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Statistically improbable is not impossible, so on occasion one will beat the odds. But no matter one's knowledge, skills and abilities, to beat the odds this time does not guarantee the same individual will beat the odds next time. The individual has obviously reduced their personal statistical improbability perhaps by a significant amount (and the overall statistical improbability by a tiny amount), but depending on the beginning odds, odds are a statistical improbability will remain a statistical improbability. And of course the other side of this coin is that on occasion one will lose to odds that were in their favor. This reasoning affirms the presence of luck; the capricious whim of fractious circumstance.

I guess my question this week is why do we congratulate someone who wins a lottery? Why do we afford respect and even adulation to someone who was born on third base? And why do we blame someone for their suffering from our oppression? Within this last question, this withholding, this refusal, of opportunity is (in so many ways) the poster child for “capricious whim of fractious circumstance.” A circumstance created and perpetuated by us.

Perhaps to recognize the folly in our consistent and consensus censure of those (we perceive as) less deserving, we must first understand the inanity of acclaim. But as humans we are driven not only to exist, but also to justify our existence. So we are compelled to stop and bask in glory, soak up accolades, and, when necessary, embellish, exaggerate and boast. But think how much better we would be if effort spent seeking and soaking were instead spent learning and growing. I should not need kudos for merely doing my job, and a supervisor or peer should not feel obligated to expend effort handing them out. To be driven by praise is to aid and abet status quo by defrauding improvement; diverting time and effort from change-for-the-better to building-one's-ego.

Today, more and more, instead of guiding and rewarding productivity and efficiency Adam Smith’s invisible hand appears to be guiding ego and rewarding power, which is perceived by many as feelings of importance that come from recognition. And when one is motivated by recognition, especially recognition from those they perceive as powerful or important, little or no thought is actually given to improvement. For the worker, maintaining the status quo becomes the most efficient way, the shortest route, to the hearts of the rich and powerful; and maintaining the status quo is the ultimate objective of those in power – it’s good to be King. And today, instead of appearing greedy, the ruling class works to come across as generous. And they are generous, sometimes expansively so, with their words and their rules and their processes and their bureaucracy and their thank yous and their smiles. And too often, the working class is as (or more) effusive. And all this mutual admiration does not move us forward. Comedian George Carlin once said, “That invisible hand of Adam Smith’s seems to offer an extended middle finger to an awful lot of people.” Today, though the middle finger is still prominent, that invisible hand also offers condescending pats on the head. And finally one result, (perhaps the worst result), of this greed-to-gratitude shift is that the rich and powerful are also focusing less and less on productivity and efficiency, and even less on a future that requires change-for-the-better.

So perhaps I have stumbled across the realization that acclaim is in actuality a wolf in sheep’s clothing; a dressed up version of censure and oppression. Misleading and manipulative. Yet we like it. Perhaps because it makes us feel better about all the hardship and injustice.

“It is really great that 100% of our students are in the top 50%.” I work in a medical school and I recently said this to a clerkship director. She didn't like it.

Satisfactory: adequate, suitable, fulfilling all the requirements. Imagine a largely subjective evaluation with a 5 point scale on which 1 is Outstanding, 2 Above Average, 3 Average, 4 Below Average, and 5 Unsatisfactory, and using multiple evaluations to calculate an average for the final grade expressed as Honors (overall average of 1.0 to 1.74), or Commendation (overall average of 1.75 to 2.30), or Satisfactory (overall average of 2.31 to 3.50), or Unsatisfactory (average greater than 3.5). So, with 3.0 as the defined average, mathematically 100% of our students on clinical assignments are in the top 50%. In my three-plus years in this position, (more than 5,000 evaluations requiring more than 20,000 reminders for more than 700 students), no one has averaged more than 3.0, much less more than the 3.5 necessary for remediation; (or at least I assume some form of remediation would be required for Unsatisfactory, but since I have never seen it, I guess I don't really know).

The fact that 100% of our students are in the top 50% is a tribute to and a reflection of our priorities and processes. Yet it works very hard to come out the other end as a tribute to the excellence of our students, which is misleading; and for the faculty it justifies their self-importance and their belief in their own excellence in teaching, which is also likely misleading. Medical school, (as I believe is true for much of higher education), is no longer the formal education advertised; it has become an apprenticeship.

Maybe it has always been so? And maybe this is okay? But if it is, why the charade? Why not admit it is pass/fail? (Or for all intents and purposes, pass/fail-pass?) Is it so the University can justify its existence and continue to charge exorbitant fees for an education that is not what it is supposed to be? If so, it is consistent. Maintain that status quo! Go America!

Some would argue that the first two years of medical school are largely classroom learning, thus formal education. And these same Pollyannas would argue the same about most of traditional higher education. I would argue that the college experience has more and more become on the job training teaching the social skills necessary for many of the jobs requiring a college degree. My argument is supported by research on grade inflation and the student as customer; (look it up). Our priorities, (graduation rates, placement rates, more students, more tuition), guide and encourage our processes. In my experience, documented quality formative feedback is nearly nonexistent.

There is another factor at play here: because medical school is so expensive and so exclusive only to those who can afford the time and effort required both in preparation and attendance, equal opportunity is absent. The first question (though a bit rhetorical) is, “Is this purposeful?” The next question is, “Does this contribute to our priority-led process?” I believe it does. Not only must we work to justify our existence, we also tend toward easy and status quo is much easier (and less expensive In the short term) than change.

100% of our students on clinical rotations are in the top 50%. It aligns with our priorities, it is easier, and it is the way everyone does it. This is not only a condemnation of the medical school I am attached to, but (I believe) also of all medical schools, all higher education, our culture and our country.

Go America!

Our priorities need to change. Instead of today, tomorrow. Instead of hard currency, an open exchange. Instead of an accomplishment, a gift. Instead of a statement, an ellipsis. An acknowledgement that I am an adumbration; a mere foreshadow of those to follow. So what will I choose to portend? Am I a champion for Beauty, Truth, Wisdom, Justice? Or am I a Harbinger of Doom?

Pretty heavy conclusion for a mathematical aberration. But we have to start somewhere.

I am dismissable. Constantly being told, “You can just go sit down now.” But then, aren't we all? Some don't notice because they are focused to a larger degree than is necessary and/or helpful on the moment and me; (me being their self). To focus on the moment and/or one's self is to severely limit one's scope of understanding. Sounds obvious, when stated. Others don't notice their own irrelevancy because they control the power dynamic and in the moment, (yeah, that moment), they say all the right things; and perhaps in that moment they convince themselves that they really mean these right things and will follow up. But once I am dismissed, once I go sit down, I am no longer urgent, (in the moment), and as long as I remain seated, I slowly slide, (and sometimes not so slowly), from procrastinated priority to inconsequential inconvenience.

Perhaps I am better off closer to reality; closer to Truth. I believe I am. But it still hurts.

I am necessary. Constantly being told, “You should be conscious of your obligation.” But then, shouldn't we all? To have an obligation is to be necessary. Unfortunately, “obligation” is frequently misconstrued within the context of a power dynamic. I believe my obligation is to Beauty, Truth, Wisdom, Justice. Yet we live (as a species and as individuals) as if our obligation is to power. And even if to live, we must live within constantly shifting power dynamics our obligation should then be to power that moves us (as individuals and as a species) toward Beauty, Truth, Wisdom, Justice. Power merely for the sake of power negates the future.

To be both dismissable and necessary seems counterintuitive. It is not. If one defines necessity as requisite (as opposed to important), then for another to dismiss me, it is a precondition that I be here; I am required; I am necessary. And the fact that I am the one being dismissed (or perceived as unimportant) is a reflection of the power dynamic, not of who is more necessary. This can be said of any interaction.

So what? Splitting hairs? Isn’t importance still more important than necessity? Not necessarily. If an individual wields power in the interest of Beauty, Truth, Wisdom, Justice and if I recognize my obligation (i.e. necessity) to those unreachable ends and act accordingly, then necessity rises to the level of importance. But if one wields power merely for the sake of power (as is done in a bureaucracy), then my obligation to Beauty, Truth, Wisdom, Justice acted on in good faith is more important in theory, but in practice power has more influence and is thusly widely seen as more important. For example my anger and sadness (see 3/12/22 and 3/19/22) regarding the injustice endemic in the power wielded at my employer (a large state university) is constantly dismissed and forgotten because the rich and powerful influence the existing bureaucracy (power for the sake of power) to maintain status quo. There are billions of these examples perpetuated every day. So why fight? Why be angry? Why be sad?

…to maintain the integrity of my necessity.

I say I want to save the world and what I mean of course is I want to save Humanity. I am not doing a very good job. Besides being only one inconsequential voice, (duh), I think one (big) hump I’m having trouble getting over (being completely truthful) is that my heart is just not into saving ignorant people. Sometimes I look at Humanity and think that yes, we deserve to be a short-lived mammalian species; our extinction would do the world some good. And I suppose in that regard, perhaps together we are working to save the world. But it would be better if we could add one inconsequential voice plus one inconsequential voice plus one inconsequential voice and keep adding to a point of consequentiality. As a whole I believe that as each generation (and even as each decade) comes and goes we are less and less ignorant; but between some generations the incremental improvement is pretty small. To truly save Humanity, we need to step this up; more of us need to find our voice. I also believe, (perhaps merely due to proximity), that in recent decades we, as a whole, have become less ignorant but for whatever reason(s) we continue to allow the volume (i.e. loudness) to increase, making us appear more ignorant. As technology has advanced, what used to be pockets of mostly hidden or ignored ignorance have become reverberations rocking the world stage. And it is hard for me to see and hear this and feel all warm and fuzzy about saving Humanity. But perhaps saving Humanity should not be warm and fuzzy. But I also don’t believe it should be all clanging metal and sharp edges. Instead of having to choose one extreme or the other, there must be empathy and compassion alongside reasoned consideration, a degree of toughness, and consensus expert planning, for improvement.

This week I started the book “The Invisible Life of Addie LaRue” by V. E. Schwab. The opening words attributed to the fictional character Estele Magritte were as follows:

“The old gods may be great, but they are neither kind nor merciful. They are fickle, unsteady as moonlight on water, or shadows in a storm. If you insist on calling them, take heed: be careful what you ask for, be willing to pay the price. And no matter how desperate or dire, never pray to the gods that answer after dark.”

We are still praying to the old gods and expecting them to save us. A mix of tradition and certainty and indolence and ignorance. And for those who call on “the gods that answer after dark” throw in disdain and partisanship and intolerance and oppression and clanging metal and sharp edges. Within this volatile fusion I am afraid we will soon pay the price.

So I need to work on leaning more toward nice and softening my truthfulness? Maybe; at least in my daily interactions. I do have some sharp edges and I am pretty sure that is not the way to encourage less ignorance. It is difficult though to stay energized looking up at the peak, enlightenment, layered on Beauty, Truth, Wisdom, Justice layered on reason layered on learning layered on urgency layered on quiescence layered on ignorance. It is a large mountain to climb and it is easy to fall back on apathy; especially when one's apathy is a lush flowering green meadow and most especially in one’s own Springtime.

Every day I walk to work and the route includes one long, steep, uphill curve where for a few minutes I look to my left at the towering rock bluff, to my right at trees, and behind me and up ahead at a seemingly endless curve. It is not difficult to imagine that I will be climbing forever. This is what, (as one inconsequential voice), working to save the world feels like. At least Sisyphus periodically got a change of scenery by starting over at the bottom of the hill; and he had to put his heart into it to avoid the interminable threat of the crushing weight that was his boulder. Unfortunately today many (Most? All?) of us are able to ignore the very real weight of the very real threat that is our ignorance.

I can feel that my time is measured. By whom? Perhaps at birth each one of us is assigned a personal timekeeper. A timeless, changeless individual on a tall work stool hunched over a chronometer on a bench strewn with cogs and wheels and spinners and tiny, intricate shafts and hinges and nuts and bolts and likewise the tools necessary for all manner of maintenance and upkeep, and their singular focus is on the timepiece before them in an effort to keep it reliably ticking away. I picture my timekeeper as a bent, gnarled, pinched, spry old man with a gleam in his eye and sparkling flecks of white in his long, gray hair and beard. Or perhaps that is too traditional. Perhaps my timekeeper is a beautiful, young woman with long flowing red and golden hair, green eyes and a determined look and manner that would keep the most intrepid of curiosity-seekers at a distance. I would like to approach. But I believe it to my benefit if she is allowed to work with no distraction. Does the timekeeper know when the timekeeping will stop? Is the timepiece before them counting down? Or counting up? If it is counting down, to what? A predetermined number of minutes? An ordained event? An eventual stifling quiescence? And does this imply mortality? Insignificance? Emptiness? Nothingness? If it is counting up, to what? A passing into a different possibility? A fulfilled potential? Punishment? Reward? Enlightenment? And does this imply a referee and/or a scorekeeper? Or is the time, counting up or down, truly random, dependent upon the skill of the timekeeper, the availability of parts and tools, and the intensity and number of distractions? Perhaps there is a combination of factors. If I fulfill my potential at 30, but it is my destiny to live to the age of 66, is my timekeeper out of work for 36 years? Game over? Or am I perhaps assigned an apprentice timekeeper, a personal Siri, learning their trade on my now easier-to-maintain countdown? And is this why one may prefer a count down to a counting up? Because it offers a greater possibility for longevity?

I believe a countdown to be easier to maintain and to offer a greater possibility for longevity due to momentum. I don't believe a temporary lapse in the workings of one's timepiece counting down will immediately stop one's time. In fact, I believe, because the countdown is for a determined moment ahead, if done reasonably quickly, a new stopwatch could be synchronized and assigned.

I believe power (merely perceived or otherwise) forces a counting up to turn around and become a count down. And I believe the greater the power the greater the momentum, and the less likely / the more difficult it becomes for one to again begin counting up. And as implied I believe a countdown eliminates the possibility / need of a referee and/or a scorekeeper. Sad.

Perhaps one’s lifetime holds the potential for multiple switchbacks. I would like to believe that one’s childhood is a counting up, but I can see how some of those on both ends of the privileged spectrum may more likely spend their childhood counting down. And I would like to believe that one can choose at any time throughout one’s life to again begin counting up, but I can see how some (perhaps many, most or all) of those on the lower end of the privileged spectrum may not have that option.

I began by saying I can feel that my time is measured. Perhaps beyond the innocence of childhood, this recognition is necessary to enable one’s timekeeper to count up. Once one reaches a majority balance of cynical certainty (vs active hope), coupled with a denial of one's possible mortality, and regardless of perceived or actual power, one is pretty much in a state of time-biding apathy in which the end is on its way. As a species, the more and more of us who settle for countdown, will not only not move us forward, it will also expand, intensify and steer that end toward us. As a species. Sad.