Dying in hospital

“Good morning, it’s Gregory the surgical SHO. You bleeped – how can I help?”

To contact a doctor overnight, you generally paged them, and I had a well-rehearsed patter when replying. The delivery was slightly too jaunty for 2AM on a Saturday morning, but there were worse images to project than eccentric enthusiasm.

“Hello, it’s Sabine the sister on ward eight. Can you review Mr. Amir? I think his breathing has gotten worse.”

My heart sank. I was on call, and although Mr. Amir wasn’t under my team when I was working normal shifts, I knew him by reputation. Metastatic colorectal carcinoma, resection was unsuccessful, leaving him with both a poor prognosis and a major operation to try and recover from. I had heard his team talking about him with little hope – the best case scenario would be he would recover from our forlorn attempts to help him and could go home with palliative treatment. The worst case would be that he would die in hospital. I knew he wasn’t doing well: recurrent chest infections, multiple courses of antibiotics – ineffective, poor wound healing, bedbound.

“Of course. Is there a purple form?” Continue reading

Log-normal lamentations

[Morose. Also very roughly drafted.]

Normally, things are distributed normally. Human talents may turn out to be one of these things. Some people are lucky enough to find themselves on the right side of these distributions – smarter than average, better at school, more conscientious, whatever. To them go many spoils – probably more so now than at any time before, thanks to the information economy.

There’s a common story told about a hotshot student at school whose ego crashes to earth when they go to university and find themselves among a group all as special as they thought they were. The reality might be worse: many of the groups the smart or studious segregate into (physics professors, Harvard undergraduates, doctors) have threshold (or near threshold)-like effects: only those with straight A’s, only those with IQs > X, etc. need apply. This introduces a positive skew to the population: most (and the median) are below the average, brought up by a long tail of the (even more) exceptional. Instead of comforting ourselves at looking at the entire population to which we compare favorably, most of us will look around our peer group and find ourselves in the middle, and having to look a long way up to the best.[ref]As further bad news, there may be progression of ‘tiers’ which are progressively more selective, somewhat akin to stacked band-pass filters: even if you were the best maths student at your school, then the best at university, you may still find yourself plonked around median in a positive-skewed population of maths professors – and if you were an exceptional maths professor, you might find yourself plonked around median in the population of fields medalists. And so on (especially – see infra – if the underlying distribution is something scale-free).[/ref]

normal

Yet part of growing up is recognizing there will inevitably be people better than you are – the more able may be able to buy their egos time, but no more. But that needn’t be so bad: in several fields (such as medicine) it can be genuinely hard to judge ‘betterness’, and so harder to find exemplars to illuminate your relative mediocrity. Often there are a variety of dimensions to being ‘better’ at something: although I don’t need to try too hard to find doctors who are better at some aspect of medicine than I (more knowledgeable, kinder, more skilled in communication etc.) it is mercifully rare to find doctors who are better than me in all respects. And often the tails are thin: if you’re around 1 standard deviation above the mean, people many times further from the average than you are will still be extraordinarily rare, even if you had a good stick to compare them to yourself.

Look at our thick-tailed works, ye average, and despair![ref]I wonder how much this post is a monument to the grasping vaingloriousness of my character…[/ref]

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