Lately, I have become a bit obsessed with the idea of ‘practice’. Practice is a repetition or rehearsal of something, an action, activity, work, and so on, in order to become skilled at it. It is both a noun (‘standards and practises’- spelled with an ‘s’ if it’s a noun) and a verb (‘I am practicing violin’- spelled with a ‘c’ if it’s a verb. My mom will laugh at sentence, I hated practicing violin and probably never used this phrase in my life, except when lying to my violin teacher about my upcoming week’s activities). The definition hinges on ‘ACTIVITY’. The DOING of SOMETHING over and OVER in order to become better at it. Sometimes, when you’re really good at your specific activity, you move from the verb to the noun (medical practise or law practise).
I really like this idea that you aren’t ever really done- even if you’re an expert, you still have to practice. In fact, it’s what you do every day. You go to your job to keep getting better at your job. It’s one of the things that I love about yoga- you’re never perfect at it, you’ve just got to keep working on it. Even the people that do it every day still strive to attend to their practice and make it stronger.
In his book, Outliers, Malcolm Gladwell argues (and has the science to back it up) that there’s a magic number of hours that people need to do something to transition from good to great. When people cross the threashold of 10,000 hours, they somehow move from good at something to very very very good. He uses examples from sports, music, medicine, even art. After working on a certain activity for 10K hours, people reach a state of expertise.
Ok, after reading this part of the book, I think to myself- “SWEET!!! That’s all I have to do!! Get to 10,000 and I’m home free! I will be Good. At. Something. Important. I wonder how many hours I’ve done so far, probably like 5,000. I feel that I am at about 5,000 hours of expertise.” So of course, I calculate it. I started as a research assistant when I was a junior in college at the Wright Patterson Air Force Base (3 months, avg 40 hours a week= 480 hrs) then stayed on through my senior year (8 months, avg 20 hours a week=640 hrs), then started my master’s program with about a 3 month break between, for 2 years (21 months- vacation and times when I was goofing off, avg 40 hours a week = 3360), then Mayo for 2.5 years (25 months- wasn’t always doing research and was on vacation, avg 40 hours a week= 4000 hrs), then PhD (22 months- lots of goofing off, avg 40 hrs a week= 3520 hrs).
HOLD UP A SECOND.
Now I am no statistics genius, but I think that adds up to more than 10,000. Crap. Where’s the magic? I am in fact at a surplus of 2,000 hours! Damn. Damn damn damn.
Perhaps it’s because it’s just not that simple. Maybe it’s more than an endurance sport. If it were only endurance, this would be a lot simpler. There must be something else to this (please, let there be something else to this). I went back to the book and continued to read. As it turns out, experts are made because an expert works not just on the stuff they’re good at, but also the stuff that they aren’t good at. It’s not just the PRACTICE that’s important. It’s also that you have want to become BETTER at what you’re not good at already. That is significantly trickier.
How do I take this next step? How do I move from endurance to confident, passionate, thoughtful? And significantly for me, how do I do it in the way that I want to? To achieve the things I want to? To find what’s best not just for me, but for my family? What are the things that I am not good at that I have to practice?
I’ve realized over the last 6 months or so that I struggle with the ‘philosophy’ part of getting a PhD. Seems silly, like I should’ve realized that was part of it before I started… Well, I don’t always read the directions before I attempt to put together the swing set, just ask Mike. I thought this would be a place where I could hone my skills, I could become better at solving practical problems, I could explore new health care and teamwork innovations and apply them within a new domain. As it turns out, yeah, that’s part of it, but it’s not the entire thing.
Philosophy: phi·los·o·phy (n.)
1. Love and pursuit of wisdom by intellectual means and moral self-discipline.
2. Investigation of the nature, causes, or principles of reality, knowledge, or values, based on logical reasoning rather than empirical methods.
3. A system of thought based on or involving such inquiry: the philosophy of Hume.
4. The critical analysis of fundamental assumptions or beliefs.
5. The disciplines presented in university curriculums of science and the liberal arts, except medicine, law, and theology.
6. The discipline comprising logic, ethics, aesthetics, metaphysics, and epistemology.
7. A set of ideas or beliefs relating to a particular field or activity; an underlying theory: an original philosophy of advertising.
8. A system of values by which one lives: has an unusual philosophy of life.
Fascinating. The definition of this word is absolutely fascinating. I almost can’t believe it. The problem lies right there in the definition. I mean I love pursuing wisdom by intellectual means and self-discipline. I 100% believe in that. But, one of my biggest problems with getting a PhD is all the thinking about thinking. The lack of actual DOING- ‘rather than empirical methods’ and ‘underlying theory’. I had a fight with my advisor on my first week here because I want to focus on the front line, and how my research will impact what people DO, ie: will impact PRACTISE!!! He said to me, ‘well, Sarah. We’ve also got to think about how you’re going to contribute to the theoretical study of leadership.’ I must’ve made a face or something, because he said ‘what?’ and I almost said, well, I really don’t care about that so much. Mercifully, my frontal lobe kicked in and I just shrugged.
As I approach my final year of the PhD, I am getting deeper and deeper into the philosophy bit, and I feel that I am losing my touch with reality. I still go back to the OR from time to time to remember why I am doing what I do, but it’s a struggle. Mike says that this is a good thing because now I know more about what I should and shouldn’t do with my life, and he’s absolutely right. But for now, this is the part of practice where I have to work on the stuff that I’m not good at, and don’t really enjoy. Because maybe I’ve miscalculated, and my 10K is just around the corner.
Showing posts with label Work. Show all posts
Showing posts with label Work. Show all posts
Thursday, July 8, 2010
Monday, June 14, 2010
Epic Fail
Today, for what feels like the billionth time, I sent my advisors a redraft of a manuscript I'm working on. This process is so absolutely soul-crushing, it's difficult for me to justify why I keep doing it.
First, I spend weeks (months) working out the perfect data analysis plan, only to find that as soon as I run it past someone else, it's got about as many theoretical imperfections as Branch Dividianism for Dummies by David Koresh. I rework the plan, now it is less heinous, but only slightly, like Jabba the Hut when he's asleep. I go back to the drawing board, which is actually my highly unromantic desk, only made tolerable by the random pictures I've put up and a little piece of paper that says 'Beer is for Champions (aka Sarah)' made for me by my husband. I sit and stare at the gross blue cubie dividers, wondering whether they're made out of the same material as the carpet on the floor, and if I were to rip the material off, drape it over myself and curl in a ball on the floor if perhaps I'd be camouflaged enough to have somebody else do my PhD. Then right at the end, I could pop up and say- "Oh wow! This looks really great! Nice work! I'm back though- I was here the whole time! You look exhausted, why don't you just crawl under this nice blue carpet and rest for a while. I'll take it from here."
Anyway, eventually my advisers feel enough pity for me that they allow me to move on from Analysis. Perhaps they can tell that I am having statistics nightmares (which actually scare me more than mass murderer nightmares. NOTHING and I mean NOTHING is as scary as a statistics nightmare. Not only are there all these greek letters, odd symbols and assumptions you've inadvertently violated, but the fact is that, if you're dreaming about them, statistics has invaded your subconscious. Is nothing sacred?!) or maybe they think that if I go down this path, I will see the err of my ways and then realize that I should just start all over. With Psychology 101. Or maybe take up basket weaving.
After the Analysis is complete, the next step is to figure out What The Data Mean... the academic question is always "What story does it tell?" I think this is a really nice way to think about it. The problem is, even though I've been doing research as a living for 6 years now, I still can't always answer this question. My advisers or a fellow researcher will ask and I imagine myself to be a beautiful but dark criminal ingenue, who has finally been caught and is sitting in a small room in the heart of France, with a single 20 watt bulb hanging from the ceiling. 'I am not sure,' I say evocatively. 'What story do you think it tells?' Then I realize, I am quietly drooling on my cigarette, which has been transformed back into a ballpoint pen, and I actually haven't said anything at all. I might've grunted.
After putting together a story McGuyver-style (duct tape, potting soil, and a pig valve), then comes the writing-up. I tend to spend 2-3 days thinking about a particular paper. I write the easy part first, the method and the results (because goodness gracious, if I can't write that after all the previous hoo-ha, then it's back to the 'drawing board'- NOOOO!) Then I write why each one of the results is interesting. I actually ask myself 'why is this interesting? why should anyone, other than my mom and husband (xoxo) care about this?' Most of the time, the list that I come up with gets whittled down to a couple of key points, the rest are thrown away. I was heartened to learn that writers for The Onion actually come up with 600 headlines per week, for only 17 or 18 to be chosen. That's 583 throw aways, and those guys are geniuses.
Then I send the manuscript draft off to my advisors. This is the particularly ego-damaging point. Here is where completely valid, obvious, supremely helpful comments are made. Comments that basically make you hang your head in school-girl shame, mumble something about not knowing that Wikipedia isn't a reliable source, and go back and rewrite most of what you've done so far. I always have this moment where I am just shaking my head in disbelief... how in the world did I not think of that? Seriously, a 7 year old boy with a Buzz Lightyear t-shirt and an imaginary friend named Bucket could've thought of that.
So, today, I sent the manuscript off to my advisors. I now have between 24 hours and 1 week to build myself a strong foundation (mainly made of pinot grigio, After Eights and brownies) prior to impact.
The whole reason I started this particular entry was because I have been thinking a lot about failure lately. That sounds harsh... I've been thinking about the condition or act of not achieving a desired end or ends which I (and the princeton dictionary) define as a failure. How it feels to me to not do something to the standard that I know I can do it. And, more importantly, how awesome it feels to get it right, after seriously hard work. But how risky it is to actually try at something... I mean, to try, you are giving yourself the option to fail. As long as you don't try, you're safe. Or if you do try, but don't try as hard as you can, then you can write it off- 'I didn't try that hard. It's ok.' I've always believed that if I work hard enough, and seriously give things my all, that I will be successful. What I've realized, through these paper writing... exercizes... through running, through moving to a foreign country, and many other things, is that failure, really and truly, isn't that bad. When I feel that I've failed, I can't look at myself. I can't look myself in the eyes. But gradually, I begin to take the little failure lessons and gather them like pickup sticks. (Currently I have so many pickup sticks that I am going to soon begin work on a George Washington-esque log cabin.) I am becoming less and less afraid of dismal, never ending, failure. Because failure hasn't been like that for me. In my experience, it does end. And people who love you will continue to love you in spite or even because of it. In fact, I am beginning to think failure is, in some respects, imperative.
Enough waxing philosophical. I am going to go get Bucket and crawl under a piece of carpet with a brownie or two.
First, I spend weeks (months) working out the perfect data analysis plan, only to find that as soon as I run it past someone else, it's got about as many theoretical imperfections as Branch Dividianism for Dummies by David Koresh. I rework the plan, now it is less heinous, but only slightly, like Jabba the Hut when he's asleep. I go back to the drawing board, which is actually my highly unromantic desk, only made tolerable by the random pictures I've put up and a little piece of paper that says 'Beer is for Champions (aka Sarah)' made for me by my husband. I sit and stare at the gross blue cubie dividers, wondering whether they're made out of the same material as the carpet on the floor, and if I were to rip the material off, drape it over myself and curl in a ball on the floor if perhaps I'd be camouflaged enough to have somebody else do my PhD. Then right at the end, I could pop up and say- "Oh wow! This looks really great! Nice work! I'm back though- I was here the whole time! You look exhausted, why don't you just crawl under this nice blue carpet and rest for a while. I'll take it from here."
Anyway, eventually my advisers feel enough pity for me that they allow me to move on from Analysis. Perhaps they can tell that I am having statistics nightmares (which actually scare me more than mass murderer nightmares. NOTHING and I mean NOTHING is as scary as a statistics nightmare. Not only are there all these greek letters, odd symbols and assumptions you've inadvertently violated, but the fact is that, if you're dreaming about them, statistics has invaded your subconscious. Is nothing sacred?!) or maybe they think that if I go down this path, I will see the err of my ways and then realize that I should just start all over. With Psychology 101. Or maybe take up basket weaving.
After the Analysis is complete, the next step is to figure out What The Data Mean... the academic question is always "What story does it tell?" I think this is a really nice way to think about it. The problem is, even though I've been doing research as a living for 6 years now, I still can't always answer this question. My advisers or a fellow researcher will ask and I imagine myself to be a beautiful but dark criminal ingenue, who has finally been caught and is sitting in a small room in the heart of France, with a single 20 watt bulb hanging from the ceiling. 'I am not sure,' I say evocatively. 'What story do you think it tells?' Then I realize, I am quietly drooling on my cigarette, which has been transformed back into a ballpoint pen, and I actually haven't said anything at all. I might've grunted.
After putting together a story McGuyver-style (duct tape, potting soil, and a pig valve), then comes the writing-up. I tend to spend 2-3 days thinking about a particular paper. I write the easy part first, the method and the results (because goodness gracious, if I can't write that after all the previous hoo-ha, then it's back to the 'drawing board'- NOOOO!) Then I write why each one of the results is interesting. I actually ask myself 'why is this interesting? why should anyone, other than my mom and husband (xoxo) care about this?' Most of the time, the list that I come up with gets whittled down to a couple of key points, the rest are thrown away. I was heartened to learn that writers for The Onion actually come up with 600 headlines per week, for only 17 or 18 to be chosen. That's 583 throw aways, and those guys are geniuses.
Then I send the manuscript draft off to my advisors. This is the particularly ego-damaging point. Here is where completely valid, obvious, supremely helpful comments are made. Comments that basically make you hang your head in school-girl shame, mumble something about not knowing that Wikipedia isn't a reliable source, and go back and rewrite most of what you've done so far. I always have this moment where I am just shaking my head in disbelief... how in the world did I not think of that? Seriously, a 7 year old boy with a Buzz Lightyear t-shirt and an imaginary friend named Bucket could've thought of that.
So, today, I sent the manuscript off to my advisors. I now have between 24 hours and 1 week to build myself a strong foundation (mainly made of pinot grigio, After Eights and brownies) prior to impact.
The whole reason I started this particular entry was because I have been thinking a lot about failure lately. That sounds harsh... I've been thinking about the condition or act of not achieving a desired end or ends which I (and the princeton dictionary) define as a failure. How it feels to me to not do something to the standard that I know I can do it. And, more importantly, how awesome it feels to get it right, after seriously hard work. But how risky it is to actually try at something... I mean, to try, you are giving yourself the option to fail. As long as you don't try, you're safe. Or if you do try, but don't try as hard as you can, then you can write it off- 'I didn't try that hard. It's ok.' I've always believed that if I work hard enough, and seriously give things my all, that I will be successful. What I've realized, through these paper writing... exercizes... through running, through moving to a foreign country, and many other things, is that failure, really and truly, isn't that bad. When I feel that I've failed, I can't look at myself. I can't look myself in the eyes. But gradually, I begin to take the little failure lessons and gather them like pickup sticks. (Currently I have so many pickup sticks that I am going to soon begin work on a George Washington-esque log cabin.) I am becoming less and less afraid of dismal, never ending, failure. Because failure hasn't been like that for me. In my experience, it does end. And people who love you will continue to love you in spite or even because of it. In fact, I am beginning to think failure is, in some respects, imperative.
Enough waxing philosophical. I am going to go get Bucket and crawl under a piece of carpet with a brownie or two.
Sunday, May 30, 2010
The Strength of Culture
This American Life, a podcast I listen to religiously, did a piece a couple of weeks ago on Haiti called 'Island Time'. The show examines life post-earthquake for people on the ground, the people who've lost everything, and how these people, along with NGOs, volunteers, physicians, economic experts, are using their different areas of expertise to try to rebuild or more effectively build a stable Haiti. During the first act (that's what they call segments of the show. I think it's a throw back to the old days of radio as a storytelling medium, rather than an archaic method to get news that only Grandparents and Liberals use) they focus on the story of one woman and her mango trees (not a euphemism). This woman has a couple of mango trees on her farm, which would be extremely profitable, if she could water them regularly, harvest them and get a good crop going.
Mangos are the top export for Haiti. This tiny country grows enough mangos to satify all the American demand, but they're not grown on large farms, rather by individual farmers, like the woman, with only a few trees. Therefore, the exporters have to figure out a way to gather all the mangos together before they can be shipped. Americans like their mangos beautiful, pinky and green on the outside and firm to the touch. Haitians don't care if the mangos are bruised, nor what they look like on the outside, just that they're edible. So once each individual farmer picks the mangos, he or she stores them under their beds or in piles outside their homes, because they're so valuable. As you can imagine, this leads to quite a bit of bruising and marking on the skin and overexposure to the sun. Then a middle man comes, buys the mangos, and brings them to a city via donkey and cart for export. This process, developed over centuries, ultimately leaves many mangos unsuitable for export.
Exporters and NGOs have tried to work with people, give them plastic crates to store the mangos in, keep them safe, but people don't understand that this is what the crates are for. The process of picking the mangos, putting them directly into crates, and setting the crates out for exporters to pick up is so non-sensical to the farmers, that they don't do it. They end up using the crates as seats or as shelves, because using them as a vessel for mangos is ridiculous. This seems like an easily solvable problem. Just tell the farmers to use the crates. Tell them that if you do, you'll make more money. Easy.
As the story goes along, you find out that the crates were brought to the woman farming the mangos by some guy she'd never met. He was white, articulate, drove a car, and just handed out the crates. He made no explanation other than, do this, it'll decrease the bruises. But to this woman, who cares about bruises? The mangos taste good. This woman hasn't ever been away from her small village. She can't even imagine an American, much less an American grocery store where young mothers carefully examine every mango, to find the best ones to feed their children (I am not criticizing, I do this. I am extremely picky in terms of how my food looks). It just doesn't make any sense to her. In her culture, having a good mango is good enough. Because she doesn't value these things, she has a hard time conceptualizing why another person would.
I heard a similar story not too long ago at a talk I went to about using science and innovation for development. During this talk, the speaker told a story about how scientists had engineered a new type of sweet potato which had been infused with beta-carotene for consumption in areas of sub-Saharan Africa. He said that when they first introduced the new potato, it was extremely difficult to get the people in the villages to eat it. The scientists were frustrated. They'd spent all this time and all this money to develop this new, healthier, vitamin fortified sweet potato and now the people won't eat it, even though it's good for them, and will improve their health. As it turned out, finally (FINALLY) the researchers realized that people weren't eating the potatoes because they were a different color than the traditionally grown white potato. People thought there was something wrong with them because they were a different color and tasted funny.
Another story, not quite as dire, but with a similar theme: When Pele first came to the US to play with the New York Cosmos, after a game he looked at his feet and saw that they were green. He immediately told the manager that he quit, citing green foot fungus that he'd contracted since coming to America. He was in a panic because he said his feet were his livelihood, and since coming to America they'd gotten sick. What had actually happened was, in an effort to make the field look better, the grounds staff had painted the dirt field green, and the paint had come off on the players' feet.
The point I am trying to make, sloppily, is the importance of culture in the evolution of improvement and innovation. Not just culture, the individuals that are part of that culture. In the first example, the woman needed to be trained on how to use the crates, taught that there are people who value the look of the mangos, not just the taste. The exporters needed to translate the desires of the customer back to the woman in a way that she would understand. She's not stupid, she just doesn't know, or have the capacity to figure it out on her own. In the second example, the scientists didn't take the culture of the villagers eating the potatoes into account. They thought that because the innovation was good, was healthier, that people would automatically be on board. But this isn't the case. People need to understand the WHY, not just that it's better. In the Pele example, again, it's a classic clash of cultures. At one point in his career, Pele played on dirt fields. Lush, green, grassy fields aren't always the norm. But in American sports, the spectacle is really important. Sometimes, it's half the fun (see: Dallas Cowboy Cheerleaders).
There are also more subtle examples of culture within culture in the world around us. In the work that I do in the hospital, culture is extremely important. There's a surgery culture, a nursing culture, an ICU culture, an ER culture, etc. Some sort of patient safety innovation that works in the OR, might not work in the ER. Not just because the work that they do is different, but because the people, the culture of these areas, is different. What we're talking about here is the idea that another culture might value a particular quality that you, in your culture, find to be ridiculous, or superfluous, etc. The point is that if you want to innovate, make change, and hopefully improve life for someone else, culture is extremely important. If you want to make a lasting change, it's imperative to work with the system that people have established, not criticize it, and to innovate both from a bottom-up and top-down approach.
People are extremely important. In almost every circumstance I've encountered, the people have built a culture for a reason. They do things in a certain way for a reason. To ignore the history and context leads to instability and usually only temporary improvement.
There are two quotes that keep running through my head as I write this.
1) 90% of success is just showing up.
2) People don't care what you know until they know that you care.
Mangos are the top export for Haiti. This tiny country grows enough mangos to satify all the American demand, but they're not grown on large farms, rather by individual farmers, like the woman, with only a few trees. Therefore, the exporters have to figure out a way to gather all the mangos together before they can be shipped. Americans like their mangos beautiful, pinky and green on the outside and firm to the touch. Haitians don't care if the mangos are bruised, nor what they look like on the outside, just that they're edible. So once each individual farmer picks the mangos, he or she stores them under their beds or in piles outside their homes, because they're so valuable. As you can imagine, this leads to quite a bit of bruising and marking on the skin and overexposure to the sun. Then a middle man comes, buys the mangos, and brings them to a city via donkey and cart for export. This process, developed over centuries, ultimately leaves many mangos unsuitable for export.
Exporters and NGOs have tried to work with people, give them plastic crates to store the mangos in, keep them safe, but people don't understand that this is what the crates are for. The process of picking the mangos, putting them directly into crates, and setting the crates out for exporters to pick up is so non-sensical to the farmers, that they don't do it. They end up using the crates as seats or as shelves, because using them as a vessel for mangos is ridiculous. This seems like an easily solvable problem. Just tell the farmers to use the crates. Tell them that if you do, you'll make more money. Easy.
As the story goes along, you find out that the crates were brought to the woman farming the mangos by some guy she'd never met. He was white, articulate, drove a car, and just handed out the crates. He made no explanation other than, do this, it'll decrease the bruises. But to this woman, who cares about bruises? The mangos taste good. This woman hasn't ever been away from her small village. She can't even imagine an American, much less an American grocery store where young mothers carefully examine every mango, to find the best ones to feed their children (I am not criticizing, I do this. I am extremely picky in terms of how my food looks). It just doesn't make any sense to her. In her culture, having a good mango is good enough. Because she doesn't value these things, she has a hard time conceptualizing why another person would.
I heard a similar story not too long ago at a talk I went to about using science and innovation for development. During this talk, the speaker told a story about how scientists had engineered a new type of sweet potato which had been infused with beta-carotene for consumption in areas of sub-Saharan Africa. He said that when they first introduced the new potato, it was extremely difficult to get the people in the villages to eat it. The scientists were frustrated. They'd spent all this time and all this money to develop this new, healthier, vitamin fortified sweet potato and now the people won't eat it, even though it's good for them, and will improve their health. As it turned out, finally (FINALLY) the researchers realized that people weren't eating the potatoes because they were a different color than the traditionally grown white potato. People thought there was something wrong with them because they were a different color and tasted funny.
Another story, not quite as dire, but with a similar theme: When Pele first came to the US to play with the New York Cosmos, after a game he looked at his feet and saw that they were green. He immediately told the manager that he quit, citing green foot fungus that he'd contracted since coming to America. He was in a panic because he said his feet were his livelihood, and since coming to America they'd gotten sick. What had actually happened was, in an effort to make the field look better, the grounds staff had painted the dirt field green, and the paint had come off on the players' feet.
The point I am trying to make, sloppily, is the importance of culture in the evolution of improvement and innovation. Not just culture, the individuals that are part of that culture. In the first example, the woman needed to be trained on how to use the crates, taught that there are people who value the look of the mangos, not just the taste. The exporters needed to translate the desires of the customer back to the woman in a way that she would understand. She's not stupid, she just doesn't know, or have the capacity to figure it out on her own. In the second example, the scientists didn't take the culture of the villagers eating the potatoes into account. They thought that because the innovation was good, was healthier, that people would automatically be on board. But this isn't the case. People need to understand the WHY, not just that it's better. In the Pele example, again, it's a classic clash of cultures. At one point in his career, Pele played on dirt fields. Lush, green, grassy fields aren't always the norm. But in American sports, the spectacle is really important. Sometimes, it's half the fun (see: Dallas Cowboy Cheerleaders).
There are also more subtle examples of culture within culture in the world around us. In the work that I do in the hospital, culture is extremely important. There's a surgery culture, a nursing culture, an ICU culture, an ER culture, etc. Some sort of patient safety innovation that works in the OR, might not work in the ER. Not just because the work that they do is different, but because the people, the culture of these areas, is different. What we're talking about here is the idea that another culture might value a particular quality that you, in your culture, find to be ridiculous, or superfluous, etc. The point is that if you want to innovate, make change, and hopefully improve life for someone else, culture is extremely important. If you want to make a lasting change, it's imperative to work with the system that people have established, not criticize it, and to innovate both from a bottom-up and top-down approach.
People are extremely important. In almost every circumstance I've encountered, the people have built a culture for a reason. They do things in a certain way for a reason. To ignore the history and context leads to instability and usually only temporary improvement.
There are two quotes that keep running through my head as I write this.
1) 90% of success is just showing up.
2) People don't care what you know until they know that you care.
Sunday, March 28, 2010
Heart Surgery
I always loved science, specifically anatomy and physiology. I really loved when we got to dissect pigs and frogs in high school. As a psych major, we weren't required to take any advanced A&P courses in college, but we did get to do neuroscience. I loved it. During 'family dinners' my junior year of college, I would tell my housemates all about the brain, specific neurotransmitters, why people can't quit smoking, why smell is so strongly associated with memory, why we get drunk and then subsequent hangovers... I thought I was going to study the brain as a career. As it happened, I got the opportunity to work in a few very applied settings, and realized that I really love the application of science to solve practical problems.
However, if someone had told me that I would get to watch surgery as part of my professional life, I would've laughed. I feel like the luckiest person in the world when I get to go into the operating room. I am always amazed at what happens in there. Before we moved to Scotland, I used to get to go down to the cardiac surgery operating rooms whenever I wanted to and watch the surgeries (I wasn't just going down to watch, it's not a sporting event, I actually did some studies and all that). The awe never has worn off for me.
When I first started spending lots of time in the OR, my job was to help think of ways to improve teamwork and patient safety in the cardiac surgery division. However, that's pretty difficult when you know absolutely NOTHING about the task that the team is trying to accomplish. So for a few weeks, I just went down to the OR and watched. I remember the first surgery I was in, the surgeon introduced me to the team, and the circulating nurse asked if I was squeemish. I told her I didn't know, becuase I'd never seen anything like this before. She said 'if you start to feel woozy, just try to fall backward' (ie: not onto the sterile table). Helpful tip.
As the surgery started the circulator came over to me and said 'You can go stand up at the head of the table if you want'. So I went around where the anaesthetist stands, and asked if I could look over. Side note: in some surgical disciplines, they hang a sterile sheet between the patient's head, where the anesthetist works, and the surgical field. The sterile sheet is a bit like a huge flexible post-it, with adhesive on one side that sticks to the patient, and then gets pulled up and clipped to IV poles on the anaesthetic side. This way the anaesthetist can monitor the patient's head and all their equipment without worrying that it'll get blood on it from the surgery. Surgeons and anaesthetists call this the 'blood-brain barrier' (brain joke!). Anyway, so I went around and stood on a stool and looked over the sheet. The surgical assistant was watching me (probably for signs of faintness, and to make sure I didn't touch anything sterile), and when I caught his eye and almost laughed out loud. I couldn't believe what I was seeing. It was a heart! A real heart! It was beating, moving, keeping the patient alive, even though their chest was cracked open. It looked like a science project. As a novice, I almost forgot that there was a person, a living breathing thinking feeling person, attached to the open chest that I saw.
The heart is awesome (not in the 'duuuude! awesome!!' way, but in the formal definition of the word). It's not like a balloon that fills and then empties. Rather it's a muscle that twists on itself to push the blood through. It's such a complex thing. If you make a fist with your hand, and then squeeze it, pinky first, then ring finger, middle finger, index finger, and hold it, then release, that's a beat. It is a muscle. You can strengthen and train it like you can any other muscle, and it atrophies or stops working properly if you don't care for it. On the outside, it looks very smooth, usually pink, but it depends on the age of the patient and the progression of the disease. The inside is very complicated, lots of small compartments and intricate muscles and valves that open and close to allow blood and nutrients in and to push waste out. When one of these valves or chambers is broken, it means that bad things are coming in when they shouldn't, and good things aren't coming in when they should.
In order to do heart surgery, the team must stop the heart from beating (in most cases, sometimes they do beating heart surgeries) which they do by re-routing the blood into a machine that oxygenates it and sends it to the brain and body, and that takes the waste out when the blood comes back the other way. There are about a million very complex steps to this process, which I know very little about, despite some very patient and intelligent people explaining it to me over and over. This is called cardiopulmonary bypass. The point is, they have to stop your heart in order to fix it. They have to do a manual reset.
Throughout history, emotions have been associated with the heart, although most scientists will say that they exist because of interactions in the brain. I've said time and time again 'I know it in my heart' or 'my heart is telling me...', 'my heart goes out to you', 'my heart will go on' (just kidding) etc. Even in the bible there's reference to God hardening pharoh's heart. Aristotle (I think it was Aristotle) rejected the brain, seeing it a superfluous to the heart, which he thought was the seat of emotion and reason. Historically, the Egyptians thought that the heart was the center of emotion because the pulse would change with great emotion, and would create visible differences in the psyche.
There is some research that says that the heart has an effect on emotion because it effects blood flow to the brain and oxygenation, which makes sense. Negative emotions, stress, frustration, anxiety, can lead to heart diesease. It's also been shown that the heart has a very strong electromagnetic force, because of all the electrical activity that's going on in there. I suppose this is why sometimes I can swear that I've felt my heart hurt or swell or twinge when something really good or really bad is happening.
Its really interesting to consider that there's such a connection between the physiological and the psychological. I've heard that a lot of heart surgery patients feel like their heart is giving up on them when they are faced with heart or valve disease. Like their heart rejected their body. Maybe all it needed was a manual reset? I don't know. There's a small but forceful push in medicine to start to investigate more holistic treatments for patients- ie: treat the patient not the disease. Using things like yoga, psychological therapy, homeopathy, etc. as a compliment to surgical intervention to fix a leaky mitral valve.
In my work, I don't interact much with patients, rather with their care-givers, hoping to improve the system in which the care-givers work, thus improving outcomes for patients. But this is a really interesting, and entirely different perspective that I've only recently begun to think about. Obviously, it's something I need to think about more.
However, if someone had told me that I would get to watch surgery as part of my professional life, I would've laughed. I feel like the luckiest person in the world when I get to go into the operating room. I am always amazed at what happens in there. Before we moved to Scotland, I used to get to go down to the cardiac surgery operating rooms whenever I wanted to and watch the surgeries (I wasn't just going down to watch, it's not a sporting event, I actually did some studies and all that). The awe never has worn off for me.
When I first started spending lots of time in the OR, my job was to help think of ways to improve teamwork and patient safety in the cardiac surgery division. However, that's pretty difficult when you know absolutely NOTHING about the task that the team is trying to accomplish. So for a few weeks, I just went down to the OR and watched. I remember the first surgery I was in, the surgeon introduced me to the team, and the circulating nurse asked if I was squeemish. I told her I didn't know, becuase I'd never seen anything like this before. She said 'if you start to feel woozy, just try to fall backward' (ie: not onto the sterile table). Helpful tip.
As the surgery started the circulator came over to me and said 'You can go stand up at the head of the table if you want'. So I went around where the anaesthetist stands, and asked if I could look over. Side note: in some surgical disciplines, they hang a sterile sheet between the patient's head, where the anesthetist works, and the surgical field. The sterile sheet is a bit like a huge flexible post-it, with adhesive on one side that sticks to the patient, and then gets pulled up and clipped to IV poles on the anaesthetic side. This way the anaesthetist can monitor the patient's head and all their equipment without worrying that it'll get blood on it from the surgery. Surgeons and anaesthetists call this the 'blood-brain barrier' (brain joke!). Anyway, so I went around and stood on a stool and looked over the sheet. The surgical assistant was watching me (probably for signs of faintness, and to make sure I didn't touch anything sterile), and when I caught his eye and almost laughed out loud. I couldn't believe what I was seeing. It was a heart! A real heart! It was beating, moving, keeping the patient alive, even though their chest was cracked open. It looked like a science project. As a novice, I almost forgot that there was a person, a living breathing thinking feeling person, attached to the open chest that I saw.
The heart is awesome (not in the 'duuuude! awesome!!' way, but in the formal definition of the word). It's not like a balloon that fills and then empties. Rather it's a muscle that twists on itself to push the blood through. It's such a complex thing. If you make a fist with your hand, and then squeeze it, pinky first, then ring finger, middle finger, index finger, and hold it, then release, that's a beat. It is a muscle. You can strengthen and train it like you can any other muscle, and it atrophies or stops working properly if you don't care for it. On the outside, it looks very smooth, usually pink, but it depends on the age of the patient and the progression of the disease. The inside is very complicated, lots of small compartments and intricate muscles and valves that open and close to allow blood and nutrients in and to push waste out. When one of these valves or chambers is broken, it means that bad things are coming in when they shouldn't, and good things aren't coming in when they should.
In order to do heart surgery, the team must stop the heart from beating (in most cases, sometimes they do beating heart surgeries) which they do by re-routing the blood into a machine that oxygenates it and sends it to the brain and body, and that takes the waste out when the blood comes back the other way. There are about a million very complex steps to this process, which I know very little about, despite some very patient and intelligent people explaining it to me over and over. This is called cardiopulmonary bypass. The point is, they have to stop your heart in order to fix it. They have to do a manual reset.
Throughout history, emotions have been associated with the heart, although most scientists will say that they exist because of interactions in the brain. I've said time and time again 'I know it in my heart' or 'my heart is telling me...', 'my heart goes out to you', 'my heart will go on' (just kidding) etc. Even in the bible there's reference to God hardening pharoh's heart. Aristotle (I think it was Aristotle) rejected the brain, seeing it a superfluous to the heart, which he thought was the seat of emotion and reason. Historically, the Egyptians thought that the heart was the center of emotion because the pulse would change with great emotion, and would create visible differences in the psyche.
There is some research that says that the heart has an effect on emotion because it effects blood flow to the brain and oxygenation, which makes sense. Negative emotions, stress, frustration, anxiety, can lead to heart diesease. It's also been shown that the heart has a very strong electromagnetic force, because of all the electrical activity that's going on in there. I suppose this is why sometimes I can swear that I've felt my heart hurt or swell or twinge when something really good or really bad is happening.
Its really interesting to consider that there's such a connection between the physiological and the psychological. I've heard that a lot of heart surgery patients feel like their heart is giving up on them when they are faced with heart or valve disease. Like their heart rejected their body. Maybe all it needed was a manual reset? I don't know. There's a small but forceful push in medicine to start to investigate more holistic treatments for patients- ie: treat the patient not the disease. Using things like yoga, psychological therapy, homeopathy, etc. as a compliment to surgical intervention to fix a leaky mitral valve.
In my work, I don't interact much with patients, rather with their care-givers, hoping to improve the system in which the care-givers work, thus improving outcomes for patients. But this is a really interesting, and entirely different perspective that I've only recently begun to think about. Obviously, it's something I need to think about more.
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