Wyzga On Words

The Sounds Of Silence Mean More To Us Than We Know.

It's been a dog's age since I've gone cross country skiing in a snowy woods. The silence was so profound you could hear a snowflake fall and meet up with another. Even now I can summon the peace and tranquility of that memory in my mind.  It takes effort to separate myself from the hum of civilization.

More and more we are assaulted by noise.  We may think we are doing a good job of blocking it out or coping or managing.  But the truth of it is we may not really appreciate what good the sounds of silence do for our souls; especially those found in nature.

I am encouraged by the work of folks like Davyd Betchkal, Denali Par and National Preserve's physical-science technician as he locates and captures "nature's soft voice before human sounds completely drown it out."  Kim Tingley reporting for the NYTimes trekked along with Betchkal and has a remarkable story to tell in "Whisper of The Wild."

What compositions would nature play without us?  Excerpt.

"An undeveloped swath of land nearly the size of Vermont, Denali should be a haven for natural sound. Enormous stretches of wild country abut the park in every direction save east, where Route 3 connects Fairbanks to Anchorage. One dead-end and mostly unpaved road penetrates the park itself. Yet since 2006, when scientists at Denali began a decade-long effort to collect a month’s worth of acoustic data from more than 60 sites across the park — including a 14,000-foot-high spot on Mount McKinley — Betchkal and his colleagues have recorded only 36 complete days in which the sounds of an internal combustion engine of some sort were absent. Planes are the most common source. Once, in the course of 24 hours, a single recording station captured the buzzing of 78 low-altitude props — the kind used for sightseeing tours; other areas have logged daily averages as high as one sky- or street-traffic sound every 17 minutes. The loudest stretch of the year is summer, when hundreds of thousands of tourists flock to Denali, embarking on helicopter or fixed-wing rides. Snowmobiles are popular with locals, and noise from the highway, the park road and daily passenger trains can travel for miles. That sort of human din, studies are beginning to suggest, is imperiling habitat — in Denali as well as wilderness areas around the world — as surely as a bulldozer or oil spill. But scientists have so little information about what landscapes should sound like without human interference that trying to correct the problem would be like a surgeon’s wielding a scalpel without knowing the parts of the body, let alone his patient’s symptoms. To restore ecosystems to acoustic health, researchers must determine, to the last raindrop, what compositions nature would play without us." 

More importantly, human chatter is severing the link with nature.  Everything is connected to everything else. Excerpt.

"Indeed, though soundscape ecology has hardly begun, natural soundscapes already face a crisis. Humans have irrevocably altered the acoustics of the entire globe — and our racket continues to spread. Missing or altered voices in a soundscape tend to indicate broader environmental problems. For instance, at least one invasive species, the red-billed leiothrix of East Asia, appears to use its clamorous chatter to drown out the native European blackbird in Northern Italy. Noise can mask mating calls, cause stress and prevent animals from hearing alarms, the stirrings of prey and other useful survival cues. And as climate change prompts a shift in creatures’ migration schedules, circadian rhythms and preferred habitats — reshuffling the where and when of their calls — soundscapes are altered, too. Soundscape ecologists hope they can save some ecosystems, but they also realize they will bear witness to many finales. “There may be some very unique soundscapes around the world that — just through normal human activities — would be lost forever,” Pijanowski says — unless he and colleagues can record them before they disappear. An even more critical task, he thinks, is alerting people to the way “soundscapes provide us with a sense of place” and an emotional bond with the natural world that is unraveling. As children, our grandparents could hope to swim in a lake or lie in a meadow for whole afternoons without hearing a motorboat, car or plane; today the engineless hour is all but extinct, and we’ve grown accustomed to constant, mild auditory intrusions. “Humans are becoming an increasingly more urban species, and so we’re surrounding ourselves with concrete and buildings” and “the low hum of the urban landscape,” Pijanowski says. “We’re kind of severing the acoustic link that humans have with nature.” [Emphasis added.]

Who could ever have imagined that soundscapes are worthy of protection - or would need to be?  But that's what it's come to.  Excerpt.

"Only recently, however, have governments from Japan to the European Union begun to recognize natural sounds as a resource requiring protection. When Woodrow Wilson created the National Park Service in 1916, it was to “conserve the scenery”; not until 2000 did a Park Service director issue systemwide instructions for addressing “soundscape preservation.” In 1986, a midair plane crash above the Grand Canyon National Park — where sightseeing tours had operated virtually unchecked for almost 70 years — prompted Congress to pass the National Parks Overflights Act, requiring the Park Service to work with the Federal Aviation Administration in remedying the “significant adverse effect on the natural quiet” that aircraft there appeared to be having. The act also called for studying the impacts of overflight noise on other parks.

Initial research returned alarming results. In Yosemite, planes were heard 30 to 60 percent of the day. In the Haleakala volcano crater in Maui, 8 to 10 helicopters passed overhead per hour. What’s more, other experiments showed, much as the M.I.T. study did, that noise affected the way visitors saw landscapes: when volunteers viewed photos of natural vistas while listening to helicopters on tape, they rated the scenes less picturesque than they did under quieter conditions. By 2000, the National Park Service had staffed a division to gather data on park soundscapes nationwide and create, with the F.A.A., air-tour management plans at 100-plus locations. More than a decade since — partly because of disagreements between aviation and conservation interests — no such plan is in place, though many parks have begun looking for ways to trim other noise, turning off idling shuttle buses, curbing car traffic and investing in less uproarious maintenance tools. Grand Canyon managers, after nearly 25 years of laboring, last year proposed amendments to the timing and routes of sightseeing flights that would make the park somewhat more serene."

Who lives and who dies can be a matter of who is the loudest.  Excerpt.

"Species can fight for airtime in a limited bandwidth by changing their volume or frequency, or by rescheduling the timing of their calls. But there’s no way animals can alter their ability to listen — for their very survival — if human noise conceals, for example, the twig-snap of a prowler or the skittering of prey. In the United States, where more than 80 percent of land is within two-thirds of a mile of a road, the listening area available to most creatures is rapidly shrinking. Beyond hunting and hiding, even invertebrates use the gabbing of unwitting cohabitants for navigation. Sightless, earless and adrift in the open ocean, coral larvae seek to settle on tropical reefs by swimming toward the throbs of muttering fish and snapping-shrimp claws. Eurasian reed warblers en route to southern Africa at night flutter blind over pine forests, sand dunes and the Baltic Sea until, hundreds of feet below, the cheeping of other warblers signals the presence of sustaining wetlands. If those aural cues disappear, the species that heed them may be floating and flying without a compass." 

I was asked recently, "What can we do to help the honeybee situation?"  I replied, "A hive in every backyard is one grass roots approach that's quick, cheap, easy and is working."

For just a moment, stand in the quietest place you can find and listen.  Maybe all you will hear is the beating of your own heart.  That's critical.  Because if we fail to stop killing the planet, what's the point of anything we are working on, right now?

 

 

Glamorous Movie Star + Weapons Systems + Cultural Story Themes Of Bias Against The Beautiful.

My father used to wax nostalgic about the glamorous Hollywood actress, Hedy Lamarr.  And no wonder!

Who knew that behind all the glamour was a brain?  And imagination? 

When Lamarr put those skills to work she invented and patented weapons systems that were a precursor to today's "smart bombs" as well as technology for cell phones, the Bluetooth and GPS. 

Could she sell it?  Not a chance.  The problem was that the men in charge could not be persuaded beyond her beauty.  And Lamarr assumed that the men in charge would overlook her looks and bank on her brains. 

Bias against the beautiful.  Then as now you have to prove yourself twice as much.

Lamarr got nowhere until at the age of 82 when she was awarded the Pioneer Award by the Electronic Frontier Foundation.

Click here to read John Adams' review of Hedy's Folly: The Life and Breakthrough Inventions of Hedy Lamarr, the Most Beautiful Woman in the World in his NYTimes Book Review article, "Brainy Beauty."

Here's the best part that resonates with this storyteller:

"Behind the uniqueness of this story lie deeper themes that Rhodes touches upon: the gender biases against beautiful and intelligent women, the delicate interpersonal politics of scientific collaboration and, perhaps most important of all, the never-ending, implacable conflict between art and Mammon in American culture."

Bias against the beautiful.  Then as now you have to prove yourself twice as much.

Software That Listens For Lies Reminds Us To Keep An Ear Tuned In Focus Group Research.

Imagine this: computers are being taught to spot patterns of emotional speech - human speech that reflects deception, anger, friendliness and even flirtation.

How far we've come from "Hal."

Anne Eisenberg writing for the NYTimes, "Software That Listens For Lies," takes us to a world of promising detective research: computer linguistics.  Excerpt.

"That’s because Dr. Hirschberg is teaching computers how to spot deception — programming them to parse people’s speech for patterns that gauge whether they are being honest.

For this sort of lie detection, there’s no need to strap anyone into a machine. The person’s speech provides all the cues — loudness, changes in pitch, pauses between words, ums and ahs, nervous laughs and dozens of other tiny signs that can suggest a lie.

Dr. Hirschberg is not the only researcher using algorithms to trawl our utterances for evidence of our inner lives. A small band of linguists, engineers and computer scientists, among others, are busy training computers to recognize hallmarks of what they call emotional speech — talk that reflects deception, anger, friendliness and even flirtation."

While it is unlikely that the research or the software will be used in courts of law, the goal is to plumb the depths of human speech for the clues it gives in analyzing speech.

“The scientific goal is to understand how our emotions are reflected in our speech,” Dr. Jurafsky said. “The engineering goal is to build better systems that understand these emotions.”

The programs that these researchers are developing aren’t likely to be used as evidence in a court of law. After all, even the use of polygraphs is highly contentious. But the new programs are already doing better than people at some kinds of mind-reading."

Admittedly, the computers are still struggling with the finer signs of emotion - a not too different situation from us homo narrans.  Yet, what we do have that the computers lack is access to facial expression, body language, and experience to help us discover meaning in language.

TIP:    One place litigators can practice focused listening is in focus group research.  Stop all else and listen to what is being said about the legal stories you are telling the members of the community.

TIP:    Pay attention to three things: (1) the facts the participants use to discuss the legal stories, (2) the emotion they use to express their thoughts, and (3) the intention behind the words.  You might hear energy, boredom, fatigue, doubt, confusion, or enthusiasm.  The way words are spoken informs the attorney about underlying messages.

TIP:    Take careful note of the analogies the participants use to bring their life experiences and world views closer to (or further away) from your client's. 

TIP:    If they are not finding the universal story in your client's particular life experience that is a most important clue to inform you how you could lose this case. 

TIP:    Rework the legal story from a place of "How can we lose?" based on what you heard them say to more closely align the legal proof of your story with this "community proof" necessary to persuade the decision-maker.

 

Playing This Weekend In Napa, CA: Medical-Legal Conference On TBI.

The Brain Injury Association of California is hosting its annual Neuroscience of Brain Injury Conference November 4th and 5th at the Silverado Resort in Napa, CA.

The Conference Program--2011 is enticing.  We intend to come together to do good work.  Hope to see you there.

A Must Read About Traumatic Brain Injury & The Issue That Besets Litigators.

An issue that besets and bedevils personal injury litigators representing the harms and losses suffered by a client with traumatic brain injury (TBI) is how to tell the story of those harms and losses.  TBI damages are often "hidden in plain view" leaving the decision-maker less inclined to comprehend and believe the depth and breadth of the injuries.  Far easier to see third degree burns.  It's a real work of art and science to expose the damages for what they are. 

Jane Rosett eloquently writing her own story for the NYTimes, "Starting Again After a Brain Injury," relates the remarkable fight for her life beginning with what goes wrong with the brain when it is slammed in a traumatic event - and what can happen to rebuild, albeit not replace, what was lost. Excerpt.

“WANT a piece of gum, Jane?” asked my friend Andrée.

“What?” I asked her.

“Gum!”

I didn’t know what she was talking about.

“It’s Trident.”

It was delicious.

That evening, I told my friend David about my day’s big discovery. “It’s called gum and you chew it and it’s fun and there’s this one kind that will let me blow bubbles!”

“Yes, it’s called bubble gum, Jane,” he told me, patiently."

Here I am struggling to function with a newly acquired Logitech WAVE keyboard after decades of using the Microsoft ergonomic one in the misplaced hope that it would stave off carpal tunnel.  I remind myself that it's a simple matter of relearning where to place my fingers with confidence and dexterity.  And it frustrates me.

With TBI how does one "rethread" the lines of one's life?  What does it take?  59 months ago Rosett was jolted at the age of 45 into a new existence.  26 months of rigorous work allowed her back into the home where she had lived independently for 17 years.

Ironically, who she was, her activism for AIDS organizations, and the diverse interests she had engaged in previously created a perverse dress rehearsal for dealing with the challenges of her life today.  How does the past reassert itself?  One vehicle is neuroplasticity.  Excerpt.

"I once believed that I could not grieve for what I do not remember. I no longer believe that. I do grieve for what I can no longer connect with. Phantom memories. “Your pies!” “Your bread!” Friends tell me they miss my baking. One woman whom I still don’t recognize told me I used to shred beets into my chocolate cake batter. Her comment reintroduced me to an evaporated passion I no longer remembered and had not missed until then.

More than four and a half years post brain damage, memories still do not serenely knit back together as in those nifty “How the Brain Heals” neurology cartoons. Shards of memories pierce my consciousness before fragmenting and melting into fresh half-syllables. Some memories hover in shadows. Others gouge and flee.

Initially, memories came back in my dreams and later through my writing and photography. It’s the images, not the words, that come back to me.

My friend Andrée, a physician who treats patients with traumatic brain injuries (though she isn’t one of my doctors), offers me the clinical word for what I am describing: diaschisis, sometimes said to be Greek for “shocked throughout.” She explains that neuroplasticity lets me bypass damaged parts of my brain and forge new neuronal communication routes so I can access, or remember, sensory information that I received as a word, from another place from within my brain and in an entirely different format. Like an image. “So for example, if your brain receives the word ‘love,’ it can recall the word ‘love’ as an image of a heart,” Andrée explains.

Thank you, neuroplasticity!"

Rosett closes with a plea for all of us temporarily able-bodied folks to heed:

"If you want to connect with someone who has a traumatic brain injury, hire us, include us in conversations that regard us instead of speaking about us in the third person in front of our faces. And instead of pressing us about what we “must” remember from our past, simply be present with us. People with traumatic brain injuries are often scolded for having “no sense of time,” but the present is, for many of us, our only authentic time.

So when you see us, please don’t be offended if we don’t remember weathering earthquakes with you, baking your birthday cakes or bouncing your babies on our knees. We’re struggling to make sense of a world that seems brand-new — sometimes wonderful, often overwhelming — with all the courage we can muster."

When Doctors Become Patients & Lawyers Become Clients, Who Calls The Game Shot?

Eric D. Manheime is the director of Bellevue Hospital Center.  He is also a physician.  And the survivor of throat cancer. Writing for the NYTimes, "When Doctors Become Patients," he reveals that when it comes to serious and profound illness affecting them, "doctors are as irrational" as the rest of us; and probably more so given what they know intellectually. 

Dr. Manheim recounts the ups and downs of being diagnosed with squamous cell carcinoma of the throat, brutal treatment regimens, the removedness of physicians from the real world of their patients, the peaceful resignation of choosing not to go on, and the intervention of his spouse who told him he would complete the treatment.  It's a rigorous read.

In Dr. Manheim's story he is a better doctor for having been a patient.  Once he let himself be the patient.  Still and all he will tell you that even if he had to do it all over again, he would not be any more prepared.  "No amount of doctoring can prepare you for being a patient."

What happens back in the Land of Jurisprudence when a lawyer becomes a client?  Do you make it any easier for those who are on your side, fighting your case?  Or are you still in charge? 

In Manheim's situation his wife made the crucial decision for him to finish the treatment.  As a result he is three years now a survivor of the cancer.  He recognizes the dilemma of who will make the right decision when the physicians and the patient can not.

A law suit may be equivalent to a case of cancer.  I am forced to wonder how much control the lawyer has clenched in her fist because she has seen the bad outcomes when she was sitting on the other side of the desk.  Will she allow herself to be a client?  How will she let another advocate on her behalf?

In situations like these, Counsel, those of us working on your behalf may disagree and differ with your assessment, legal story and strategy.  Who is there to help call the game shot?

NJ Supreme Court 1 Step Ahead Of SCOTUS Revising Eyewitness IDs

From the land that's known for prolific winter birding sites, great summer tomatoes, and being a trailblazer in criminal law - my home state of New Jersey - comes precedent setting changes from the Supreme Court on handling and accepting eyewitness testimony.

Benjamin Weiser writing for the August 25, 2011 NYTimes, "In New Jersey, Sweeping Shift on Witness Identifications,"  reports about a significant shift in laws that make it easier for defendants to challenge evidence, mandate judges to inform jurors about eyewitness mis-identification, and come at a critical time when eyewitness identification is under scrutiny for wrongful convictions. 

What makes this new set of rules unique?  The changes are under-girded by an exhaustive review of the literature that points to eyewitness identification as the leading cause of wrongful convictions across the country.  Excerpt.

"The State Supreme Court’s ruling was seen as significant because it was based in part on an exhaustive study of the scientific research on eyewitness identification, led by a special master, a retired judge, who held hearings and led a review of the literature on the issue. The special master, Geoffrey Gaulkin, estimated that more than 2,000 studies related to the subject had been published since the Supreme Court’s original 1977 decision, the court noted.

“Study after study revealed a troubling lack of reliability in eyewitness identifications,” Chief Justice Rabner wrote. “From social science research to the review of actual police lineups, from laboratory experiments to DNA exonerations, the record proves that the possibility of mistaken identification is real."

From a practical standpoint, there are more than a dozen factors that judges should consider when faced with the question of the reliability of eyewitness identification, such as:

1.     whether a weapon was visible during a crime of short duration,
2.     the amount of time the witness had to observe the event,
3.     how close the witness was to the suspect,
4.     whether the witness was under the influence of alcohol or drugs,
5.     whether the witness was identifying someone of a different race,  and
6.     the length of time that had elapsed between the crime and the identification.

New laws always cut both ways.  I am curious to know who will enforce the new laws in the spirit in which they were intended and according to the letter as they were written.  Whether these new laws will discourage eyewitnesses from coming forward.  Or, whether feeling intimidated by the judge's hearing will eyewitnesses hesitate to offer what they "believe" they saw?

Meanwhile, "Attaboy, Jersey!"

When You Decide & What Energy Stores Are On Board Makes A Difference What You Decide.

Who here recalls interviewing for jobs?  I imagine you might have wondered if the time of day you interviewed made a difference for the decision maker.  Turns out it does.

John Tierney (a science columnist for The Times. His essay is adapted from a book he wrote with Roy F. Baumeister, “Willpower: Rediscovering the Greatest Human Strength,”] writing for the Augsut 17, 2011 NYTimes, "Do You Suffer From Decision Fatigue?", cites to a parole hearing to begin his article.  The question asks the reader to choose which of three parolees was released?  A pattern had emerged from the parole board revealing that if your case was heard in the morning (before decision fatigue set in for the judges) you had a whopping 70% chance of being freed. 

It's not a fluke.  Research shows that when we are alert, awake and well-fed we choose well.  When we are tired, worn out, and on a glucose slump we choose poorly.  Think about what this could mean for you and your cases whether they are being tested in small group research, heard by a single decision-maker such as a mediator or arbitrator, or deliberated by a jury.  Excerpt:

"There was nothing malicious or even unusual about the judges’ behavior, which was reported earlier this year by Jonathan Levav of Stanford and Shai Danziger of Ben-Gurion University. The judges’ erratic judgment was due to the occupational hazard of being, as George W. Bush once put it, “the decider.” The mental work of ruling on case after case, whatever the individual merits, wore them down. This sort of decision fatigue can make quarterbacks prone to dubious choices late in the game and C.F.O.’s prone to disastrous dalliances late in the evening. It routinely warps the judgment of everyone, executive and nonexecutive, rich and poor — in fact, it can take a special toll on the poor. Yet few people are even aware of it, and researchers are only beginning to understand why it happens and how to counteract it.

Decision fatigue helps explain why ordinarily sensible people get angry at colleagues and families, splurge on clothes, buy junk food at the supermarket and can’t resist the dealer’s offer to rustproof their new car. No matter how rational and high-minded you try to be, you can’t make decision after decision without paying a biological price. It’s different from ordinary physical fatigue — you’re not consciously aware of being tired — but you’re low on mental energy. The more choices you make throughout the day, the harder each one becomes for your brain, and eventually it looks for shortcuts, usually in either of two very different ways. One shortcut is to become reckless: to act impulsively instead of expending the energy to first think through the consequences. (Sure, tweet that photo! What could go wrong?) The other shortcut is the ultimate energy saver: do nothing. Instead of agonizing over decisions, avoid any choice. Ducking a decision often creates bigger problems in the long run, but for the moment, it eases the mental strain. You start to resist any change, any potentially risky move — like releasing a prisoner who might commit a crime. So the fatigued judge on a parole board takes the easy way out, and the prisoner keeps doing time."  [Emphasis added.]

What is "decision fatigue"?  Actually, it is a form of mental depletion involving the ego.  We humans have a finite supply of mental energy.  We use it up and there it goes.

I imagine it's much like a runner hitting "the wall" in a long race.  They say you have to train for a race, develop your endurance, and pace yourself.  Like your leg muscles, willpower is a form of mental energy that can be exhausted. 

 

"Shop til you drop" is not a misnomer.  By the end of the day anyone can sell you pretty much anything.  A fascinating series of personal and laboratory experiments reveals that we settle for a default option as decision fatigue sets in. 

Recall the last time you bought or leased a car and all the options you had to select or deselect.  What about those of you who registered for wedding gifts?  Do you really care if the sheets are 700 thread count or not?  And then, of course, think about all those choices for the jurors on the multi-page verdict form.  At the end of the day it's no wonder folks throw up their hands and

take whatever is behind Door #3.

 

TIP:    Keep your glucose level up.  Brain power needs glucose.  Even a dieter needs to eat - well.

TIP:    Pace yourself:  [“Good decision making is not a trait of the person, in the sense that it’s always there,” Baumeister says. “It’s a state that fluctuates.” His studies show that people with the best self-control are the ones who structure their lives so as to conserve willpower. They don’t schedule endless back-to-back meetings. They avoid temptations like all-you-can-eat buffets, and they establish habits that eliminate the mental effort of making choices. Instead of deciding every morning whether or not to force themselves to exercise, they set up regular appointments to work out with a friend. Instead of counting on willpower to remain robust all day, they conserve it so that it’s available for emergencies and important decisions."]

TIP:   Pay attention to the length and complexity of jury verdict forms.  Is there a way to use a simpler, more easily understood set of instructions?

TIP:    Pay attention to the energy level of the focus group participants, to your jurors, to the decision-maker.  Perhaps taking a mental and glucose break is what will give you the best decision.

TIP:    When faced with a quandary that did not require an immediate decision, my mother used to advise: "Have a little something to eat, sleep on it and decide in the morning." 9 times out of 10 she was right.   

Q&A Tuesday: Doctors Get Sleep - Hospitals Still Unsafe - Why? Poor Handoff & Communication.

Q:    Rule changes allow first-year residents to sleep; how come serious medical errors continue?

A:    The shift-to-shift handoff about a patient is a communication nightmare.

Time out of mind when I was a nurse working on a hospital pediatric floor, we did not welcome with open arms the new crop of first year residents.   They were over-worked, over-wrought, and over-fatigued from lack of sleep.  Many is the time a nurse would correct a medication error or other order.

Teaching hospitals finally took note.  It was time to get away from the 30-hour overnight shifts that seemed more medieval than blood-letting to remove dangerous "humours" from a patent's body. In hindsight, it seemed like the right idea:  more sleep should mean clearer thinking medical residents; clearer thinking medical residents (trainees) should mean less hospital errors.

However, as a recent study reports serious medical errors continue. Darshak Sanhavi (sanghavi@post.harvard.edu is the chief of pediatric cardiology at UMass Medical School and Slate's health care columnist) reporting for the NYTimes, "The Phantom Menace of Sleep-Deprived Doctors," reveals how sleep is not enough.  We need to learn how to communicate with care what is going on with each patient in an uninterrupted setting.  And that is just not happening. Excerpt.

"The question, then, is why? There are several possible explanations for the failure of the nationwide 80-hour rule to reduce medical harms. In 2008, the journal Pediatrics reported that two-thirds of residents regularly broke the rule, suggesting that poor enforcement, perhaps related to ingrained norms, had undercut the reform. Landrigan, one of the authors of that study, also thinks that the accreditation council did not go far enough; it had not, after all, banned being on call overnight and still allowed shifts up to 30 hours. Now that the council has abolished extended shifts, at least for first-year residents, Landrigan expects fewer errors.

And yet there are reasons to believe otherwise. About 98,000 people die every year from medical errors. Some of those mistakes are made by doctors whose judgment has been scrambled by lack of sleep. But fixating on work hours has meant overlooking other issues, like lack of supervision or the failure to use more reliable computerized records. Worse still, the reforms may have created new, unexpected sources of mistakes. Shorter shifts mean doctors have less continuity with their patients. If one doctor leaves, another must take over. Work-hour reductions lead to more handoffs of patients, and the number of these handoffs is one of the strongest risk factors for error. As a result, many hospitalized patients are at the mercy of a real-life game of telephone, where a message is passed from doctor to doctor — and frequently garbled in the process."

Click here to read a verbatim record of a trainee giving a report to the doctor coming on shift.

As if that is not enough, click here to read a shift change report with a light census - two trainees without a supervising doctor or nurse in the room manage the handoff between shifts.

What's the key? Supervision.  Excerpt.

“Supervision, not regulation of hours, is the key to improving the quality of patient care,” said Bell, who is now 81 and is still an active clinician at Albert Einstein College of Medicine.

There were other holes in Zion’s care too. Edward Boyer, the director of medical toxicology at the University of Massachusetts Medical School (where I am chief of pediatric cardiology) argued convincingly in The New England Journal of Medicine that Zion died from a medication-related reaction called “serotonin syndrome.” This, he said, was a result of a disastrous interaction between the antidepressant phenelzine, which she had been on for weeks, and the Demerol she was given at the hospital. Though the syndrome was first described more than 50 years ago, surveys show that 85 percent of physicians have never heard of it and fewer still know the drugs that cause it. More than 7,000 people develop serotonin syndrome each year — it can occur as a side effect of common drugs like Prozac, Zoloft and over-the-counter cold medicines, and the risk jumps when offending drugs are given in combination, as they were to Zion.

I walked to our outpatient clinic to see what might happen if I prescribed both phenelzine and Demerol to a made-up patient using the clinic’s electronic medical-record system. Immediately, a large box appeared with the message, “This combination of drugs is associated with a potentially fatal adverse reaction.” Then I went over to the inpatient wards, where, as in roughly two-thirds of American hospitals, there is no computerized prescribing system. Nothing would prevent me from writing the orders for Demerol on the paper chart. Were Libby Zion admitted to a typical hospital today, no matter how rested her doctor was, the same error that killed her could happen again."

Comments to this lengthy article bear reading for the insights and experiences.

TIP:    Patients need to be on top of the hospital and the staff.  Families need to be on top of the hospital and the staff.  Lawyers need to be on top of the hospital and the staff.

Hospital, heal thyself.

 

What Do We Know About Time? Why Eye Witness Testimony May Be Unreliable As To Time.

Think back to a time when something scary happened to you:  maybe your car skidded on black ice; maybe you tripped and fell headlong down a flight of stairs; maybe you took a dare and went on the tallest roller coaster ride at the amusement park.   How did time feel?  

A brush with death taught David Eagleman about the mysteries of time and the brain.  Burkhard Bilger takes us along on a journey of discovery in his tautly written and provocative New Yorker article profiling neuroscientist Eagleman and his work in "The Possibilian."  Read all 10 pages.  I am betting that you won't look at time, amusement park rides or eye witness testimony quite the same way.  Excerpt:

"When David Eagleman was eight years old, he fell off a roof and kept on falling. Or so it seemed at the time....

In the years since, Eagleman has collected hundreds of stories like his, and they almost all share the same quality: in life-threatening situations, time seems to slow down. He remembers the feeling clearly, he says. His body stumbles forward as the tar paper tears free at his feet. His hands stretch toward the ledge, but it’s out of reach. The brick floor floats upward—some shiny nails are scattered across it—as his body rotates weightlessly above the ground. It’s a moment of absolute calm and eerie mental acuity. But the thing he remembers best is the thought that struck him in midair: this must be how Alice felt when she was tumbling down the rabbit hole."

Eagleman is 39 years old now and an assistant professor of neuroscience at Baylor College of Medicine, in Houston.  Excerpt.

"If Eagleman’s body bears no marks of his childhood accident, his mind has been deeply imprinted by it. He is a man obsessed by time. As the head of a lab at Baylor, Eagleman has spent the past decade tracing the neural and psychological circuitry of the brain’s biological clocks."

 And this is how he spends his life - figuring it out for the rest of us.  Excerpt.

"Although Eagleman and his students study timing in the brain, their own sense of time tends to be somewhat unreliable. Eagleman wears a Russian wristwatch to work every morning, though it’s been broken for months. “The other day, I was in the lab,” he told me, “and I said to Daisy, who sits in the corner, ‘Hey, what time is it?’ And she said, ‘I don’t know. My watch is broken.’ It turns out that we’re all wearing broken watches.” Scientists are often drawn to things that bedevil them, he said. “I know one lab that studies nicotine receptors and all the scientists are smokers, and another lab that studies impulse control and they’re all overweight.” But Eagleman’s ambivalence goes deeper. Clocks offer at best a convenient fiction, he says. They imply that time ticks steadily, predictably forward, when our experience shows that it often does the opposite: it stretches and compresses, skips a beat and doubles back.

The brain is a remarkably capable chronometer for most purposes. It can track seconds, minutes, days, and weeks, set off alarms in the morning, at bedtime, on birthdays and anniversaries. Timing is so essential to our survival that it may be the most finely tuned of our senses."

 So, we all have some sense of time, but it is "intrinsically subjective."  Which may explain why one of my sisters will always be late no matter how early she starts out.  The biggest question: where and how does time exist?  Apparently, time does not match reality.  And this data led Eagleman to research: 

"Why does time slow down when we fear for our lives? Does the brain shift gears for a few suspended seconds and perceive the world at half speed, or is some other mechanism at work?"

 It seems that the only way to find out was to re-create situations in controlled settings.  This leads to the amusement park ride and human subjects.  "He needed something completely safe yet plausibly deadly. “I really chewed on this for a while,” he told me. “I couldn’t put people in a car accident.” Then he heard about the SCAD."

I am going to jump ahead here because I am fascinated with just how complex we human creatures really are.  Folks try to dissect us this way and that way into isolated brain parts but the bottom line is a lot is not clear.  Excerpt.

"Just how many clocks we contain still isn’t clear. The most recent neuroscience papers make the brain sound like a Victorian attic, full of odd, vaguely labelled objects ticking away in every corner. The circadian clock, which tracks the cycle of day and night, lurks in the suprachiasmatic nucleus, in the hypothalamus. The cerebellum, which governs muscle movements, may control timing on the order of a few seconds or minutes. The basal ganglia and various parts of the cortex have all been nominated as timekeepers, though there’s some disagreement on the details. The standard model, proposed by the late Columbia psychologist John Gibbon in the nineteen-seventies, holds that the brain has “pacemaker” neurons that release steady pulses of neurotransmitters. More recently, at Duke, the neuroscientist Warren Meck has suggested that timing is governed by groups of neurons that oscillate at different frequencies. At U.C.L.A., Dean Buonomano believes that areas throughout the brain function as clocks, their tissue ticking with neural networks that change in predictable patterns. “Imagine a skyscraper at night,” he told me. “Some people on the top floor work till midnight, while some on the lower floors may go to bed early. If you studied the patterns long enough, you could tell the time just by looking at which lights are on.”

“There’s always an impulse toward phrenology in neuroscience—toward saying, ‘Here is the spot where it’s happening,’ ” Eagleman told me. “But the interesting thing about time is that there is no spot. It’s a distributed property. It’s metasensory; it rides on top of all the others.”

The real mystery is how all this is coördinated. When you watch a ballgame or bite into a hot dog, your senses are in perfect synch: they see and hear, touch and taste the same thing at the same moment. Yet they operate at fundamentally different speeds, with different inputs. Sound travels more slowly than light, and aromas and tastes more slowly still. Even if the signals reached your brain at the same time, they would get processed at different rates. The reason that a hundred-metre dash starts with a pistol shot rather than a burst of light, Eagleman pointed out, is that the body reacts much more quickly to sound. Our ears and auditory cortex can process a signal forty milliseconds faster than our eyes and visual cortex—more than making up for the speed of light. It’s another vestige, perhaps, of our days in the jungle, when we’d hear the tiger long before we’d see it."

Before I leave you to delve further into Eagleman's work, two mentions: (1) he fell under the spell of Francis Crick, the biologist who years earlier had won the Noble Prize with James Watson for deciphering the structure of DNA.  Crick called the work of inquiring into the notion of individual awareness "the scientific search for the soul."  And (2):

"Something similar happens in language all the time, Dean Buonomano told me. If someone says, “The mouse on the desk is broken,” your mind calls forth a different image than if you hear, “The mouse on the desk is eating cheese.” Your brain registers the word “mouse,” waits for its context, and only then goes back to visualize it. But language leaves time for second thoughts. The flash-lag effect seems instantaneous. It’s as if the word “mouse” were changed to “track pad” before you even heard it.

 The explanation for this is both simple and profoundly strange."

 And now for the rest you're on your own.  No storyteller worth her salt would ever reveal the end too soon or tell the listener what the moral of a story is - it's your own discovery.