Field of Science

Life and Lemons: Follow-up on 'the' conversation

I told you we would get back to Dr. Ego Tistical

This isn't really about Dr. Tistical specifically, but the medical doctor (as opposed to nurses, EMTs, etc.) profession in general. Based on my experience I expect that a majority of medical doctors care deeply about titles and I wonder why. My issue isn't so much with the focus on titles, it's the implicit disrespect of others that comes with their use of titles. The conversation between myself, the Dr. Tistical, and the medical technician John, is one I have seen played out many times. The doctor goes by Dr., I have a Ph.D. so I am introduced as Dr., and the non-professionally degreed individual is referred to by their first name. (Of course if the doctor is unaware that I have a Ph.D., then I am also introduced by my first name.)
Establishing positive relationships, from here
Herein lies my issue, if you are going to introduce yourself as Dr. Tistical, your colleague is not John, it's Mr. Getoveryourself. By promoting your lofty accomplishments, but not granting your colleague, and dare I say fucking partner in the whole patient care-testing process, the same level of respect, you are a douchebag. In this specific conversation, Dr. Tistical always called me Angry, and I always called her Ego, until we were in the presence of John, then I was Dr. Choice. I am ok being introduced as Dr. Choice or Mr. Choice as I think we could do with certain level of formality in professional settings. When I introduce my son to new adult friends/colleagues, I almost always introduce them as Ms. or Dr. Lastnamehere. My issue is that I was introduced as Dr. Choice and John was introduced as John. Why not Mr. Getoveryourself or why not introduce me as Angry?

This is not an isolated case. I have met with many doctors over the last two months. They are uniformly introduced as Dr. Soandso. It's a toss-up on whether I am introduced or referred to as Angry or Dr. Choice. I have also met with many nurses, technicians, and other hospital staff. They are uniformly introduced by their first name. I am introduced or referred to almost always as Dr. Choice. Why? 

There are many ways a doctor could introduce themselves. For example, one could introduce themselves thusly: 
Hi I'm Ego, I'm your neurology doctor. How are you feeling today Angry?
This is the form the nurses and staff used to introduce themselves to me.

I want to stress that the interactions I had during my life and lemons episode with the doctors, nurses, and staff were wonderful. And my issues with introductions and titles were  mild. I did not get the sense that my doctors were being elitist snobs and I actually believe this is a training issue. When students are in the clinic they see the Dr./staff and Dr./patient interaction modeled. However, this culture can foster a cesspool of elitism where douchebaggery can thrive if not flourish. This is my reason for writing this post. For example, one weekend my ex-wife and I were in the elevator going to her lab when a guy wearing a lab coat got on. My ex introduced me to Paul (name not changed because he is a waste of space).
"Paul, Angry. Angry, Paul." 
"It's Dr. Imanarrogantfuck" immediately responded Imanarrogantfuck. 
Wow just fucking wow, was my only thought."Dr. Choice, Dept. of kissmyass" was my reply.
Paul looked somewhat abashed, maybe professionals don't ever wear jeans with holes in them like I had on or maybe MDs and/or PhDs in Paul's world do not marry non-MD and/or PhDs or maybe they don't allow their spouses to work. I don't know or care, from that instant on, Paul was and always will be a waste of a sperm and an egg. (Aside: Paul is a small man, literally and figuratively.)
A possible result of unreciprocated titles, from here

Life and Lemons: Testing and Results

When we last met I told that I was recovering from a seizure(s) and detailed a bit about how my short memory was fried or at least seared. After a few more weeks of recovery and numerous doctor visits and tests, I know a bit more about what happened and what didn't happen. The important thing is that mentally I am back to normal or back to the same level of abnormality I was at pre-seizure (I think).

I also know that I have to accept the fact that there are important aspects of the 'medical incident,' as one colleague described it, that will never be known. However like any scientific study, we have hypotheses that are best supported by the available data. But this is a story for another time. 

Today I want to discuss the neuropsychological testing I had done and the outcomes of those tests. (Aside: Anyone think I would be writing these posts before the ACA and changes in insurance regulations preventing being kicked off the roles for a preexisting condition or massive increases in rates?) Several weeks after the birthday gift from god, I went in for a scheduled four hours of testing. At this point, my short term memory seemed to be working reasonably well, I had mostly recovered from an angiogram (the recovery was from having my femoral artery perforated as part of the procedure), and was back at work part-time. In short, I was feeling confident and not too concerned with the upcoming tests. 

Then I got to the hospital. I found the check-in office easily, despite the fact the hospital is actually four or five distinct buildings connected by walkways. The buildings are color coded and signs directing you to each building by color are frequent. Basically finding your building and the elevators within each building is trivial. After check-in, I was brought through a number of doors and down a few corridors to a new area to wait. My doctor, Dr. Ego Tistical more about her later, said she needed a few minutes and asked if I needed anything. I asked for directions to a cafeteria for some food and coffee, mostly I wanted coffee. She gave me directions to another building that used a different set of elevators. Getting there was no problem, the directions were great. Getting back, not so much. I was able to get back to the elevators easily and to the floor I needed, but then I was in the tangled web of similar corridors and doors. I made a couple of correct decisions/guesses and was about to go the wrong way, when the doctor waved to me from her office door.
'Was that the first test?' I asked
"No, but it would be a good one.' was her reply.
We sat down and talked about my recovery, how I thought I was doing, etc. I tried to be as honest as possible, not embellish or over-estimate how I was doing. In response to my mental functions, I said I thought I was back to normal although I tired out faster. I thought back to 90% of pre-seizure function was a conservative estimate. We talked about the seizure and events surrounding it, wasn't sure why though. Maybe it was to see  if I remembered anymore details, see if I had any questions (I did, and still do). After going over the results of the testing, I think a major reason for this discussion was to have a discussion. The topic was probably irrelevant, but it allowed her to get an idea on my verbal and language skills. She talked about the testing that would be done and answered my questions about what the tests assess and how they do it.

Then we began the testing.

Actually we went to a different room, where I was introduced to John. (All names changed to protect the innocent and not so innocent.)

"John, this is Dr. Choice. Dr. Choice, this is John, he will be administering the tests."
I extended my hand, "Nice to meet you, please call me Angry."
"Nice to meet you too, do you need anything before we begin?" asked John
"Well I'll let you get started and will talk with you again after the exams are completed." Dr. Tistical told me.
"I'm good John, thanks," I noted, coffee in hand, "Thanks Ego, see you then."
(See subsequent post for some thoughts on this conversation.) 
So now we begin the testing.

First, as I recall was the repeat the number game. John says 1, 2, 3. I say 1, 2, 3. We start with three digits all 1 - 9, then four digits, five digits, six digits, etc. We do a bunch of each group before we move up to the next group getting progressively harder. This easy to more difficult is a recurring theme throughout. Not sure how many digits we ultimately got to, I think it was eight but maybe ten. It's fairly easy to repeat back a single set of six digits, but try it after doing 5 - 10 sets of three digits, 5 - 10 sets of four digit numbers, 5 - 10 sets of five digit numbers, then do the six digit numbers. Maybe it will be easy for you, but it started getting difficult for me.

After doing digits forward, we repeated the process, but I had to repeat the numbers in reverse order. This was much easier than the forward process, probably because it was easy to memorize the first couple of digits, then the last couple of digits were fresh in my mind. So this reversing the digits was much easier. Except it wasn't. This was actually turned out to be my worst performance, but I felt good about it at the time (Kruger-Dunning?).

Finally, I had to repeat the digits back in numerical order: 4, 6, 2, 4 was repeated 2, 4, 4, 6. I also found this one easy because I could simply bin the numbers or remember that there were sequential runs of numbers like 3, 4, 5, 6 became 3 - 6. Apparently I actually did well on this exam, like I thought I did.

Now we move on to different tests. There was the see a picture like the one below:

The picture goes away and now I have to redraw it. Then the next picture comes up and as above they get progressively more complicated and have multiple objects. After completing this test, I am told that in a few minutes I would have to draw the pictures again from memory. Wish I known that at the beginning, but of course that is part of the test. Surprisingly, I was able to nail all these pictures. First time through and more importantly the second time through.

Next test was to be read a story and repeat it back as close to verbatim as possible. These were fairly long passages that were heavily detailed oriented. Not sure how I did, but it was frustrating trying to remember all the specific details. After the first pass and my attempt at repeating the story, John reread the story and I repeated it again. This time I was able to include more details or correct those I got wrong the first time through. We then repeated this process with a different heavily detailed oriented story. FYI the first story was about a woman, Mary, who cleaned offices and was robbed on 12th Ave. while going home on 8th St. This was problematic because she didn't have money for food for her kids or the rent. Luckily, the police officers took up a collection and gave her some amount of money $50 and change. (Probably the details are incorrect, except 8th St. but these are the kind of details included and only represent a tiny minority of the details included.) No idea what the second story was about, but I bet if you started it, I would recall the major details. After this activity was concluded, John then went back and read a number (20/story?) of statements me to which I had to give true-false responses. 'Mary worked as a secretary.' 'Mary was robbed on 8th St.' those kind of statements. Often upon hearing the factoid in the statement, I realized the error I made in my retelling. I have no idea how I scored, but it felt painful.

There were dexterity tests. Using just your left or just your right hand, pick up these pegs and insert them into the holes as fast as possible. Repeat using the other hand. I'm left handed so of course my fastest hand was my right. There was also keep your hand flat on the table and use your index finger to press a counter as fast as possible for 10 seconds. Repeat a couple times. That sucked, but I think I did ok from years of cell counting. Actually I didn't do as hot as I thought. I realized at the time my left hand was not as good as my right hand in these tests. This was surprising to me because I am left hand dominant, and it isn't even close. Of course, it turns out I have an issue with the right hemisphere of my brain (topic for another post), which correlates well with brain lateralization and handedness.

There were trivia tests. 'Who is associated most closely with the theory of relativity?' and language tests 'What does those who live in glass houses should not throw stones mean?' These latter tests also included John showing me a written word and asking me to say the word and define it. Again they got progressively harder, but were all simple for me. Until we got to the penultimate word, John unfortunately flipped to the final word, which I saw, before flipping back to the second-to-last word. I said and defined it, then as John was going to the final word, I said the word (as I think it was pronounced) and said I didn't have a clue what it meant. He asked if I wanted to take a stab at it, to which I replied 'No.'

There were three more tests I want to mention, although there more tests taken. The first was a move the block test, referred to as the Tower of London test. Basically, you start with the blocks arranged on the posts as shown on the left and John has another set arranged differently, like that shown on the right. The goal is to move one block at a time among the posts to make the image on the right. 

Starting position, from here
Goal position, also from here

The other point is you need to do this in the least number of moves and also in the fastest amount of time. I was never told which factor was more important, move number or time. In one trial, I made a couple of moves quickly and realized I screwed myself. Instead of trying to figure a way out, I simply reversed the moves back to start and did it the right way.

The next test I want to mention was the last test I took and one John had never given before. It was a pattern recognition test, kind of like the Wisconsin Card Sorting test. I was shown a picture and asked if it was represented by the number 1, 2, 3, or 4. The practice trial was the only one where I could guess more than once. The key thing here is that the picture was the first of many in a series that all followed the same rule. For example, the practice picture was:
 My first guess was 2, for two things, a white square on a black background. 'Wrong' John said. Then I guessed 4, for the four-sided object. 'Wrong' John repeated. Since there was no way 3 made any sense, except by way of exclusion, I went with 1, thinking one object. 'Right' John stated. The rule was in fact # of objects on the background. Once I had this card correct, John went to the next card and the next and the next, all of which I got correct because I had determined the correct rule. Now remember, this was the practice trial. For the real trials, I got one attempt on the first card. Right or Wrong, we went to the next card in the series. So in a real trial, it would have taken me three cards of trying to get the correct rule and the remaining cards correct. You should also realize that the cards varied in number of objects, shapes of the objects, colors, etc. So in the above example the next card could be 2 black triangles on a white background and now the correct response would be 2. Once the real trials began, if you guessed/deduced the correct rule in the first couple of cards, you breezed through them. If you did not things got more complicated, because you had to remember the previous cards, your guesses, and the hypotheses (rules) you already tried. You get to card 4 after incorrect guesses on the previous 3 cards and think of a new rule. Now you think back, does this new rule work for the previous cards and do I actually get different answers using this new rule for those cards? I was told this tests for 'executive function' but in many ways I think it tested for frustration coping mechanisms.

Finally, there was the memorize, in about 2 seconds, this person's face, now this person's face, now this person's face, etc. There were many faces, I guessed 30, but was told during the results phase that there were 48! Once we went through the 48 faces, John got out another stack of pictures and I was simply asked whether a face he showed me from this new stack was in the original stack or not. Some of these were easy to pick out, there was angry guy, happy guy, high guy, Ego (looked a bit like the Dr.). There were many others I remembered or could eliminate due to some particular hair style, facial feature, etc. and many I could not recall one way or the other. We know eye witness testimony sucks, but remember I was asked to specifically remember these faces and that I would be asked to recognize them or not afterwards. I found much of this test extremely difficult and think it reinforces those studies raising concerns about eye witness testimony. Of course, about 20 minutes later after taking some other tests, John pulled out a stack of pictures and asked if the faces were in the original deck or not. Now I am trying to parse whether a given face was in the first deck or one I remembered from the second deck. This test sucked.

Four hours of testing completed in two and a half, this was off-set by the fact I didn't take any breaks and also that I did not have any significant impairment (I was not aware of this at the time.). Regardless, when I left I did not feel good about myself and how I did. The confidence I had going into the testing had fled. After two weeks, I met with Dr. Tistical to go over my results. The good news, as mentioned a second ago, is that I have no loss of mental function. I scored extremely well overall, and ended up on the right hand side of the curve. Even those tests I did poorly in, I was still well to the right of the curve. Dr. Tistical told me about cognitive reserve, which I hadn't heard about before, and apparently I had enough of it to recover from the seizures. Here's hoping I do not have another, as there is no guarantee that I will be so fortunate in the future.  
From here, I ended up in the 3σ area