A couple of conversations about money have interested me lately. The first was a twitter conversation I had with @sciliz, and the second is going on in the comments over at Doc Becca’s place. Essentially, both conversations were about the ethics of spending more money than is required on things like food and clothing. It’s not something I’ve ever put an extraordinary amount of thought into. But it will surprise no one who knows me that I am one of the people who spends more than is necessary on clothes and food.
I come from privilege. There’s no question about that. And from more privilege than is already inherent in being a white, male American. My family is one of reasonable means, which allowed me to graduate from school without debt. I have had just about every advantage in life that one can have. I try to be conscious about that. I try to be magnanimous. I try to be aware of how my fortunes have colored my perceptions. And I’ve traveled to some of the poorest places on earth, to gain perspective. Recognizing and doing those things, I hope, allows me to understand the world better than isolating myself in the gilded ivory tower.
But I cannot agree with the attitude that spending more than is necessary on staples is unethical. In fact, I think it many cases it may be preferable to spending money on cheaply made, mass-produced goods. Yes, it represents privilege. But it also represents redistribution. When a person buys a $1,000 suit jacket (as was the example in my conversation on twitter), that money doesn’t evaporate. The salespeople are usually commissioned. The clothes are generally made by artisans with good jobs. When a person buys a $45 suit jacket from Walmart, it’s probably made in a sweatshop in China or Bangladesh. The salespeople make minimum wage, usually without benefits, certainly without commission.
Many people truly benefit from the sale of a high-end product. Cheaply-made, mass-produced products support a system of exploitation and extraction that primarily benefits people like the Waltons.
Now, there’s a lot of real estate between those extremes. And $1,000 suit jacket doesn’t even represent an extreme! And yes, there’s certainly a bit of justification. But I don’t believe that people need to apologize for spending the money they earn. The idea that the only ethical things to do with money are to subsist, prepare for emergencies, and give it away is absurd I think. There is nothing wrong with accepting what people will pay to do your job, even if it is a lot. There is nothing wrong with spending your income so long as you are prudent with your reserves.
And I do believe a bit in noblesse oblige. People who’ve been fortunate enough to find themselves with high incomes and large pots of wealth certainly do have an obligation to be charitable. The great charitable foundations set up by famous families are important, but more important is that individuals are charitable with the people in their lives. We all need to be generous with time and treasure as we can.
But the ethics of how we choose to spend our money is far more complex than “expensive things are bad and cheap things are good.” Ideally, we could know how the products we buy are made, and support those that make reasonable profits while paying their workers well. That have good corporate consciences and do good in their communities. But there’s often no way to tell what those things are. I propose we are guided by our own consciences. And that we recognize that how others choose to comport themselves financially may not be malicious or thoughtless, but the result of a calculus that is simply different from our own, not less moral.
I don’t know about you, loyal readership, but I am in dire need of the upcoming three-day weekend. Work has been good, but I’m deeply unfocused today. As I was the latter half of yesterday. I’m having trouble not counting my grant-chickens. I need to relax and let things go and be at ease. One of the things that we are striving for, in AA, almost universally, is serenity. I’m not a huge fan of the word, but I understand and hunger after the concept. I long to feel at ease, peaceful. Tranquil. Maybe that’s the word. I am seeking emotional tranquility.
I write that with the same fingers that wrote about loving the rollercoaster of grant submission. It’s complicated, I guess. But emotional tranquility does not, I think, preclude highs and lows. It means that I understand and accept them, as part of life, part of being, without them running away with me. Without distress. Emotional slopes are understandable and inevitable. Emotional crises, I think, are not. A well-prepared mind and heart can manage through the swales of trial without panic and frantic grasping.
I have simple plans of seeing friends and spending time engaging in fitness activities and maybe going to the zoo. I have a dinner date planned too, at a restaurant near my apartment that I haven’t tried yet, but which has an excellent reputation. Mostly, I’m just looking forward to the time. It’s likely to be cool and rainy in ECC. It’ll be good to spend time indoors.
Here at MECMC, I get fewer vacations than I did at my old position. We only get 7 holidays instead of 10. So, fewer three-day weekends. Because of how Christmas and Independence Day fall, it’s only 4 this year. The difference between 4 three-day weekends and 7 three-day weekends is huge, from a rejuvenation point of view. For me, a three-day weekend is an incredible luxurious feeling. And it’s deeply needed to restore my mental focus.
So, I asked my boss if I could take July 5th off. I don’t like taking time my first year, but this is only one day. And it gives me a four-day break. I won’t take a real vacation until I’ve been here a year or so. But a day here or there around a holiday to get a 4 day weekend? I think I can do that. I need to do that. I won’t be much good to anyone if I don’t make time for myself. People in academia talk a lot about work/life balance. Well, this is mine. I need time off. I need to travel. I need to see the people I care about deeply. So that’s what I’ll do. This weekend. And in July.
Well, my grant is away. It should be a short turnaround. It was a miniscule application, one page including the budget. And the process for negotiating MECMC’s sponsored projects gateway for grant submissions was confusing. But I think I got it done correctly. I really do enjoy the thrill of submitting a grant. It’s a little like jumping out of an airplane. Exciting, thrilling, and if it goes even the slightest bit wrong, you die. Well, not exactly. But you get the point. Especially now that I don’t have to depend on grant money to maintain my position, I’m relived of the anxiety associated with grant submission, but still feel the excitement. Of course, if it isn’t funded, I’ll have the same crushing disappointment. But not the existential fear for my job.
And once again, the online world gave me excellent support, with two of my twitter science friends performing external review on the grant, giving me recommendations for improvement. I think it’s a strong application, given the restrictions on the application format. I’m excited. My department is going to have a strange awakening when they realize that the funds come to the research department and that I have control over them. I’ll end up transferring a lot of the money to them of course, for assets they own, but as PI, I’ll have the purse strings. I’m not entirely sure how they’ll respond to that. They’ve never worked with research before.
But I’m not worried. And I’ll play ball. Providing funds to my department will be an excellent feather in my cap, and come with decided perks for me. I somehow doubt I’ll have to spend my (very) little slush fund on my first conference, for example, if I win this grant. But I also need to temper my expectations. Even an opportunity like this one, with limited eligibility and a small enough budget to make many of the eligible researchers unlikely to pursue it, funding is very competitive. The most likely outcome is that I will not receive the award. After all, I don’t have any idea how many applications they’ll receive or how many awards they’re making.
I’m just thrilled to be where I am. I just submitted a grant as PI at a seriously major institution of health and research. I don’t know how I got to be where I am. I don’t know that I deserve it. In fact, I’m pretty sure I don’t. But I’m grateful for the opportunity, and intend to do as well as I can with it.
I feel very productive today. I finished my tiny grant (not terribly difficult when it’s only one page), and will be submitting it by Friday. It’s kind of an open-ended idea, but that’s to be expected for a pilot grant. We are trying to build the groundwork for a bigger submission in the future. Or at least, we’re trying to convince the funding agency that we’re going to be laying the groundwork for a bigger submission later. I’m not sure that’s what we’re actually doing, because I’m not sure my department is willing to commit to the kind of investment of time and trouble I’d need to make in order to write a major NIH or AHRQ grant.
But the people who administer the funds for this grant are aware of me, and still seem to think of me as a hotshot new guy. The funding is institutional money from one of MECMC’s partner universities. And with any luck, they’ll want to give me some funding and opportunity before I reveal that I’m an idiot. And of course, I’d love to be developing ideas for grant submissions. And writing grants. As long as my job doesn’t depend on their success. I don’t want to talk myself back into a soft-money position.
And I also got my first protocol at MECMC through the IRB. Well, actually, I didn’t write a protocol. I wrote a tiny blurb about what I was essentially doing, and how I only used deidentified data, and they agreed that under the rules it does not constitute human subjects research. This gives me carte blanche to simulate and then publish the results. That’s very exciting. I am now permitted, sans restriction, to do what I came to MECMC to do: create simulations, improve health care delivery processes, and publish the results.
I’m a happy engineer, my fellow denizens of the web. And a happy scientist.
There’s an opportunity for some local (but not internal) funds to submit for a tiny health care grant. It’s $10,000. While my job here is not about getting funding, this opportunity came out of the blue, and my boss’s boss is interested in going for it. I have to submit the one-page proposal on Friday. No salary support, which is just as well. That kind of money doesn’t go far if it needs to go for salary.
My job isn’t very research-y. But if I can submit for this, and get it, then maybe I can help shift the vision of my position more over toward research. Or, at the least, I would be able to demonstrate that I continued to seek and get funding in the event that I decide in the future to focus more on an academic position. Though, for the moment, and for the forseeable future, I’m very happy where I am.
Nevertheless, I’m excited to have the opportunity to demonstrate my expertise in a venue that my office hasn’t traditionally participated in. If I can succeed here, it may open up new doors for me in a way that is really exciting. So, wish me luck. I have 5 days to dream up, write, and submit a grant. And figure out, what do I want to spend money on that isn’t already available to me? One really nice thing about MECMC: they provide me with everything I can possibly imagine needing.
I am beginning to feel a tiny bit odd about my sponsorship situation. My sponsor is in St. Louis. I’m living on the East Coast. It’s not an ideal situation. But it’s also not awful, theoretically. I know people with out-of-town sponsors, and they do just fine. But I also know that I need to have regular contact with people in the program and someone who I’m directly accountable to in order to work the best program I can. And I’m not 100% certain that I can do that with a sponsor who is something like 1000 miles away. I’m also not sure that I can’t. But I’ve met a couple of men at my men’s meeting Wednesday nights that seem like they might fit the bill for a sponsor “in loco parentis” even if not the real full thing.
So, what is a sponsor? What to they do? When someone is new to AA we tell them to get a sponsor right away. We tell them that getting a sponsor and doing what they say will help them stay sober. Does it work? Well, hard to say. Now, obviously, if you get a sponsor and do what they say, you’ll stay sober, because one of the first things a sponsor tells you is: “Don’t drink.” But of course, the research is conflicting. A recent study suggests that meeting attendance and sponsorship are quite important, while noting that previous research has not shown the same. But, as I’ve noted many times, I don’t know that we understand how to research recovery very well. So even when the research supports my own view – meetings and sponsorship matter – I remain skeptical.
Fundamentally, a sponsor is someone who has what I want. Long-term sobriety. A pleasant countenance. And optimistic view of the world. And the supposedly superficial things too. I wanted a sponsor with a family. A nice home. The things I wanted to have or to keep. AA allows us to engage with the world, and live good lives, while being of service to others and to fellow alcoholics. So I found a sponsor who had those things.
But I feel like I may need to adopt a local sponsor. I don’t want to risk my program getting out of whack. I’ve missed a few meetings lately, and I need to make sure that that doesn’t happen regularly. If I miss a meeting, I need to make up a different one. I need to talk to my sponsor more, or get a local one. It’s too easy for me to become complacent. Then I begin remembering my drinking differently from how it really was. I remember the euphoria. Not the misery and compulsion. My disease will use whatever tricks are available to satisfy its needs.
But I know the tricks. I know the score. I understand the consequences. And I know what I need to do. I need to engage with the program here, in ECC. It’s not enough to do what I’ve always done when my circumstances have changed. I need to take new measures. Life is too precious. And my sobriety is the cornerstone of my life. If I lose one, the other will follow shortly. This is how I work my program. But understanding the dire circumstances of my disease. And by being willing to do the things that are required to forestall it.
Which means understanding that I cannot relieve my alcoholism if I see it as a battle. I cannot approach my sobriety as if it comes from some inner strength in fighting my addiction. My war has been over for years; all my strengths and weapons lie broken on the field. I am lost. I am defeated. And so, I fight no more. Such freedom there is in true surrender. I do not have to struggle any more. I am unbound.
Zemore SE, Subbaraman M, Tonigan JS, Involvement in 12-step activities and treatment outcomes. Subst Abus. 2013 Jan;34(1):60-9.
My first project here at MECMC is to develop a discrete event simulation (DES) of the surgical core. It’s a cool project that I can’t get into all the details of, but suffice to say that there’s a lot of interesting work to be done and much of the work is brand new to me. Obviously, I’ve specialized in DES for many years now. It’s my wheelhouse. I enjoy it, I’m pretty good at it, and I was hired specifically for this skill.
But operating rooms are a whole different world from my usual areas of application. DES is, in large part, a system for building very intricate networks of queues. Queues in parallel and series that interact with each other in peculiar ways. This allows us to model real-world Complex Systems and make predictions about their responses to perturbations. Perturbations might be to arrival rates, service times, or the flow of objects from one queue to another. But fundamentally, it’s about things lining up for service by other things.
This makes it ideal for healthcare delivery systems. Because we have servers (physicians, nurses, and facility capacity, etc.) and we have customers (patients, but also supplies, and phone calls, and other demands on resource time and attention). So healthcare delivery is well-modeled by queueing systems. This is especially true in the environments I’ve worked in in the past, like emergency departments and telephone systems.
However, there are challenges when writing simulations of systems which use scheduled arrivals. Queueing theory was developed with random arrivals in mind. All the math is done for random arrivals. But when we’re modeling elective surgeries, the arrivals aren’t random. Sure, they might be if you go far enough back in the chain (i.e., the ‘arrival’ of a person discovering they need surgery), but for my purposes, I need to model the patients from when they are scheduled for surgery. And that schedule is a rigid object, with particular timed events associated with it.
It would be far easier if the operating rooms were for emergent patients. Then, you just feed them in according to their interarrival time. But when dealing with scheduled patients, you have to devise a different kind of arrival system. What I’ve done, is build a separate “patient creator” entity, which looks at OR availability each day, and iteratively fills the OR with patients until there’s no capacity left using a greedy algorithm. I could simply have generated a bunch of patients and stuffed them into the rooms until there was no room left and then sent the rest home. But this way is far more elegant.
I would say that in general, DES is not necessarily the best tool for the optimization of appointment-based healthcare delivery systems (Mixed Integer Programming, for example, may be appropriate.). It’s far better for systems where the random arrival stream is a feature of the system being investigated, like the ED. In order to treat appointment-based systems with DES, you need to rig it like I described above. But in the position I’m in, I don’t necessarily get to choose the approach to the problems. I’m the simulation guy, and they want a surgical simulation. So I took the challenge to build something, and I think I came up with something kind of elegant.
Now I’m hoping the IRB decides it’s exempt.