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A Strange Turn into Research Policy.

28 August 2014

Twitter is a fascinating, self-contradictory place for scientists. A huge and robust community. By turns enlightened and enlightening, ruthlessly orthodox, whimsical and humorless, unified and fragmented, quixotic and hypocritical, absolutist and relativist. Just as it is impossible to pin down any individual to a label-board, so the community of scientists and academics on twitter defies any description. But it is a fertile soil for planting and harvesting ideas.

And it has led my own research in directions it never would have gone if not for my interaction there. Including things that are not part of my job, I’ll get no credit for from work, and will not help me advance any currently conceivable career path. I have two papers currently under review which fall under the broad category of “research policy”. I’m not trained in research policy any more than any PI who is required to receive basic ethics and policy instruction. But a couple of things that came out of interactions on twitter led me to conduct (or assist in conducting) a few interesting experiments, and now I’m trying to publish the results.

If I were a professor, this would probably help me, career-wise. One of them involves simulation, and the other is a really cool result that may have broad implications for research ethics. And neither of them would ever have happened except for twitter. In the latter case because it is the result of a collaboration with better researchers than I am that I met on twitter, and in the former because it is a topic I had little interest in until I discovered the impact is has on people through my interactions on twitter. As a professor, I could let these ideas take me where they take me.

But as a hospital engineer, I have this whole other job to do, which has nothing to do with these topics. I’m working on publishing there too, and on developing a position for myself where publishing matters, and I am rewarded for putting papers out there. I’m building a (mostly) hard-money quality-improvement research program here where none has existed before. And doing it in a mildly-clandestine manner, in the sense that I want to establish it, and make it robust and integrated with my department’s QI activities, without exposing myself to the risk of becoming a soft-money researcher. I don’t want my bosses to decide I’m doing so much research that I should be grant-supported.

It just goes to show the strange paths a career can take. I have no training in policy, and yet now I am poised to (hopefully) publish two papers with policy findings. One of which at least ostensibly relates to my professional expertise, in that it involves a computer-simulated thought experiment. In the event I am ever truly aiming for a professorship, these publications, and the ones from my job, will provide evidence of my academic acumen and ambition. That’s important. Hopefully, in about 8 weeks, I’ll have a good grant score to report too.

I don’t know, exactly, how much twitter has influenced my career. I know it supported my willingness to change cities when my funding was running out at my last job. I know that it has helped me develop new lines in inquiry. It’s a strange, wonderful, maddening place. And it’s helped position me to make a contribution to a field I never imagined having anything to contribute to. That’s gratifying. Or, it will be, if the papers get published.

What an odd place this world is. I don’t know if I’m doing it right. But I’m doing something. And it feels like I’m moving forward.

 

Homeland.

26 August 2014

Saturday, I’m taking my partner and heading to St. Louis. It will be the first time I’ve been back since I moved to ECC. I am really looking forward to visiting. First, I get to introduce my girlfriend to my best friends. People I spent 20 years building friendships with, and then suddenly abandoned when my career changed, and I had to move cities. It’ll be so good to see them again. I get to go to my old AA meetings, Sunday and Wednesday, my mixed meeting and my men’s meeting. People I love and miss.

I get to check in on my house, which I am renting out to a former colleague. She painted and did some minor remodeling. I told her to go ahead and make it her home. I want it well taken care of, so I’m not charging her a great deal for rent. I could probably get 20% more than I’m getting. But it pays the expenses and my tenant is fabulous, so I have no complaints. I cannot over-emphasize the value of an empty-nest, government-employed, former Navy Commander who wants the place long-term as a house tenant.

I’m going to run in Forest Park. Something I never did while I lived there. I’m going to take BB to my favorite places in the city. She has to go home Monday evening, but I’m staying for a few more days. I have an appointment to get my tattoo updated with Japan (日本国), Bermuda (Bermuda), and South Korea (대한민국). I was going to get a larger more colorful tattoo too, but I’m still not sold on my design. I need to design something that’s more meaningful before I ink it. And I should find an artist in ECC I trust instead of having to fly to St. Louis to get ink done.

I’m fuzzy and confused at the moment. My brain is soft and unfocused. I haven’t taken any time off since my trip to Asia, and that was five months ago now. It’s easy for me to get wrapped up. I don’t work so hard that I have no time for me. I take plenty of me time. And I don’t have kids, so I don’t need to worry about that either. I have plenty of time to cook and to work out and to sit in my jacuzzi. I really can’t complain from a lifestyle perspective. But I do need some time off so that I can walk away from work and let it all go for a few days in a row, to refresh my perspective.

It’ll be good to go find my connections in my homeland.

 

Feedback.

25 August 2014

I need pretty constant feedback. And I need it to be good. What drives me most is people telling me I’m doing well. This charges me to continue to meet their expectations. If I get bad reviews, I feel angry and betrayed and insulted. Then I feel lost and bewildered. Then I get bogged down in self-recrimination. And it spirals. I must be on the top rail at all times, or I feel like I’m falling into oblivion, poverty, and despair.

Don’t get me wrong. When I’m on the wrong path I want to know about it. It just launches me into terror and shame until I can put it right. And I am constantly convinced that my next evaluation will be the one where I am told that I am failing and have one foot off the plank. And it doesn’t matter how many good interactions in a row I’ve had, it seems. I’m terrified constantly.

In part, this is because I know I don’t work very hard. I’m always distracted. I’m lazy. I blog from my desk. Sometimes it feels like whole weeks go by and I don’t do anything at all. But, somehow, whenever there’s a deadline or a need to produce a result, there it is, living color, right where it needs to be. I don’t really know how it happens.

But I must be doing something at least reasonably right. Because I had my first full-year annual review on Friday. And I was given the highest rating in the history of my department. This comes with a nice little raise (though not a huge one – more like a reasonably generous cost-of-living adjustment) and the opportunity to set an even higher bar the next year. And it comes with another perk.

I get to write the job description for my promotion. It’s not set in stone. But it’s highly probable. My boss and his boss are apparently on board. The VP clinician in charge of my whole division will need to sign off, and HR will need to agree that the compensation is appropriate. This will also not be a huge raise. But it will be like a very generous cost-of-living adjustment. And two of those back to back starts to look like a real raise. My boss believes it will all be done within three months. And it may involve me having supervisory responsibilities.

So it’s all very good news. I appear to be flourishing. I’ve laid out an ambitious agenda for the next year. And I think I’ve managed the expectations of my new institution very well for the first year and a half that I’ve been here. I have more publications in the hopper. I am going to be promoted. I am doing all the things I set out to do professionally and that’s wonderful.

And then, just as I’m fretting about me and what I am and what I do and need and me me me me me, I get the only kind of feedback that really matters. I get a note from someone who has been reading Infactorium and has decided to get back into meetings and get their shit back together and commit to sobriety. Which is what actually matters in this world. Real people, leading real lives, moving forward day by step. Mine is one of those lives. And I’m doing it. Doing the things I couldn’t do as a drunk. Taking steps forward.

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 price 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.

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