Monday, August 21, 2017

Total Eclipse of the Brain

The world of modern educational administration will probably not soon be accused by anyone who understands it as being overly bogged down by an insistence upon using common sense as any sort of a barometer. Anyone with much of a sense of awareness who has been in the public school system in the past fifteen years or so should be able to identify with this concept. I would suspect that such has been the case for far longer than fifteen years, but I cannot speak from personal experience with much authority about things that happened in the school systems before I was seven years of age. Likewise, the same might be fairly said of most private school systems, but because I spent only two of my kindergarten-through-twelfth-grade years in private schools of any kind, I cannot form valid conclusions about even the parochial system I attended for the two years I did not attend public schools, much less about private school education as a whole. I will, however,  speak with apologies to no one in terms of much of the madness I have seen with my own eyes.

A mid-sized school district that I attended very briefly and in which I worked even more briefly as a substitute teacher has a superintendent who would be described as cautious. Caution with regard to other people's children entrusted to one's care is generally a good thing. School district personnel are charged with acting in loco parentis, or in place of the parent. The welfare of children should be first and foremost in the minds of school personnel in dictating policy.
All reasonable efforts should be made to safeguard students. Reasonable is a key concept. Because individuals, including children, have the volition to act, and because forces of nature can come into play, no one's safety can be one-hundred per cent guaranteed. Furthermore, what might be the safest policy in terms of injury prevention may not be the safest in terms of facilitation of learning, in terms of student emotional well-being, or in terms of overall wellness and disease prevention.

For example, students can be injured in a variety of ways while playing on a playground. On the other hand, students can develop life-long sedentary habits that lead to poor overall fitness and even to serious cardiovascular disease if they are not allowed or encouraged to take part in physical play. What is a reasonable course of action in response to this? The most reasonable course of action is to remove the greatest contraindications to safety from a playground, to provide competent supervision to students while on the playground, and then to encourage students to move about freely and to play. Even though trampolines offer many developmental and cardiovascular fitness-related benefits, they can be dangerous for large groups of children. Trampolines, therefore, are not typically found on school playgrounds. Along similar lines, the sport of archery has its benefits, as do lawn darts, but neither of those are typically found on school playgrounds for obvious reason. Common sense has prevailed in the balance between physical activity and safety.

Bad things sometimes happen when students interact with each other. Sometimes students disagree, and the disagreements can become physical, which on occasion has led to injury. Sometimes children say things that hurt other children's feelings, and sometimes bullying between students happens. School personnel could conclude that the risk of physical or emotional harm might possibly happen as a result of student interaction. They could ban all student interaction at school. They don't, however; in addition to bad things that might happen, good things can and usually do happen as a result of interaction between students. Furthermore, students will eventually have to interact with others. If children and youth are not allowed to interact while in school, where will they learn to deal with each other? For those reasons, it would be considered ludicrous to attempt to ban interactions between young people at school despite the realization that bad things sometimes happen as a result. School personnel provide supervision in order to mitigate damage happening as a result of student interactions, but students are allowed and even encouraged to interact. Once again, common sense has prevailed in the balance between student interaction and the need for physical and emotional well-being.

If I stopped there, a person might conclude that common sense is a major guiding factor in the dictation of school policy. The person would be sadly mistaken, at least with regard to the  particular school I mentioned earlier. Allow me to elaborate.

When I worked as a substitute teacher, the students were working on the geometric concept of determining the areas of triangles. We all remember that the area of a triangle equals one half of the product of the base and the height in square units. If a triangle's height is four inches (The term height is used as opposed to length to differentiate between the length of one of the other sides in a three-sided object; the height is the number of units between the base or bottom and the  point or vertex at which the other two sides meet. Any of a triangle's three sides can be designated as the base with the same result being reached) and the base is five inches in length, four and five would be multiplied, then divided by two. The answer would be ten square inches, with the term square being used because when multiplying perpendicular units, square units result.

We all have sufficient background knowledge to comprehend that any given triangle is one-half of the surface area of a rectangle (one with the dimensions of its base multiplied by its height). Most nine- or ten-year-old children don't approach the lesson with that level of background knowledge. In the olden days, a child would simply have been told that  base times height over or divided by two is how the area of a triangle is calculated, period. Commit it to memory, kid. It didn't seem to matter whether a kid understood why it was that one-half of (the base times the height) equaled the area of the triangle. It was taught with no thought to concrete understanding or conceptualization.

While I am critical of many modern trends in education, and while I feel that educators have taken many good ideas and have extended them too far, it makes perfect sense to attempt to conceptualize an idea for children. If  child understands why it is that the area off a triangle is the one-half of the base times the height, the child is more likely both to remember the algorithm and to have some idea if his calculation is way off. If objects have been used in repeated attempts to objectify a concept, and if the child still cannot grasp the why of the concept, at some point a teacher almost has to use the old base times height over or divided by two is how the area of a triangle is calculated, period, with the hope that someday in the future, if it is explained again, the child may grasp it. The child cannot be left behind because he cannot understand the underlying concept. He has to learn the concept even if he doesn't grasp the underlying reason. Some of today's educators would say the child is not to be taught the algorithm until he understands the reasoning behind it. The problem with this philosophy is that if the child has trouble understanding this, he may have trouble understanding many other concepts as well. By the time he grasps the underlying reason for any of them, he's years behind his classmates in learning the basic math. He cannot afford to be that far behind; he has to be taught what to do to reach the correct answer even if he doesn't understand why it is that we do it the way we do.

So, because a teacher was out for a complete week, she had to leave it to me, her substitute, to teach the concept and the method of determining the area of a triangle. The teacher had a sudden case of appendicitis (as is typical with appendicitis) and did not know in advance that a substitute would be teaching the lesson plans that she wrote for herself.  Had she known, she might have given me different ways to teach the concept. I attempted to use what seemed to be the logical way of teaching it. I cut a paper into a triangle. I used the standard algorithm to calculate the area of the triangle. I then used the existing triangle as a template to cut another triangle. I had the children direct me in how to put the two triangles together to form a rectangle. With the children, I calculated the area of the new rectangle. We discovered that the rectangle's area was twice the area of the triangle, or that the triangle's area was one-half of the area of the rectangle.

I'm taking entirely too long to express the point that children learn better by doing something themselves than by watching something be done. I handed pre-cut rectangles to the children and asked them to take out their scissors and to cut the rectangles corner-to corner in order to create two equal triangles. The children looked at my dumbfoundedly. "We don't have scissors," one of them finally volunteered. We got through the lesson by folding and tearing the rectangles into triangles, but it would have been both simpler and more effective had the children been able to use scissors to cut the shapes.

At lunch, I asked another teacher why Mrs. Ernst's class didn't have scissors. The teacher and all the others within earshot laughed. One of them explained, "About three  years ago a kindergarten boy cut a girl's hair with scissors. The girl's mother went to the district superintendent and complained. After the next principal's meeting, all of the student scissors in the district were confiscated." No students in the kindergarten-through-twelfth-grade district are allowed to use scissors now because one kindergartner cut a lock of another kindergartner's hair.  

Are scissors potentially dangerous? Yes. Could they potentially be used as weapons? Absolutely. Could they be used by students to cut hair? Obviously. Is that sufficient reason to ban all student use of scissors? I wouldn't think so, but my opinion didn't matter. One teacher mentioned that inevitably a student would eventually poke himself or another student with a pencil or pen and cause an injury. It hadn't happened, or hadn't been reported, since the present superintendent had been in power. The teachers were afraid that the superintendent would ban writing implements when that happened.

Other policies the superintendent had instituted were a ban on all peanut products including peanut butter even in lunches from home because one student in the school had a peanut allergy. (This is perfectly ludicrous but he's not the first principal to have instituted such a policy regarding peanuts.) Tetherball was not allowed because the superintendent feared that a suicidal child might ask to use the bathroom, then go to the playground and  hang himself on a tetherball rope. The teachers said site principals offered to take responsibility for getting the tetherballs on and off the poles so that they would be out only when children were supervised on the playground, but the superintendent insisted that someone would eventually forget, and that might be the one time a child was suicidal and decided to end it all. The teachers told me that one principal then commented to the superintendent that if a child were sufficiently desperate to end his or her life, the child could potentially drown himself or herself in a toilet.  They told me that the superintendent worried about that possibility for a long time and considered banning the use of all restrooms except for the one student toilet in the nurse's office. The superintendent doesn't allow teachers to use paper clips at all in their classrooms because children could turn them into weapons even though it's never happened in the district, or the children might steal the paper clips, take them home, and stick them into electrical sockets. I'm sure there are many other asinine restrictions in this district based solely on the superintendent's unreasonable obsession on safety.

The superintendent's safety obsession, I have learned from a relative who teaches in the district, is in full force today -- the day of the solar eclipse.  It would have been better had he taken the eclipse into consideration when the year's school calendar was developed and had the day declared to be a school holiday. It would have been inconvenient for working parents, but the students could at least have had the opportunity to observe the eclipse. Instead, the superintendent has decreed that on all campuses in the district, a rainy-day schedule will be in effect so that no one is to observe the eclipse. There hasn't been one in North America in thirty-three years, there won't be another one here for eight years, and the students and teachers of the district are going to miss out on all of the excitement and the learning opportunities associated with the phenomenon because he's too cheap to order protective glasses for the children. This blows my mind.

When they learned of the policy, many teachers went out of their way to inform parents of the district policy so that the parents could keep their children at home today if they felt strongly about wanting their children to observe the eclipse. The superintendent will pay a financial price for his absurdity. A large chunk of school funding is based on student attendance. Teachers are guessing that as many as one-third of students in the district will be absent today. The superintendent's lack of common sense will hit him where it hurts most.

I am utterly flabbergasted by the stupidity of this person who has been elevated to a position of authority over every student and teacher in a school district with an enrollment of nearly 20,000 students. 

Cucumbers are not just for salads anymore.

I never met either of my maternal grandparents. My mom's father died about a year after my parents married, which was several years before my twin and I were born. My mom's mother passed away when my mom was fifteen and in her final year of high school.  Though it's not the same as actually having met them, I've heard all the stories my mom and her siblings tell about their parents. Perhaps I've heard even more than I would have heard by way of ancient family lore than I would have heard if if my Grandma and Grandpa were still around.  

They're my only grandparents who allowed anyone to call them "Grandma" and "Grandpa." My dad's parents claim French and insist on being called "Grandmere" and "Grandpere." They probably think the terms sound classier than do the English equivalents. The joke is on them.

My maternal grandmother traveled to the United States as a fourteen-year-old to live with an aunt and uncle in Colorado. She received nurses' training at the University of Colorado College of Nursing and was a registered nurse. Following graduation, she worked as a civilian nurse in a clinic on the premises of the United States Air Force Academy. She met my grandfather when she gave him a tetanus shot after he stepped on a nail that poked through his shoe. He thought she was cute, and he was charmed by her Irish accent. His parents were immigrants from Ireland. My grandparents married almost immediately following my grandpa's graduation from the academy. Ten years later, they had seven children, including two sets of twins. 

My Grandma was a bit of a bohemian, which would have been perfectly acceptable in many circles. Among spouses of military officers, it wasn't all that acceptable. She dealt with not fitting in particularly well by attending only those events she absolutely couldn't avoid.  She survived living in base housing because she was a generous and likable person who was always willing to watch someone else's children for a few hours or who would cook double portions of a meal she planned to serve her own family if one of the neighboring wives was under the weather. Even in a military setting, others are willing to overlook a bit of nonconformity when it behooves them to do so. On two occasions when my grandfather was deployed for lengthy stints, she took her brood back to Ireland, the land of her birth and where her parents still lived, to live among relatives until my grandfather's deployments ended. The family was in Ireland when my mom learned to talk, and traces of an Irish lilt can still be heard in her speech.

Once my grandma's youngest children were old enough not to need immediate supervision every moment that they weren't in school, she sometimes served as a chaperone for her children's various activities. She especially liked accompanying the band and choir groups when they traveled to competitions.  She was a much sought-after chaperone because of her training as a nurse and because she got along with children and adolescents especially well.  The other parents, however, didn't always know what to make of my grandmother's rather frank speech.  

Once, on a school bus en route to a band competition several hours away from their town,  my grandmother shocked the other parents by telling them of how she demonstrated to all of her children, once they were at an appropriate age to know, how to properly put on condoms by using condoms and cucumbers to demonstrate. Some parents were stunned, while others were amused. One mother wanted to know how a person as devout a Catholic as my grandmother was could sanction condom use. My grandmother responded that she didn't necessarily sanction it, but that she sanctioned teen pregnancy even less and felt that keeping kids in the dark was an ineffective deterrent. Another parent wanted to know why my grandmother thought her daughters needed to know how condoms were properly applied. My grandmother answered that if girls were going to be sexually active, they needed to know enough to insist that their partners wear condoms and they needed to know whether or not the condoms were being used properly.

It's probably not so unusual for today's parents to speak so frankly to their children about sexuality, but my grandmother's children came of age in the late 60's and 70's. (My grandma died when her youngest children, my Uncle Kevin and my mom, were 15 in 1981, but she managed to give them the condom demonstration before she moved on.) Some of the other parents apparently thought my grandma was practically encouraging her children into sexual activity.  I don't know for certain whether or not any of them were promiscuous, but I do know that none of them either had children out of wedlock or married because a baby was on the way, and neither have any of their children done so. Three of us are still unmarried, so the verdict is not yet entirely in, but, for the most part, it can be said that my grandmother's frank approach to prevention of pregnancy  was successful. The same cannot be said for my other grandparents' offspring and for their offspring. 

I've been told before that I am too direct in my communication.  I don't know if such a specific personality attribute can be genetically transmitted or if I acquired the quality of bluntness from my mother who picked it up from her mother. Either way, I come by it quite naturally.

Friday, August 18, 2017

When the Moon Is In the Seventh House

I'm growing rather tired of this temporary cast. It's unbelievably bulky and itchy, Temporary casts are almost always very uncomfortable. It's most noticeable at night; when a person is trying to sleep, the affected part aches in places it wasn't even injured just because the temporary cast is so uncomfortable.  I was a little concerned because I counted my Vitamin V tablets and discovered that I'd taken more than I had planned to have taken by now. I still have several left, and the orthopedist says I haven't abused them and that he'll write me another prescription if I run out. While that is good to know, my aim in life is not to become a stoner.

Baths and showers are a major production with an above-the-knee cast. I ordered a plastic cast-cover, which arrived yesterday. The cover is both easier to use and more effective than is a kitchen trash liner used for the same purpose, but it still doesn't allow for full immersion. I am capable of getting myself into and out of the tub, but showers are simpler with a high cast. I knew this before because it's not my first fracture requiring a full-length cast, but one would be surprised at how many of life's daily activities are made significantly more complicated with the inability to bend one of one's knees.

My job is obviously tougher with a cast and crutches. Some procedures are not safe for me to perform while standing. Sitting on a high stool isn't all that easy or comfortable with a full-length cast. i will spend a bigger portion of my time in this clerkship just observing than I have in previous rotations.  Many of my cohort mates have done just that for most of their clerkship experience, though. I've been fortunate to have been supervised by attending physicians and residents who have trusted me enough to have allowed me to have more hands-on experiences. As my knee recovers and I can spend more time standing, even with crutches, I hope to get to participate at least a bit more in patient care in the pediatric portion of my gastroenterology rotation.

It's now time for a psychedelic experience. I've tolerated enough pain for the night. I am taking a Vitamin V  and will soon be tripping. I will see without the use of my eyes, will hear without ears, and so forth. I will be one with all things living and non-living, and my consciousness will swirl through the entire universe. Unfortunately, I'm lying.. it's just Vicodin, not LSD, but I can imagine.

Jupiter is supposedly aligning with Mars here.

Wednesday, August 16, 2017

crazy versus stupid, and how to tell the difference

I had a post-surgical appointment with my orthopedist on Tuesday afternoon, followed by an appointment with the dean who oversees the students in my cohort. my surgical wound looks as it should look, and the swelling seems to be on the decline. I will be allowed to work mornings for the reminder of this week. When I get my permanent cast (meaning the hard fiberglass cast I'll have until my leg heals, not meaning I'll have it for the rest of my life), which I hope will happen on Friday, I will be allowed to work more hours per day. Because I have a knee injury on the leg that doesn't have broken bones attached to it, and because the knee will not heal if I don't spend more time off it than on it, I will be limited to eight-hour workdays for at least the reminder of this month. 

As I waited for my friend to drive me home following my appointment with the dean, a third-year medical student consulted with my friend who was transporting me. The subject of their consultation was a patient the two of them had seen earlier in the day in their emergency medicine rotation. The patient had been given instructions on how to care for a wound at home. The third-year student expressed concern that the patient may lack the competence to follow the discharge instructions. My friend, a fourth-year medical school student, was less concerned. My friend explained to the third-year student that while the patient seemed a bit nutty, she clearly was not stupid.

"Stupid, crazy . . . What's the difference?" the third-year student said, throwing up his hands. 

There is actually a rather large difference. I told the third-year student the story that I've told here one before. I copied it from another person's blog tonight because I'm too lazy either to find my own version in my blog or to re-type it from scratch. Here it is.

A truck driver was doing his usual delivery to the Mental Hospital. He discovered a flat tire when he was about to leave. He jacked up the truck and took the flat tire off. When he was about to replace the flat tire with the spare tire, he accidentally dropped all the nuts into a storm drain. Realizing he can't fish the nuts out, he starts to panic.

A patient walking by asks him what happened. The driver told him his problem.

And the patient said, "
Here's what you can do: take one nut each from the other 3 tires and then tighten them onto the spare. Then replace the missing ones as soon as is practical. It's as easy as that!"

The driver was very impressed and asked: "You're so smart . Why are you here in a Mental Hospital?"

Patient replied:  "Hello, I am here because I'm CRAZY, not STUPID!!"
Source: cook'n & eat'n
My friend asked which is worse: stupidity or insanity. The answer would depend on the situation, the degree of either stupidity or insanity present, and the particular form of insanity.  If a person suffer from a form of mental illness that causes him or her to  hear voices that tell him to harm himself or others, that's probably the worst-case scenario, and in that case, insanity is probably worse than any form of stupidity could ever be. If, on the other hand, a person merely operates under the assumption that he or she is Emperor Hirohito, his or her insanity is probably less an impediment to following discharge instructions than stupidity would be.

I've seen some crackerjack cases of stupidity when it came to complying with medical instructions or even with living in general.  One patient was putting her inhaler up to her nose when using it. She thought all of the inhalers were defective, as she continued to wheeze after using them. Another was taking rectal suppositories orally.  Another patient had her boyfriend take her birth control pills because they caused her to gain weight. Perhaps they did cause her to gain weight, but not even close to as much weight as the resulting pregnancy caused her to gain. One guy used his ringworm medicine for hemorrhoids. The medications for both hemorrhoids and ringworm should be the same thing because both hemorrhoids and ringworms are basically round. (?!?!?!?!) An overweight patient who was consuming the nutritional shakes in addition to meals (and dessert) instead of in place of them. She thought the shakes contained an ingredient that would magically cause her to lose weight. In each case the instructions were stated explicitly.

Whatever anyone does to himself or herself because of stupidity is at least fair. What's unfair is when a child suffers because a parent is too stupid to comply with medical instructions.  We had a parent who put her child's ear drops in his mouth. Another patient didn't fill the prescription for topical ointment for her kid's yeast diaper rash and instead used leftover medication from her own yeast infection. (A topical medication that is to be used for an external infection would have to be much stronger than would one for an internal infection. I wouldn't necessarily expect the woman to know this, but I would expect her to at least ask before using the wrong medication on her baby.) Another parent for some reason thought all of her children were protected from chickenpox if just one of them was immunized. (I can't understand how she even came up with that.) A child with a known peanut allergy was brought to the E.R. for anaphylaxis from eating peanuts M & M's. The parents thought the peanuts in peanut M & Ms were fake peanuts.  A six-month-old baby came for a well child exam with Dr. pepper in his bottle. We knew it was Dr. Pepper because the mother admitted it. The doctor was far more patient than I would have been in thoroughly detailing all the reasons why babies should not have Dr. Pepper or other soft drinks. The child came to the office about three weeks later for an ear infection. The mother proudly showed us her baby's bottle and told us that she was following the doctor's orders. Instead of Dr. Pepper, his bottle was full of Mr. Pibb. The doctor actually walked over to the wall and banged his head against it.
Unless a parent is so far gone that voices in his or her head are telling the parent to drown a child in a bathtub or elsewhere, stupid is usually far more dangerous to a child than is crazy.

Monday, August 14, 2017

the grass Is always greener if you water it

My next appointment will be early Tuesday afternoon. I won't be allowed to return to work until after that appointment at the very earliest. I want to get back to work as soon as possible. I don't like being stuck here with so little to do. I'm reading and watching many videos to distract myself. It's better than nothing. Back in the olden days, I would be limited to whatever books I could talk someone into buying or checking out from a library for me. Now all I have to do is to click once on amazon to purchase the book and once to open it in my kindle reader. I'm not a huge fan of much of today's social media, but I'm not against the information age as a whole. The instant  access to any book available on kindle is mind-blowing. 

I really don't mean to be a whiner. People exist who are so overworked that they would love to have almost a week to lie around reading and watching whatever suited them even if they had to suffer broken bones and a torn ACL to get the much-needed rest. Please humor me as i attempt to view my circumstances through a more rose-tinted lens. I wouldn't willingly break bones and tear a ligament to have a few days off, but others toil away day after day at jobs so demeaning or oppressive that this enforced rest would seem like veritable paradise to them. I'm fortunate enough to have a job. And, since I'm not being paid to do the job even when I'm there, I'm not losing out on any income by not showing up. I am endeavoring to be a glass-is-half-full sort of person as I make ludicrous assertions in trying to convince myself of just how great things are for me right now.

The job I have is not exactly a proper job, as instead of being paid to do it, I'm paying a university a whole lot of money for the privilege of doing it, yet it is my work for now. It is the culmination of eighteen years of study if I count preschool, which (counting preschool)is probably a bit preposterous. Still, I've studied for a long time to be prepared to come into contact with real and living patients who are not just pretending to be patients. It's virtually impossible not to be excited when the opportunity has finally arrived.  

Children and adolescents grow so weary of hearing adults tell them that they need to study and learn the very best they can in school in order that their career options may be as limitless as possible. As much as they get tired of hearing it, it is, nonetheless, true. Regardless of our diligence as students, some professional and vocational limits are a reality for most of us. I could have studied and/or practiced for every waking hour that I wasn't in school or eating, but I still could not have been a professional athlete. I lack the physical prowess needed for any professional sport.  Furthermore, at least one area of specialty in medicine is not available to me because I lack the physicality to perform some aspects of the job.  

Because I have reasonable intelligence and because I studied diligently in school, however, my career aspirations were limited by only physical constraints. There probably wasn't a career option that was unavailable to me by virtue of any lack of cognition. Nuclear physics, for example, would have been a stretch for me, and I would have struggled in completing the required education for the field more than would much of the competition in the field of study, though I would have been accepted for training into that or virtually any other similarly cognitively demanding field and, with sufficient focus and effort on my part, could have completed the program of study.  I'm certainly not stupid**, though neither am I all that much brighter than have been my classmates. What I am is a very hard worker who developed excellent study skills. 

Some students may have more limitations than most of us have, but almost any student who studies diligently and effectively enough should be able to find a career that would hold his or her interest and would provide adequate financial support for him or her provided that he doesn't spawn babies with almost every female residing within his zip code. And admittedly, some individuals, usually through no fault of their own,  struggle with physical, cognitive, or learning deficits that close off all but the most basic and menial of career options for them.  Be that as it may, such is not the case for the vast majority of us.  Most of us are limited primarily either by past efforts or by  the efforts we're willing to put forth now and in the future, and not so much by any inherent weaknesses we may possess. 

Even finances are not an insurmountable impediment to the fulfillment of the education of our own choosing. If we're willing to take on the burden of incurring some debt, and if we use the funds we've acquired through student loans wisely and devote the time and attention to our studies that would need to be given, lack of funds isn't really a reason why we cannot complete the course of education we would choose for ourselves. It's absolutely dispiriting to have to rely on debt and to have to take on  extra employment to get through through university while seeing others receiving generous grants and scholarships or whose parents foot the bill for their educational costs. 

A person would probably be abnormal if he or she were not at least a bit disgruntled by the imbalance and unfairness of it all. It's best, nevertheless,  not to dwell too ponderously on the un-levelness of the playing field, because, to quote a rather trite [but still true] aphorism, it is what it is.   Or, if it sounds better coming from the mouth of Bruce Hornsby, "That's just the way it is. Some things will never change." The Trump children have a cushier path to success than do the Rousseau children. The path undertaken by the Rousseau kids is likewise far less embedded with figurative booby traps than is the path traveled by the progeny of the Jutes and Kallikaks, for entirely different reasons. Whatever the path that anyone's particular circumstances have carved out, the person can see both those who have it easier and those for whom things are far more challenging. Read or even memorize the Desiderata for help in maintaining perspective in this regard.

In relation to a matter about which I cannot, at the present, share specifics, I'm facing ethical and legal challenges at the present. My instincts tell me  that I'm not the person who faces any serious peril in this situation, but there is tremendous potential for my superiors to be angry with me. Instincts notwithstanding , I will feel much more at ease if or when I hear from my superiors that I face no dire consequences and do not have to rely solely upon my instincts to tell me this. I'll be more specific when I can.

The turmoil in D.C., Virginia, North Korea, and wherever the next disaster strikes is more than sufficient to fuel my anxiety.  I would gladly abdicate the drama of my personal life, and will be greatly relieved when someone in power tells me I no longer have cause for concern.

On that note, have an awesome week, everyone!

Saturday, August 12, 2017

Chawneys, Bad Teeth, and Other Elements of British TV

To combat the boredom of being housebound, after reviewing my work-related material until I can outline it from memory, I have taken up the hobby of watching Youtube videos.  I've discovered a world of Youtube sensations, some of whom are sensational only to me.*

I've also discovered an abundance of British programming and documentaries. I discovered The Jeremy Kyle Show, which has a bit of a  Jerry Springer/Steve Wilkos format but with a snarky British twist. Jeremy Kyle openly mocks the guests on his show. I'm curious as to how much Kyle's producers have to pay their guests in order to get them to humiliate themselves on national T.V. Plenty of people in the U.S. seem more than willing to do it practically for free, but I would expect the British on average to possess a bit more dignity than the trailer trash Jerry Springer/Judge Alex/Dr. Phil/ Judge Judy clientele. There was supposedly a time in the history of the U.S. in which a person could only be found humiliating himself or herself on TV on perhaps The Newlywed Game or The Amateur Hour. Then came The Gong Show**, and the rest was history. Programming in which people willingly air their dirty laundry and/or expose their two-digit IQs is probably more available now than is scripted programming. I'm not certain what if anything that says about our society other than that it's damned tough to turn away from a train wreck.

One of my Youtube discoveries was the British documentary series The Nightmare Neighbor Next Door.  It's an ideal series for Britain, because it seems that the British middle class lives in closer proximity to neighbors than does the American middle class anywhere other than in New York City.  Even though the British might, for the most part, conduct themselves with ever so slightly more civility than do their American or Aussie counterparts, proximity and familiarity would seem to provide an exceptional breeding ground for contempt. 
Where only in  the U.S. could a reality program be made featuring the repossession of cars, only in Great Britain could a quality program featuring neighbors hating on each other provide entertainment. If the "nightmare neighbor" concept were used as a reality TV plot in the U.S. or Australia, the warring factions would probably kill each other before any decent footage was obtained. Besides that, there's something about hearing neighbors rag on each other with snooty British accents that makes it all the more delectable.

It was while watching The Nightmare Neighbor Next Door that I discovered the Chawney Family. They were the first set of residents I saw whose neighbors turned on them in an ugly but understandable way.  The Chawney family featured two parents and their two twenty-something daughters. Their son -- older than his sisters -- lived elsewhere. The family had two dogs (one especially obnoxious pooch had an especially shrill and yappy bark that could be heard continually for most of the day and night; I'm not sure when the animal slept), two cats, and two birds.  Neighbors complained that the family members fought with one another constantly, that they yelled at their animals, that the animals made constant noise and that, on the rare occasions that dogs were taken out, no one picked up their poo. The straw that metaphorically broke the neighbors' camel's back happened when Emma, the older of the two daughters, decided to audition for The X Factor, and frequently practiced her singing in the street outside the family's home at 3:00 a.m. It was the twilight hour rehearsals that ultimately provided the ammunition for the neighbors to have the family evicted.

The video features Emma's initial appearance on The X Factor. She returned the following year. As a kindness to my readers, I will offer the caveat that the video might not be suitable for the pitch-sensitive among us***. I do not own the video and sincerely hope not to have affronted the video's owner by sharing it in this blog.

A both figurative and literal un-thickening of the plot came about when the family appeared on some British program focusing on weight loss and fitness for the morbidly obese. The combined weight of the four family members was at one time reported to have totaled either eighty-three stone or ninety-three stone depending upon which report one chooses to believe.. (A stone equals fourteen pounds. I'll allow you to do the math.) I'm not sure  how many different programs on which members of the family were featured, but they became quite the national celebrities of the "famous for being famous" ilk. I supposed they could be described a Great Britain's version of our Kardashians.

My viewing of The Nightmare Neighbor Next Door and other British programming prompted me to ask the age-old and oft-asked question of why it is that more British than American or Australian people appear to have unsightly teeth. I googled the topic. it seems that the British have become sensitive regarding what they see as a stereotype concerning the state of dentition among their population. Studies have been conducted [by Brits] recently, the findings of which have disputed the stereotype. Those who conducted the studies compared the teeth of Great Britain's middle class to the teeth of the U.S.'s present and former methamphetamine addicts and found the British teeth to be both cosmetically and structurally superior to those of the U.S. meth addicts. They concluded, therefore, that the popular perception equating British middle class with bad teeth is nothing more than a myth. Right.

In an equally scientific study conducted by yours truly in the days since my malleolus was fractured, I have viewed equal numbers of episodes of Supernanny (US) and Supernanny (UK) and have compared the teeth of those featured on the respective programs. The teeth of the British middle class truly are worse than those of the american middle class. In an equally scientific study, I consulted scholarly periodicals to determine that the families of the British royals and even the commoner families into which they married either are born with perfect teeth or have access to quality dental care including orthodontia****. 

Is there a shortage of orthodontists in Great Britain, or are there plenty of orthodontists there, and all of them starving because the general population does not give a hoot about having straight teeth? 

If a shortage of cosmetic dentists and orthodontists is determined to be the cause of the discrepancy, perhaps I should abandon the practice of medicine altogether in order to become an orthodontist somewhere in Great Britain, in which case I might soon become a billionaire. Then again, perhaps I should not. I would quite possibly starve because, rather than joining the world's ranks of billionaires,  I might not earn any money at all due to not being able to force myself to go to work because of the compelling nature of the television programming there.

*    Check out the Stormin' Mormon on Youtube if you get the chance.

**  My aunt dated a guy whose sister won The Gong Show by singing while doing bird calls, frog croaks, and other miscellaneous animal noises in the middle of her song. She was a talented and trained opera singer; the animal noises she just picked up on the sweet potato farm.  My aunt, the guy she dated, and another tuba player were supposed to appear on "The Gong Show" as a trio that played basketball and tuba at the same time (they used Nerf basketballs and threw them into the bells of each other's tubas), but one of the three of them was too hung over to travel on the assigned day, and the other two decided that the show didn't necessarily have to go on.

*** Seriously, I could barely tell what song she was trying to sing, and it's a song I and probably all of you know well.

****Kate and Pippa Middleton are not walking around with overbites or with gaps between their teeth. i know this because I checked it out in People and Us magazines, both of which are known to be erudite and authenticated academic works.

Friday, August 11, 2017

Trump or Kim Jong Idiot: Who Has Less Self-Control?

I don't often delve deeply into politics in this space. I have no qualms about discussing specific politicians I consider good-looking or at least mildly cute, and neither do I hesitate to mention it when I find a given politician distasteful, boring, or especially lacking in competence or intelligence. Regarding the broader issues, or even why individuals chose to vote for whom they did, however, I mostly leave it alone.  No one is going to change anyone else's mind either on social media or on a blog.  Few good things and all sorts of bad things come as a result of attempting to create posts of substance in regard to partisan politics. All of this notwithstanding, I shall go against  my personal policy at this time. My intent is not to offend anyone who will read this, and I hope I don't.

The 2016 election was the first presidential election in which I was eligible to vote. The election was a disappointment to me.  Neither party offered what I could consider a viable candidate. The democratic candidate seemed to me to be ideologically close enough to me for me to vote in her favor, while I had and continue to have issues with her integrity. For most of us there will seldom if ever be a perfect match with a candidate, or at least with a candidate chosen by a major party. In a normal election, we all have the luxury, if we choose to exercise it, to vote for a candidate who has no actual chance of winning the election based on our convictions that the person is a superior candidate. 

In a closely contested election, however, the reality is that a vote cast for a minor candidate is, in reality, a vote in favor of whichever of the two major candidates one finds less suitable to hold the office. In a nail-biter as we had in 2016, either the democratic party's candidate or the republican candidate was going to win the election, which has been the norm for many years, but the 2016 presidential election was so tightly contested that your vote or mine might actually have mattered. It was probably the wisest course of action in 2016 to have looked closely at the candidates and to have decided, even if neither candidate was anyone's idea of a dream candidate, whether one of the two was especially distasteful, and to have cast a vote in favor of the other one. Once the major parties chose their candidates, at least in the 2016 election, either Clinton or Trump was going to be president. Even though, when presented with such a Hobson's choice, the temptation to vote for an obscure candidate or to write in the name of somebody's pet might have been overwhelming so that when whatever would inevitably go wrong ultimately did go wrong, one could quite honestly claim none of the blame, the wiser option was to examine the slate as presented by the major parties and to vote for the lesser of the evils. We were all going to have to live with one candidate or the other following the 2016 election; it was prudent for anyone eligible to vote to choose wisely.

The voting public spoke and, according to our present system of the Electoral College (which is no longer relevant in my opinion and is an inane way of selecting a president), Trump was elected to our nation's highest office. While I didn't like the outcome, I could accept that a portion of the voting public was every bit as disturbed by Clinton as I was by Trump.  It wasn't exactly easy for me to vote in favor of Clinton, either. The quandary in which the two major parties placed us created a difficult situation.

What I don't understand, however, is that many voters actively chose Trump as opposed to opting for what they considered to be the lesser of two evils. Everyone has a right to his or her opinion. Still, I cannot comprehend how any lucid person could believe such a  pompous, bombastic, unstable, venom-spouting reality TV icon would be even a fitting chief executive for our government of, by, and for the people, and worldwide representative of all that is American, much less a competent steward of the black box containing controls for our nuclear weapons.  From public opinion polls and news accounts, the man was the first choice of a portion of those among us capable of registering to vote and of filling out a ballot.  The people of whom I write didn't merely opt for Trump because voting for Clinton was an unconscionable prospect for them; they likely would have voted for him regardless of who opposed him. The very idea flies in the face of all reason.

Now we're seeing the results of the choice made by the unwashed masses of our society. Once again, I don't fault anyone who voted for Trump solely because he or she felt Clinton was unsuitable for the office of president. The two major parties put us all between the proverbial rock and hard place. I voted as I felt had to vote. You did the same. The collective fault belongs neither to you nor I.

Donald Trump and Kim Jong Un are engaged in a pissing war, boasting of superiority and threatening each other with nuclear weapons, when neither will face close direct contact with said weaponry. Both of them will be holed up in the most protective bunkers their nations can devise if and when the nuclear warheads fly. 

Members of the military -- your cousins and mine, some as young as eighteen years of age -- will suffer the consequences of this battle Trump and Kim Jong Idiot are puffing out their chests and proposing to start.  While Trump is protected in the comfort of Cheyenne Mountain or some other fortress, young people on the front lines and otherwise in harm's way will lose their lives. Even civilians living in South Korea are in grave danger, as are those living in Guam, the Philippines, and a host of other locations. For all we know, we're not even safe here. There isn't room for all of us in Cheyenne Mountain, though Trump's extensive progeny likely has reservations there or in another similarly protected location. 

I'm not suggesting we should continue to allow North Korea to build their nuclear arsenal. I am saying that the preservation of the ego of our president isn't a sufficient reason for him to be allowed to make incendiary comments and tweets that may unnecessarily cause an erratic head of state with delusions of grandeur to unleash whatever nuclear warheads he has with the intent to to take out as many Americans and American allies as possible on his way to Hell*. Trump, work with your advisers, who are, I hope, a whole lot smarter than you are, to devise a well-conceived plan, and follow it. If that involves the use of heavy weapons, so be it. But don't start a war we're not quite ready to fight because you cannot control the words that come out of your mouth or travel from your fingers to your phone or computer keyboard.  Shut the fuck up, Donald Trump, before you get my cousins and their colleagues killed!

This is stupid, I admit, but I'm all for Trump and Kim Jong Un traveling to a remote location, taking with them the weapons of their choosing that will not harm anyone other than the two of them, and fighting it out in any way they choose as long as only they will be harmed by their actions. This is becoming a war between the two of them, anyway. Why not let them fight it out? Even Alexander Hamilton and Aaron Burr had the decency to schedule a duel and to leave others out of their personal feud.

*Hell is a figurative term here. I'm not convinced of its actual existence as anything other than a state of mind.

Thursday, August 10, 2017

The Girl With Kaleidoscope Eyes

Tuesday evening my left lateral  malleolus (the bony protuberance at the bottom of the fibula on the outside of the ankle) was fractured as a result of a blow from a hard and dense flying object. My left cuboid (a small bone in a cluster of bones just above the metatarsals) also endured an evulsion fracture, which would have happened when I fell to the floor following the initial impact of the flying object.  My anterior cruciate ligament was also partially torn. Mild displacement of the malleolus was present. I was initially given a soft cast and told by an orthopedic resident to see an orthopedist on Thursday, but the attending physician supervising me for my gastroenterology rotation called me very early Wednesday morning because the orthopedist and radiologist who had reviewed my x-rays recommended surgical setting of the bone (open reduction internal fixation, or ORIF, it's called, meaning that the bone is put into place, then a plate is attached, usually with screws or pins).  Concern about possible damage to dorsalis pedis artery dictated that surgery needed to happen sooner rather than later. My brother drove me to the hospital at 4:40 a.m. on Wednesday, and I was immediately prepped for surgery.

My surgery went exactly as planned, I was told. I somehow thought in my drug-induced haze that I had a boot over my injury, but the area has been enclosed in a cast to my mid-thigh -- higher than it would otherwise be  because of the injury to the ACL. The doctor really wants me ACL to heal without surgery, as do I. I will need to use crutches for six weeks. I'll be in the hospital until Friday. I may be allowed to return to work as early as Tuesday.

I'm not really hallucinating now, but neither am I feeling much pain. Negotiating for drugs has been a bit like participating on "Let's Make a Deal." Fentanyl seems to be the drug of choice these days, but I dislike it and fear it. I don't care for morphine, either. I'll deal with Demerol or Dilaudid if necessary, but's that's as far as I want to go with IV pain killers. My brother already filled my prescription for Vitamin V that one of the residents gave me Tuesday night, so I can use those if there isn't time to fill whatever the surgeon gives me when I'm discharged from this place.

My supervising attending physician has been very kind to me, especially considering that the accident wasn't in any way connected to him. I had already put in a full 50 hours for this week by the time I left the hospital on Tuesday night. I did so last week s well, which means that I'm ten hours ahead.  Still, he's taking the position that because the accident happened at work, I should not be penalized  for needing to be off work any more than I would be if I were a paid employee of the hospital and now on Worker's Comp. (From what I've heard about worker's Compensation, I'm very fortunate not to be dealing with the nightmarish red tape associated with it.) My uncle was injured on-the-job when he was a resident. He told me that if he were ever injured on-the-job again, he would drag himself home and would lie with his hand on a stack of Bibles if necessary in order to convince everyone concerned that the accident had not happened at work and was, therefore, not subject to Worker's Compensation regulations.

I was concerned about an earlier blog I had authored describing the accident, as I didn't want to suffer any wrath from my medical school's powers that be. He asked if he could see the blog. I brought up a draft of it that didn't identify my URL (I don't need additional scrutiny). He read it and said it was fine. It painted my former supervising resident in a somewhat negative light, but, he said, deservedly so, and was mostly a recitation of events with the minimal judgment  of only a few adjectives interjected on my part as commentary to the dialogue offered by the former supervising resident.  Since I have no intention of suing anyone, it's fair game, he said,  to share what was said in the heat of the moment. Since I'm not naming my medical school, my administrators don't have to fear being made to look bad by my recounting of the events.

I was set to begin my sub-internship in October. My preceptor was contacted, and she made the necessary contacts in order to delay my externship until November. With some specialties, it really wouldn't matter one way or another if I were in a cast, but with a pediatric surgery specialty, I will need the ability to be on my feet. I will have my neonatology clerkship following this one, and will then fulfill my sub-internship. In some ways it might be better to get a bit more experience with neonates before potentially assisting with their surgeries, anyway.

If I were a religious zealot, I might say the leg injury happened so that my schedule could be changed for the better. I'm not a religious zealot, though, and I don't believe that silly line about everything happening for a reason. The flying object hit my fibula because I was in the wrong place at the wrong time. Period.

Perhaps I look a bit this way right now. IV opioids are potent.

Wednesday, August 9, 2017

Alexis in the Sky With Diamonds

what I may look like in twenty-four hours

I was the victim of a freak accident at the very end of my workday earlier this evening, and now I'm in extreme pain. I didn't bother to fill a prescription for pain meds because I didn't think they would be needed. Suffice it to say that I was wrong. Dead wrong.

My supervising resident and I were going over charts. My presence isn't really needed in order for him to go over the charts, as the guy does not allow me  to actually write anything in a patient's chart, but he has been unbelievably reluctant to allow me to leave before his workday has finished even though my workday has usually started roughly two hours before his began. He invents work for me so that he can justify making me stay. He asked me to read all of the charts before he made notations and to comment. He then made his notations and asked me to read them. In most cases he wrote down what I said verbatim. The activity was a complete waste of my time.

For some reason unbeknownst to me, the resident had his laptop in the physicians' computer pod.  Residents don't usually need their personal laptops, but his was there, plugged in and charging. As he was finishing up, he picked up his laptop, apparently forgetting that it was plugged in. The adapter part of the charger flew off the table on which it had been resting. It swung and hit my left lateral malleolus (the wide protuberance of the fibula where it reaches the ankle) very hard and probably, judging from the residual bruise, struck my ankle with one of its edges. It was a relatively flukish occurrence -- probably not even in the top five of flukish accidents involving me, but still a rather freak happening. I don't think the two of us could recreate the mishap with the same outcome if we attempted it a hundred times.

My immediate reaction to the rendezvous between my fibula and the resident's charger was to fall to the floor, clutching my ankle, and to let loose with a string of expletives. The resident was at first taken aback by my choice of words and by the volume at which I unleashed them, and lost no time in rebuking me for having risked offending someone. Then another resident standing nearby took a closer look at my ankle and said it appeared to be broken. "No fucking way!" the supervising resident blurted out at roughly twice the volume I used in my expletive rant. I can only assume that the degree of affront caused by the utterance of expletives is to be considered inversely proportional to the importance of the person from whose mouth they emerge.

My supervising resident knelt to look at my ankle.  "With ankles the size of yours, " he rationalized, "you really should keep them covered for your own protection. My charger could not have hit you that hard.  This was not my fault.
You have defective bones."

"Way to blame the victim, spaz," another resident contributed.

Someone sent a nurse for a wheelchair and someone else got ice. I was taken to radiology and wheeled in ahead of God knows how many people who were waiting. I suppose there should be some advantage to having been maimed by a senior resident. A technician quickly took the necessary shots of my leg. The films were ready almost immediately. The residents huddled around them. My supervising resident was incredulous at what he saw. "It had to have been broken before my charger hit her!" he insisted.

"Right," another resident responded. "Your charger just happened to hit her foot in exactly the place where the bone had previously been broken. She managed to work all day on a broken fibula without once complaining about it. You realize how stupid that sounds, don't you?"

The supervising resident then turned to me. "You know I didn't do this on purpose, I hope," he told me.

I laughed. "You couldn't have done it on purpose if you had tried," I answered.

The jerk actually argued that he could have purposely have done it if he had tried. I didn't even engage him. I looked away and let him talk to the wall. It's the same moron who insisted that there's no such thing as perfect pitch. He would argue with a cadaver if there were no live body present.

"I'm really sorry," he said for the first time.  

I accepted his apology. Someone went to show the X-ray to the orthopedic resident who was on the floor. I was moved from the X-ray room to an empty exam table. The orthopedic resident came in and poked and prodded, then felt my toes to ensure that the blood supply was getting through. He told someone to put a temporary cast on it and said I needed to be seen in two days. He said that someone needed to give me a prescription for hydrocodone. I said I wouldn't need it. He told me to fill it anyway. I didn't. 

He was right and I was wrong. I've been awake with my entire leg throbbing all night. I suspect that in addition to the fracture, I did some additional damage when I fell. Matthew has to be at work at 6:30. He will drop my prescription off then. I'll get someone to bring the goods here for me.

The resident told me not even to think about showing up tomorrow (which is now today). Someone drove me home in my car. I'm not sure how the person got back, but I don't him lurking outside, so I assume that someone must have picked him up. 

I've been watching youtube videos all night in a futile attempt to distract myself from the pain. I had forgotten how much fractures hurt. I still think I'd take a fracture over a perforated intestine as long as it's not a spine, skull, hip, or pelvis fracture, but it's far from a fun way to spend an evening. I don't plan to be in pain tomorrow night. By this time tomorrow I will probably have kaleidoscope eyes.

Make Love, Not War

Image result for flower child

The child pictured here is not my mom, as my mom doesn't allow pictures of her to be posted on my blog. it might just as well have been my mom. I'm told that she was one of the original flower children. She used to write "Make Love, Not War" and draw peace signs with chalk on the sidewalks outside her family's home when she was two. (She was precocious to the extent that she made me look like a late-bloomer by comparison.)  Her political expressions didn't go over terribly well, as her father was an air force pilot, and her family lived in base-owned housing at the time. 

The local Catholic school that educated her siblings allowed her to enroll in kindergarten a year early because their enrollment in kindergarten was low that year. Most of the year was uneventful for her, as she did her work quietly and didn't bother others. 

My aunt said there was a problem once because my mom wrote once "Free Love" on the top of her spelling test. The nun who taught her class insisted that when she got home, she must ask her mother what was the meaning of the term "Free Love," then come back and report it to the class the next day. Her mother told her that "Free Love" meant living with a person of the opposite sex when the two were not married. i'm not sure exactly what the nun/teacher hoped to accomplish by this, but by the end of the day, every kid in the class who could write was writing "Free Love" on his or her paper, and they all knew what it meant, or at least knew the G-rated definition of the term.. They apparently told their parents that Erin had taught it to them. 

Several of the parents called my grandmother to complain about her daughter providing sex education to their offspring. (My mom did not yet have a clue as to the mechanics of sex.) My grandma pretty much passed the buck and blamed the nun/teacher. She told the other parents her daughter had only written the slogan on her own paper, but that the nun had called attention to it and made a huge deal out of it, requiring that my mom recite the definition of "Free Love" in front of the class.

Still, my grandmother had better things to do than to field phone calls from irate parents of my mom's classmates, so she taught my mom a few other slogans to write. My mom learned "Flower Power," ''Groovy,' "Sock It To Me," 'Smile! God Loves You," "Have a Nice Day," "Right On," "Stamp Out Reality," "Sock It To Me," and others. One mother of a classmate eventually called to complain about my mom teaching her kid to say, "Look it up in your Funk & Wagnall." (The kid was too dumb to write that or anything else, including his own name.) My grandma was at an officers' wives' club meeting that night, and my grandfather had to take the call. He was dumbfounded, but eventually got a word in edgewise in order to tell the woman that "Funk and Wagnall" was a publisher of encyclopedias, dictionaries, and other reference materials. The rather dim bulb thought the term was some sort of expletive. 

Children's vocabularies can be modified, but stupidity is often irreparable.

I don't own this video. I sincerely hope the rightful owner is not offended by my use of it. i added this video after posting because I found it after the fact, but it perfectly depicts the scene of which my mother would have loved to have been a part had she not been less than a year old during the summer of love. she would have enjoyed participating even as a child, but she was born to an air force officer. Alas, some things are not meant to be.

I don't own this video. I included it because it features my mom's favorite song from when she was little. I hope the owner does not object to my use of the video.

Tuesday, August 8, 2017

Tone Deafness Versus Tune Deafness

imnotignoringyou-bla Magnet

I mentioned in my most recent post that true tone deafness does not exist except where actual deafness exists. since then I've researched the concept a bit further. According to research, my statement was correct, but my rationale for it may have been somewhat flawed, or at least not in total accord with the current school of thought as espoused by the expert.

True tone deafness does not exist separately from actual deafness primarily because almost anyone, once taught the musical concepts of "higher' and "lower" in relation to pitch, basically anyone who can hear the pitches can determine the higher or lower of the two except possibly with intervals of only one-half step. Furthermore, few people need to be taught the concept of "higher" or 'lower" in pitch, and nearly all can differentiate between higher and lower even with one-half-step intervals. still, it would be unfair to classify a person as possessing the quality f tone deafness without first ascertaining a basic understanding of the underlying concepts.

I stated in my most recent blog that most people can hear when others sing or play an incorrect note. Such is apparently not always the case. I found a video of a young woman who plays the clarinet. She sometimes adds flats or misses sharps. She doesn't hear the melodic changes (usually not for the better) that are created in doing so.If you know the hymn she is playing, you will hear the A-flat concert (B-flat on clarinet) that should be A-natural concert (or B-natural on clarinet). I would like to have selected a more well-known hymn for non-LDS readers, but for some reason, the young woman who made this video favors they hymns in the LDS hymnal that are not in common with other denominations. C'est dommage!

                      I do not own this video. I hope that I have offended no one in borrowing it.

Sunday, August 6, 2017

Perfect Pitch; What does it mean, and is it even real?


As I was reviewing patient charts on Thursday, a member of my cohort who had just finished his gastroenterology rotation came into the conference area where I was looking over records after the supervising resident physician made notations.  The resident looked up and briefly greeted him. My cohort-mate said to the resident, "So you're working with Alexis now."

It was a bit of a Captain Obvious moment, as there would have been no other logical reason for the two of us to have been simultaneously in the physician's computer pod and passing patient records to one another, but the resident let it go. "Yes," he responded to the preceding comment with no perceivable enthusiasm.

"Alexis is a musician," my colleague told my superior. "She has perfect pitch."

"There's no such thing as perfect pitch," the resident intoned.

"Really?" I queried, though not with any marked incredulity, as I've heard the line before.  

It's all a matter of semantics, though in this case it's also a matter of the resident physician's ignorance as to what is meant by perfect pitch. I don't typically  use the term perfect pitch because it's an imprecise and sometimes misunderstood term. 

I prefer the term absolute pitch over perfect pitch. Absolute pitch refers  to a person's ability to reproduce a given musical tone or to identify a given tone without external reference. A person who can spontaneously produce a given note within a quarter-tone of standard pitch is usually considered to possess the skill of absolute pitch. Likewise, anyone who consistently identifies notes without external reference also would be said to possess the trait. Regardless, the only arguable point in reference to absolute pitch is the criteria used in measuring or determining who is in possession of the skill.  The concept of absolute pitch exists. Some individuals possess the ability to identify pitches or to produce tones spontaneously.

Relative pitch refers to a person's ability to hear notes in relation to one another. This pertains both to the concept of identifying specific tones on a scale as well as to the premise of pitch in reference to a specific note.  When musical tone is produced by voice or by any instrument for which a tone is not fixed, the pitch may, obviously, be higher or lower in relation to any other tone. A person with a strong sense of relative pitch possesses the ability to match pitch vocally or mechanically with accuracy to a greater degree than does a person with a weaker sense of relative pitch. It could be argued that anyone who is not clinically deaf probably possesses some degree of relative pitch. Relative pitch is, as is absolute pitch, a very real concept, and its existence is not a point for debate.

Tone deafness is another pitch-related concept. In actuality the concept is something of a misnomer.  True tone deafness exists, for the most part, only where actual deafness exists.  If a person truly lacked the ability to hear and to differentiate between tones, the first seven notes of "Old McDonald" would sound identical to the first seven notes of "Twinkle, Twinkle, Little Star."  Almost anyone who knows both songs will hear the distinction between the two. What is
most commonly equated with tone deafness is the inability to sing on key or to match pitch. Yet people who cannot sing on key can usually tell if someone else is not singing on key. Singing is a complex skill -- both a motor skill and an auditory skill. Individuals who lack the ability to sing on key either cannot hear themselves as others hear them when they produce vocal tones, or they lack the motor ability to control their voices precisely, or both.  Some accomplished musicians cannot sing on key.* Others can eventually find a pitch with their voices but cannot hit a note cleanly at the outset. Other people can come close to maching a pitch, but cannot differentiate between the production of a tone that is mildly sharp or flat as opposed to producing the identical tone, or matching the pitch. Some people have more refined senses of relative pitch than do others. It doesn't mean that the others are tone deaf, though,  unless they're actually clinically deaf.

I suspect that any confusion over the reality of perfect pitch occurs  as a result of the occasional practice of referring to a person's highly refined sense of relative pitch as perfect pitch. 

One of the nurses with whom I worked in my dermatology rotation recently spoke to me of the violin studies of her ten-year-old son, Ian. The nurse's child was studying violin under the tutelage of the nurse's fiance. "My fiance doesn't believe in perfect pitch," the nurse told me, "but he says that Ian's pittch is pretty darn good."

Along those same lines, when I was a child, I read If You Could See What I Hear, which is the autobiography of blind singer Tom Sullivan (on which the subsequently produced and heavily panned movie of the same name was based.) Sullivan related the story of his being evaluated for placement in a choir by being asked to match the tones produced on a piano by the choir director. The  choir director told Sullivan, based on his vocal reproduction of the piano tones, that he had perfect pitch. 

I asked my mom, who was the only parent home at the time, how a person could possibly tell that another had perfect pitch simply by having the person hum or sing notes that were played on a piano. My understanding of perfect pitch had been that it equated with a sense of abolute pitch, and reproducing the notes one heard would be no evidence whatsoever of anyone's sense of absolute pitch. My mom explained the concept of relative pitch to me, and said that some people considered a refined sense of relative pitch to mean perfect pitch, but that it was a misuse of the term. She explained why, in musical academia, the terms absolute pitch and relative pitch were used instead of perfect pitch.

But what if we agreed,  for the sake of argument,  to equate perfect pitch with highly refined relative pitchWould that, then, support the premise of my supervising attending physician (and of Ian's mother's fiance) and others that perfect pitch is a myth and an unattainable standard, and that no one actually possesses it -- that perfect is, like infinity, an unreachable quality or quantity? No; even equating perfect pitch with relative pitch would not create an unattainable standard, thereby negating the existence of the skill of perfect pitch. If pitch existed only in the ears of those who heard it,  and pitch couldn't be quantified or measured, perhaps the non-existence of the skill of perfect pitch could be supported.  Instruments exist, however,  to measure any pitch's vibrations in a given interval of time, thereby availing the option of standardizing pitch. Likewise, the capacity to measure or to document a person's perception of pitch exists as well.

Again, because pitch can be precisely measured, an individual's perception of pitch can likewise be measured. Hence, even if we used highly refined sense of relative pitch as our standard for perfect pitch, people exist whose senses of relative pitch allow them to differentiate between pitches with differences as minute as a single rotation per minute. Some people can actually hear the difference between four-hundred-forty rotations per minute and for-hundred-forty-one rotations per minute. People with such refined auditory perception are few and far between, but they do exist, which is proof positive that perfect pitch exists regardless of whether its definition is encompaased by the parameters of relative pitch or of absolute pitch. I assume that both my supervising resident physician and my nurse acquaintance's fiance are operating under the assumption that however refined a is person's capacity to distinguish  pitch, it could be better still. Maybe or maybe not, but if a person can auditorially differentiate between one-hundred-thirty-nine, one-hundred-forty, and one-hundred-forty-one vibrations per second,  both Ian's mother's fiance and my supervising resident physician are wrong no matter what is the agreed-upon definition of perfet pitch.

I really couldn't care less about what the resident physician thinks about perfect pitch or about any other aspect of music except that most people who waste time and energy arguing that  perfect pitch does not exist do so because they don't have it. They believe that because they don't possess it, perfect pitch is therefore not real, and no one else can have it, either. I do not need for my supervising intern to hate me just because I have a better sense of pitch than he does. 

*Composer Burt Bacharach was known for his ability to compose and to play the piano both by reading standard music notation and by ear, but couldn't sing on-key.

**The hertz (the symbol of which is Hz) is the standard unit of frequency for reference purposes, defined as one cycle per second.