Chetan Phadke MD, DM

You started Telmisartan for hypertension. A week later, creatinine doubled. The kidney just gave you a clue about the real diagnosis. 👀

pay solid attention; an average millionaire is 40 not 23 an average billionaire is 55 not 35 the average age to buy a house is 35 not 25 most men hit their peak confidence at 32 not in their 20s it takes the average person 66 days to build a habit not 7 the average ceo is 57 not 30 most people meet their life partner after 27 not 18 the average successful business takes 5-7 years not 6 months most people don’t know what they want until they’re 30 not at graduation stop letting social media brainwash you. you are not behind, you’re on your own track. live it ❤️

Addiction is proof that you are capable of intense devotion. You just have a false god

He was paid millions to play a miserable man — and couldn't tell where the character ended and he began. When the creators of House M.D. were casting in 2004, they wanted someone quintessentially American. British actors, they believed, couldn’t pull off the accent convincingly. They weren’t even looking overseas. Thousands of miles away in Namibia, Hugh Laurie was filming a movie and heard about the role. He couldn’t fly to Los Angeles. He couldn’t walk into a polished audition room. So he went into his hotel bathroom — the only space with enough light — propped up a camera, grabbed an umbrella as a cane, and recorded two scenes. He sent the tape, apologizing for how rough it looked. Executive producer Bryan Singer watched it and was captivated. He had no idea Laurie was British. That tape changed everything. The pilot drew seven million viewers. Respectable. Not earth-shattering. But over the following seasons, House became a global phenomenon. Laurie became the most-watched leading man on television, according to Guinness World Records. What nobody saw was the weight he carried. For eight seasons, Laurie worked sixteen-hour days. He was in nearly every scene. Los Angeles on set, London with his wife and three children — six thousand miles apart for nine months each year. The isolation crept in slowly. Laurie had battled depression since his youth, seeking help in 1996. The relentless schedule made it worse. He described “very, very black days” on set, a feeling of being exposed and trapped. The irony was impossible to ignore. Here was a man grappling with darkness, praised for playing a character defined by misery. The line between Hugh and House blurred with every episode. He kept his American accent between takes. Rode his Triumph Bonneville at dawn, finding brief freedom in speed and air rushing over him. But he never walked away. Eight seasons, 177 episodes. He stayed because it was the role of a lifetime. When House ended in 2012, Laurie stepped back. Music called. He released blues albums, toured with a band, and returned to acting on his terms — smaller, stranger roles, a Golden Globe-winning turn in The Night Manager. He didn’t disappear. He just stopped running on someone else’s clock. Playing House was like carrying a heavy, beautiful stone. You can’t set it down. But you can’t ignore its weight. Sometimes the greatest performances come from people who have lived the pain they portray. Laurie didn’t act misery. He understood it.

Even if we assume life is fairly common in the universe, that doesn't mean intelligence is. Life on Earth was strictly microbial for the first three billion years that it existed, then it took another 600 million years for something smart enough to make fire to emerge. And keep in mind that intelligence simply isn't necessary to survive in most ecological niches. Actually, a large brain can be a hindrance due to high calorie demands, which is why most animals are only smart enough to survive long enough to reproduce. Evolution doesn't care about the survival of the individual, which is why so many species persist by reproducing really fast. It doesn't matter if 90% of your babies die before adulthood if two members of your species can produce hundreds of offspring, and you don't need to be smart to do this. Intelligence just doesn't provide much benefit to a species until it crosses a certain threshold, and until it does, the large brain it requires is a liability for an investment that may not pay off. And even if intelligence is fairly common, that doesn't mean technology is. What a species can accomplish is limited by their biology and biome. A purely aquatic species with no ability to manipulate tools will never discover fire, and so will never master metallurgy or any other technology fire is a prerequisite to. Being land-dwelling (or at least being able to survive outside of water for long stretches of time) is a minimum requirement to becoming technological. And even if an intelligent species discovers fire, that doesn't mean they will advance beyond stone age technology. That species has to be social and cooperative. If you're forced to spend every waking moment looking for food and avoiding predators, then it doesn't matter how smart you are, you will never develop space travel on your own. And even if that species is cooperative, that doesn't mean they will advance. Humans had to decide to give up a nomadic hunter-gather lifestyle and form permanent settlements and start farming despite the obvious disadvantages, such as crowding and proximity to animals enabling the spread of disease, putting themselves at the mercy of the weather, making themselves an obvious target for raiders, and so on, before the first cities could develop. This is what led to organized warfare and the precipitating technological arms races that eventually gave rise to the bronze and iron ages. An intelligent and cooperative species that never settles down won't accomplish this. Then even if an intelligent, cooperative species manages to develop technology, they have to survive long enough to figure out space travel. Now, consider how long it took life on Earth to go from microbial to something capable of building rockets, and realize how long of a lucky stretch we needed to last for billions of years without some natural disaster resetting the clock on evolution. All it would have taken was one gamma ray burst, one nearby supernova, or one really big asteroid impact (I'm talking much bigger than the one that killed the dinosaurs) to set everything back to square one. And then, after all that, even if an intelligent, cooperative, technological species manages to get into space, there's no guarantee they will explore outside of their own solar system. It takes an extremely long time to travel between stars, so any interstellar journey would take decades or centuries, and would cost a huge amount of resources and concerted effort, and would come at a huge risk to the explorers who most likely wouldn't be able to make it back home. Unless their species happens to live a really long time, they would need multiple generations to be born, grow up, and die on a voyage of questionable profitability. By the time a species is able to attempt an interstellar journey, they might lose any interest in doing so because they will have mastered using materials from local asteroids to construct artificial habitats in orbit around their parent star. Why go through the effort and risk of colonizing other solar systems when you can just build a Dyson swarm around your own sun and support quadrillions of people indefinitely? They might even figure out how to digitize their minds and live in a virtual paradise, and forsake reality altogether. Lastly, consider the fact that the universe is only about fourteen billion years old. That sounds like a long time to us, but the Earth has been around for about a third of that time, and it took nearly all that time for us to evolve. Also consider that the star-forming era of the universe is expected to last another hundred trillion years. We probably live at the earliest time that it's even possible for a technological civilization to exist. The reason we don't see aliens might simply be because we're too early. There may come a time in the distant future when every star and every galaxy has been claimed by some galactic or intergalactic empire, and we will be the ancient forerunners to them, but that won't happen anytime soon.

Thank goodness the humerus remained in place 🫣

Went down the rabbit hole on this. You traveled about 17 million kilometers in your sleep last night, roughly 45 trips to the Moon in a single nap. The 600 km/s in this post is a real number. Satellites measured it by comparing our motion against the faint glow left over from the birth of the universe. But the speed alone is only half the picture. Where we're headed is the part that got me. Your body is riding four things at four different speeds, all at once. Earth spins at 1,670 km/h. Earth whips around the Sun at 107,000 km/h. The Sun circles the center of our galaxy at 828,000 km/h. And the Milky Way is tearing through space at 2.1 million km/h. You don't feel any of it. All the galaxies near us, about 100,000 of them, are being dragged toward one spot. Astronomers call it the Great Attractor. It sits about 250 million light-years away and has the combined gravitational pull of thousands of galaxies. We can't see it, because our own galaxy's dust and stars block the view completely. That whole section of sky is so obscured that astronomers named it "the Zone of Avoidance." We only know something is there because every galaxy near us curves toward the same blind spot. Infrared and X-ray telescopes eventually confirmed a massive pile-up of galaxies hiding behind the curtain. I kept digging. The Great Attractor is itself being yanked toward something even larger called the Shapley Supercluster, about 650 million light-years out. The thing pulling us is also being pulled. In 2014, an astronomer at the University of Hawaii named Brent Tully mapped all these galaxy flows and realized we're part of one enormous structure. He named it Laniakea (Hawaiian for "immense heaven"). 500 million light-years wide, about 100,000 galaxies, all draining toward the same gravitational low point like water running downhill. But Laniakea won't hold together. The expansion of the universe is speeding up, slowly ripping the whole structure apart. Our cosmic address has an expiration date. While all this plays out, the Milky Way is also drifting toward the Andromeda galaxy at about 400,000 km/h. Those two will merge in roughly 4 billion years. But that crash is happening at a fifth of the speed we're falling toward the Great Attractor. Even the collision is a subplot. You went to bed, stayed completely still for 8 hours, and woke up 17 million km from where you fell asleep. Tonight you'll do it again.

me omw to work at 8:30am hoping to get there by 8am: