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2020-02-03 05:05:51

    Four Elements Meditation

    The Earth is beneath me.  Roots grow down from my body, thin and thready at first, and reach downward.  They snake through my floor, through the foundation of my house, find the Earth, and grow into it. As they grow deeper the roots grow thicker, gnarled, like those of an ancient tree.  My roots touch the Earth and through them I feel its solidity, its persistence.  I feel a thing of unimaginable vastness, that existed a billion years before me and will exist a billion years after me.  In the Earth I touch permanence.

    There is Water beside me, flowing in wild rivers and lakes.  Veins extend from my body, the vessels of my fingers and toes growing beyond the skin and forking outwards.  My veins find the Water and dive into it.  My blood pours into the Water and Water pours into me.  In the Water I feel something that constantly changes form but never loses its self; frozen, steaming, falling, Water remains Water.  You can break an ice cube, but let it melt and freeze again, and you’ll never know it was broken.  In the Water I touch resilience.

    The Air is above me.  Tiny feathers grow out of my skin, reaching upwards, fluttering in the little currents eddying above my body.  In communication with the Air I feel how easily it flows from place to place; the Air that touches me has been everywhere in the world, and will be everywhere again.  The movement of a single molecule of Air defies borders, cannot be traced, cannot be predicted.  In the Air I touch freedom.

    The Fire is within me.  Every cell of my body is a tiny furnace, constantly burning.  There is nothing I need to grow outwards to feel Fire; the Fire is me.  Glucose burns, and I live.  Every movement, every breath, every thought draws its strength from Fire.  A trillion tiny flames dance within me, growing together, and my existence is a single glorious flame in the night.  In the Fire I touch power.

    I’ve gotten out of the habit of posting here, I’m afraid.  It’s a shame, because it’s a really flexible medium for all kinds of things, but “all kinds of things” is a tall order.  A blank page is frightening, and the more colors of ink you have, the more frightening it is.

    At some point I’m going to have my own website set up where I can really post all kinds of things (I actually have made progress on this), but until that comes to fruition, I don’t want to totally lose touch with Tumblr.


    Hello Cliff! I've been reading a lot about pyramid schemes and multi-level marketing, and one thing that sticks out to me is that (anecdotally) a lot of nurses seem to be involved in them. Do you have any experience with and/or insight into this? Are there any structural factors that might make nurses valuable candidates for MLMs (e.g. are they encouraged to pitch to colleagues or patients?)? Do people ever try to pitch to you? I'm interested in anything you have to say on this.

    Yeah, MLMs and lower-key “buy stuff from my overpriced catalog of drop-shipped crap” schemes are endemic in nurse break rooms.  (I’ve never seen anyone pitching to patients, though. I’m sure it happens but most nurses would consider that very unethical.)  Here’s some random theories on why:

    1. MLMs tend to market to women and especially moms, demographics that are over-represented in nursing.

    2. Nurses are middle-income; they make enough that they can spare the “investment” these schemes require, but not so much as to be uninterested in a small-stakes side hustle.

    3. As a broad stereotype, nurses tend to be mushy caring sort of people, thus easily pressured into giving a few bucks to a coworker to support their endeavor even if they know it’s a lousy deal.

    4. Nursing education includes absolutely nothing about business management or related subjects, so nurses are more likely to be naive about how a “business opportunity” is supposed to work.

    5. Nurses tend to work long hours in small groups with a lot of interdependence, and thus form the kind of social bonds with coworkers that make high-pressure sales tactics really high-pressure.

    The good news is that most of the MLMs I’ve seen promoted at work are cookware or candles or jewelry, not things with health claims like essential oils or supplements.  So at least the only harm those do is financial.

    There’s a big meme in a lot of our cultures that says that sex is only hot when it feels like it just happened to us and our partners; when throughout, there’s a sense of wild abandon, a lack of control, an effortlessness, or when someone is being, or feels like they’re being, taken or surrendered in some way.

    Some of that meme is crap, and some of it is even bullshit of the worst possible kind: the kind that enables and excuses rape and other abuse, that presents sex or sexuality as something that is out of everyone’s control and which we all need to be afraid of, a collective vulnerability some big groups have exploited throughout history – and are still exploiting now, and boy howdy, do you know about that if you’re a young person – to socially control or oppress people.

    On the other hand, some of that meme is about some of the good stuff people often want from sex that not only doesn’t hurt anyone, but is beneficial for everyone involved: an escape from the more stressful parts of life, for instance, or from negatives we might often experience or feel about our bodies or minds. An ease. A place or way to feel free or less guarded. A safe way to explore parts of ourselves we wouldn’t bring to dinner with anyone’s parents. A way to be vulnerable with someone else where we and our partners might well be giving or sharing parts of ourselves to each other we often keep just to ourselves. An adult way to play like we played in other ways as kids, where we do things on the fly, forget who we are a little bit, and get totally caught up in the play to the point where we almost forget about everything else, like what time we were supposed to be home for dinner or that we’re not, as it turns out, in an actual castle, but instead are playing inside a cardboard box.

    There’s no need to get all judgy about anyone who wants to enjoy or experience spontaneity, or a feeling of surrender, freedom or abandon in their sexual life. There’s nothing that isn’t okay about enjoying those things or wanting those kinds of experiences.

    The good news is that whatever good feelings we can have or enjoy from that general feeling of sex “just happening,” are things we can still have when we’re all being a lot more intentional, and when we all have real control in and of sexual experiences and interactions. We have the capacity to have sex that feels like a lot of it’s just happening in the good ways – where plenty of it feels spontaneous, and like we can let ourselves go in it, or float in it – while it’s all also what we’ve mutually, consensually and actively chosen, both at the time and in advance. We can feel out of control with something while still actually being in control, and if you don’t believe me, ask a professional skydiver, a musician or a dancer.

    When Sex “Just Happened” (And How to Make It Happen Instead)

    Sorry I've been quiet for a few. December kind of got away from me.

    I've been working way too much and it's been way not worth it. I'm going to make every effort not to repeat this in January while trying in the long run to restructure my career into something that doesn't remind me of things that happen to people who anger Greek gods.

    Let’s Fix Knives Out

    I went to see Knives Out last night, and I want to say first of all, it’s a great movie.  The plotting, performances, cinematography, art direction - all amazing.  I highly recommend seeing it and I do not recommend reading the rest of the post if you haven’t.  It’s a mystery with a lot of twists and it’s more fun unspoilered.

    But I went to see it with another nurse, and she also loved it, but we both had some technical issues with a certain plot point.



    In the key scene of the film, Marta gives Harlan two IV medications, and accidentally switches them.  (Fortunately for her, they had already been maliciously exchanged and she’s switching them back to the correct medications, but this only comes out later.)  The medication vials are shown and the dosages are stated onscreen, so we know exactly what happened.

    Harlan was prescribed 100mg ketorolac and 3mg morphine for pain after a shoulder injury.  The ketorolac comes in a 30mg/mL concentration and the morphine in a 5mg/mL concentration.

    Therefore, Marta should have given him 3.3mL ketorolac and 0.6mL morphine to deliver the correct doses.  But because she switched them, she (supposedly) gave him incorrect dosages: only 18mg ketorolac, but 16.5mg morphine.

    However, she exclaims in horror that she gaveit Harlan 100mg morphine.  This is not possible; it would have required 20mL of solution and there wasn’t that much in the whole vial.  Also, a 20mL syringe is gigantic and we don’t see Marta using one anywhere near that large.  I think what happened is the filmmakers worked out how this med error could occur with the same number of milligrams, but disregarded the different concentrations, even though they’re clearly shown onscreen.

    Some other problems with this scenario:

    - 100mg ketorolac is too high a dose.  A normal dose would be 30mg or at most 60.  100mg ketorolac isn’t likely to kill someone, but it’s not good for your kidneys.  I give ketorolac a lot at my job and I’ve never given someone 100mg in one dose.

    - Neither of these meds has to be given IV.  Ketorolac can be given orally or as an intramuscular injection and morphine can be given orally or sublingually.  There’s no reason to put the patient through the hassle/pain/risks of daily home IV injections.

    - What doctor prescribed morphine for a week after a shoulder sprain so mild that Harlan doesn’t even need a sling?  Even the ketorolac is probably overkill.  Realistically he’d probably get an oral NSAID and maybe a muscle relaxant.

    - IV morphine works fast.  There’s no way Harlan would have ten minutes of full consciousness to work out a harebrained scheme with Marta.  (Well, he didn’t really get overdosed.  But there’s no way Marta would have seen his total lack of symptoms and not thought “maybe I didn’t OD him after all.”)

    But fortunately, with the help of a fellow nurse, Epocrates, Allagash White, and a pink margarita cocktail described as tasting like “the opposite of cough syrup” and “a headache in a bottle,” I have fixed this!  Here’s an alternate scenario I worked out:

    - Instead of a shoulder sprain, Harlan is under hospice care for lung cancer with bone metastases.  (This would also address some other plot issues: why he changed his will only a week earlier, and why he accepts death so readily.)  This better justifies him being on morphine.

    - He is prescribed 30mg oral prednisolone for airway inflammation, and 10mg oral morphine for bone pain.  Both are given as liquids because as a late-stage cancer patient he has difficulty swallowing pills.

    - The prednisolone comes in a concentration of 15mg/5mL, so his dose would be 10mL.

    - The morphine comes in a concentration of 20mg/mL, so his dose would be 0.5mL.

    - In switching them, giving 10mL morphine and 0.5mL prednisolone, Marta accidentally gives Harlan only 1.5mg prednisolone, but a whopping 200mg morphine. (or would have, if that dastardly Ransom hadn’t switched them)

    - Normally, these two medications are dyed different colors.  But Harlan has a food dye allergy so he has gotten a compounding pharmacy to make him clear solutions.  He also doesn’t like the taste of the medications (which are both pretty awful), so he has Marta mix them in juice for him, obscuring any difference in flavor, consistency, or odor.

    - Because he took the morphine orally, it’ll take longer to take effect, making it more plausible that he doesn’t just immediately pass out.

    This scenario isn’t perfectly plausible and still requires a little reaching, but at least the math works out.

    One more Star Wars opinion, this one from adulthood:

    Mark Hamill’s whining and crying in the first two movies is actually good acting.  Vulnerability and flaws make a character more relatable and create more room for development, and good for him for having a flaw that was actually a flaw and not the acting/screenwriting equivalent of telling a job interviewer “my greatest weakness is I work too hard.”

    I love that the male lead of the original blockbuster is kind of still a boy, and not a steel-jawed Action Hero.

    I have decided that my only true Star Wars headcanons are those I developed when I was seven years old and watched the original trilogy via grainy VHS tapes of poorly-cropped TV edits.

    To wit:

    - Darth Vader is not a human in a suit.  He is a beetle-like alien and his “armor” is his natural exoskeleton.  (Except for the cape. The cape is because he is also a vampire.)  This makes it much more startling that he is Luke’s father.  When Luke takes Vader’s helmet off at the end, he looks all gross underneath and dies shortly thereafter because this is basically like taking a turtle out of its shell.

    - The Emperor is not a deformed human named Sheev Palpatine or Darth Sidiuous.  He is another species of alien who naturally looks that way, and his only name is The Emperor.

    - Han is an alien too.  You can tell because he has a vest.

    - Stormtroopers are not clones or even really intensively trained; it’s just a uniform and a job title.  The reason they don’t fight very effectively is because they’re basically suburban cops; until the Battle of Yavin, they spent their time doing space DUI checkpoints and space noise complaints, not dealing with armed rebellion.

    - Yoda is a native of Dagobah and has been living there in his swamp for all 900 of his years.  He developed all his wisdom and Force powers because living in a swamp that long makes you philosophical.  Obi-Wan Kenobi knows him because he came to Dagobah to train with Yoda the same way Luke did.  Dagobah Boot Camp is a routine step in Jedi training.

    - Leia having Force powers means that she’s going to become a Jedi after the series ends.  Like full-on she’s going to get a lightsaber and a robe and do flipkicks.  At some point she’s going to Dagobah to train with one of Yoda’s colleagues.  (There’s loads of Jedi-trainer-Kermits all over that planet and Yoda is just the one Luke happened to get referred to.)

    - After the second Death Star gets blown up, this really does bring lasting peace to the galaxy and all the planets return to being locally governed and all the Rebels make themselves a new home on Endor and spend the rest of their lives relaxing and having fun.  Sometimes stories can just have happy endings.


    Hi Cliff, I'm starting testosterone soon (as soon as my insurance company and the pharmacy get their collective shit together) and I'm excited but nervous. Is there anything you know now that you wish you'd known before you started T?

    First of all: congratulations!

    I did a ton of research beforehand so I’m not sure anything really caught me off guard, but here’s a random grab bag of stuff to expect:

    1. It’s honestly kind of subtle at first.  You don’t get a rush of... really anything, other than your own feelings about it, when you first inject (or apply gel or whatever).  It takes time--days or weeks of time--for your body and brain to really catch on to “oh, so this is what we’re doing now.”

    2. Everyone’s body responds a little bit differently, in much the same way that cis men vary greatly in how they experienced puberty.  If you have the chest hair gene, T will activate it--if you don’t, all the T in the world won’t make a difference.  And so forth for pretty much every kind of change.  Beard growth in particular is very variable.  Some people can grow a full lush beard within the first year.  For others, it takes years on T before they notice.

    3. The first thing you notice is usually genital enlargement.  If you’re looking for a physical sign that it’s working, check your pants.  Actually if you’re like most people on T, you won’t need to checkYou’ll know.  It might take a month or two to not constantly know.

    4. At some point, there will be changes you cannot hide.  If you aren’t out to people in your life, they probably will notice at some point that you look and sound a little bit different.  This is important to know--you cannot 100% secretly go on T.  (I realize most people’s plans are the opposite of that, but if you had any thoughts along the lines of “I don’t want to come out to X so I’ll just let them believe I’m still a cis woman forever,” be aware that your body may not make this possible.)

    5. If you feel tired and shitty and sad one day and can’t figure out why, check if you forgot your last dose.  I’m not sure if it’s the hormone swing itself or a dysphoria rebound, but it’s a thing.


    Er. I hate to pull a "gotcha" on someone as intelligent as you, but... deplatforming/shaming/violence/etc. is also agreeing to go with whoever wins the arm-wrestling match, except that instead of a low correlation with the truth there's now literally zero. Nobody said debating was perfect, but at least you're at a *disadvantage* if you seriously try to defend honest-to-goodness Nazism in a debate. On the other hand... well, Nazis have historically proven themselves BETTER at the Dark Side.

    Nazis are more enthusiastic about the Dark Side, but they’re not better at it.  They did rather decisively lose the ultimate arm-wrestling match in 1945.  And more recently, alt-righters who have been kicked off major platforms have generally been forced to rebrand or lapse into obscurity.

    Sure, they’ll say “This only makes me stronger!”, but fact is, once they get booted off YouTube or denied space at conference halls, they actually lose a ton of followers and funding.  They get stuck on Gab or Voat where their audience is down to like twelve people who are already radicalized anyway.  And because extremists don’t own major platforms, they can’t inflict a mirror-image version of this on progressives; if I get banned from making an account on Gab I give exactly zero shits.

    Conversely, if I agree to debate a Nazi, I’ll be linking that event from my Twitter and Tumblr and Facebook and YouTube.  All my followers have to see how righteously I pwned this person, right? And then the algorithm sees this event is popular, and promotes it more.  And that Nazi gets to put his face and ideas in front of a ton of people who haven’t seen him before.

    I’d argue that this is more impactful than anything we could possibly say in that debate.  The Nazi is at a disadvantage as far as winning the debate on points, but no one’s actually assigning points.  If we measure wins in terms of “number of people made aware of your existence and curious to hear more about what you have to say”--the Nazi absolutely wins the debate.

    And yes, all this is basically uncorrelated with who is right. Deplatforming and shaming (I never said violence, you added that) aren’t truth-seeking mechanisms, they’re methods of political action.  Which is okay.  Voting also isn’t a way to seek the truth, but that doesn’t mean it’s somehow unfairly coercive to vote for your preferred candidate, instead of insisting that campaign season continue until everyone in the country reaches a consensus.

    Hey, let’s talk about debate a little bit.

    I was a high school and college debater.  Lincoln-Douglas, parli, humorous interpretation, extemp.  I was on one of the top teams in the country.  (I was not one of the top debaters personally, I was just okay, but just-okay at a high level.  If you get me.)  I’ve got trophies in being an “um, actually” dude.

    And this is why I don’t believe in the power of debate for settling serious issues.  Because teams alternate positions over the course of a tournament, but teams with better preparation and training tend to win no matter which position they take.  The whole sport wouldn’t work if the morally right side of an issue was always the one with the strongest arguments.

    (In fact, being personally invested in the rightness of your argument is sometimes a detriment, because you can get flustered and emotional while the other guy is projecting nothing but calm confidence.)

    I learned to speak passionately about why the US needs to retain nuclear supremacy for world peace, and also to speak passionately about why the US needs to lead the world in nuclear disarmament.  I can’t say “I can convince you of both,” because your own preconceptions are such a huge factor, but if you agree to be an impartial judge, I can absolutely convince you of both.  The “but in the end the truth wins out” factor is so much smaller than you’d like to think.

     This isn’t to say you shouldn’t ever engage in debate.  If you think you can win, go in and kick some ass.  It’s a valid way to present and defend your beliefs.  But don’t trust debate as a truth-finding process.  Don’t leave human welfare up to “whoever wins the debate.”  Don’t get sucked into believing debate is somehow a morally superior tactic to deplatforming or protest.  There’s so much style and technique involved in debate, it’s little better than saying “we’ll agree the truth is on the side of whoever wins this arm-wrestling match.”

    Impartially moderated debate is a great college sport for people who don’t work out.  But there’s absolutely nothing sacred about it as a political process.

    I got a note from an angry MRA on this post accusing me of using “Nazi debate tactics,” which is just a fascinating accusation, as if the problem with Nazis was that they used unfair debate tactics.  It’s such a perfect encapsulation of the kind of Internet guy who thinks everything could have been solved with equal debate time and an impartial moderator between Team Jews Should Be Murdered and Team Oh Fuck, We’re Jews, They Mean Us, Oh Fuck.


    What do you think of Buttigieg? I’m not much for his politics but I think it’s a pretty cool sign of acceptance that a gay person has a real chance to be president.

    Same basically.  I really appreciate that the vast majority of criticism of him has been substantive, and not about him being gay.  (I haven’t even seen a lot of coded language about “identity politics,” of course I’m not homophobic, but don’t you think it’s too much of a risk in this election”, which is impressive.)  I won’t vote for him* though, because healthcare is a massively important issue to me and his healthcare plan is called “Medicare For All Who Want It,” which is as insulting a title as the policy details are unsatisfying.

    *In the primary.  If he makes it to the general, we have to compare him to Trump, not to what we’d theoretically want out of an ideal candidate.  So that makes that choice obvious.


    I am the manboobz asker and also used to be a regular! it really is depressing how misogyny only seems to be getting worse and worse; and I also feel kind of guilty for taking all those trolls lightly. i actually used to think maybe mocking misogynists was helpful and now it almost seems like they are getting more loud. What do you think is the best way to talk to misogynists?

    The real answer is I don’t know.  I haven’t actually fixed one.  I think personally deradicalizing someone is a huge task that requires a big commitment and close relationship, and I’ve never really gone through it.  Maybe I’ve contributed peripherally to some small percentage of someone’s deradicalization journey?  But here’s some thoughts I have:

    1. Don’t talk to them; deplatform them.  Ban them from your forum/subreddit/blog permanently and without second chances.  Rat them out to their ISPs and social media sites for TOS violations, repeatedly and aggressively and in concert with as many allies as you can muster.  Publicly shame any venue that hosts them, online or offline.

    It probably won’t deradicalize them, but it’ll make it much harder for them to attract new converts.  Deplatforming is something that we’re taught to think of as mean, as anti-free speech, as a low dirty tactic compared to an honorable debate.  Fuck that.  Deplatforming works, and these people are dangerous.  Debate has the effect of legitimizing a position, of making it seem like both sides of the debate have good points. Don’t give them that.  Silence them.

    2. Mocking misogynists is helpful, but more for the audience than the misogynists themselves.  In particular, I think the best kind of mockery is implying a social norm that misogyny is for losers.  Not that it’s morally or factually wrong; more that it’s pathetic and pitiable.  This probably just makes committed misogynists dig in their heels even harder (incels have pretty much embraced being pathetic as their brand), but it makes them less appealing to potential converts.

    The goal here is not really humiliation, but the establishment of the implicit standard that being a misogynist is as unthinkable, as deviant in the sociological sense, as wearing your shoes on your head.  You know how parents often say to their kids not “don’t tease the doggy but “we don’t tease the doggy”?  We treat women as peers.  If you don’t, you’re not a glamorously threatening villain, you’re a weirdo with a shoe hat.

    3. Directly deradicalizing someone is the part of this I have the least knowledge about, but cribbing from what I’ve read about neo-Nazi deradicalization: you have to start with the fact that extremist beliefs don’t appeal to happy people. The guys who get sucked into MRA/incel/MGOTW shit are for the most part people who struggle tremendously with loneliness and low self-esteem. While manosphereians are wrong about the causes of their pain, the pain itself is real, and they mistrust anyone who denies that.  If the alternative to misogyny you offer them is “you can be just as unhappy, but respect women while you do it!”, that’s... not really all that appealing.

    The point of this isn’t that you should go easy on them, but that to really reach someone you have to offer them a pathway to a better life.  Getting people out of neo-Nazi groups involves convincing them that Jews are human; but very often, it also involves helping them find job training, health care, and stable housing.  I don’t think your garden variety internet MRA is in quite as bleak a place as someone who lives on a Nazi cult compound, but I think some of the same principle applies.  They have needs that they’re trying to meet via bigotry.  Getting them to change is less about persuasion, and more about finding out what those needs are and how they can be better fulfilled by developing healthy relationships with the women in their lives.

    If all of this sounds vague and speculative, honestly it is.  If there was an easy solution to this shit, it would have been solved.  But these are my thoughts on the subject.  I’d say “don’t feel guilty for taking the trolls lightly,” but I kind of feel that too.  We didn’t cause them, but I wish we’d either shut them out completely or seriously taken them on as deradicalization projects, instead of letting them have the kind of argument that lets them into the Overton Window.


    Hey you've been getting a lot of anons from people who sound aren't sure if they are trans or are just cis women who hate being women and I just thought it might help to let themknowthat they can come to me in rivate because I have had this internalquestioning and come to the conclusion that I was a cis woman who hates being a woman and am learning to hate it less. (1/2)

    (2/2) Growing up I watched my mum go through a lot of health issues due to pregnancy complications, I was bullied for being bi & mildly gnc as a teenager and in my early 20s I dated an abusive man who belived he had the right to mistreat me because (according to him) women are too stupid to make decisions. All ofthese things made me hate being a woman but are not things that would be fixed by transition. (obvs some of these things ALSO happen to tans men but that's another topic.)

    (3/2, sorry, I guess I'm too ~~womanly~~ to count to three or something) but anyway, there are lots of cis women who hate being women for these and other similar reasons and sometimes we get used to say that trans people aren't real, which is BS. Trns people are real and transition is life-saving and life-improving but it won't fix this type of issue. But it can get better especially when you are removed from sexist relationships and environments and my askbox is open if people want to talk.


    Imagine being told one is not queer enough being one's biggest problem

    It’s more a problem of being rejected from mainstream society, seeking refuge in queer culture, and then being told you’re not queer enough.

    If there was a 1:1 correspondence between people who are seen as queer in queer groups, and people who are seen as queer (or unacceptable in some way related to sex/gender) by society at large, then exclusionism would be less of a problem.  But there’s not.  Gatekeeping can leave people shut out of both worlds.