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A Review of Progress.

19 August 2014

Sometimes I go look at old copies of my CV to see the professional progress I’ve made. It’s stupid and vain, yes. But it’s meaningful to me to see how over the course of two or three years, I’ve increased my publication and grant output, I’ve changed positions and added invited lectures, etc.. I feel effective for those few minutes while I look at the paper version of the old me.

A friend that I was talking to about fitness today suggested that I review some of my very old blog posts from years ago when I just started exercising right after I quit smoking. So I did, and found this wonderful little passage:

The running is still misery inducing. My thighs ache a lot after I run, especially the right one. Deep bone ache. Not soreness. My shoulders tighten, my abdominals get sore, my lower back aches. And this all from running roughly 8 minutes a day. I still cannot go further than 1/3 of a mile on flat ground before having to rest.

Shocking. That was from October of 2009. I was 235 pounds, and had been smoke free for about 75 days. I was still married, but on the downslope. I didn’t keep it up. I did that for a month or so and gave up. I didn’t start exercising again in earnest for about a year. It’s taken almost 5 years to get from there to here.

This weekend I ran a total of 14.6 miles, over about two hours and forty minutes. And walked a lot more. I’ve been stalled at about 184 pounds for a while, but I’m changing shape a little. I still have a huge, long way to go. But I need to remember to look back, and let may progress propel my investment.

Five Years.

18 August 2014

Today, the 18th of August, is the fifth anniversary of my quitting tobacco. According to all the web-based stuff, I’m now down to a non-smoker’s risk of stroke. About half the risk of lung cancer of a smoker, and my heart disease risk is approaching normal. The epidemiology is pretty clear: smoking is bad, and quitting smoking has massive benefits. My personal experience corroborates the science.

For me, quitting smoking was a bit different from quitting alcohol. There was much more in the way of will power involved. I used nicotine gum and I used it according to the directions. I also first quit on the 16th, and then gave myself permission to screw up if I really needed to. So I had 1 cigarette on the way home from work on the 17th of August, and that was the last one.

I ended up chewing nicotine gum for about six or eight weeks, and slowly tapering off. I still will occasionally have cigarette cravings. I still find myself breathing in the smoking fashion, where I draw air into my mouth without inhaling, and then inhale as if I have a mouthful of smoke. I miss smoking in a way that I don’t miss drinking. The little rituals, my pipes, having something to do with my hands (though, my phone has replaced that a bit).

Math suggests I’ve saved somewhere around $10,000 by not smoking. And as cigarette taxes continue to rise, the prices is ever increasing. I read that in NYC cigarettes are like $9 a pack or more. Chicago is the same way. At that price, I’ve probably saved more like $15,000.

And it’s amazing how the body rebounds. Slowly but surely, I’ve gone from an obese alcoholic smoker to a clean, dry, only-mildly-overweight half-marathon runner. This weekend, while running with my partner, we set as our fundamental fitness goal to be in constant half-marathon shape. Meaning that we should be in good enough shape at all times that if we read about a half-marathon that sounds cool in two weeks, we should be able to go run it.

I love that I have that option. When the Lord of the Rings movies were coming out, after seeing The Two Towers, I remember wondering if I would live to see The Return of the King. I was 28 and getting ready to die. Today I’m 40. And I’m living.

What I Hope to Contribute.

14 August 2014

Yesterday I got the reviews back for two papers I have out. One paper was rejected, one had a revision invited. The paper that was rejected had four reviews, all of which were blandly positive. Nobody hated it, but no one raved either, and the editor decided it wasn’t “focused or well-organized” enough to be of high priority for publication in his (rather august) journal. This is a relatively common result for me. People like the work, but editors think it should go to a management journal, not a medical journal. And that’s a fair criticism.

The other paper, the one written by my interns, got three similarly bland-but-positive reviews (if anything, a little less complimentary than the other paper), but this journal asked for a revision. I’m quite gratified. The journal is a perfectly respectable second or third tier specialty journal. A medical journal as well. I’m curious how much to ask for from my interns seeing as I can’t pay them anymore. I don’t like volunteer labor, but they are authors (co-first authors), and they have the right to review and contribute to work that their name is on.

I’m also gratified because this is my first grant-funded last-author paper. A revise and resubmit almost always (but not always) means that the journal wants to publish the paper. If I can respond to the review productively, and I think I can, then the paper will be accepted. Sometime around the spring, I’ll have another published piece from my work at MECMC, and that’ll be three papers in two years, which makes me feel reasonably productive, especially considering I have several other irons in fires (like that rejected piece I plan to send back out ASAP).

I’m sensitive to the suggestion that I send my work to management journals. But I don’t really want to have MBA/MHA types as my audience. I believe to do the best work that can be done of this type, to make the biggest impact, I need the clinicians on board with the process. That means a couple of things. First, it means that MDs and RNs see the work in the journals they read, and recognize its value. Second, it means that when I come in to do a job, they know that it will result in publication in a journal that will matter to their bosses and career aspirations. This is especially true when working with residents and fellows.

One of the biggest problems quality engineers have is getting buy-in and engagement from physicians. Frequently, they don’t see the value of being engaged in QI work. But “you get to be an author on a paper in a journal in your field” is a real currency to a resident or a fellow, or a junior faculty member.

So I continue to deliberately make things a little harder for myself. I have the luxury of being able to do this, because I don’t have to worry about my citation count, or a tenure package. I am able to simply go and advance my engineering agenda in medicine, and publish where my main goal with regard to my contribution to my field is that a department-head somewhere will read my paper, pick up the phone, and say, “Hey Margaret, did you see that thing in Annals of Impressive Medicine about the computer deelie? Why don’t we do that here?”

And then someone like me gets a job, and patient access and quality of care improves. That’s what I hope to contribute.

Celebrity and Alcoholics Anonymous.

13 August 2014

I sobered up in  fancy rehab out in Los Angeles. The rehab I went to took us to AA meetings, and NA meetings, and CA meetings. There was a meeting every day, in addition to individual therapy and group therapy and spirituality and personal training, and some hippie stuff like acupuncture and aromatherapy. Some of it that stuff was mandatory, some was optional. I tried everything. I had reached a point that I was deeply tired of being sick, and willing to try anything that had any hope of improving my life and helping me stop drinking (even though I still imagined, at the beginning of rehab, that I was drying out and learning to drink normally.).

At those AA meetings we went to, I saw and met a lot of celebrities. Some real A-listers. Many of them men and women who have no public history of trouble with drugs and alcohol. People who, just like you find in AA meetings all across the country, have healthy, long-term sobriety. Who are now productive and happy and engage with their communities. Some of the people I saw there were there because of repeated, high-profile problems with drugs and alcohol.

I’m a person who is somewhat impressed with celebrity. I get a little giddy when I meet a person who is famous. Whether in the arts and entertainment world, or the science world, or sports, or whatever. In St. Louis, once, in a coffeeshop (Not at an AA meeting, I wasn’t even sober yet. Just at a coffeeshop.) I met Mark McGwire. I shook his hand and told him how great it had been to go to a game with my dad where McGwire had hit two home runs. I don’t remember what he said. Something short and gracious. I buzzed for hours after. But meeting celebrities at AA meetings in Los Angeles, and later in St. Louis, couldn’t have been less impressive.

Because in those spaces, we’re all just drunks. We say in AA that we are “people who would normally not mix.” I think part of this hearkens back to the 1930s and 40s when AA was a place that just naturally integrated itself racially and by gender, open to all from the start. If anyone had cared to spend any time considering it, it would have been radical at the time. AA has never had any history of exclusion, so it never had to be integrated. Likewise, rich and poor, gay and straight, privileged and not, all co-mingle in the rooms. And the only acknowledgement we make to the extraordinariness of that is to occasionally say that we recognize that we are people who would normally not mix.

I never saw a paparazzo at a meeting. Not even when there were huge stars there. I don’t think that’s because the paparazzi have boundaries, but because most celebrities who go to AA meetings take special care to protect those rooms. Because all of us do. They are places of healing and honesty and openness, and it is crucial for all of us that they remain that way.

There’s a lot of outrage online right now that apparently some newsrag or another published a photo of Robin Williams at an AA meeting. And yeah, that’s kind of classless. And I’m appreciative that people who don’t really understand AA or alcoholism are reflexively protective of the anonymity we need to do our work. It would be better if that photo had not been made public. But I can’t find myself too angry about it. I’m not outraged. Time will pass. Memory will fade. People will forget the faces in that picture. And we’ll go on doing what we do.

I don’t really need anonymity anymore. I’ve been sober long enough that if I were exposed, I can stand on my time, because people who don’t get it think it’s about time. And that’s ok. I can talk to my boss or my human resources manager and describe my life and my sobriety in vague terms, and casually mention phrases like “Americans with Disabilities Act” and I’ll be just fine. I’m not ashamed. But my life is easier if I don’t have to go through that. And so I value my own anonymity, even if I don’t need it.

But I stay anonymous for others. And Robin Williams stayed anonymous for others, I feel confident saying, though I never knew he was sober until two days ago. We do it so that the starkly terrified newcomer will see that it can be done. That recovery is possible. That alcoholics in recovery can go on to live ordinary lives. They think their shame is permanent; they want to feel it can be protected. And it can. Until it doesn’t need to be. Because we learn being an alcoholic isn’t shameful.

I stay anonymous because my opinion about AA is just my opinion, and other people have other opinions, and theirs might be better than mine. I don’t speak for Alcoholics Anonymous. Unfortunately, in the eyes of many, celebrities who speak about things are often seen as spokesmen for those things. And so celebrities keep personal anonymity to protect others. If they fail, if they die, if they drink, that shouldn’t cast shadows on AA itself. Their experience may not be your experience.

I don’t know Robin Williams’ story. And I will never know it. I know that he did the anonymity part of AA right, because we never knew he was one of us. He didn’t make AA about himself. I don’t know why he relapsed, and I don’t know why he died. Sometimes, all we have is why, and there is no following because.

When Phillip Seymour Hoffman died last winter, I discovered that friends of friends, in New York, in the rooms, knew him simply as “Phil”. That sounds right. I’m sure the same is true of many people in LA, who know Robin Williams simply as “Robin”. And knew his story. And considered him a friend. And I’m sure that he helped many dozens of people recover in the twenty-some years he was sober. And I’m sure his death, like Hoffman’s, will help some more. We take courage from where we can find it.

Life and Death.

11 August 2014

I found out Robin Williams was sober when I found out he killed himself. Another incandescent talent. Another squalid death. Another public face on this disease I have, ironworked in choking little spirals around the columns of my own self.

I am Robin Williams. I have gifts and talents. I have a life to share and a work to do here in this place. I love people, and people love me. I am stupid and silly and passionate and cowardly and angry and I have so much inside sometimes I burst at the hope of telling it all.

I am an alcoholic. I nearly died a drunk. I wasted a decade. I shuddered at the light and recoiled into the dark so that none of you could see my shame. I drank until I couldn’t drink anymore, and I didn’t care if I lived or I died. I drank in the dark, because the light let me see myself.

And like Robin Williams must have, I finally found myself at that place where I was defeated. And like Robin Williams must have, I turned into the light of surrender and found that millions of us have ascended from the graves we dig for ourselves in the darkness. And like Robin Williams did for so long, I no longer drink, and I work my program, and I share my story so that you can come get what I have.

After twenty years, Robin Williams drank again. He tried again to recapture his sobriety. And in the end, he decided death was preferable to the cell he found himself in. I know Robin Williams. I’ve known too many suicides. We die. By the thousands and in dark, lonely places, all over the world, we die.

I am Robin Williams. I am powerless over this disease. I understand that coffin’s luster. I don’t know that I could return from relapse and desolation back into this green, gold landscape that I have been set on by powers beyond me, communities stronger than me, love more powerful than me. I can’t know that I will never drink again. I can’t know that suicide won’t ever be the best option I have left.

Today I am sober. Today I am alive. Today, I am fucking angry at another fine man laid in earth or burnt in a box because of this same wretched affliction that I have written on my soul. Today, it wasn’t me.

I am in great middle of my life. While I live, while I’m sober, while I breathe clear air, I stand humbled by the men and women around me who cannot attain or cannot keep what I have. And I don’t know where I will stand at the end of my life. Among those sober? Among the silent dead, lost? I cannot know.

I am Robin Williams. But I don’t have to die like he did. Today, I am a sober member of Alcoholics Anonymous. Today, I walk among the living, rather than hanging among the dead.

Paid Interns Only.

7 August 2014

I don’t accept unpaid interns. MECMC is a teaching hospital, and it is affiliated with VFU, a major university with a prominent medical college. Just down the way there is UHR, another fine school with a well-respected school of medicine, and school of nursing. Vast swarms of undergrads at both institutions are, like just about everywhere, “pre-med” majors. As a quality and safety researcher, there is no shortage of engineering students who would love to work for me without remuneration, who intend to move on in healthcare, or medicine, or simply get real-world experience on their resumés.

I like working with students. I’ve mentored more than a dozen through internships, school projects, and my own research projects. I like teaching how to do systems engineering at the professional level. I like teaching engineers how to communicate with physicians. I’m a fan of the student engineer in the healthcare setting, and I’ve even published about it.

I don’t take on unpaid interns. In order to work with me, a student must receive either money or scholastic credit worth a commensurate amount to the work they put in. I try to pay at least $15/hour for undergraduate labor. I can usually not arrange benefits, because I haven’t had enough money for actual hiring, just stipends. But if I can’t pay enough to make the internship a legitimate source of income for the work done, a real value, I don’t accept the student. And authorship on a paper is not a fiduciary instrument. That alone is not sufficient value. Value must be quantifiable, and real rather than imputed.

The reason is that I believe that unpaid internships reinforce class structures that exist to the detriment of science, productivity, education, and society. Students from lower socioeconomic backgrounds often do not have the option of doing unpaid work: they must earn a living while studying. This often means accepting whatever paid work they can find, which is usually not something that will further their career and help them make professional connections. Conversely, students who can afford to work without pay, for experience alone, generally already have significant privileges (or scholarships).

I do not, however, means-test my interns. When I have funds to provide student interns with stipends, I hire according to the resumés I receive. I try to do the best I can at finding the best students without regard to their personal status. Like all humans, I have biases and preconceptions, but I work hard to limit them. And I have mentored students from just about every race and gender and socioeconomic category there is among undergraduates at private R1 universities in the USA.

I believe in trying to set a flat field to compete on. I know I’m not perfect at it, and I’m not sure a perfect solution exists. But I think it starts with the basic justice of reasonable pay for reasonable work, and not selecting against fine students who simply can’t afford to work for free.

The World’s Best Coffee.

6 August 2014

I grew up in Seattle. As a child of the grim Pacific winter, I was bottle-fed coffee from birth. And there is good coffee in Seattle. Little trailers with espresso machines in grocery store parking lots are your best bet for the truly great stuff. Usually operated at a languid pace by someone who desperately wishes they’d been at Woodstock (the real one, in the sixties) and could not possibly be happier that recreational marijuana is now a thing in Washington State. They see it as a matter of civil justice. And they make ruthlessly magnificent coffee and charge you like robber baron.

Thus, I grew up something of a coffee snob. Though, if I’m honest, I grew up as an everything snob, and coffee falls into the set of ‘everything’ as an element. I prefer, all things considered, brewed coffee over espresso. Milk, no sugar. No flavors. Simple, classic. Medium-dark roast. Shade-grown* is a sucker’s cup. Trying to fool you with expensive placebos.

Even in the appalling years of my alcoholism, when I drank vast quantities of liquor and did little else of value, I still drank coffee and appreciated it. And it wasn’t until I entered sobriety that I discovered the best coffee in the world. The very best.

The world’s best coffee can be found all across America. In church basements and community centers. In museum rec-rooms and VA hospital activity areas. It’s usually a store-brand, freeze-dried. But it might be instant. The person making it is probably doing so as a commitment they keep to remind themselves that real happiness comes from serving others. Or because they’ve been told to keep making the coffee until they discover that, and then they might be pissy and resentful about it.

There’s a folding table in the room, probably. And metal chairs. And survivors. And we tell each other our stories. And we share our struggles. And we reclaim our lives from that grim winter.

And some of us fall. And some of us die. I’ve known too many suicides. Too many who slip away and then months later, “Did you hear how they found her?”

But so many of us rise. From ash and bankruptcy and the cold silence of withering misery, we rise to daylight and sunlight and color shining from the apple-cheek of all this impossible beauty around us. This path we walk, out from war-torn desolation and into the serene places of soft green silence. We rise to living. We rise to fellowship.

I am a sober member of Alcoholics Anonymous. And if you are where I’ve been, then I can show you how to get where I am. Come have coffee with me. It’s awful. And it’s the best in the world.


*As I understand it (poorly) the concept of “shade grown” was originally about biodiversity in orchards, to ensure that vast areas had more than just coffee trees, for more robust ecosystems. If that’s true, then I obviously have nothing against such efforts. But let’s all be grown-ups and admit it has nothing whatsoever to do with the flavor.


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