Reading a note from an outside clinic on a patient referred to me:
“Edward Said is a 43 year old Other Race male….”
Category: PGY-3
Book #5: The Monsters of Templeton
This was another book club read, from way back in February. It’s the story of a young archeologist who falls pregnant (as they used to say) and travels home to the Upstate New York village of Templeton to reconnect with her mother and escape from her married lover — even though she spends half the book mooning over him and wondering why he doesn’t call. Her mother promptly lands a bombshell on her, that her father was not a California hippie, but rather one of Templeton’s upstanding respectable men, scion of the Founding Family, and so Willie (aka Wilhelmina) spends her summer tracking down the descendants of Marmaduke Temple in order to discover who her father really is.
Taken as a mystery novel (whodunit = who got my mom pregnant?) it’s not the greatest. The plot “twists” are advertised a mile up the road. But as a study of a small town, especially through the centuries, it’s compelling. Each main chapter is narrated by a different Temple, ranging from the colonial era through relatively modern times. There are helpful family trees interspersed throughout the book, updated as appropriate as Willie learns more information about her family’s background. Willie herself is a tad passive, gleaning information from library books (Templeton has a library to rival the Bodleian in terms of access to primary sources, diaries, and whatnot) and mostly lets the truth fall into her lap.
A few subplots in the book were gratutitous. Willie has a friend with lupus cerebritis who calls up at all hours, stark raving psychotic. There’s a personal ghost — a strange moment of magic realism that doesn’t fit with the style of the rest of the book — and even more bizarrely, a Loch Ness monster named Glimmie who is essentially the town’s guardian spirit. Any of those elements would have been a good stand alone book, but I couldn’t really see how they added, complemented, or enriched the main plot of Monsters of Templeton.
Overall, 3/5 stars. I liked it and would check it out of the library again, but wouldn’t buy it.
[I’m going to start adding a star system to these reviews, as follows:
1/5: No good
2/5: Eh. Might pick it up again in a few
3/5: Enjoyable. Would check it out of the library again.
4/5: Pretty good. Would definitely read again, and recommend to friends.
5/5: Amazing. A desert island book. ]
Book #4: Purple Hibiscus
Chimamanda Ngozi Adichie has been on my to-read list for ages. I’ve had Americanah on my library Hold list for months. (I should just buy it outright, because after reading her first novel as a “consolation prize,” I can tell that this writer is going to be a keeper.)
Purple Hibiscus is a coming-of-age story in modern Nigeria, with themes of violence both domestic and national, religious influence, and family. POV is a teenage girl from a rich family, losing innocence and gaining some degree of awareness of the larger world. Structured very well indeed; you could almost map out the physical journey between city and country as a surrogate for the emotional journey she takes. The voice is excellent; it’s a real challenge to write a character on the border between childhood and adulthood, both in terms of the language as well as avoiding heavy handed flashbacks.
On a nerd level, I kind of loved that the opening line is “Things began to fall apart…” — clear allusion to probably the most famous Nigerian novelist in the Western world, Chinua Achebe. I, like most former literature students, read Things Fall Apart in college, where it was presented as a colonial answer to Heart of Darkness. I remember at the time thinking it was much richer than that, but I’ve never gone back to it. Perhaps I should. In this novel, like that one, Nigeria the country, the land, is very much a character in itself. Purple Hibiscus intersects with the Nigeria of Chinua Achebe, giving us a contemporary world, where Achebe’s was historical (written in the 1950s but set a half-century earlier), and a domestic focus where Achebe was more nationalistic (again, that might have been the lens the professor was using).
The thing with this project is that every book I read opens up to at least three others. It’s like a fractal tree!
Book #3: Good Omens, and some life outside the hospital
I read this one for my book club, way back in January. It’s very much like The Hitchhiker’s Guide … to the Apocalypse. An angel and a demon team up to ensure that the end of the world goes smoothly, except of course it doesn’t. Mostly it’s a chuckling satire of bureaucracy and general human stupidity. I’ve never read anything else by Terry Pratchett or Neil Gaiman (those I’ve been gifted copies of the first Discworld book and American Gods, by wiser geekier friends) but I think I’ll have to hunt down some more of their work.
In other news, Spring is FINALLY here, after an endless East Coast winter. We didn’t suffer as much as the hardy fools in Boston, but I’m so so glad to see some green again. Especially that first spring green (Nature’s first green is gold) that signals that life is returned. One of my co-residents put it well: “I can tell you the exact time of year that I stop being a bitch — it’s the first day after Daylight Savings Time, when I walk out of the hospital and it’s light outside.”
It was a busy busy weekend for me. Socially as well as work-wise. I was the “senior” of sorts this weekend (all the real seniors are at the Academy meeting, so us 3’s are covering). This meant I had to round with the inpatient teams in the morning and generally make sure everything was ship shape. That in itself wasn’t bad, but part of being the senior means running stroke codes independently. Which means when that BEEP BEEP BEEP happens, you jump in your car and drive like a maniac. I wish we had little sirens to put on our cars, because waiting for a green light when there’s no one coming is the most frustrating thing.
But I’m glad I did it and got it over with. Monday morning was challenging, because I’d been woken up about every hour throughout Sunday, staffing consults from home. (The junior resident in house has to run things by the senior before calling the attending.) It’s a little weird being in a pseudo-attending role, I gotta say. But it’s a great sign of our program that I felt comfortable managing everything I got called with. I used to think that attendings had it easy compared to residents, but I’m starting to think it’s actually a lot more challenging. You are relying on someone else’s story to make decisions, which means you have to really trust that other person. It’s very different from supervising a med student, where you know you are going to retake part of the history and redo the exam. Just laying eyes on a patient makes all the difference — you get a sense of sick or not sick very quickly.
But the rest of this week has been a blast. I mean, I’m sitting on my porch after a very light clinic day (AAN this week = lots of cancellations), watching the sunset and drinking a leftover Bellini from a baby shower this weekend. Life could hardly be better.
Book #2: Drive by Dan Pink
This one was a work-related read. We have a “leadership book club” in my residency program, wherein the Powers that Be select a book on corporate management type stuff to have us read and discuss. I think it fulfills some kind of “systems-based practice” type requirements. Or something.
OK so the premise of this book is that intrinsic motivations are as compelling as extrinsic rewards. That’s a Nobel Prize winning statement, right there. When choosing a field of study or a line of work, no one has EVER considered inherent interest in the subject. EVER. Dan Pink jazzes this up by calling it “Motivation 3.0” (the original motivator being the caveman ethos of eat-mammoth-and-try-not-to-get-killed; and 2.0 being the carrot-and-stick model) and says that businesses should encourage employees to maximize intrinsic motivations instead of extrinsic rewards. Like, you know, salaries.
The book starts off with some psychology studies by Harlow (the man who did this to monkeys) on how people like solving puzzles, and if you pay them for solving puzzles, they lose interest, because then it’s about the money and not the cool Rubik’s cube. He then generalizes those findings, bizarrely, to the modern officespace, to say that corporations should pay people “the minimum necessary to live” (???) and instead focus attention on the trifecta of Motivation 3.0: autonomy, mastery, and purpose.
Look, that’s a valid enough point. If you are lucky enough to have a job that gives you a chance to succeed at all three things (and I do!), you’ll be more invested in the company, happier, and will be a more productive worker. But I think I am a very lucky exception … most people do not have the chance to have a job that allows them to achieve some sense of higher purpose. I have had jobs like that — janitorial work at the local library, transporting patients as a hospital volunteer, transcribing a paper dictionary into a computer. In my case there were all temporary high school / college positions, but there are lots and lots of people whose job, their everyday, pay-the-bills job, is some iteration of the above.
There are plenty of things that need done to keep things turning along. Bus drivers. Long distance truckers. Retail clerks. Cafeteria cooks. Street sweepers. Who is going to fulfill these roles during “20% time,” of which Pink makes a huuuuge deal. (Give your employees 20% of their paid time to do whatever they want. In my case, that time would be spent watching Netflix. Let’s be real.) Pink is very very optimistic when he thinks that everyone works in some sort of magical creative paradise all the time. I envision his “managerless company” as a sort of Lord of the Flies, wherein we all ritually slaughter Piggy on day three.
There are some interesting ideas in the first half of this book about creativity and puzzles and thinking outside the box. It starts to drag about halfway through, and loses its focus. The last 100 pages are a “toolkit” which basically rehash the whole book, in case you weren’t paying attention the first time around. Most frustratingly, he talks a big game about how important institutional culture is in promoting autonomy, mastery, and purpose, but he never once gives any practical tips on how to help encourage that.
Book #1: The Casual Vacancy
Oh my god, you guys. This book? Is good.
Ignore the Amazon reviews. They are written by people who expected another Harry Potter book with TEH MAGICKS and were shocked / upset / generally kerfuffled that JK Rowling is not a one-trick pony.
(I liked the Harry Potter books a lot. But what was great about them was they were children’s lit written like adult lit, no punches pulled, no saccharine sentimentality. And what’s great about The Casual Vacancy is that it’s just … adult lit written like adult lit.)
The plot is straightforward: local council member dies abruptly, by-election is held to replace his seat. But the real strength of the novel is in the characters, drawn sharply and with an excellent eye. It reminds me in that way of Austen or even more of Middlemarch, but if Dorothea Brooke had a blog.
Perhaps it’s because I live in a relatively small city with similar class distinctions as fictional Pagford, but the characters, even the less likeable ones, were very real. Everyone knows a meddling Shirley, and middle-aged Samantha’s crush on a young musician is so common as to be almost a cliche. The teen characters are definitely the most well-rounded here and the most sympathetic, especially Krystal. Krystal’s heartbreaking. I can’t tell you why; just read.
Yes, it’s tragic and dark and the last few pages are like watching a slow inevitable explosion and you finish it in the middle of the night because you stayed up far too late and you just have to stare up at the ceiling. It’s a book with an impact even bigger than its tome-like size.
Apparently the BBC just did an adaptation starring Keeley Hawes, Michael Gambon, Julia McKenzie, which aired last month in the UK and will air here on the 12th of Never, because Masterpiece Bloody Theater would rather air their fifth Downton Abbey marathon than some new programming. So if you are lucky enough to live in places where BBC player works, tell me, was it any good? Worth tracking down in the usual nefarious places on the internet, or give it a miss?
Patient letter
Dear Dr. [Scrivener],
Because of my chronic daily headache, I cannot get out of bed most days, so I cannot work and am now applying for disability. Can you fill out my paperwork?
Oh, and I need to reschedule my appointment with you next week because I’m going on vacation to the Caribbean. Even though I just told you I am bedbound and cannot work, I am still able to deal with airport security, cramped airline seats, and sitting out in the tropical sun sipping pina coladas on the beach. Can I get an early refill of Imitrex tho?
Thx!
— Migraneur
Foul, fetid, fuming, foggy filthy….
I went up to Philadelphia last weekend for a wedding of a good friend of mine from medical school. The wedding itself was tons of fun — both the ceremony and the chance to catch up with our old med school crowd — but I confess I had ulterior motives. I’m thinking about applying to some programs there for fellowship, so it was a great excuse to try out the city in a non-pressured way.
Philly reminds me a lot more of Washington DC than NYC. By which I mean, it may be more liveable for me. You can see the sun so that’s good, I guess? I don’t know. It really breaks my heart to have to leave this town in a little over a year. As much as I complain sometimes about (non-existent) traffic, just spending the weekend in Philly reminded me of all the little annoyances of city living. Slush piles everywhere. Running errands on foot, especially hauling groceries several blocks or on public transport. Lack of greenery. People around ALL THE TIME. Better than NYC, but still, I was very happy, if a little exhausted, to come home.
More on patient satisfaction
The patient satisfaction forms I mentioned in the last post? Are making it to the residency program now, courtesy of JCAHO (I think).
We were each given a packet of forms, printed on hideously green paper with black type (who made these, the Wicked Witch of the West?) to hand out to our patients.
The statements themselves are in size 10 italic font (great for our elderly patients! so readable!) and range from “My doctor introduces himself or herself” to “My doctor is sincere, trustworthy, and doesn’t keep information from me.” Patients have to rate the resident on a scale of 1-5.
No mention of other things like “My doctor seems competent.” or “My doctor can answer my questions or direct me to more information.” Medical knowledge, it seems, is somewhat irrelevant in this brave new world.
In non medical news, I’m currently reading Wolf Hall, by Hilary Mantel. It won a bazillion prizes when it came out, and it’s being made into a movie in the spring. It’s a tad introspective, but I do like it. Also slogging through The Martian, by Andy Weir, my book club’s official selection, which … it’s like a survival guide to being on Mars. There’s lots of info on how to generate oxygen from hydrazine. There’s lots of “Yay! It worked!” or “Boooo! The generator failed!” which makes Our Hero (TM) sound more like a pre-teen girl than a 30-something mechanical engineer.
Can’t get no
The clinics here do patient satisfaction forms, and periodically we get aggregate feedback emailed out. For the most part, this is a good thing — helps us understand issues with workflow, ease of scheduling appointments, all those things that as a doc we don’t have direct access to, but surely affects patients’ perceptions of our clinic and our overall competence.
Then sometimes we get gems like this:
HONESTLY some of the questions I answered I had to guess. I did not know how to answer them. I did not have the all the knowledge needed to answer them.
I don’t … I can’t even …. In what world do you blame the clinic for your own stupidity? And if you don’t understand the question because of jargon or something, just SAY SO.
On a bigger scale these stats (% positive reviews) are almost certainly being including in some sort of pen-pusher quality metric. It’s part of larger moves in Health Policy. In the private world, I hear physicians’ pay is being directly linked to patient satisfaction ratings, which seems like a great way to produce a community of candy-men and sycophants. In academia, departments with more satisfaction probably get more perks, or something. They keep promising us that we’ll move out of the basement one day, but with reviews like this …..
Off-White Coat 