations. Therefore, there’s a possibility my site could be worth 2X – 2.5X my assigned value if we normalize for traffic.
From an estate planning perspective, I want my business to be valued as low as possible. It’s the same way you want your house to be valued as low as possible to pay less property tax. To prepare for hard times, I’ve kept my business at 0% growth in my net worth calculation.
Net Worth Growth
Here’s my 2018 net worth progression chart according to Personal Capital. The chart is a little chunky because of cash recognition delays. But overall, it was doing pretty well until the end of the year.
2018 Net Worth = +6.5%
The main reasons why my net worth is up ~6.5% in 2018 are business cash flow and aggressive savings. I continue to save over 70% of my after-tax income. If I didn’t aggressively save, my net worth would have been flat. As my net worth has grown, it’s harder to move the needle as much.
6.5% is OK, but at one point I was up ~11%. Hence, it feels a little disappointing. 10% YoY growth has always been my minimum net worth growth target since graduating from college. Despite the disappointment, I’m glad my net worth didn’t go in reverse.
If you’re feeling bummed out, it helps to look at how far your net worth has come over the past five or 10 years. When I left work in 2012, I was comfortable with what I had. Otherwise, I wouldn’t have left. Having another six years of growth, excluding 2018, has really been a blessing post earl retirement.
The key is to not lose all your gains to a bear market.
Related: Recommended Net Worth Allocation By Age Or Work Experience
Family & Fatherhood – 4.7 Stars
I could not have tried harder to be a great stay at home dad. I only have one shot, so I did everything to educate myself about parenthood. I also spent as much time as possible with my son as a stay at home dad.
My greatest moments of joy all year came from seeing my son’s milestones. He started waddling with help at around 11 months and slowly started to walk unassisted at 12 – 13 months. By 18 months he was able to count to 30, say all letters of the alphabet, and identify eight different colors.
His favorite words and phrases at 20 months old are “hot dog, ketchup, yum, yum, yum” “double wide garage door,” “walk with daddy,” “knock knock,” “verde,” “voila,” and “da hai bao (big seal in Mandarin).” He’s also just begun to sing a couple lullabies, one in Japanese and one in French. We try to talk to him in multiple languages as supposedly that helps brain development. He’s hilarious and full of determination. Oh boy is he determined.
When I’m not working on Financial Samurai or managing our investments, I pretend I’m a pre-school teacher and occupational therapist. Because he has a vision issue, I’ve been helping him track objects, work on his depth perception, and hand-eye coordination. So far he can walk up stairs no problem, but he still needs assistance going down stairs.
Now we’re focusing more on his fine motor skills, like drawing, holding a pencil, brushing his teeth, playing piano keys, and using scissors. The duties are never-ending, but it’s been a blessing to care for him every day and watch him grow.
He is a determined boy
My greatest sorrows have also all come from my son. Between 11 – 15 months old he would fall frequently or accidentally bonk his head on something hard or sharp. I felt his pain each time and admonished myself for not doing a better job protecting him.
As a result of his accidents, I ended up padding everywhere around the house and padding every wall and table corner. Interior design be damned! Thank goodness we live in a modest size house. The padding has saved him from injury numerous times, including on Christmas, when he stumbled on a package and hit his head on our coffee leg corner which was padded, hooray!
It turns out that toddlers between 12 – 19 months fall about 17X an hour on average according to one study of 120 toddlers. Only until about age 4 do most toddlers fully master their walking and running skills. That made me feel a little better, but it still made me so sad whenever he hurt himself. Taking him for a walk with a harness has helped tremendously. I’m teaching him to look both ways before crossing the street.
It’s also interesting it takes up to 24 months before a toddler’s fontanel closes. Therefore, we as parents might as well be as diligent as possible in trying to protect his head before his skull gets to full strength. So much about about parenthood the first several years is about survival – from preventing suffocation while sleeping to making sure they don’t walk off a ledge.
The better our boy sleeps and the more he is able to communicate his desires, the more rewarding parenthood has become. Because he is so strong-willed, his temper tantrums are also quite a challenge.
One of my concerns is that he will hurt himself during these temper tantrums by banging his head on something hard or arching his back and hurting himself on the floor. Doctors say temper tantrums peak by around 24 months, subside, and then rise again at around 36 months. Here’s where I need to demonstrate maximum patience as a parent for the next 18 months.
Before my son was born, there was never any whining or crying around the house. But once he arrived, I have heard crying and whining every day, multiple times a day for 20 months in a row. Unfortunately, there is no logical reasoning with a young boy, except to use a technique called “caveman speak” while voicing what we think he wants to calm him down. Adjusting to this new scenario has been hard.
It’s also difficult to write, record a podcast, or mentally relax when there is so much noise. Being able to more easily find a quiet space is one of the benefits of upgrading to a larger house. As a result of needing to find quiet time, I often had to wake up between 4am – 5am to get things done. But I’m proud to say I’ve never lost my temper around my boy.
I’ve still got to improve my patience with my wife and not let business stress or stock market stress hurt our relationship. We operate at different paces, and I need to do a better job slowing down. The whole point of financial independence is to be free from money stress to live your best life.
Given my wife is a full-time mom and absolutely does more of the caregiving, the pressure is on me to make sure our finances never go in reverse. As the stock market melted down in 4Q2018, my stress level definitely increased.
Our goal is to both stay full-time parents for at least our son’s first two years of life and ideally try to be full-time parents for five years before he attends kindergarten. Fatherhood is the hardest thing I’ve ever had to do.
Related: How To Survive The Pressures Of Being A Sole Income Providing Parent
Health & Fitness – 3.2 Stars
I’m the same weight as I was in 2017, which is OK. But I gained 5 lbs in 2017, which was not OK. I need to get down to 162 lbs from 170 lbs. At least I exercised 3X a week on average plus took light walks with my son 5X a week on average. Given my goal is to live until 75, or whenever my son can establish himself and find a life partner, it’s important for me to stay in mental and physical shape.
Luckily, I’ve had no serious injuries or medical mishaps this year. I did catch some flu-like virus that knocked me out for 1.5 days in October, but that was it. We did have our first emergency room visit for my son at 5am because he seemed to have come down with a similar virus I had a month later. We also went to an after-hour care facility for some inflammation. Luckily, things got better after 24 hours.
At 41, I still haven’t sprouted any grey hairs, which is a surprise since I first got several grey hairs at 33, the year before I left my day job. The only reason I can imagine for this phenomena is that not working a full-time job is less stressful. It’s one thing to say how much better life is after achieving financial independence. It’s another thing for the body to show us.
My most fun physical addition has been joining a softball meetup group that plays every Saturday it doesn’t rain. I must have played over 30 games in 2018. Ah, now I remember sustaining a left knee bone contusion that hurt for six months. My personal highlight was drafting and captaining a 4th of July softball tournament and winning. Curiously, it was one of my most satisfying life moments!
Finally, I found out in December I wasn’t getting bumped down to 4.5 in USTA tennis from 5.0. I did poorly in 5.0 league at the beginning of the year and was hoping to get bumped down after three seasons. When I didn’t, I appealed and got denied.
5.0 level tennis is brutally tough. From an ego perspective, it does feel good to be in the top 1% of all tennis levels. Other players give you respect as you puff out your chest and start thinking you’re the shiznits. But after you start repeatedly getting beaten by players younger than you, it starts to get demoralizing! Therefore, I always try to make fun of myself to others by saying the computers must have malfunctioned to keep me at 5.0.
Business – 4.8 Stars
I could not have tried harder to build Financial Samurai either. Here are some of the accomplishments:
Published three posts a week on average
Published three pages a week on average
Published one newsletter a week on average
Improved my short-form writing skills with the newsletter
Produced over 40 podcasts
Did several podcast interviews on other platforms
Launched the Financial Samurai Forum with 1,300 members thanks to my wife who set everything up over a year
Got mentioned in Business Insider, CNBC, MarketWatch, MSN, Apple News, Forbes, and Yahoo
Updated How To Engineer Your Layoff with a new forward for 2019
Increased overall traffic by 20% YoY, with 50% YoY traffic growth between August 11 – December 27
The 50% YoY traffic surge since August 11 seems like an anomaly. It’s like suddenly turning into a speedboat after being a cruise ship. But traffic has been elevated for almost four months so far, with December being the highest traffic all year. For years, December has always been a quiet month due to the holidays. Perhaps the traffic increase is due to a combination of more production, search algorithm changes by Google, and content syndication.
Overall, I’m just really happy there’s been a correlation with effort and reward. That’s all I’ve ever wanted, hence part of the reason why I left work in 2012. Every year since the birth of Financial Samurai in 2009, Financial Samurai has drastically outperformed the S&P 500 and the San Francisco real estate market. As a result, blogging has surpassed real estate as my favorite asset class to build wealth.
For poops and giggles, here’s another net worth chart if I manually input a business value based on recent comparable sales. The 30% spike is nice, but is also dangerous because it brings a false sense of complacency. It’s best to stay motivated as the economy softens. Just know that creating next level wealth is all about owning growth equity over the long term.
Net worth including market value of business = +30% YoY
Life’s Odds & Ends – 4 Stars
In May, I helped coach my high school boys varsity tennis team to the Northern California Sectional championship. This was the first championship in the school’s entire 40+ year history. This victory was particularly sweet because we had come so close my first year in 2017 only to lose in the finals to a school 3X our size. This was another incredible life moment that had nothing to do with money. I only got paid $3,500 for 3.5 months of work. The relationships I developed with some of the parents were a nice bonus.
My dad came to visit three times and my mom twice. My mother-in-law also visited twice and my father-in-law once. It is always great to see them, and I hope they continue to visit us more often. My dream has always been to have three generations spend as much time together as possible. Unfortunately or fortunately, all our grandparents want to remain independent and live in their respective cities. It’s hard to change the older you get, which is why I’ve been trying so hard to move to Hawaii.
I further strengthened a couple friendships. This is huge because as a stay-at-home dad, it’s often hard to make new friends or deepen friendships. There are simply less social events to attend e.g. happy hour. I love having a good buddy to shoot the shit with. I also developed a new in-person relationship with an FS reader, who also so happens to also be a professional athlete on my favorite team. Pretty neat!
I did some decent home maintenance projects this year: caulked the top of our living room window sill to prevent leaks, varnished all our wood planter boxes, rooted the upstairs sink that was clogging, re-roofed the leaking light well, maintained the yard, and fixed a leaky faucet at my rental. Man, I forgot about all this stuff until my wife reminded me. Thank goodness I sold the other rental.
Finally, we finalized our will and revocable living trust. My wife also led the charge getting us through this cumbersome and complicated process. There were so many documents to gather and questions to ask the estate planning lawyer that she estimates the whole process took her about 40 hours. But after we finally signed all the documents on December 20, I felt a huge sense of relief that I could die knowing that my wife and son wouldn’t have to go through probate court.
2018: 3.8 Out Of 5 Stars
Although I didn’t decide to take it easy per my 2018 goal, I have no regrets staying consistent with Financial Samurai. I don’t think I’ll ever change my work ethic until my body starts breaking down. The joy of writing is so tangible because it is an identifiable product that can be eternally consumed.
It’s been hard to accept no longer making a positive return on my public investments after nine years of up, up, up. I’ve got to do a much better job at not letting financial loss negatively affect my mood and my relationship with my wife. Not taking unnecessary risk will help.
During downturns, I envy those in professions that have nothing to do with the stock market. For example, when I asked my estate planning lawyer about what she thought about the stock market collapse in December, she said she had no idea because she outsources all her financial planning to someone else. What a blessing.
I also have zero regrets being a stay at home dad all year. Yes, the days were long and there were many moments of frustration, but just hearing his squeals of joy made full-time fatherhood worthwhile. All I want to do is squeeze and kiss him 100X a day! I’m so thankful my wife has been an amazing mother and partner all year.
Family and Financial Samurai are my two great loves. Everything comes a distant second. There was a point where we thought we’d never have a child. So we say a prayer of thanks every evening. Financial Samurai has been a part of me since the bottom of the last financial crisis in 2009. It’s like an old friend that has stuck with me in the worst of times.
The key is to not let my two loves collide, but to let them be synergistic. My family gives me motivation to write, while Financial Samurai is a creative outlet that helps ensure we remain stay-at-home-parents until we decide otherwise.
There’s always a silver lining to a downturn too.
For Financial Samurai, it’s increased traffic as more people are paying attention to their finances. Book sales on how to negotiate a severance are also increasing as savvy employees are trying to get ahead of the layoff curve. Finally, our passive income has also increased due to higher interests rates and my shift towards higher yielding assets like cash, bonds, and CDs.
For family life, it’s being less tempted to go back to work because the return on effort has declined. When all is in shambles, why bother dealing with a commute, company politics, difficult clients, and a declining company stock price.
I hope if my boy one day reads this article that’ll he’ll be proud of his dad. Although 2018 wasn’t a fantastic year, it was filled with many positive milestones.
I’ll be sharing my 2019 outlook and goals next. In the meantime, I’d love to hear some of your hits and misses for 2018!
Related: The Best Financial Samurai Posts For 2018
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Financial Samurai 2018 Year In Review: Almost A Fantastic Year
Although 2018 ended on a down note with the stock market selling off, I feel good about how things unfolded. I’ll take the ratio of three good quarters to one bad quarter any year.
Believe it or not, my theme for 2018 was: back to early retirement life. I pushed myself to the point of burnout in 2017. But the funny thing about hard work is that it’s over. I only remember bits and pieces of how difficult 2017 was.
At year-end, it’s easy to forget our accomplishments and our failures. With this post, I’m excited to relive the good and the bad in the following categories: Finances, Family, Health, Business, and Odds & Ends.
This post is like a 4-for-1 special. It needs to be thorough so I can prove to my son his old man wasn’t a deadbeat when he inevitably starts rebelling or when I’m no longer here to defend myself.
2018 Year In Review
Finances – 3 Out Of 5 Stars
At the beginning of the year, I predicted we’d see a slowdown in coastal city real estate, a 10-year bond yield under 3%, and a stock market that would have one last hurrah with a 10% return. I was almost three for three with the stock market up ~8% in September. Too bad it gave up all its gains and then a whole lot! At least I got more defensive starting in March.
My net worth is roughly made up of:
30% in stocks/bonds = -1.5%. After writing Your Risk Tolerance Is An Illusion in the Spring, I reduced my stock allocation in my House Sale Fund to roughly 52% from 70%. As bonds began to outperform stocks coupled with further profit taking, my end allocation is roughly 40% stocks / 60% bonds. Owning a bunch of equity structured notes in my other main fund has helped minimize volatility. But clearly I wasn’t defensive enough and should have taken more profits during the summer.
My House Sale Fund portfolio was up around 13% at one point until I gave all the gains up in the 4th quarter. Right now, it’s holding onto a tenuous 0.6% gain, excluding the huge rally on Dec 26. Overall, my public investment portfolio is slightly down, which violates my rule of never losing money post retirement.
House Sale Fund Portfolio went from +13% to just +0.6%
I’m disappointed with my public investment portfolio performance. This goes to show that no matter how concerned you are about an asset class or the economy, greed can override logic.
Here’s a good chart that shows how the Vanguard Long-Term Bond Fund has outperformed the S&P 500 since 1999. The next time I start feeling greedy, I need to remind myself that slow and steady wins the race, especially if you’ve already passed the finish line.
6% in cash/CDs = +2.3%. Thanks to rising short-term rates, you can now get around 2% in a money market and 2.5% in a 12-month CD. It’s wonderful to earn something from our risk-free investments now. Cash and short-term CDs have been 10%+ outperformers against the S&P 500. Hopefully, folks will no longer badger me about the risks of underperforming inflation when the real risk is losing absolute dollar value. Unfortunately, I should have had closer to 15% of my net worth in cash and CDs.
30% in real estate = -5%. The online estimates say my real estate holdings have gone up ~6% YoY, but I doubt it now that the stock market has sold off so aggressively from the peak. Online price estimates and public data are always lagging estimates. Prices did continue to go up until about January 2018, but began falling for the remainder of the year. The chart below shows data months before the 4Q2018 stock market correction. Therefore, I’ve manually inputted -5% from +6% for a 11% swing.
Even though my real estate holdings are down, I thankfully feel no stress compared to my stock holdings, which is one of the reasons why I prefer real estate over stocks. One rental property has no mortgage since 2015, my primary residence is providing utility every day by sheltering my family, and my vacation property is generating a positive cash flow. I can’t wait to bring my boy up to Lake Tahoe to touch his first snow in March!
It’s unfortunate that I reinvested $600,000 of the $1,800,000 proceeds from my house sale into the stock market. I should have just stayed super conservative. But I suspect the best I could get now for the house is $2,600,000 today versus the $2,740,000 sale price in 2017. My house was on a busy street next to the busiest street in all of San Francisco. Fringe location properties, even in a good neighborhood, tend to underperform during a market softening.
8% in alternative investments = +5%. My alternative investments in venture debt and real estate crowdfunding seem to be doing well, to the tune of a 11% – 20% IRR. But these figures are probably too aggressive as well, so I’ve assigned a +5% performance instead. REITs and rental property have outperformed all year as rents are stickier than stocks. I remember back in 2009, my rents stayed flat because by the time the lease was over a year later, the recession was over.
25% in my online business = 0% – 150%. My business is the trickiest to value. Revenue and profits are up 20%+ YoY. Therefore, one might conclude that its value should also be up by 20%+. However, valuations have probably compressed since the stock market sell-off. The good thing is that a peer site with about 35% less traffic sold for 2X the value I assigned for my business in my net worth calculations. Therefore, there’s a possibility my site could be worth 2X – 2.5X my assigned value if we normalize for traffic.
From an estate planning perspective, I want my business to be valued as low as possible. It’s the same way you want your house to be valued as low as possible to pay less property tax. To prepare for hard times, I’ve kept my business at 0% growth in my net worth calculation.
Net Worth Growth
Here’s my 2018 net worth progression chart according to Personal Capital. The chart is a little chunky because of cash recognition delays. But overall, it was doing pretty well until the end of the year.
2018 Net Worth = +6.5%
The main reasons why my net worth is up ~6.5% in 2018 are business cash flow and aggressive savings. I continue to save over 70% of my after-tax income. If I didn’t aggressively save, my net worth would have been flat. As my net worth has grown, it’s harder to move the needle as much.
6.5% is OK, but at one point I was up ~11%. Hence, it feels a little disappointing. 10% YoY growth has always been my minimum net worth growth target since graduating from college. Despite the disappointment, I’m glad my net worth didn’t go in reverse.
If you’re feeling bummed out, it helps to look at how far your net worth has come over the past five or 10 years. When I left work in 2012, I was comfortable with what I had. Otherwise, I wouldn’t have left. Having another six years of growth, excluding 2018, has really been a blessing post earl retirement.
The key is to not lose all your gains to a bear market.
Related: Recommended Net Worth Allocation By Age Or Work Experience
Family & Fatherhood – 4.7 Stars
I could not have tried harder to be a great stay at home dad. I only have one shot, so I did everything to educate myself about parenthood. I also spent as much time as possible with my son as a stay at home dad.
My greatest moments of joy all year came from seeing my son’s milestones. He started waddling with help at around 11 months and slowly started to walk unassisted at 12 – 13 months. By 18 months he was able to count to 30, say all letters of the alphabet, and identify eight different colors.
His favorite words and phrases at 20 months old are “hot dog, ketchup, yum, yum, yum” “double wide garage door,” “walk with daddy,” “knock knock,” “verde,” “voila,” and “da hai bao (big seal in Mandarin).” He’s also just begun to sing a couple lullabies, one in Japanese and one in French. We try to talk to him in multiple languages as supposedly that helps brain development. He’s hilarious and full of determination. Oh boy is he determined.
When I’m not working on Financial Samurai or managing our investments, I pretend I’m a pre-school teacher and occupational therapist. Because he has a vision issue, I’ve been helping him track objects, work on his depth perception, and hand-eye coordination. So far he can walk up stairs no problem, but he still needs assistance going down stairs.
Now we’re focusing more on his fine motor skills, like drawing, holding a pencil, brushing his teeth, playing piano keys, and using scissors. The duties are never-ending, but it’s been a blessing to care for him every day and watch him grow.
He is a determined boy
My greatest sorrows have also all come from my son. Between 11 – 15 months old he would fall frequently or accidentally bonk his head on something hard or sharp. I felt his pain each time and admonished myself for not doing a better job protecting him.
As a result of his accidents, I ended up padding everywhere around the house and padding every wall and table corner. Interior design be damned! Thank goodness we live in a modest size house. The padding has saved him from injury numerous times, including on Christmas, when he stumbled on a package and hit his head on our coffee leg corner which was padded, hooray!
It turns out that toddlers between 12 – 19 months fall about 17X an hour on average according to one study of 120 toddlers. Only until about age 4 do most toddlers fully master their walking and running skills. That made me feel a little better, but it still made me so sad whenever he hurt himself. Taking him for a walk with a harness has helped tremendously. I’m teaching him to look both ways before crossing the street.
It’s also interesting it takes up to 24 months before a toddler’s fontanel closes. Therefore, we as parents might as well be as diligent as possible in trying to protect his head before his skull gets to full strength. So much about about parenthood the first several years is about survival – from preventing suffocation while sleeping to making sure they don’t walk off a ledge.
The better our boy sleeps and the more he is able to communicate his desires, the more rewarding parenthood has become. Because he is so strong-willed, his temper tantrums are also quite a challenge.
One of my concerns is that he will hurt himself during these temper tantrums by banging his head on something hard or arching his back and hurting himself on the floor. Doctors say temper tantrums peak by around 24 months, subside, and then rise again at around 36 months. Here’s where I need to demonstrate maximum patience as a parent for the next 18 months.
Before my son was born, there was never any whining or crying around the house. But once he arrived, I have heard crying and whining every day, multiple times a day for 20 months in a row. Unfortunately, there is no logical reasoning with a young boy, except to use a technique called “caveman speak” while voicing what we think he wants to calm him down. Adjusting to this new scenario has been hard.
It’s also difficult to write, record a podcast, or mentally relax when there is so much noise. Being able to more easily find a quiet space is one of the benefits of upgrading to a larger house. As a result of needing to find quiet time, I often had to wake up between 4am – 5am to get things done. But I’m proud to say I’ve never lost my temper around my boy.
I’ve still got to improve my patience with my wife and not let business stress or stock market stress hurt our relationship. We operate at different paces, and I need to do a better job slowing down. The whole point of financial independence is to be free from money stress to live your best life.
Given my wife is a full-time mom and absolutely does more of the caregiving, the pressure is on me to make sure our finances never go in reverse. As the stock market melted down in 4Q2018, my stress level definitely increased.
Our goal is to both stay full-time parents for at least our son’s first two years of life and ideally try to be full-time parents for five years before he attends kindergarten. Fatherhood is the hardest thing I’ve ever had to do.
Related: How To Survive The Pressures Of Being A Sole Income Providing Parent
Health & Fitness – 3.2 Stars
I’m the same weight as I was in 2017, which is OK. But I gained 5 lbs in 2017, which was not OK. I need to get down to 162 lbs from 170 lbs. At least I exercised 3X a week on average plus took light walks with my son 5X a week on average. Given my goal is to live until 75, or whenever my son can establish himself and find a life partner, it’s important for me to stay in mental and physical shape.
Luckily, I’ve had no serious injuries or medical mishaps this year. I did catch some flu-like virus that knocked me out for 1.5 days in October, but that was it. We did have our first emergency room visit for my son at 5am because he seemed to have come down with a similar virus I had a month later. We also went to an after-hour care facility for some inflammation. Luckily, things got better after 24 hours.
At 41, I still haven’t sprouted any grey hairs, which is a surprise since I first got several grey hairs at 33, the year before I left my day job. The only reason I can imagine for this phenomena is that not working a full-time job is less stressful. It’s one thing to say how much better life is after achieving financial independence. It’s another thing for the body to show us.
My most fun physical addition has been joining a softball meetup group that plays every Saturday it doesn’t rain. I must have played over 30 games in 2018. Ah, now I remember sustaining a left knee bone contusion that hurt for six months. My personal highlight was drafting and captaining a 4th of July softball tournament and winning. Curiously, it was one of my most satisfying life moments!
Finally, I found out in December I wasn’t getting bumped down to 4.5 in USTA tennis from 5.0. I did poorly in 5.0 league at the beginning of the year and was hoping to get bumped down after three seasons. When I didn’t, I appealed and got denied.
5.0 level tennis is brutally tough. From an ego perspective, it does feel good to be in the top 1% of all tennis levels. Other players give you respect as you puff out your chest and start thinking you’re the shiznits. But after you start repeatedly getting beaten by players younger than you, it starts to get demoralizing! Therefore, I always try to make fun of myself to others by saying the computers must have malfunctioned to keep me at 5.0.
Business – 4.8 Stars
I could not have tried harder to build Financial Samurai either. Here are some of the accomplishments:
Published three posts a week on average
Published three pages a week on average
Published one newsletter a week on average
Improved my short-form writing skills with the newsletter
Produced over 50 podcasts
Did several podcast interviews on other platforms
Launched the Financial Samurai Forum with 1,300 members thanks to my wife who set everything up over a year
Got mentioned in Business Insider, CNBC, MarketWatch, MSN, Apple News, Forbes, and Yahoo
Updated How To Engineer Your Layoff with a new forward
Increased overall traffic by 20% YoY, with 50% YoY traffic growth between August 11 – December 27
The 50% YoY traffic surge since August 11 seems like an anomaly. It’s like suddenly turning into a speedboat after being a cruise ship. But traffic has been elevated for almost four months so far, with December being the highest traffic all year. For years, December has always been a quiet month due to the holidays. Perhaps the traffic increase is due to a combination of more production, search algorithm changes by Google, and content syndication.
Overall, I’m just really happy there’s been a correlation with effort and reward. That’s all I’ve ever wanted, hence part of the reason why I left work in 2012. Every year since the birth of Financial Samurai in 2009, Financial Samurai has drastically outperformed the S&P 500 and the San Francisco real estate market. As a result, blogging has surpassed real estate as my favorite asset class to build wealth.
For poops and giggles, here’s another net worth chart if I manually input a business value based on recent comparable sales. The 30% spike is nice, but is also dangerous because it brings a false sense of complacency. It’s best to stay motivated as the economy softens.
Net worth including market value of business = +30% YoY
Life’s Odds & Ends – 4 Stars
In May, I helped coach my high school boys varsity tennis team to the Northern California Sectional championship. This was the first championship in the school’s entire 40+ year history. This victory was particularly sweet because we had come so close my first year in 2017 only to lose in the finals to a school 3X our size. This was another incredible life moment that had nothing to do with money. I only got paid $3,500 for 3.5 months of work. The relationships I developed with some of the parents were a nice bonus.
My dad came to visit three times and my mom twice. My mother-in-law also visited twice and my father-in-law once. It is always great to see them, and I hope they continue to visit us more often. My dream has always been to have three generations spend as much time together as possible. Unfortunately or fortunately, all our grandparents want to remain independent and live in their respective cities. It’s hard to change the older you get, which is why I’ve been trying so hard to move to Hawaii.
I further strengthened a couple friendships. This is huge because as a stay-at-home dad, it’s often hard to make new friends or deepen friendships. There are simply less social events to attend e.g. happy hour. I love having a good buddy to shoot the shit with. I also developed a new in-person relationship with an FS reader, who also so happens to also be a professional athlete on my favorite team. Pretty neat!
I did some decent home maintenance projects this year: caulked the top of our living room window sill to prevent leaks, varnished all our wood planter boxes, rooted the upstairs sink that was clogging, re-roofed the leaking light well, maintained the yard, and fixed a leaky faucet at my rental. Man, I forgot about all this stuff until my wife reminded me. Thank goodness I sold the other rental.
Finally, we finalized our will and revocable living trust. My wife also led the charge getting us through this cumbersome and complicated process. There were so many documents to gather and questions to ask the estate planning lawyer that she estimates the whole process took her about 40 hours. But after we finally signed all the documents on December 20, I felt a huge sense of relief that I could die knowing that my wife and son wouldn’t have to go through probate court.
2018: 3.8 Out Of 5 Stars
Although I didn’t decide to take it easy per my 2018 goal, I have no regrets staying consistent with Financial Samurai. I don’t think I’ll ever change my work ethic until my body starts breaking down. The joy of writing is so tangible because it is an identifiable product that can be eternally consumed.
It’s been hard to accept no longer making a positive return on my public investments after nine years of up, up, up. I’ve got to do a much better job at not letting financial loss negatively affect my mood and my relationship with my wife. Not taking unnecessary risk will help.
During downturns, I envy those in professions that have nothing to do with the stock market. For example, when I asked my estate planning lawyer about what she thought about the stock market collapse in December, she said she had no idea because she outsources all her financial planning to someone else. What a blessing.
I also have zero regrets being a stay at home dad all year. Yes, the days were long and there were many moments of frustration, but just hearing his squeals of joy made full-time fatherhood worthwhile. All I want to do is squeeze and kiss him 100X a day! I’m so thankful my wife has been an amazing mother and partner all year.
Family and Financial Samurai are my two great loves. Everything comes a distant second. There was a point where we thought we’d never have a child. So we say a prayer of thanks every evening. Financial Samurai has been a part of me since the bottom of the last financial crisis in 2009. It’s like an old friend that has stuck with me in the worst of times.
The key is to not let my two loves collide, but to let them be synergistic. My family gives me motivation to write, while Financial Samurai is a creative outlet that helps ensure we remain stay at home parents until we decide otherwise.
There’s always a silver lining to a downturn too.
For Financial Samurai, it’s increased traffic as more people are paying attention to their finances. Book sales on how to negotiate a severance are also increasing as savvy employees are trying to get ahead of the layoff curve. Finally, our passive income has also increased due to higher interests rates and my shift towards higher yielding assets like cash, bonds, and CDs.
For family life, it’s being less tempted to go back to work because the return on effort has declined. When all is in shambles, why bother dealing with a commute, company politics, difficult clients, and a declining company stock price.
I hope if my boy one day reads this article that’ll he’ll be proud of his dad. Although 2018 wasn’t a fantastic year, it was filled with many positive milestones.
I’ll be sharing my 2019 outlook and goals next. In the meantime, I’d love to hear some of your hits and misses for 2018!
Related: The Best Financial Samurai Posts For 2018
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Do the review assignments and recipe reviews at the end of ab calc help your grade somewhat significantly? Aka even though we've almost finished can I still bring my grade up?
Response From Fleur:
I’m not sure how much your grade could improve but a calculator could give you a good estimate.
Thankfully there are tons of ways to earn points at the end of the school year. The projects would always would help my grade last year in AB calculus. The final really tanked my final grade :O but 4th quarter really brought up my grade though and it could for you too. Hopefully ya’lls final goes well for you
I’d make use of and try and get all of those easy/free points 4th quarter. Really put time and effort into those and it’ll help. In the game of improving your grade, every point counts and 100%s and close to 100%s on the little stuff and especially the big stuff REALLY helps.
Random Tangent: I remember I made a cheesecake for the recipe review. It was a damn good cheesecake. Ms. Gabriel should have given us extra credit for how unbelievably delicious it was haha. If you want to make a really good easy cheesecake factory level cheesecake to take your mind off of school, here’s the recipe: https://www.simplyrecipes.com/recipes/perfect_cheesecake/ It’s so easy, and so good. I can’t cook or bake anything, and every time I make this people are really impressed. JUST MAKE SURE that your waterbath does not leak into the cheesecake springform pan. Wrap it with tons and tons of aluminum. If any water leaks into the pan, the cheesecake will be the equivalent of vomit instead of yummy beyond words ;)
GOOD LUCK in calculus friend :D Keep at it! You can do it!
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OMFG LAST QUARTER EVER + some spring break stuff???
Took a weekend off of life Retail therapy at its finest today Even though new jeans were overdue
It’s crazy how it still came I guess it’s a force of nature But omg it’s gonna be here on the concert T^T
This nerd would have mitsuha’s theme on his playlist smh #nochu
April 2nd, 2017 BTS Wings Tour I still can’t believe it happened I’ve been awake since 8am lol and it’s like 1:54am and i’m still trying to process and remember everything that happened today It felt like a dream! I can’t believe I saw them in real life. ohmygod Hands down, easily one of the best day of this week - if not this entire year so far holy shit will continue this tomorrow as i reminisce ok but one thing i noticed is that jungkook’s thighs are actually so real like wtf? shookt EDIT: lol i never finished this but oh well
oop i just bought more rings goodbye money
my charger broke gg time to get another one
I have a newfound appreciation for the color pink or more like my appreciation for pink is coming back
When you get anxious because bts hasnt posted on twitter for 3 days but then you also know they’re resting and that they deserve this break
SPRING QUARTER LEGGO tu/th schedule let’s hope this all works well keke
week 1 recap tuesday - sees everybody in freaking AB LOL sees harry after walking out of my tdpw sees alana and dylan outside my global health class which alana is also taking, and becca and tanya lOL goes to cogs 122 to find chen screaming my name - also vania and stella <3 last class is normal - with nobody in management BUT LOL LEIGHTON ADDED THE CLASS ON THURSDAY HAHA there’s also this girl in my tdpw class who looks like lindsay lohan and her name is also lindsey but with an e cause i saw it on the email lol not a stalker
Decided to gel nails it out friday of week 1 whut whut
First attempt at 양념치킨~
been using the soundtrack of your name this past week to get over pcd it’s been a week and i still haven’t recovered T^T
went to kbbq with harry! lol week 1 sunday started at manna….having an adventure in between at manna keke “started here and ending it here?” LOL
currently craving anything strawberry
don’t understand why i need to have my email as a send&receive in order to sms to work on my laptop bb why are you being stubborn when you’ve been working fine all this time
under yuri’s recommendation, i microwaved my coffee because it was lukewarm and she called me extra LOL
i’m getting nervous about a presentation when i shouldn’t be because ?? my AB service leader self is like completely gone i wanna crawl into a hole
i just finished season 2 and 3 of htgawm in less than a week… how they gonna do season 4 i wonder
Week 2 thursday I was actually really looking forward to class today Also my rings came! Though were they worth the $50….not so sure Were they cute? Yes But not as cute as the other one T^T So i mustnt give in to temptations nowww
I found out what matcha powder mom uses to make their matcha latte Cappuccine frappe mix But it’s sadly not on amazon ):
This new tumblr function is really inconvenient cause i cant tell how many thing i have on queue brcause i have to keep switching blogs -_-
Han came to visit! Friday Papa johns Saturday Snooze brunch Infinitea Abeh hangout In n out Sunday Aquarium! Koon thai Ramen yamadaya Boba bar and then i drove him to irvine where we got coco curry! and then i drove back and he bought me milk tea with pudding
Had an epiphany It’s not anenome It’s anemone
Omg but like why dont people call spoiler alerts “spoilerts”
Started 13 reasons why with Han Finished it, tuesday week 3 Hmmm How to feel
finished strong woman park hyung sik is so…adorable? IT’S SO WEIRD. HIS AEGYO LEVEL IS INSANE
When you realize that 둘! 셋! is probably the title of the fan song because that’s what BTS always say when they introduce themselves And that BTS + ARMY forever ㅠㅠㅠㅠ I’m not crying r u crying ;___;
어떻게
Omg when you wake up for reorientation and jungkook does lives <3
highkey need to crawl into a hole tbh
You know what i want to do? Go to an olive garden Even though i know it’ll taste bad lol
Not really sure what i want… But i dont want my 4 years to be a waste ):
i….skipped out on an interview today was it the right choice i may never know
most recent ep of snk got me fucked up SOMEONE TELL ME WHAT YMIR AND CHRISTA’S RELATIONSHIP IS WHO IS CHRISTA
Lol i hella bombed my quiz GOODBYE GONNA P/NP HAHA
Week 4 weekend Fuck me in the ass i twisted my ankle and i am in irvine had to pop an advil and cruise control all the way back thank god there weren’t many cars lol 0/10 do not recommend
Slept on the couch the past two days to elevate my ankle Glad to be back in bed But i think i might be a little…sick? Fuck Need to grocery shop
Dammit i got called for jury duty
Ok but i twisted my ankle and two recruiters emailed me back the next day so was it really a loss
Week 5 i’m sick…
just watched 5 centimeters per second a little sadder than i was an hour ago
fuck i forgot that my jeans are new and i washed it and my pink shirt is ruined fml triggered
thursday after rolling over ma ankle i can finally see that it is a lil swollen and there is bruising LOL also saw an owl at school today and a bunny while leaving to go to meeting
week 5 tuesday saw two bunnies on my way out to school
I just saw two hummingbirds! 😍
I cant believe yuri and i finished twenty SMH
ABCD today Some qualitee photos were taken Im tired now
Really debating the 4th term
third day of back pain flexibility dying wow what is happening???
…..army 4th term is $75 cries EDIT: it’s $66 because i forgot exchange rate but still cri EDIT EDIT: it’s $45 if i ship it to taiwan - seriously really highkey considering that now oh dear
bro i think i just experienced katawaredoki whut
i keep thinking that my ankle is ok but i always end up doing something that ends up hurting it like hella im
Week 6 thursday last leadership meeting one of my favorite meetings because whoa INFORMATION!? it was nice wanted to discuss and add in my two cents but i honestly just wasn’t able to wrap my head around everything loool then…we decided to go to PB LOL chen, jeong, yuri, justin and his friends (including nicole, nicole, sandy) and then more people. we also met leslie, brett, dexter, allison, kenny, peter, abby, ben…and more? at pb lolol and also we saw miguel and anthony - it was like a freshman year flashback tbh lOL went to vallartas after and then came home to shower and finally sleep at 3:30am wot is life NEXT DAY ADVENTURES - leighton and i finally pulled out the weeds and now we’re tired
salty that i wasnt invited to the birthday celebration, not that i would really make the trip per say but wtf gurl
I just had this really sad thought that i’m probably never gonna ever get to know bts like friends y i do dis to meself
Wait so like i got sick while at clew’s and it didnt happen until week 5 and so i was sick from week 5 through week 6 and at this one point i couldnt taste my food it was terribad
May 12th I bought the membership LOL Hopefully it mails it correctly back to Taiwan ☺️
im dumb i didn’t save the color i wanted for my hair
omg the song vania recommended to me a few days ago was recommended by jungkook like a year or so ago on twitter lOOOOL
Just tryna level up here :<
Struggles when places are in the east coast and phone calls are early in the fckin morning
Note to self: Ridge cut potato chips with sea salt is good for stuff with dip Ridge cut salt and pepper is good for regular eating, but gets salty at the bottom LOL EDIT: per vania’s suggestion, i salted and peppered my chips
watching jungkook’s vlive AND HE JUST HARMONIZED WITH HIMSELF IM DED
Just woke up from a dream where someone hurt my brother/nade him fall and i was so angry? Was about to go ape shit on that person im ded lol who is rhis angry me
Rewatched and finished reply 1997 Wow what is life when yoon jae is life But also what is life when your idols are life Daily reminder to not be as obsessed as shiwon LOLOL
i can’t go to giraffage and elephante anymore im on the otherhand i get to go to virginia???
lol but like i haven’t been writing drafts because i often write in my notebook now but here are some updates - my nails are constantly chipping - forgot about grad photos that clashed with the weekend han is coming - im ded because i probs won’t have a weekend to myself until week 10 - struggles to figure out graduation things - paid my $54 to walk #mostexpensivewalkever
LAST LEADERSHIP MEETING (turnover) what am i going to do with my thursday nights now? it’s been a good run
Jealous of the staff that holds and records the camera during vlives? LOL who am i
When you forget that jeon jungkook did taekwondo before Hnnnngh
i just reaffirmed? or discovered? that i don’t like fruity pebbles o_o
Trying to think of a thing to put on my grad cap Tis hard Let’s make a list: 花樣年華 Strong power thank you You never walk alone Ireumeun deborah LOL Lol omg but why is yoongi’s “cheater never win but i just graduated” quote so appropriate for grad EXTRA + ORDINARY* Lost my way/found my way* Click clack to the bang Smile with me, cry with me, fly with me (you make me begin, you made me again) Ctrl+c, ctrl+v do you know “____” (hci? annyeonghasaeyo) To lose your path, Is the way to find that path* 꽃길만 걷자* Let’s fly with our beautiful wings in 2017 EDIT: i’m too lazy, i didn’t do anything to my cap lOL
Im shookt cause namjoon doesnt say 이제 feelin the vibe. HE SAYS IF YOU FEELIN THE VIBE. I feel…betrayed
Non whitewashed bangtan gives me life
May 21st My first haircut since… Since i got it cut over the summer?????
Bought me stole and tassel today Smh that i cant grab my muir tickets?? Cause i ordered all commencwment tickets SMH
Lowkey afraid of not passing mgt LOL
Omfg i knew we were going to have a pop quiz. It really happened
nicole and evelyn commented that they liked my hair and audrey and malia agreed i gotta say i’m so glad people remember me in my tdpw class LOOL
Cant get the seventeen song outta my head Shookt by the choreography
Y'all im so fckin shookt First the chainsmokers post on twitter like “see you in the summer” Then they win the BBMAs like a boss Then you see them on halsey + steve aoki’s snapchat Next things you know steve aoki is postin shit like “BTS x AOKI COMING SOON” Im SCREAMING
Yo my lyft driver dropped some knowledge again and told me his life story lmao he was a police officer in chicago and he was forced to retired and then ?? after chasing down a rapist and getting into a fight, he was seriously injured. but his dad (a judge or someone powerful idk) forced him out of retirement by telling everyone to not give him his benefits and shit and i was like. whoa bro. slow down? “embrace the unknown”
I finally tried the coconut black tie at peet’s 10/10 a mistake
Okay but can we talk about how on point everybody looked in the comeback Esp wonwoo and dk But also vernon 👌🏼
First time in virginia/ being so close to washington dc! Whoa Also gonna pass by texas too :O Knocking some states off my list
I WITNESSED MY FIRST CIRCLE RAINBOW THINGY ON THE PLANE FROM VIRGINIA TO DALLAS TODAY HOLY IT WAS V COOL
i don’t know why i never realized this about myself before but i need to be/live by a body of water at all times or i won’t feel comfortable this is weird
i told han i joined the fanclub and he like died for like 2 seconds lOL
ok but like i bought a carton of eggs and 6 or 7 of them were double yolks and i have 2 more eggs left im starting to think i’m eating some weird hybrid chickens EDIT: those last two eggs were both double yolks. this was a wild adventure
omg i knew that the TA MOST LIKELY RYAN WOULDNT UNDERSTAND OUR IDEA JUST LIKE HOW HE ALWAYS MISINTERPRETS THEM??? like what kind of constructive feedback is that if he doesn’t understand what we’re trying to do im… sigh
Already excited about the festa But like omfg they released the schedule today And just WE DONT TALK ANYMORE PT 2?? SO FAR AWAY FEATURING JIN AND JUNGKOOK? Im IM SCREAMING also sad but the radio show is right before my finals gotta prioritize, no bts fo me ;__;
after waiting two weeks, my application to get leveled up was rejected *cries* time to try again! *^*
okay but really feeling seventeen’s song as well as suran’s song like hIGHKEY
i finally got my commencement tickets the third time that i went to the bookstore third time’s the charm right? also whytf is the parking pass for all campus commencement so huge -_-
hnngh omg that feel when you have hella shit to do TPDW1 final play due week 9 friday because we won’t have class at all on week 10 then there’s the presentation (elevator pitch) that happened today week 9 thursday but also just hauling ass on things for A5 tbh what is this what is everything wot is the meaning of life when vania and i stay up till 3:30am lol… and then there’s me. tired af but didn’t sleep til 4:30 anyways cause i’m a dumbass l e l let’s not be a potato this last week k?
burger king in pc has its own free wifi called WhopperWifi and it’s so much faster than school wifi this is revolutionary
week 9 weekend to irvine irritated on the way over irritated on the way back lol wot is life i should’ve just turned around to go back home
NO TDPW1 WEEK 10 WOOT wow that means i won’t have class until 2pm whoa
“why are you reading math formulas” - yuri i was actually reading bts profiles lOLOL she just dissed their handwritings
Just spent the past hour or so looking at kakao friends merchandise And discovering that apeach is a genetically modified peach lol
that moment when you ask for a png file but get a jpg
dyed my hurr twice today for a darker shade still not what i was going for but this will do for now
Omfg i slept through my alarm until 1pm Goodbye study time?? Also omg i like it pt 2 video SHIT SHIT SHIT THEY KNOW WE BEEN WAITING FOR THIS. HAD IT SINCE BAEPSAE DAYS. BUT DIDNT RELEASE IT. Freakin bighit
My request to level up on the fancafe has once again been rejected ); EDIT: oMFG IT’S BECAUSE I DIDN’T CHANGE THE SETTING TO SOMETHING im screaming, what a first world problem THIRD TIME’S THE CHARM AMIRITE
Doesnt feel like it… But thursday was my last time going to class…pretty much like ever unless i go to more school Holy shit
Oh man I didnt think i’d have THAT much shit. But…i think i have A LOT of shit….
saw bts MBIT and i was like omfg! knew that i was INFJ but took the test again yesterday and ended up INFP….but just barely P so i think i’ll stick with INFJ lol EDIT: i took the test again today because vania and yuri were talking about it again and i am still INFP…and more P this time. SO LOST. WHO AM I
put my things up for sale i forgot that i might need my light el oh el crying on the inside cause i want to keep my desk but then i’m selling it off because i don’t think i’ll have space for it and i just CRYING ON THE INSIDE BECAUSE IT’S BEEN WITH ME FOR SO LONG T^T
ON ANOTHER NOTE. THIRD TIME IS THE CHARM LEVELED UP ON JUNE 12TH AT ONE SOMETHING AM
JUNE 12TH FINISHED MY FIRST AND LAST FINAL I AM OFFICIALLY DONE WITH MY UNDERGRADUATE CAREER??? also lmao i spent 45 min on the final wot
i dyed my hair darker but now it’s become lighter? wait wtf wait no go back EDIT: wait no it went back to being dark? is this a thing? when i get exposed to the sun it gets lighter and when i sleep it gets darker??? smh at light for fckin with me
so i set an alarm to watch the bts home party last night for like 3:57am and i didn’t hear it but i guess i kinda did cause i woke up at 4:05am and was like ??? i decided to watch a bit of it but ended up streaming the whole thing until 5:45am looooool also watched the numbers grow from the 500,000 all the way to 2,000,000 and then 3,000,000? it was nuts
omfg all these years of rereading chapters and only now do i realize that i could save bookmarks on mangahere *slaps forehead*
Moment of silence cause i sold my desk that’s accompanied me for almost 10 years It even has battlescars (aka X marks by Jacky, 3 of them) LOL memories ;___; Oh and i guess my chair too
lol was gonna sell that yamaha guitar for $45 but it’s going for like $190 on ebay?? so ima just bring it home
finals week hangout list: tuesday: fud with kimberly, peyton, harry wednesday: more fud with stephanie and ellius thursday: KBBQ FOR LUNCH with jeong, justin, yuri, harry LOOOOL
and so...that’s the end of the quarter. my last quarter of school ever (unless i decide to go to more school...which seems unlikely as of right now) it feels weird.................................. but! onto graduation~ looking forward to being reunited with family and whatever’s gonna hit me in the face LOL
and with that goodbye undergrad, hello world ㅇㅅㅇ
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Presenting Complaint: Social Injustice
By ANISH KOKA, MD
Bobby
It took some doing, but I had finally made it to Bobby’s home.
It was a rowhome tucked into one of those little side streets in the city that non-city folks wouldn’t dream of driving down. As I step in, I’m met by the usual set up – wooden steps that hug the right side of the wall leading up to the second floor. Bobby certainly hasn’t made it up to the second floor in some time. At the moment she is sitting in her hospital bed in the living room. The bed is the focal point to a room stuffed to the gills with all manners of stuff. At least three quarters of the stuff seems to be food. Cinnamon buns, Doritos, donut holes, chocolate frosted Donuts, crackers, Twinkies. The junk food aisle at Wawa would be embarrassed by the riches on display here.
Bobby weighs in at four hundred pounds, 5 foot 5 inches. She has a tracheostomy from multiple prior episodes of respiratory failure that have required ventilatory support. I’m here at the request of a devoted primary care physician that still makes home calls. I’ve looked through the last number of hospital stays. The last few discharge summaries are carbon copies of each other. Hypoxemic respiratory failure related to pulmonary edema complicated further by morbid obesity. Time on the vent. Antibiotics. Diuretics. Home. Return to the hospital 2 weeks later. The last echocardiogram done was 3 admissions ago. A poor study. Not much could be seen due to ‘body habitus’.
I sit on the side of the bed trying to acquire my own images of her heart. I talk to her as I struggle. Bobby is 58, the youngest of three sisters, and the only surviving member of the family. Her elder sisters died of respiratory complications as well. They both died with tracheostomies. The conversation is circular. The problem according to Bobby is the tracheostomy. Everything was fine before that. I explain that a prolonged period of time on the ventilator on a prior admission prompted the tracheostomy, and that the multiple recent admissions to the hospital that required a ventilator seemed to validate that decision. She doesn’t waver. Both her sisters died shortly after they got tracheostomies. Bobby thinks the physicians taking care of her sisters had a hand in their demise. “They didn’t care”. “We told them they were sick.”
Perhaps.
The picture on the nightstand suggests Bobby was the smallest of the three sisters.
It doesn’t take much to get Bobby talking. Her favorite holiday is July 4th because she makes the family favorite tuna casserole, and her favorite niece, April, helps her with the casserole every year.
Meanwhile, the echocardiogram shows a large right side of the heart. Her pulmonary pressures are elevated, and she seems to be fluid overloaded. Review of her bloodwork from the hospital also strongly suggests her weight may be hampering her ability to expel carbon dioxide. She really needs to be on a ventilator nightly. In other more normal contexts there are additional diagnostic steps to take, but trust won’t be built in a day. She’s heard variations of these recommendations before. She is adamantly opposed to any other invasive tests.
But a small victory. She agrees on the higher diuretic dose.
Bobby is black. I’m brown. We hail from very different zipcodes. She clearly harbors a deep mistrust of the medical system. But I’m hopeful to make some inroads. It doesn’t seem to matter to Bobby that I’m brown, or that I was born in Delhi, or that I reside in a much different zipcode than her. At the moment, I’m just another caregiver in her living room.
I sense a thaw. As I pack up, she asks me when I’ll see her again.
Hopefully soon, Bobby.
Mr. Chalhoubi
Hussain Chalhoubi is in the office with one of his three devoted daughters. It’s a different daughter every week and I can never keep their names straight. I met him after he had suffered a stroke that leaves him frustratingly aphasic. He enjoys food and drink, and like clockwork would appear in my office in the early years frequently with swollen hands and feet days after a dietary indiscretion. He always had a sheepish look on his face as his exasperated daughters would tattle on him.
At some point I learned there was little point to piling on. Scolding only gets you so far. Instead, I asked him about Syria. Boy do those eyes light up. His family had fled shortly after Syria had been plunged into civil war.
I’m curious who he blames for the mess. Assad, the dictator who the US has held responsible? He vigorously shakes his head. His daughter chimes in.
“We are Christians.”
Not much more needs to be said. Assad may be the boogie-man to many, but he is an Alawite, a minority sect of Islam in a sea of Sunni Muslims that makes up the Levant in the Middle East. The rebellion against the Alawite Assad is of the behead-first-ask-questions-later extremist Sunni kind that scares the Syrian Christian minority much more than the ruling dictator accused of his own share of atrocities.
As the conversation comes back to the medical, he forwards through his daughter that he has been trying to flush out his kidneys by drinking copious amounts of water. I try to explain to him that his kidneys and his heart don’t function normally, so they can get overwhelmed.
No flushing.
Over time, he’s started to listen more. He doesn’t skip his medications, avoids drinking too much. He used to be in the office monthly, but now every 3-4 months for routine visits.
Serving patients, or populations ?
It is now a rather quaint idea that outcomes for patients are best improved one doctor-patient relationship at a time. I understand the sentiment. For most patients the outcome is decided well before their encounter with me. Your zipcode seems to be a lot more important to your outcome than your doctor, and unsurprisingly a movement to address matters that have traditionally lived outside of the health care system has gained steam
In an earlier era the doctor’s mission was to recognize and manage diseases. Medical students were taught to hear the severe aortic regurgitation that was causing the progressive shortness of breath. The advances in the management of disease over the last half century have been nothing short of magical. Crack open a chest, arrest the heart, replace an aortic valve, bring the heart back to life. The power of medicine realized was to change the natural history of disease for the ill patient that arrived in distress seeking help.
And here the very reasonable human desire to address systemic inequities in society found synergy with a darker current of thought within medicine that felt the resources expended to care for the very ill are resources poorly spent. The focus, the theory goes, should be on preventing illness in the much larger healthy population. The scope of keeping the healthy well, of course, extends well beyond the medical, and puts everything in play. Sanitation, transportation, air quality, climate change, access to the means to pay for healthcare are just the start of a long list of priorities for those in charge. These programs need scarce budgetary dollars, and so it was only a matter of time after the government started paying for healthcare that politicians and the public health gurus they empowered to manage the health of the population began to voice their disdain for the care of those deemed “too ill”.
The tension here is that medicine’s greatest strides in the last half century have come in those with afflictions that brought them to death’s door. The inroads in this group of unfortunates have come by way of super-specialists far removed from the concerns of the worried well. Richard Lamm, the former governor of Colorado famously derided the work of Thomas Starzl, the father of organ transplantation, questioning the great surgeons use of public health resources to attempt to save individual patients at death’s door. These were the early days of transplantation, when successes were a far cry from the results enjoyed today. As the passage of time made transplantation success rates north of 90% and the public watched children destined for death skipping down hallways, Lamm’s cold calculus came to easily be rejected.
Yet in 2000, writing for Health Affairs, Lamm doubled down.
“Colorado’s doctors were constantly reminding me that in medicine, ‘cost was never a consideration.’ But health care was the fastest-growing segment of my budget, demanding increasing amounts of public funds for the medical school, for new equipment at the hospital, and for Medicaid. Daily, if not hourly, hospitals in my state would effectively appropriate state funds for a high-risk, low-benefit procedure, while I knew that those funds could easily save more lives elsewhere in the health care system or outside of it, say, by buying three new teachers, fixing a broken sewer main, or adding two police officers to a high-crime area for a year. How could cost not be a consideration in making a public budget?”
“How can patient advocates feel so good about the system they work in when I, as public advocate, feel so guilty for having so many people without even basic health care?”
It never strikes Lamm that the citizens he is so desperate to ‘cover’ with health insurance may want to choose not to die and opt to receive an organ transplant. What good is a health insurance plan that doesn’t pay for life saving therapy when you actually need it? This would be akin to paying for a fire suppressing sprinkler system, but not paying to have firefighters come to battle a structure threatening blaze.
The kinder, gentler, smarter society the ideology Lamm represents is a society that turns its back on the tangible, acute needs of the sick for hypothetical needs of the well. In a perfect world, perhaps one could do both. Unfortunately, when it comes to interventions for the worried well, controversy abounds for how exactly one accomplishes this. Does one advocate for zoning and tax policy to allow fresh produce and groceries to be sold in poor zip codes to address ‘food deserts’ so Bobby has more healthy options? Should we advocate for sin taxes on alcohol, tobacco and sugar containing products that by their very nature are meant to be regressive taxes that affect the behavior of patients like Bobby? Does caring for Mr. Chahloubi mean taking a position on US foreign policy interventions in that country, or perhaps advocacy for immigration for asylum seekers?
In an age not so long ago, it was easily recognized that the answers to these questions were to be wrestled with well outside the purview of the medical field. That a growing number in the medical community think medical training gives us special expertise to solve these problems speaks to a self-important medical echo chamber that believes society’s values should mirror its values.
We would be wise to heed the words of C.S. Lewis – “Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies… those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.. This very kindness stings with intolerable insult. To be “cured” against one’s will and cured of states which we may not regard a disease is to be put on a level of those who have not yet reached the age of reason or those who never will; to be classed with infants, imbeciles, and domestic animals.”
Bobby and Mr. Chalhoubi aren’t particularly interested in my views on sugar taxes or my feelings about Bashar al-Assad. They want someone invested in them, not in some abstract population. Advocacy by physicians has its place. Its just not in the exam room.
Anish Koka is a physician in private practice in Philadelphia.
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