Research Subject

When I was on staff at a large medical center, the CEO established four core values for the institution which he arranged in a diamond pattern, safety at the apex, think of yourself as a patient at the bottom corner.  While it seems hard to assess how seriously this mission statement was taken, or if anyone really remembered which value went in which corner, the institution expanded and he got to retire shortly after my departure to a different institution.  Thinking of yourself as a patient usually includes not wanting to be one.  Fortunately, medical care is not all rescue from misfortune.  Research abounds.  If American health care underperforms markers of access and outcome of other countries, our laboratories sparkle like no other.  We have assigned once dreaded diseases to the medical history books, made pneumoencephalography obsolete, and have transformed our biochemistry courses from understanding metabolic pathways to understanding the molecular basis of diseases.

Having watched patients on Medicare assign their too frequent doctors' visits to their prime social outings, I resolved on retirement that I would find other reasons to venture out of my house.  The Osher Lifelong Learning Institute became a valued destination.  While the ties to the state university are generally loose and subordinate, they are not absent.  As our health varies from unimpeded to not entirely independent, we make for a good pool of research subjects to enroll in several ongoing projects at the university's expanding health institute, which does not yet have a medical school but promotes allied health professions training in a big way.  Seeing a project on mental acuity, my son's neurology fellowship pursuit, I opted to sign onto one of the research protocols.  Since I can drive my car safely in all but highly flooded weather and never have to hit the alarm option on the key to find it in the parking lot, they designated me a Control.

While I've done mental status assessments as part of history taking for my entire career, I was not prepared for the sophistication of the battery that came my way.  Lists of words, unrelated, floundering at first but able to put the unrelated single words into a few categories.  My memory is mediocre, attention span so-so, ability to learn verbally very good.  They showed me shapes and had me place them back in order.  I named each shape, then put each back on the screen.  Right sided spacial reasoning did not go as well.  I had to find an object but could not relate fixed landmarks that would enable me to find it when hidden.  I was also not allowed to move the joystick backwards.  What I did instead with limited success is the fishing technique of fanning.  Having no idea where the fish are in the pre-electronic age, we would cast repeatedly in a semicircular pattern from our starting point.  It got me to the target about a third of the time.  I'm just not right-brained but my spacial orientation is adequate to drive safely, though I still struggle to parallel park.

Finally the uncontrasted MRI.  An hour's relaxation with a supine posture, slightly itchy nose that had to wait, noises that reminded me of a confined contraption at an amusement park and an occasional instruction from the technician as there were some dynamic elements.  At the end, I read my scan.  An empty sella, I think, More cerebral atrophy than I might have predicted from my still pretty decent intellect, and no masses or asymmetry.

In another month we get to part 2, an exercise test for which I am self-training on my treadmill with decent compliance and another battery of psychometrics.

Medicare folks whose office visit is their periodic home escape often make a day of it.  I thought about doing that too, especially since I still had 40 more minutes before the next parking surcharge.  Looked for lunch on campus.  Too expensive.  Went into their 5&10, a dying breed, dominated by University logo items.  More than I wanted to spend.  Paid the parking fee and went home.

Medical School Scholarships

Having retired and wanting to stay busier than a Maytag repairman but not as busy as and endocrinologist, I volunteered to review college scholarship application that a local charitable foundation manages for a variety of donors.  It was one of my more fulfilling tasks, 61 submissions, every one of them worthy of consideration.  There really are some terrific young folks floating around.

While the scoring of the applications was done on my computer on my kitchen table, a meeting was held to decide who gets the monetary awards.  At the conclusion of the session, I received eight more applications to review, these from current or entering medical and dental students seeking assistance from two available sources.  Each awards $2-4000 a year, which probably would allow the student to choose between a microscope and auto insurance but still leave each with a lot of loan debt.

While the high schoolers entering college had transcripts and SAT's, medical students with one year under their belt have a series of Passes.  High school transcripts have honors and AP courses.  Medical students all take the same curriculum and the description of the curriculum has lost much of its delineation to anatomy, physiology and histology, instead being lumped as either an organ system or the more amorphous introduction to being a doctor with no discernable curriculum.  As a result, I was left to evaluate personal statements.  Everyone wants to become a doctor for similar reasons.  Where the applications separated was by intended specialty and the background that generated that decision.  Again, some very good kids.  I was asked to rank them 1-8, which I did.  Probably 6 of the 8 would be competitive for the awards.  Choosing which is somebody else's task. 

Batting 1.000

Somebody did a study, or maybe did a meta-analysis of multiple studies, on how physicians view their work.  We get enthused about 25% of the time, despise 25% and the broad middle takes up the rest.  What goes at each end varies a lot.  I did not like returning phone calls or reporting lab results over the phone.  I basically dreaded the phone.  I did find the residents energizing, even when exasperating.  On occasion one doing an elective with me would request a letter of recommendation for fellowship.  I never turned anyone down.  Most but not all were for Endocrinology fellowships, but if somebody was knowledgeable and diligent, the specialty did not matter if they were pursuing their 25%.

From the first in 1993 all the people I sponsored matched to a fellowship, often their top choice.  Only one ever called me a few years later to let me know of successful specialty board results, but I have seen a few at the Philadelphia Endocrine Society meetings, some as invited presenters of their fellowship research, to know that the good things I predicted for them were true.

My last letter, however, was left in limbo.  A fine second-year resident spent a few weeks sharing the office and hospital.  At the end she requested a letter which went off with the assistance of the residency office that had to guide me through the current electronic submission system.  I retired, heard nothing, and really did not think about it until last week.  Did my letters still score 100%?  I sent a note off to our program director who got back to me with the good news.  A match at one of the universities in Philadelphia.  Not endocrinology but something else of interest to her, a specialty not represented at my hospital.  Bodes well for the future.