Friday, October 21, 2011

Personal Bests

It is no secret that my two favorite writers in The New Yorker are (in either order): Atul Gawande, and Adam Gopnik. So it was with some pleasure that I noticed that two recent issues featured articles from them: Personal Best, by Gawande, and Broken Kingdom, by Gopnik. Each essay is different, and their topics are completely unrelated, yet I find them intriguingly inter-connected.

Gopnik's article celebrates the fiftieth anniversary of a very under-appreciated classic: Norton Juster's The Phantom Tollbooth (published the year I was born!). As Gopnik says, it really means something when a children's book stands the test of time like this:

it means that the book hasn't been passed just from parent to child but from parent to child and on to child again.

Somehow, Gopnik tracks down not just Juster, but also Jules Feiffer, the illustrator, and spends several hours with them ("a pair of wryly benevolent uncles") talking about the book, about how it came to be, and about what they think it means that it has survived to the present day: "The book is made magical by Juster's and Feiffer's gift for transforming abstract philosophical ideas into unforgettable images."

Gopnik proposes that the "enduring magic" of The Phantom Tollbooth is in fact quite fundamental:

As with every classic of children's literature, its real subject is education. The distinctive quality of modern civilization, after all, is that children are subjected to year after year after year of schooling. In the best-loved kids' books, the choice is often between the true education presented in the book -- say, Arthur's through anaimals at the hands of Merlyn, in The Sword in the Stone -- and the false education of the world and school. The child being read to (and the adult reading) is persuaded that self-reliance is a better model for learning than slavish obedience.

The Phantom Tollbooth, claims Gopnik, represents the ultimate paean to curiosity and a love of all knowledge, wherever it might lie. It is:

not just a manifesto for learning; it is a manifesto for the liberal arts, for a liberal education, and even for the liberal-arts college.

Meanwhile, Gawande is thinking about learning, too, but from a quite different angle:

I've been a surgeon for eight years. For the past couple of them, my performance in the operating room has reached a plateau. I'd like to think it's a good thing -- I've arrived at my professional peak. But mainly it seems as if I've just stopped getting better.

Not surprisingly, this worries Gawande, and he tries various techniques to figure out what is wrong, but then inspiration arrives from a somewhat unlikely corner; while at a medical conference, he takes a break to practice his tennis, and works out with the club's "house pro". Afterwards he happens to be watching a tennis match, and:

I watched Rafael Nadal play a tournament match on the Tennis Channel. The camera flashed to his coach, and the obvious struck me as interesting: even Rafael Nadal has a coach. Nearly every elite tennis player in the world does. Professional athletes use coaches to make sure they are as good as they can be.

But doctors don't. I'd paid to have a kid just out of college look at my serve. So why did I find it inconceivable to pay someone to come into my operating room and coach me on my surgical technique?

The wonderful thing about Gawande, the reason that he is so incredibly inspirational and motivational, is that he doesn't just stop with this insight, he acts upon it:

I decided to try a coach. I called Robert Osteen, a retired general surgeon, whom I trained under during my residency, to see if he might consider the idea. He's one of the surgeons I most hoped to emulate in my career. His operations were swift without seeming hurried and elegant without seeming showy. He was calm. I never once saw him lose his temper. He had a plan for every circumstance. He had impeccable judgement. nad his patients has unusally few complications.

Sounds like the dream coach!

Osteen agrees to the request, and the coaching begins:

He came to my operating room one morning and stood silently observing from a step stool set back a few feet from the table. He scribbled in a notepad and changed position once in a while, looking over the anesthesia drape or watching from behind me.

Afterward, Gawande worries that it was all a waste of time:

The case went beautifully. The cancer had not spread beyond the thyroid, and, in eighty-six minutes, we removed the fleshy, butterfly-shaped organ, carefully detaching it from the trachea and from the nerves to the vocal cords. Osteen had rarely done this operation when he was practicing, and I wondered whether he would find anything useful to tell me.

Gawande need not have worried:

I'd positioned and draped the patient perfectly for me [...] but not for anyone else. [...] At one point, we found ourselves struggling to see [...] I should have made more room [...] my right elbow rose to the level of my shoulder [...] I operate with magnifying loupes and wasn't aware how much this restricted my peripheral vision [...] the operating light drifted out of the wound.
In fact, there are plenty of opportunities for improvement:
That one twenty-minute discussion gave me more to consider and work on that I'd had in the past five years.
How wonderful!

They repeat the process, multiple times, verifying that earlier mistakes are corrected, and moving on to other areas for improvement. Gawande is thrilled:

Since I have taken on a coach, my complication rate has gone down. It's too soon to know for sure whther that's not random, but it seems real. I know that I'm learning again. I can't say that every surgeon needs a coach to do his or her best work, but I've discovered that I do.

Oh, how deeply that one sentence resonates with me: "I know that I'm learning again." Is there any sensation more wonderful? Perhaps there are one or two, but this is near to the pinnacle of what it means to be a human. Will Gawande's observations lead others to find coaches? In my own field of software engineering, one of the big breakthroughs of this century is something called "Peer programming", in which engineers are challenged to work side-by-side, thinking out loud, sharing observations and ideas, listening and learning from each other constantly. It's fatiguing, but oh-so-helpful: when I get stuck, the first thing I do is call over my cube wall:

Hey Cal, are you there? Can you come be another pair of eyes? I'm just not seeing this...

And now we come full circle, back to Gopnick and Norton Juster. Thinking and thinking about The Phantom Tollbooth, Gopnik finally zeroes in on the specific insight that the book conveys, the reason that, fifty years later, it still thrills reader after reader.

"Many of the things I'm supposed to know seem so useless that I can't see the purpose in learning them at all," Milo complains to Rhyme and Reason. They don't tell him to listen to his inner spirit, or trust the Force. Instead, Reason says, "You may not see it now, but whatever we learn has a purpose and whatever we do affects everything and everyone else. ... Whenever you learn something new, the whole world becomes that much richer."

Indeed, says Gopnik:

Learning isn't a set of things that we know but a world that we enter.

Oh, dear reader: write that down and place it somewhere important, and look at it every day.

No comments:

Post a Comment