The Simple Things

It started with a gift. My roommate offered me some leftover romaine lettuce he was unlikely to use. I said "sure, thank you!" and thought to myself: I guess it's salad time! Coincidentally, we had just come back from a grocery trip, and I'd picked up some roma tomatoes and a loaf of french bread (just as pantry staples no specific use in mind).

So chop-chop-chop in 10 cuts went the lettuce, which was still nice and crunchy near the base. And chop-chop-chop went a tomato in 10 more cuts. I ripped off one end of the french bread, tore it in half, and stuck it in my toaster to get some of those delightful burnt crunchy bits (BCBs). A little drizzle of Caesar dressing on the salad (just tomatoes and lettuce, remember), and on second thought, I decided to add a few small pieces of butter on top of the hot bread. I couldn't be bothered to spread it evenly, and they melted nicely anyway.

I kid you not, this was the most satisfying dinner I've had all week. Yet it was also the easiest, thrown together in a couple minutes with barely any thought at all. But the tomatoes were juicy, the lettuce crisp, the bread crunchy and warm and soft all at once.

Sometimes, it really is the simple things.

Shatter and Break

Lost and Found

Three steps in the ocean I found you asleep under sand under sea under sky. 

I carefully lifted you, washed you in waves that had polished you smooth long ago. 

Perhaps you erupted from fiery peaks, or tumbled from mountains of snow?

If only I knew more I'd not have to ask, and I don't think that you will reply.

I wondered what undersea creatures you'd seen, if you'd had eyes to see things at all.

I might have known all of these answers but now, they have flown and won't answer my call.

Things I Learned in Surgery

1. Make things easier for yourself: Surgery is hard enough already, so making it easier was a common theme on which attendings would mentor residents in the OR. There were 3 common varieties:
1. Visualization: If you can't see what you're doing, it is much harder to do it well. More generally, what can be observed can be manipulated, and what can be measured can be managed.
2. Tool Selection: Is there some other tool that would be better suited to what we're trying to do? That's why we have so many surgical tools in the first place - to make each individual step as easy as possible. There may be more than one way to achieve any task, but some will be better than others.
3. Ergonomics: Having picked a tool, how can we use it most effectively? Raise the table, choke up on the needle, tilt the wrist...there are so many little things that can make a process easier on the surgeon's body and the patient's.
2. Make things easier for others: This is definitely a next-level skill, but it's well worth the effort within and outside the OR. As we work toward a common goal, what can I do to help my team do their work more effectively and efficiently? If I'm the leader (e.g. the attending surgeon), how can I help my first assistant help me better?
3. Stop when you're struggling: Maybe some arteries are oozing more than I'd like. Perhaps my projects are taking longer than expected. Or my patient is not recovering as quickly as they should. Stop. Step back. This is necessary to effectively use #1 and #2 above, but beyond that, this skill is the point of entry to learning and improvement.

On manual focus and switching lenses

In the first class of one of the first courses I took in college, I learned a mind-shifting lesson. Majors, or "concentrations" as we called them at Brown, are not just sets of knowledge and skills to learn, though those are important. Every major also holds a hidden gift: a lens. A lens with which to see the world in a distinct way. A lens with which to focus the shining sun of our mind on the world's problems.

For example, a few years ago, I thought about the lenses which mathematics and computer science offer. Each of us actually has several lenses, but we usually only spend time with one or two. Many of us spend decades polishing one lens during our career. We might spend years in graduate school trying to get a clear view of some subject, hoping we have the right lens to do so.

"Blind monks examining an elephant," by Hanabusa Itchō

Sometimes Often we argue about problems or facts, because we use different lenses and can't trade. We may also get stuck using our lens at a certain distance, or tunnel in so much that we can't see anything at all. I certainly had the latter experience while on trauma call, as I fixated on the face of a dying man I was helpless to save. In such situations, how do we change focus? How can we zoom out to see the big picture rather than auto-focusing on the nearest, shiniest stimulus? How can we focus mindfully on one subject to avoid getting distracted? How can we switch lenses to see a problem in a whole new way?

xkcd #1796: "Focus Knob"

Part of my medical school training is working out my own answers to these questions, but we have had help. We discover a special lens or two to look inside our own minds at other lenses, to see if they're cracked, or if we're not using them correctly. In our last Learning Communities session, my college discussed ways to tell that it's time to step back. For each step in this metacognitive skill, I think there is room to improve with effort:

1. Recognizing that it's time to switch: Practice with metacognition; notice tunnel vision or willful ignorance; note when things are not going as I expect.
2. Zooming out: In my photography, it's become habit to zoom out and refocus when I lose sight of my subject. Likewise, I expect that practicing stepping back when non-urgent but unexpected issues arise will help me do the same in the midst of a critical event.
3. Building a collection: To pick a new lens, I need a collection to choose from (hopefully in polished condition). The best lesson I've learned here is to look for new lenses everywhere - in books, in people, in classes. To keep them in good repair, it's best to try out a variety as often as I can; this is the more effortful task.
4. Picking a new lens: This is the hardest part right now. I would like the ability to do this in an automatic System 1 blink as well as the option of running through my top choices systematically. Every lens has certain features they work well on; it'll take some work to identify them.

The Oatmeal: "Believe"

We all have our favorite tools, hammers, lenses, etc. And that's fine. We can't learn and do everything ourselves, and the diversity makes collaboration productive and conversation interesting. Manually focusing deliberately is hard work and hard to learn, and our lightning-fast auto-focus usually gets it right anyway. Yet when reality doesn't match our mental models, when we get tunnel vision, when we fail to understand each other...we should be able to adapt when the world requires it of us.

A whirlwind friendship

On my walk back from the Children's Hospital today, the sky was blue, the weather warm – a promise of spring after weeks under gloom and chill rain. Birds who had seen me off with happy chirps welcomed me back just as cheerfully, singing out from still-barren trees. As I passed through the parking lot outside my apartment, I heard a crackling reminder of autumn behind me. I turned around and met a young leaf devil, daughter of wind and earth, perhaps two feet high and twice as wide, decked in swirling brown with accents of red and green.

I walked alongside her politely, since we were going the same way, and we gossiped about the capricious clouds and the sweet cool breeze. And then, tired of such trivialities, my new friend swooped toward me, ruffling my hair and throwing leaves past my swinging legs. I found myself in the calm center of a hectic dance that whirled and cackled carelessly. When she moved beside me again, I knew her better; she was an inversion of the inner turbulence we hide behind placid outer masks.

We reached the edge of the lot, and I was surprised by the stately grace with which my friend skipped over the curb and down the sloping grass to the sidewalk, halving her width to slip between the trees in her way. She exchanged some of her leaves for those in the grass and briefly juggled a Styrofoam cup she found, but she soon tossed it back to me when she got bored.

We were now just across the street from my apartment. While I waited for a car to pass, she rushed forward recklessly and barely missed a collision (though I think she did lose a few leaves). Yet she then waited patiently for me to join her again, playing with flowers while I crossed. I thanked her for walking me to my building, and we bid each other goodbye. As I opened the door, I watched my friend drop the rest of her leaves and vanish into the air, joining the sweet cool breeze that tickled my face.

PS - If you have no idea what I'm talking about, check out her cousin here.