Friday, 14 August 2015

Audience Killer Loop: Dir En Grey

Dir En Grey
Oh man. Where do I even start with these guys? Lets start with the obvious. They are unclassifiable. At best I could say that they are Avant Garde Metal. Essentially they use a loose template of metal and build everything else from there. Metal is the canvas but it is not the palette. These guys have been around since 1997 and have kept the same line up ever since. They originally started out as a Visual Kei band, but have since morphed into this Slipknot/Korn/Rammstein band that we can hear today. With downtuned guitars, slapping bass, hip hop rhythm and industrial sensibilities. They were originally born from the ashes of a rock band called La:Sadie's, but for whatever reason they disbanded. Or rather the then bassist left, but the rest decided to hire a new bassist and forge ahead under a new name, thank goodness. As I mentioned before, they've managed to keep the same line up ever since which is no mean feat, and you can really hear that in the latest album Arche. Which is quite possibly their best album yet. If only because it also comes across as the most focussed of their albums. Which also completely defies Angry Metal Guy's Law of Diminishing Records.

 I first became aware of them due to their phenomenal album Uroboros. An album that for me was the album of the year of 2008 just about dislodging Opeth's Watershed. I had never heard anything quite like them up to that point. Uroboros has got what I consider to the be best album intro. Every they release something I let out a little noise of celebration. They are possibly the biggest musical phenomenon to be exported from Japan and by all accounts they are the biggest metal band in Japan since X-Japan. Which shouldn't be too surprising since X-Japan overlord Yoshiki helped to launch their career and 'hide' was a major influence on Kaoru guitar playing. The other remarkable thing about them is that they managed to do all of that without having to sing in English. The only other metal band that has managed international success using their mother tongue is of course Rammstein.

Visual Kei era
So they went through a stage of Visual Kei playing slightly more alternative rock, more akin to Jane's Addiction. But seemingly completely shed that image by the time they released Withering To Death.  It feels a bit like they went through the same epiphany as Sepultura did when Korn released their brilliant debut album (Yes, it is brilliant). Withering to Death, is cut from the same mould as Korn's debut album, it's full of jagged edges, slight hip-hop bass lines, off kilter rhythms and maniac vocal stylings. The main difference being is that Kyo actually knows how to sing in tune, as well as flex his vocal chords into the suffering of every victim in the nine hells as described by Dante. All those usual pop influences have been swapped for something rawer, more energetic, avant garde and more personal. They are one of those bands that have managed to transcend any kind of genrefication. At best they would fall in Extreme Metal genre. They go from nu-metal to metalcore to progressive metal with the occasional dipping into pop. Amongst all the madness and surreal violence you get from them you also get nice little piano ditties like 'Shinsou'. Or they take a jazz foundation and turn it into some brutal like 'Asunaki Koufuku, Koenaki Asu'. Funking it out in 'Stuck Man'.

Kyo with blood on
face and chest
Now some of the puzzling things about this band is that some of the song titles are in English. But none of the lyrics are so that can get a bit confusing. Not that it actually detracts from the music. Kyo does apparently write extremely good lyrics. It's just that I can't be bothered to read the translations of them because they way I think of his vocals is that it's just another musical instrument. Talking about instruments. I can understand why Kyo gets as much attention as he does, I mean he completely and utterly outdoes Mike Patton in terms of vocal ability, but the rest of the band... Just wow, they are all individually amazing. On the bass front Toshiya seems to have taken some lessons from Jason Newsted, in the sense that the bass isn't just there to fill out some kind of void. But to be an active part of the songs without being the centrepiece. Though songs like 'Phenomenon'  and 'Bottom Of The Death Valley' do put the bass front and centre to great effect. Both the bass player and the drummer, Shinya, provide excellent foundation that let Kyo, Die and Kaoru let their respective talents loose onto the listeners ear canal. The guitar riffing is great, but what is really special is the guitar noodling that comes in to surround the main riffs. Always subtle and never in the way, all seem to enhance the listeners experience. The sense of melody that they imbue is just out of this world. Often it feels like the songs are just about to descend into a gigantic mess, but it never happens. 

By all accounts their live shows are something to behold. Prior to Uroboros Kyo used to, frequently and apparently, self harm whilst on stage. Due to his singing he's been hospitalized several times, couple of times because of oedema of the lyranx and vocal nodule dysphonia. Oh and partially deaf in his left ear. The man does suffer a lot for his art and from all the videos I have seen he squeezes every single emotion into his performance. As demonstrated in this video taken from their Tabula Rasa tour.

I am a little surprised why they haven't got as much of a recognition in Europe(Or maybe just in the UK) because these guys are one of the best bands out there right now. Pumping out quality album after quality album. And their evolution from Visual Kei band to what they are now has been fascinating.

Thursday, 6 August 2015

Metal Nurse Spaketh: Critical Thinking

Critical thinking. It’s an important aspect of life and living. If there is one lesson I learnt in uni was that critical thinking was probably the most essential part of becoming a nurse (Yes, people will say care and compassion are more important, but care and compassion can be done wrong if done without critical thinking). It is also the reason why it’s a three year course. That might seem like overkill, but just look at how long doctors have to train and thank your lucky stars.

My personal tutor always made a point of it when we talked about evidence and the use of it in good care.  It is one of the many reasons how student nurses become nurses. One of the biggest parts of their studies is how to critically evaluate the evidence, the research and how to critically appraise it. It is to learn how to distinguish between a bad study (that can hinder your care for someone, for example The Wakefield study) and a good study, as in a study that can, will and does positively impact on your patient group.

In our profession we have to deal with a plethora of different medical professionals, some of course more difficult than others. Because of this we have to learn how to think critically and also make sure that our evidence based practice is up to snuff. This does not mean that we know better, we don’t (always), it means that we should know when to ask the right questions, and also when to accept the answers. But with that, we should always make sure that we follow up on those questions and if we feel that we do know better we should be able to say so and back it up. This is why nursing education is so broad and this is why as a profession we are encouraged to adopt life-long learning, it does nobody any good if you just decide that you want to stay in your present role until you retire. That is not a good enough reason to stop learning. Even if you stay as a Band 5 throughout your career you still have to learn how to move with the times.

As nurses we shouldn't just do stuff, we shouldn't just carry out tasks without thinking WHY we are carrying out those tasks. Which is why there is always a big push for evidence based practice. It doesn't just apply to doctors, it also applies to nurses. We are not there to be at the beck and call for doctors, we are there also to work as safety nets for our patients. We are there to make sure that our patients get the best care and that does not only apply to regarding personal care. It also applies to the medical treatment they get. Since doctors cannot be there all the time, we have to be their surveillance system. Seeing as the doctors care of patient  is so dependent on the reports they get from the nurses. But along with that we also should be able to work with enough autonomy and knowledge, in case something needs to be done there and then.

And this is why it boils my piss when I come across nurses who should know better. There are way too many nurses (minority, yes, but still too many) who seem to follow trends and not the evidence. When I hear nurses spout of stupid stuff like “MMR vaccine causes Autism” or “80% of the immune system is in the gut”, “I’ve never had the flu, so why should I bother with the vaccine”. Or use words like “toxins”, “detoxify” or “chemicals” without proper context. Or dabble in homeopathy. Or claim that organic is better. Or read the Daily Mail for health advice. (Don’t get me started on the diet talk)

We should know better and the fact that I know nurses who do and have said stuff like that makes me a little sad.  We have come a long way from being essentially doctors handmaidens. We are not just the task-oriented workers of yore (Though, you’d be hard pressed to believe that when you meet some of us). But sometimes it feels like we are still battling through those days.

Just in case people get the wrong idea, I am not saying that us nurses (Just me) should be all knowing and perfect in everything they do. It would be nice, but it is never going to happen. What I am asking is that nurses take their time in following the evidence up. If they read an article that says somewhere “A recent study...” then please before quoting the article, see if the study is actually referenced and if it is, to actually read the study in order to confirm that the article represented that study well or completely misled the reader. If they have that niggling doubt to make sure that they follow up on that. Be skeptical, but do not deny. Accept the answers when the evidence is overwhelming.

Good evidence trumps anecdote and intuition. A nurse who works with good evidence in conjunction with finely honed intuition that has been developed over the years is even better. But in the meantime, while the nurse is getting that experience it helps to learn critical thinking.

The most important lesson every student nurse can learn is that there is always more to learn and that your knowledge base can always be broadened, widened and stretched.   Or in the words of Neil DeGrasse Tyson: