Lectures at University of Guam

I just returned for two days in Guam. I had been invited to lecture at University of Guam by Professor Kirk Johnson. His Introduction to Sociology classes have been reading my book. I spent Monday afternoon at the UOG library preparing my thoughts, and as I sat there, surrounded by students and books, I thought it could be exciting to work in academia -- people seeking knowledge, exchanging ideas, working to change the world, mentoring one another. That stuff excites me. But on Tuesday morning reality sank it. I enjoyed my first lecture to about 50 students. The students were engaged, asked questions, wrote down their thoughts, laughed at my jokes. At the end of the hour and a half, I signed their copies of the book. Then, after a 10 minute break, another 50 students came in, and I had to give the same lecture all over again. I was exhausted by the end. I didn't anticipate that the "exchange of ideas" would require back to back identical lectures on any given day of the week.

The evening made up for it though. Kirk had read some of my essays from the book to his upper level class on Community Development and Globalization. These fifteen students gathered at the home of Dianne Strong, a retired UOG English professor, and they were joined by members of the faculty in the fields of anthropology, archeology, psychology, and library science. We sat outside, overlooking the Pacific, and since no one had read the book, I talked a bit about what motivated me to write it, and I read some of the essays. I was truly humbled by the response. People laughed at the humorous pieces, and cried (even bawled) at the more personal ones. It still amazes me that anything that I write is of meaning to someone else, and to see this response from the students and especially the faculty was very moving.

Doctor's Who Kill Themselves

(Here is my hastily written Saipan Tribune column for this week.)

This week’s issue of Newsweek magazine features an essay by this same title by David Noonan, highlighting the problem of suicide among doctors. Believe it or not, doctors have the highest suicide rate of any profession. “Struggling in Silence,” a documentary film which will appear on public television stations, examines this problem.

The underlying cause of suicide is depression. For decades we have recognized that depression is not simply sadness caused by the bad occurrences in life. It’s related to a chemical imbalance in the brain, and is treatable with medication.

According to Noonan’s essay, the rate of depression among doctors is the same as in the general population, but it remains undiagnosed and untreated in more doctors. You’d think that doctors would recognize the signs of depression within themselves and seek treatment, but it seems to be that being a doctor prevents seeking help. You see, there is pressure among physicians to be strong, and although patients can accept a doctor with some physical ailments (like diabetes or high blood pressure), the public is less likely to accept a doctor with depression.

The pressure to avoid medical care for depression is tremendous among doctors. Every year, when I receive my licensing renewal applications, there is a question on there that asks whether or not the doctor has had any mental health issues. Of course, licensing boards have a responsibility to protect the public from a physician whose mental condition may harm the public, but depression is generally not one of those kinds of problems. But just seeing the question on the renewal application can be enough to nudge a doctor away from seeking care.

The suicide rate is higher among doctors in part because they have a higher success rate when they attempt suicide. They know what they’re doing. They know the human body, and what it takes to stop a pulse. They have access to lethal drugs. They know how to use them.

The suicide rate among women doctors is even higher than for men. A female physicians is more than twice as likely to commit suicide as a non-physician.

Depression often strikes young adults, and medical schools are currently developing programs to help these young doctors-in-training to seek help for depression that may be starting to afflict them.

Depression, of course can strike anyone, and anti-depressants are the most subscribed group of medications in the United States. It’s ironic that the ones writing the prescriptions are the least likely to seek their benefit.

Ophthalmology Times Interview

A few weeks ago I was contacted by a writer from Ophthalmology Times, a biweekly nationwide publication that goes to every ophthalmologist in the United States. They wanted to do a story about me -- you know, guy in the middle of nowhere. The story is up on their website. Click here to read the article. I didn't realize how much of the story would be about blogging.

(Edit: Actually, I'm posting the article here in case it disappears from their website.)

Practicing ophthalmology in Saipan

Apr 15, 2008 By:Noelle Creamer Ophthalmology Times

David Khorram, MD, meets many ophthalmologists who wish they could work internationally and make a difference in a society that needs their expertise. Some travel for a week or two every year and find opportunities to help around the world. But Dr. Khorram is living the dream.

He is an ophthalmologist in private practice on the island of Saipan in the South Pacific.

Finding his island

Dr. Khorram grew up in Kentucky and attended Northwestern University, Chicago, then the University of Kentucky for medical school, and then returned to Northwestern for his ophthalmology training.

"This was a very exciting time, and although I had the opportunity to pursue a career in academic medicine, my heart was set on serving a community that needed an ophthalmologist," said Dr. Khorram. "I had always wanted to serve internationally, so I sent letters all over the world, and ended up in the Pacific."

He spent a year as the director of ophthalmology at the Lyndon Baines Johnston Tropical Medical Center in Pago Pago, American Samoa, before going to the Commonwealth of Northern Mariana Islands (CNMI). For his first 5 years in Saipan, he worked at the Commonwealth Health Center before co-founding Marianas Eye Institute in 1998.

Different needs

Running an eye institute on this tropical island is different from doing so in the United States for several reasons, explained Dr. Khorram. "There are no subspecialists nearby for me to refer patients to," said Dr. Khorram. "I'm the only ophthalmologist serving the island. So when something needs to be done, I'm the one to do it.

"I handle a much broader range of cases than I would in the States," he added. "Many people here delay eye care, so I see a lot of end-stage disease. A good chunk of the cataract surgery that I perform is on white lenses. Diabetes is rampant, and a lot of people walk in the door for the first time with a vitreous hemorrhage."

The demographics of the island distinguish the practice, too. Dr. Khorram explained, "There is an indigenous population of about 20,000. People die young, often in their 50s. The rest of the population is made up of young, healthy contract workers from Asia who don't access health-care. I'm doing about 80 or 100 cataracts per year. That's just all there is on the island. Minimum wage is $3.55 per hour, and the average annual income on the island is around $11,000. So there isn't any significant disposable income for people to spend on the elective facets of eye care, which, from what I understand, is driving American ophthalmology—refractive surgery, presbyopic correcting IOLs, and cosmetic procedures. We provide a lot of free care and a lot of indigent care.

"Yet, I love my work because the people I serve are extremely appreciative," said Dr. Khorram. "Economics are obviously not the driving force behind working here."

A wired practice

Technology plays a huge role in Dr. Khorram's practice—in part because he values it and in part because his remote location demands it.

"I think our level of technology is probably not typical for even U.S. mainland practices," he said. "When ophthalmologists from Japan, Australia, and the US have passed through and visited our office, they have commented that the combination of technologies in our office far surpasses typical comprehensive ophthalmology practices in their countries.

"For example, because the people here are more visual learners than verbal learners, we have digital cameras attached to our slit lamps, which project images onto computer screens in the exam rooms. The families can watch the exam, and we can freeze the images and explain to our patients what is going on with their eyes. The pictures make sense to them, and the education helps them understand their condition.

"I'm also an early adopter of new technologies. Even though I'm in the middle of nowhere and not very busy, I still want to practice first-world medicine. Because of the technology, we probably look more like the sort of practice you'd see in an academic center, rather than in this tiny practice on a far-away island. We need the best in diagnostic equipment, because if we don't have it, it isn't available down the street.

"I also rely on telemedicine quite a bit. When I have a challenging case, I send the [images]—OCTs, retinal photos, anterior segment photos, visual fields, fluorescein angiograms, you name it—via the Internet to friends around the country. The digital imaging technology makes this possible. And my friends are a great help."

More than an ophthalmologist

But this cutting-edge practice is only part of the story, part of what sets Dr. Khorram apart. The rest of the story centers on the fact that Dr. Khorram has come to realize that who he is as a person is much richer as a result of his interests beyond his profession.

In addition to being an ophthalmologist, Dr. Khorram is a husband, a father of four, writer, blogger, stand-up comedian, coach, and more.

"Because the population of the island is relatively small, I'm not very busy. It leaves me a lot of time to pursue other things," he said.

In his blog Marianas Eye, he writes widely about daily life on Saipan, his practice, his travels, family life, politics, religion, history, geography, even the "wacko of the week." He shares beautiful photos of friends and scenery and—also a popular feature—the "gory eye" pictures.

He writes a weekly column for the local newspaper, and his first published book, "World Peace, a Blind Wife, and Gecko Tails: Intriguing thoughts from an island on making life happier and healthier, and laughing along the way," is now available from Amazon and other retailers.

He is also working on a few other books. "One of them is a collection of stories by a few friends about day-to-day life on Saipan, and I think that will be the first one that's completed," he said.

"I'm a writer, so blogging is a way to capture random thoughts and experiences and let others read about them," Dr. Khorram explained. "With blogging, readers can give feedback. Sometimes the pieces that appear on my blog develop into parts of other writing projects. So, in some way, the blog is like a laboratory for my writing.

"My audience is made up of people on Saipan who just want to check in and see what's going on with me and what's on my mind. I also seem to have a following that's scattered around the globe, but mostly in the United States. There aren't too many physicians who are blogging, and certainly not many in the South Pacific, so it all makes for an entertaining story, I suppose. Quite a few people come to my blog via search engines, looking for some specific piece of information that happens to be on my blog."

Dr. Khorram said he is trying his hand at stand-up comedy, too, organizing and participating in a comedy workshop. "I'm enjoying it. It's an opportunity to focus on the funny things in life and to make people laugh. You can't ask for much more than that."

Another way to teach

Another interest of his is education. He and his wife, Mara, founded Brilliant Star School on Saipan in 2000.

"When our first daughter turned 1 year old, she seemed a bit bored at home," Dr. Khorram recounted. "We looked around the island for an enrichment program of some sort, but none existed. So, Mara and I started doing some research and came across the work of Maria Montessori. We had a friend who was a teacher at a public school and was ready for a career change, so we banded together to open Brilliant Star School as a not-for-profit toddler enrichment program.

"The program started with 12 kids. The families liked the curriculum and the philosophy behind it, and so each year, we added more grades. Our goal became to give kids on the island the opportunity for a world-class education. Eventually, the government granted us a public land lease and six buildings, which we renovated."

Now, the school is on a beautiful hillside campus with 7,500 square feet of classrooms. About 100 children represent some 15 ethnicities, from toddler age through sixth grade. Dr. Khorram and Mara continue to serve on the board of trustees but are no longer involved with the day-to-day management of the school.

"Our biggest challenge is that education, particularly high-quality education, is very expensive for the sort of incomes we have on the island," said Dr. Khorram. "We need to recruit dynamic teachers from the States and offer them competitive salaries, which is a challenge.

"Right now, I'm in the process of trying to find 100 benefactors from around the world who are willing to donate $1,000 per year, for 10 years or so, to help continue providing outstanding education to the people of this island, who otherwise might not have the opportunity. A thousand dollars a year is the sort of contribution that isn't much for a U.S. ophthalmologist, but in terms of the education it provides, it can change generations to come."

Homesick?

Dr. Khorram said he considers Saipan home now but does miss things from living in the United States.

"This may sound mundane, but I really miss the variety of fresh fruits and vegetables that are abundant in the United States. I miss things like fresh berries, varieties of lettuce, mushrooms, asparagus, things like that. When I walk into the produce section in a grocery store in the States, and see the abundance, I get choked up. We just don't have that here."

He added, "It's also hard being so far from my sister and her family. If we're lucky, we see each other once a year."

And, occasionally, he misses things such as live blues, trendy restaurants, the super store, comedy clubs, and fall weather.

But, he's happy that he doesn't own a suit.

"Seriously," said Dr. Khorram. "Most of what makes me different is that I took 'the road less traveled.' The differences are focused around having left the United States to practice international medicine—living out here in the South Pacific, exploring, and pursuing a variety of interests."

Books are Here!

After spending three months floating in the Pacific Ocean, 200 copies of my book arrived on Saipan yesterday. They are available for purchase on Saipan here.

If your name is on this list, send me a quick email to check if your copy is ready for pick up.

Anyone know anything about Paris?

Summer plans are underway and, it turns out it's cheaper for our family to get "around the world" tickets to the States than to go straight east. We're going Saipan-Tokyo-Paris as our first stop, where we'll spend five day. Anyone out there been to Paris? Can you recommend which part of Paris a romantic couple with four children ages 3, 5, 7 and 9 should stay? I've spent the last hour looking at vacation apartments in Paris, which seem to be the way to go for us. But in which part of the city?

SurgeXperiences 19 - Surgery Carnival

I'd like to thank Jeffrey Leow, the Monash Medical Student down in Australia, who found my blog and invited me to host the 19 edition of SurgeXperiences, the worldwide Surgery Carnival. As anyone reading my blog can see, the practice of medicine is just one of the activities I pursue, and so I have never really wandered the blogosphere looking for medical blogs. But now, through hosting this Carnival, I've found that there are some really fascinating ones out there. It's also inspired me to write a bit more about my own medical and surgical experiences.

I designated the theme of this Carnival,"Funny Operating Room Moments," and there are quite a few of them here, but many are just entertaining posts about various facets of surgery and medicine, and, well, the human condition. I'm posting them in the order they were received. Here we go.

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One of the most fascinating surgery blogs I came across is from Israel, and belongs to The Sandman, an anesthesiologist in Tel Aviv. (The Sandman -- get it? Puts people to sleep.) I found two of his recent posts quite compelling. The first is a story of having an elderly couple in his office. Because he took the time to get to know them better, they shared with him their story of arriving in Israel after the holocaust on the ship that was at the center of the story of the historical novel, Exodus. His second post that I enjoyed shares his thoughts on the calm face that seems to often be present on people who die violent deaths. It's a graphic post, but gives a peek into the task of pronouncing a person dead. ("I now pronounce you dead.")

You can also browse through his blog and get a different perspective on the violence in that country -- as seen from the inside of an operating room. The Sandman did send a post for this Carnival, "It ain't over til' the fat lady sings" which points out the importance of making sure your patient is asleep when you think they're asleep.

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Jeffrey Leow forwarded a few links to save me time finding them, including A Lesson (Not Just a Joke) From an Orthopedic Surgeon posted at The Differential: Medscape Med Students Blogs. It’s a story by medical student Ben Bryer that describes the unexpected use of a hand drill (instead of a power drill) to fix a patient’s leg. It’s just like here in Saipan, where improvising is a way of life. In fact, there is a sign hanging on our OR wall (by the former chief of orthopedic surgery) that reads, “If you have to have everything you need to do the case, you probably shouldn’t be here.”

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All of us have experiences of non-nonchalantly almost killing someone. I almost did it when I was an intern and admitted a patient who was experiencing weakness. I tucked him in for the night, thinking we'd deal with the problem in the morning. The resident stopped by to see him an hour later and diagnoses Guillane-Barre syndrome, a rare disorder that causes paralysis and therefore stops breathing. If the resident hadn't stopped by, the patient would have been dead by midnight. It was a learning experience I never forgot. In How We Learn posted at The Differential: Medscape Med Students Blogs, Anna Burkhead describes witnessing a surgical resident's similar learning experience.

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Jeffrey also brought my attention to the post, Surgery and the Blowfish, again by Ben Bryner, who gives proof that we surgeons are way smarter than blowfish chefs. Find out why.

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Pimping. Do other professions use the word the way we do? In medicine, it refers to the endless series of questions that will come the way of a "junior" medical type, by a "senior" medical type. Most commonly, it is a hapless medical student getting pimped into oblivion by the attending physician (the "professor"). It's usually conducted on rounds or in the operating room, and it's rare that there isn't a gaggle of spectators present -- the whole medical team -- silent witnesses with downcast eyes, folder arms and beaded sweat. Pimping ends when either the pimper runs out of questions, or the pimped doesn't know the answer. And the pimper never runs out of questions. So, the session will conclude when you're wrong, which is why pimping never feels like it has a happy ending. If you have a sense of humor, you can get away with a lot, especially if you know the answer. Once during rounds when I was being pimped, the attending, while studying an EKG asked me "What is one of the clearest indications of an elevated blood potassium level?" I answered, "The word 'HIGH' next the the letter 'K' [the symbol for potassium] on the lab sheet." Jeffrey Leow directs us to How to Survive Pimping in the OR posted by Anna Burkhead, where she gives some useful tips.

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Sid Schwab, who like myself is the author of a book, has written about a tube at an unexpected orifice. For some reason, whatever the conversation may be, orifices seem to be fertile ground for a giggle. Sid's post is Snakes on a Pan, over at SurgeonsBlog.

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When people move to Saipan (the island on which I live) and work for the government, they typically rant incessantly about the problems with the system, as if problems and inefficiencies are unique to this island. I usually respond, "Dude, you haven't ever worked at a VA, have you?" Dr. Rob Oliver paints some accurate (and funny) pictures of life at a VA at his post VA Voodoo Economics - Krugman wrong on John McCain posted at Plastic Surgery 101.

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Dr. Oliver also presents Dumb laws and smart laws re. plastic surgery. It regards legislation in California that will require medical clearance for all plastic surgery patients. Believe it or not, I get medical clearance for all my cataract patients, mostly because here on the island, you can rarely get a straight story about someone's medical problems. I send them all to see their internist, and we find some interesting things (like blood sugars in the 400's, just walkin' around). It's best in my opinion to leave medical decisions up to doctors, not legislators. We get medical clearance when we think it's necessary. And we're generally a careful group of folks, particularly in America where a lawyer with a briefcase is only a stopped heart (or an inconvenient rash) away. Thank-you, Dr. Oliver.

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All stereotypes are based on some element of reality. In medicine, we all know the stereotype of the orthopedic surgeon ("As strong as an ox, and twice as smart.") Dr. Val Jones shares some excerpts from a talk by an orthopedic surgeon, which I honestly found refreshing. I like these guys. They're the surfer dudes of medicine. Check out her post at Revolution Health.

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"I was filming a nipple reconstruction..." Thus begins a "Tale of Two... " um, no, I'm not going to say it... thus begins a tale by Norwegian surgical videographer, The Sterile Eye, who presents Yo mammae! That sentence is sure to become a classic in medical blogging literature. I give Sterile Eye the "Call me Ishmael" Award (which I just created) for week's best opening sentence of a Carnival post.

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Dr. R Bates, a plastic surgeon and quilter in Arkansas (who, by the way, is married to a wonderful man) is author of Suture for a Living. She explains the surgeon's "druthers" card, in her post appropriately named, Druthers. Her post, She's a Beautiful Girl! , which comes complete with it's own music video (is that Dr. Bates on the drums?) tells the touching story of a young girl who gains new self-image as a result of Dr. Bates skill. It's a reminder to all of us to pause and recognize how some of the little, "insignificant" things we do can so greatly affect the lives of others. Thank-you, Dr. Bates.

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South Africa's Bongi has some great posts at his site, Other Things Amanzi. If you're one of my regular readers who gets cheerfully grossed out by my "gory eye pictures," you're gonna love Bongi's writing. Here is a "taste" from his post, Fettuchini:

the patient came in after being involved in a car accident. he had an acute abdomen, but was otherwise stable. x-rays confirmed free air in the abdomen. easy call. the patient went to theater. we opened the abdomen. it was full of intestinal content. not too surprising. and then...lying in this soup, free in the abdomen we found a meter long tape worm! i'm not embarrassed to say i gagged. i threw it in a kidney dish where it entertained us with its peristaltic movements.

Bongi's hilarious post on operating in various states of undress deserves reading: Fashion Statements.

And what's worse than poop? Well, according to Bongi, it's poop that has gone rancid. Yep, rancid poop happens, and if you want to read about how it happens, and how to remain a macho surgeon in the midst of its indescribable fragrance, read this entertaining post, Tough Surgeon.

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Surgery has lots of "laws" -- dicta (that's apparently the plural of dictum) that give pithy bits of knowledge and wisdom. Many of them are specific to a particular institution. At the University of Kentucky where I went to medical school, there were "Five Laws of Surgery." I remember two of them: A bump in a breast belongs in a bottle; and Surgery, like sex, should be slow and gentle, and requires good exposure. (You're welcome to share your own opinion on whether or not good exposure is really required.) Bongi writes about this law of surgery: Eat when you can, sleep when you can, and don't f@*% with the pancreas. If you ever need advice on getting some sleep when little time is available, you can read this chilling post: Other Things Amanzi: Wakeup Call. Thanks, Bongi, I enjoyed your posts and I'm bestowing upon you a coveted Marianas Eye Funniest Medical Blogger of the Week Award.

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Doc Ness, an anesthesiologist not far from me, writes about the experience of being in the operating room, not as a doctor, but as a patient. Most of us will have to face the other side of the table sooner or later. You can read about Doc Ness' experience at random ness.

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And that's all folks. Thanks for stopping by. And buy my book, World Peace, a Blind Wife, and Gecko Tails. It's available on Amazon. (Yes, I know it's shameless self-promotions, but hey, I have four kids to put through college and Oprah hasn't called yet.) I hope you enjoy reading this Carnival as much as I enjoyed putting it together. I look forward to your comments and to regularly visiting your blogs.

The next edition of SurgeXperiences will be hosted by Dr. Sidney Schwab and will presented on April 27.

Change Your Life

Well, I wasn't really planning on doing this. I posted the review about this book, and a couple of people have gone ahead and ordered it and said, "let's get together to discuss it every couple of weeks like the author recommends." So, that's what we're going to do. Take a look at the links and let me know if you want to join us. I've read about 30 pages of it, and have done a couple of the exercises, I must say (and I'm not one to say stuff like this lightly), it's made a huge difference in my approach to life. Some total shifts in my life. Go figure.

Let me know if you want to join us. Once we find out how many people are in, we'll go from there. I'm just accepting that since people want to do it, it was meant to be. Consider that since you're reading this, you're meant to be a part of it.

Exercising for Results

For about the past nine months, I've been running intermittently, thinking I was getting into better shape. Then I had a chat with Saipan's leading triathlete, Eli Torgeson, and as it turns out, I've been sort of wasting my time -- at least in terms of building my cardiac capacity. See, aerobic activity is all about making your heart stronger. I've been stressing my heart, but not building it's capacity.

Here is the deal. You can find your maximum heart rate by taking 225 and subtracting your age. For me, that's 180. For the past week or two, when I've been on my usual run, I've been stopping to check my pusle, and it's always right there around 170. Not good.

What you need to do is build the heart's capacity to handle the load, and you can't to this by having it carry the full load all the time. Eli tells me I need to start by getting my heartrate up to 140 for about 40 minutes. If it goes higher, I need slow down, or even just walk. I need to play with my pace until I can find this spot. Gradually, as my cardiac capacity builds, I'll be able to run faster and still keep my rate at 140. And then I can work in periodic bursts of faster running, to get the rate up, and then have it come back down -- "interval training"

It's been cumbersome to stop every five minutes and check my pulse rate, so I just ordered a heartrate monitor. There are all kinds out there, including ones which include GPS and can measure your distance also. If I keep with this, one of those might be cool to have eventually. But for now, I'm just going with the $45 model that just measures heartrate. It's the Timex T5G971, favorite of mall-walkers.

I'm looking forward to getting into better shape. Will I really be ready for a triathlon? Who knows. First things first.

Me and the Kids

Today was a great day. Mara is away in Hawaii for the weekend attending a meeting of a regional Board of Trustees of which she is a member, and I decided to have our housekeeper NOT come, just so I could spend time with my kids. There is a certain peace in being the only adult in their lives for a day, in part because there is no other authority to whom they can appeal my decisions. It's also just nice to see each other.

After breakfast and chores, I took them down to Micro Beach. What a magnificent morning. The lagoon was turquoise, the sun was behind us, still rising, as we sat under the shade of palm trees and ironwoods and dug in the sand, waded on the sandbar. It was one of those days when the sky is bright blue and the clouds are gleaming white, drifting by like silent herds of animals. And off in the distant, Managaha Island. I was full of joy just watching them and spending the day with them.

Irritated eye

When provoked, an eye will on rare occasion stick its tongue out at the examiner.

Funny Operating Room Moments

So, it appears there is a "surgery carnival," and I've been asked to pick a theme and host the 19th edition. When I was first asked to host the carnival, I imagined an event where clowns would juggle solid organs, and admissions to some of the tents would include the chance to watch an amputation or two. But no, it's where surgeons and medical types around the world will write on the theme, the host will place a synopsis of all the stories on a blog, with links to the original stories. It sounds like fun.

So, medical people around the world, send me your funny stories. They don't have to be from the operating room per se (or more aptly the "operating theatre" as our British influenced colleagues would say). Write about any funny experience that occurred in the vicinity of a knife. You can see previous editions of the Surgery Carnival by clicking here.

A Life Changing Book

I don't know how I stumbled upon this book. I bought it a few weeks ago, and only picked it up to read today. I think it's going to be pretty good, despite it's lame "marketing oriented" title.

The author, Srikumar S. Rao, teaches a radical course at Columbia University Business School, upon which this book is based. Here is what has to be one of the most compelling reviews I've ever read on Amazon.

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It will be fairly difficult for me to give an unbiased review of Are You Ready to Succeed, as the course on which it's based set me upon a path of growth and self-discovery and allowed me for first time to know true fulfillment. For this, I feel immense gratitude, incapable of expression with words. I'll divide this review into two parts: 1. The effect the wisdom and exercises within the book had on my life and 2. My feelings about the book itself.

Prior to taking Creativity and Personal Mastery, the course upon which the book is based, I was an obnoxious, mechanistic, sociopathic prince of capitalism. I viewed wealth as a means to exert dominance over others, as well as a vehicle to procure hedonistic bliss. I found a happy home for this way of thinking in the world of investment banking, venture capital and startups. I drank, drugged, womanized, broke the law; I created a world in which those without a similar plunderer-type mentality were weak and destined to be dominated. At the beginning of the course, I had been fired twice, totally four cars, been arrested in five states and inflicted emotional harm on countless females. I didn't read; I thought introspection was for meek, those incapable of enjoying the finer things in life. In short, I was miserable - a gerbil on wheel of chemical and emotional highs, a slave to the influence of my fellow "pirate" peers. You could say I was ready for a change.

The course had several effects upon me. There are too many to list, so I will detail only four.

The first is the notion that the universe is benevolent, a partner in creating not only fulfilling personal endeavors, but a brighter future. The second is that I have an opportunity to be truly happy, i.e. fulfilled, not through striving and external action, but through removing that which is unreal and not me, thereby allowing my true nature to shine. The third is that HOW is not important, rather only the WHAT and the WHY, meaning I need not obsess over how desirable things such as fulfillment and impact come into my life, only a clear conception of what it is I want to achieve and why I want to achieve it. The last insight I was blessed with was, "If you build it, they will come", meaning that attention to my own personal mastery is the most important thing I can do in terms of creating the life and manifesting the impact I desire.

Since finishing the course, I have gone on to read several of the recommended texts, traveled to India to learn meditation, attended various personal growth related retreats, consulted with non-profits, helped people start companies, become a more effective writer and public speaker, begun creating healthy platonic and authentic romantic relationships, found fulfilling employment with a renewable energy company and am currently helping launch a non-profit. In addition to taking up meditation, I have stopped drinking, eating meat, eating sweets (and in doing so, lost 60 pounds), doing drugs, watching porn and have filled this gap with yoga, reading, writing, love-making, cooking and hiking.

Certainly the wisdom and exercises from the course (and book) did not do all of this, I did, but it was the seed crystal that allowed me to embark on a path of rapid transformation and achieve an infinitely more rewarding life. I owe Prof. Rao, the course, and by extension this book a tremendous debt of gratitude for which I am only beginning to repay.

I really enjoyed the book as well. It was a beautiful encapsulation of the course, touching on the major themes. Given the limited scope of the chosen media (in this case a book, as compared to a semester-long course) it is an excellent effort and if used as stated could produce extraordinary results for those who employ it. I say employ instead of read, because to merely read this book is not sufficient. As Prof. Rao says, the book should viewed more as a workbook, a guide for exercises. Viewing this book as anything else will produce only limited results. I echo the following recommendations: 1. Buy the book, 2. Convince 5 friends to also buy the book, 3. Spend 3 months reading the book, stopping to do each exercise for a week or so, 4. Hold weekly meetings to discuss the exercises with your group, 4. Keep a journal throughout the process.

Obliviously, the wisdom and exercises in this book had a marked affect on my life. I believe that if you are serious about reaching your true potential and enjoying

Fear of Success

I just received this email from a guy who's a doctor and runs a coaching service for other doctors. Very clever fellow. But, I do have to say, I think he has a point.

I was reminded recently that deep inside we are all afraid of success. I don't mean some of us or even many of us. I mean all of us. We have been conditioned in our society to believe that the price of success is very high. We are always told the story of the struggling artist or the starving actor who finally made a big. And in the very next breath we are also told of the thousands and thousands of others who sacrificed just as much and never made it at all.

What do you think of when you think of success? Do you think about how much harder you will have to work? Do you think about sacrifice and loneliness and time away from those you love? If you do, you will probably never be successful. Anytime we associate pain or sacrifice with something, we tend to avoid that thing. Just ask any fat guy what he thinks about dieting and he will probably tell you about the pain and the sacrifice involved. On the other hand, when you talk to a thin person about dieting, he or she will probably say "what diet?" Most thin people associate pleasure with the good eating habits they have developed.

I could go on and on, but I think you get the point. A successful career or business is no good if you have to trade your soul for it. Instead, it should be built on a foundation of effective strategies and habits that become unconsciously simple with time. I am there, are you?

To get started on your own path to success, call me for more information.

Technical Support

My laptop battery died after three months. I'm on hold right now with IBM in Atlanta, Georgia. It took me a solid 10 minutes, going through about 15 automated options to get there. You know, "Hello. You've reached IBM technical support. For existing tickets, press one, for new tickets, press two, for concert tickets, press three, for traffic tickets, press four, for Levono products, press five."

Once I finally got to the Atlanta connection, I sat on hold, listening to soft jazz, punctuated by a message every minute saying "Thank you for holding. All our customer representatives are helping other customers. We will be right with you." That was another solid ten minutes. Finally I hear the line ringing and a thickly accented man saying, "This really is Atlanta, Georgia, even though I sound like I'm in a far away Middle Eastern country. What is your fr digi nmba?" "I'm sorry, Mr. Technical Support Man, I didn't catch the last thing you said." "What is your FOUR DIGIT NUMBER." "For what?" "For da par you clmeantarasy." "I'm sorry Mr. Technical Support Man, I'm having difficulty understanding you." "One moment please."

Wow. That's pretty progressive. He realized I can't understand him, so he's going to look for someone with a milder accent who speaks slower. How great is that!

The line rings. How exciting! The automated voice begins. "Hello, you've reached IBM technical support. For an existing ticket, press one. For a new ticket, press two. For razor blades or a gun, press three." That's what you get for not understanding the technical support guy's accent. He's safe. I can never find him. And he's laughing in his cubicle as he hits the transfer button, sending me into another ten minutes of phone tree button pushing to get back to Atlanta.