I’ve long been interested in spelling bees (see my lament in this 2006 post), and I was fascinated by the Washington Post column by Dev Shah, who won the National Spelling Bee in June and says “This is what it takes to master spelling”:
I never expected to win. I had lost more than two dozen spelling bees since I started competing in the fourth grade, and last year, I didn’t even qualify for the national competition. If that wasn’t enough pressure, this was my final year of eligibility. This spelling bee was my last shot. […]
How did I finally break through? There are almost half a million words in English dictionaries. Add in thousands of roots and hundreds of language patterns, and it is impossible to memorize everything. Once I realized that, I changed the way I trained and started focusing on sharpening my intuition.
The skill of guessing is everything. Though I could — and did — study words for hours on end, I knew my greatest asset would be learning to guess correctly. In stressful situations, sometimes you just have to breathe, steady yourself and leave things to chance.
The secret to spelling is understanding the “how” and “why” of language. Most words have patterns based on the sounds they make. For example, words that derive from French often substitute “ch” for the “sh” sound, as in the word “chagrin.” The part of speech can clarify how to spell the end of a word. Adjectives prefer “ous,” such as in the word “egregious,” and nouns typically use “us” like in “abacus.” And studying alternate pronunciations can keep you from agonizing over multiple letters, like in “GIF” and “JIF.” The letter G can mimic a J sound, but never the reverse.
In fact, this is exactly what the spelling bee wants spellers to learn — the mechanics of words. It’s why we ask so many questions. Jacques Bailly, the longtime pronouncer for the Scripps bee, answers investigative questions about a given word. Each question plays a role in guessing a word correctly. Asking about the language of origin helps narrow which roots to ask about next. For example, in my winning word, “psammophile,” Bailly told me both parts are Greek. That eliminated about half of the roots, since most roots are either Greek or Latin.
The definition offered more clues to the right root in question. A psammophile is an organism that lives in sandy soils. Remembering the language of origin, I thought of Greek roots that mean sand. This type of linguistic deduction takes practice, and the best spellers can perform it instantly.
These are the skills that I put into practice when I had to guess the spelling of a word I didn’t know. The word “rommack” is special; it has an unknown etymology. It’s used only in England, and it means to “play boisterously.” At first, I thought of the word frolic, which is close in meaning, but I knew the panelists were trying to trick me. The expert linguists who design the spelling bee choose the competition words carefully. They want spellers to confuse a word with other simple words. I knew I was running out of time — so with 40 seconds left on the clock, I put my money on “R-O-M-M-A-C-K.”
Though I spelled this word correctly, I’ve been stung by a fatal guess many times before. To be able to lose with grace is an art. Imagine you’re onstage — in front of thousands of eyes and being watched by millions online — and after trying your hardest, you get a word wrong. You hear the infamous bell, and everyone claps for you out of consolation. It is hard to leave when you’re eliminated, especially if it’s your last year of eligibility. But the only thing you can do is walk off gracefully.
I don’t think I’ve seen that strategy described so well, and he seems like a good guy in general; I’m glad he won, and I hope he goes far in whatever direction he chooses. As lagniappe, here’s a nice sentence using rommack: “There was the white speckly hen only last week; and a parcel of young tearbacons a-rommackin’ all over the field.” (W. Besant & J. Rice, Ready-money Mortiboy [1872] vol. III. xi. 189).
I dare say that the principle is widely applicable.
It’s certainly true of medicine as She is Actually Practiced (though patients may not wish to hear this.)
On the purely intellectual (as opposed to interpersonal) side, a great deal of medicine is the art of making sensible decisions with woefully inadequate information.
Again, patients (and some doctors) may not want to hear this, but we (humanity) understand very little about how the human body works (let alone the mind.) This means that once you get outside the most humdrum situations, really all you can do it take your best guess.
Actual medical-school teaching does not tell you this at all. It’s all about getting your diagnoses and treatment plans worked out on some purely rational entirely scientific plan. The House fantasy of how medicine works (I think; never watched it.)
One of the most recognisable descriptions of what it’s really like to be a young doctor that I have ever read is Bulgakov’s Записки юного врача, which splendidly captures the fear-and-trembling of not knowing what the hell you’re supposed to be doing, but knowing that it’s all up to you, like it or not, and you have to do something. The good doctors are the ones who find out that you can, somehow, actually do this.
When I was an orthopaedic house officer, back in Byzantine times, one of the more senior doctors on call was much more clued up on the book side of things than the others at that level. I, and the other house officer, disliked being on call with him and used to avoid contacting him if at all possible (nice person though he was.) The trouble was that he couldn’t make up his damn mind. With emergency orthopaedics in the middle of the night that is a fatal flaw. You’ve often got to decide to do something, and promptly at that. Delay can easily be worse in its consequences than a second-best treatment choice.
we (humanity) understand very little about how the human body works (let alone the mind.)
Correction: we (humanity) understand very little about anything whatsoever.
a great deal of medicine is the art of making sensible decisions with woefully inadequate information.
And I (speaking as a patient) am totally ok with that. Indeed I’d prefer the medic to say stuff like: if we knew XYZ, we could have stronger confidence in the diagnosis/treatment plan — then I could go away and observe whether my symptoms are worse first in the morning/when I’m tired/under strong sunlight/etc, and report back. (Of course this doesn’t help in an emergency/I get that delay is worse than a balance-of-probabilities response.)
What particularly annoys is that after some procedure which hasn’t gone totally swimmingly, the medics are full of the fine print (adverse indications) that they somehow overlooked to mention beforehand. I’d have much preferred to know in advance an artificial lens has a sharper angled edge than the natural one, and that’ll make sparkly distractions from oblique lights until my brain gets used to it/filters it out.
(I have a rather more ‘adverse’ outcome in mind, but relating that would breach patient confidentiality.)
the fear-and-trembling of not knowing what the hell you’re supposed to be doing, but knowing that it’s all up to you, like it or not, and you have to do something
True, modulo that the best thing to do may well be nothing. Antibiotic resistance As We Know It is the product of doctors doing something and patients insisting that something be done. Earlier today, Dorian had convinced himself he had a virus of some sort (he didn’t) and wanted to take himself to the emergency room. Quoth I, “If you are right, there is nothing they can do for you anyway.”
“How about antibiotics?”
“No, they don’t work on viruses.”
“Oh.” He took my word for it, fortunately.
I myself ran into a variant of this when I went to my clinic sometime last year. They did a routine blood sugar and found it to be ~ 300 mg/dl (~ 17 mmol/l), and promptly sent me off to my neighborhood E.R., about a mile and a half (2.5 km) away from the clinic. After I sat there for a few hours, someone finally looked at my blood sugar and found it had dropped to the high 200s. “Go home. As a long-term diabetic, if your sugar is less than 1000 (~ 55), it’s not an emergency.” (Fortunately for me, it has never broken 400 (~ 22). The net result was that what I went in for in the first place never got discussed, never mind treated, at all.
I told this story (to a different doctor) the next time I went back, and got a shaking-my-head response this time. Granted, 300 is not healthy, but I did warn them at the clinic that I had forgotten my oral meds that morning (it was early afternoon). Now I attempt to gauge the doctor, and if I judge them to be over-reactive, I refuse to have my sugar taken at all.
The House fantasy of how medicine works (I think; never watched it.)
Many of the early episodes I recognized as being derived from Berton Roueché’s classic essay collection The Medical Detectives (which I recommend). One that didn’t make it onto House, as far as I recall, was the case of the man with the hypoxic-blue hands. His blood oxygen was low, so they put him on oxygen and waited for a bit (since he had no other symptoms) and tested him again. This time, and the time after, his o-sat was entirely normal, but his hands looked the same as before.
Finally it dawned on someone that he was wearing a bright blue sweater, and it turned out that had put his hands in his armpits to keep them warm. Though the blue dye was colorfast to water, it was not colorfast to sweat (presumably because of the salt content), and his dyed hands looked exactly like hypoxia. The first blood oxygen test was never explained; probably it was a matter of a lab tech finding what they were expected to find.
Now granted all that, I remember reading that back in the 1960s if about 20% of hot appendixes didn’t turn out to be normal, you were taking too many chances. Presumably diagnostic tools have improved since then, but nobody amputates anoxic-looking hands.
In any case, I wondered what constitutes an orthopedic emergency where the diagnosis is not obvious. I asked Dr. Google (who is admittedly a Ph.D., not an M.D.), who enumerated open fracture (obvious to anybody), multiple long-bone fracture (ditto), pelvic fracture (X-ray), major joint dislocation (ditto), fracture/dislocation with neurovascular compromise, compartment syndrome (“pain, pallor, paraesthesia, polar, paralysis, pulselessness”), septic joint / osteomyelitis (nasssty), and cauda equina (ditto). Can you enlighten us?
The correct treatment may not be obvious.
There is often More than One Way to Do it.
Laypersons, television scriptwriters and medical students all imagine that the difficulty in the practice of medicine is primarily in coming to a correct diagnosis. But in fact, most diagnoses are obvious (or at least easy) and the real difficulty is deciding what the hell to do (if anything,)
I’d have much preferred to know in advance an artificial lens has a sharper angled edge than the natural one, and that’ll make sparkly distractions from oblique lights until my brain gets used to it/filters it out.
This is now very much a known problem, but the fact that it might be a problem only came to light relatively recently. I think this is partly because the symptoms are not easy to describe and there aren’t any neat objective tests for it.
Presumably diagnostic tools have improved since then, but nobody amputates anoxic-looking hands.
The correct treatment may not be obvious.
“Shock treatments” seem to be back in fashion, in a covert form. Just fry areas of the brain and hope that calms patients down. Of course it does – people with crème brûlée in their skulls tend to be less anxious. That may be because there is no imminent spoon to fear, and not much left to fear with. Nothing but the Final Spoon that awaits all Puddings.
Yellow Pokémon researcher on the Final Spoon.
On the question of inaction being the right thing:
When I started Orthopaedics, I rather subscribed to the usual in-house medical view that it was not, how shall we say, a very intellectual branch of medicine.
I first realised that the issue was more nuanced when I participated in orthopaedic grand rounds (events where all the doctors in the specialty meet to discuss particular cases.)
So: they’d present some orthopaedic non-urgent case and ask for opinions, starting with the most junior doctors and working up.
The house officers would waffle a bit, and then the registrars would suggest a variety of fairly sensible operations that might help.
Then they asked the (very experienced, whizz-kid high flyer) Senior Registrar.
“Well, the first thing we need to do is to decide whether we are going to operate at all.”
Then I was Enlightened.
(One of the most intellectually impressive, and also extremely useful medical textbooks I have ever read, is The Closed Treatment of Common Fractures, by John Charnley. I kept my copy for the sheer beauty of it long after I no longer needed it. Some orthopod half-inched it.)
On the question of inaction being the right thing:
Very true in my profession, and I suppose in many walks of life. When you’re not sure, close your eyes and think of England.
“used to avoid contacting him if at all possible (nice person though he was.) The trouble was that he couldn’t make up his damn mind.”
Well, when you have time, it’s rational.
You can recreate this experience of “can’t make up your mind” by going to three leading specialists and hearing “you need knee surgery urgently or it will get worse!”, “by no means do surgery or it will get worse” and the third option incompatible with these which I forgot.
In such situations a doctor who is less quick to make up her mind sounds like a good idea.
Some orthopod half-inched it.
What (he asked timidly) does this mean?
Pinched it?
Yeah, that instance of cockney slang was what I guessed. And “orthopod” seems to be medical slang for “orthopedic surgeon”. DE is nothing if not au courant. He posolutely rejuvenates my vocab.
No matter if the main river may have moved 5 miles east twenty years ago. Backwaters are still comfy habitats, not just fly-overs.
I know next to nothing of medicine as a doctor and very little as a patient (I am physically quite healthy, and always have been), and thus found it very odd to be able to relate so much to David Eddyshaw’s thoughts on the topic of practicing medicine. But this is unsurprising, since “the art of making sensible decisions with woefully inadequate information” describes the Art of Teaching (a field I DO know a thing or two about, if I may say so myself) beautifully.
In like fashion, “the fear-and-trembling of not knowing what the hell you’re supposed to be doing, but knowing that it’s all up to you, like it or not, and you have to do SOMETHING” is a sentence I could have written myself -especially back when I first began teaching -a long, long time ago, in a teaching institution far, far away (from where I am writing this), so long ago indeed that it was before any of my current students was born…
Rhyming slang, per Urban Dictionary, and indeed meaning ‘pinched’.
As applied to teaching, this reminded me of something I had been grappling with over the last couple of weeks. Sometimes, even in an educational context, it is better not to do something.
The particle theory group at South Carolina is finally in good enough shape to have an regular journal club. The solid state physics group already has a really good journal club, and each year each grad student or postdoc in their has to do at least one presentation about a recent paper that interested them. I don’t always attend the solid state meetings, but I do when the advertised paper looks interesting. The presenter makes about ten PowerPoint slides and talks about the paper: what seemed important, what they found interesting, and what they still did not understand.
Both series are scheduled and managed by postdocs, and the first theory presentation was given by the new postdoc in our group. He’s a really smart guy, but he very clearly did not know how to give such a talk. He just put the paper up on the projector and talked through about the first two-and-a-half pages, being occasionally quizzed by the faculty present, until we ran out of time. The grad students present were simultaneously mystified by the physics and depressed by the poor presentation, so I decided I needed to volunteer to give the next journal club talk, to set an example for what the future presentations should be like. (I would have recommended they attend the solid state meetings, to get an idea of how the talks should be, but they have been scheduled for the same time slot. That’s actually a big pain for me personally.)
So I picked a relatively simple recent paper, which covered a generalization of a standard topic in radiation theory. Even the usual treatment, however, was something that some of the attendees had never seen before. (It’s the very last topic in the graduate E & M course I’m teaching this semester, and I start talking about it on Monday.) What seemed relevant to the discussion here was that, as I started preparing my slides, I felt I was in a quandary. I ultimately decided that it was important that I not do too good of a job on the presentation. I wanted to model what a good journal club talk should be, but I wanted it to be a presentation that the students could feel was within the reach of their own abilities. I could have mastered every topic in the paper I was covering and made twenty-five slides explaining everything in detail, carefully prepared to be as easy as possible for the students to understand. But while that would be the most informative approach, it could be just as demoralizing as a really terrible journal club talk, because it would not be something that a student presenter could emulate. I love our graduate students, but none of them is at the level of preparation where they could give a talk like that, even if they were discussing their own papers (which many of them will probably do). So I made a point not to get too familiar with every detail of the paper I was talking about and not too make too many slides. I copied the key equations and figures from the first two-thirds of the manuscript onto slides and surrounded them with my snap observations about what they meant and why they were interesting.
It seemed like it worked, not doing too much. There were a lot of questions, including from the graduate students.* I answered them off the top of my head, relying on what was in the paper and my own knowledge of related topics. I am weirdly proud that I did not do a perfect job of explaining one particularly confusing choice of notation in the manuscript. It was an unnecessarily poor choice of notation, but that’s something students are inevitably going to encounter, and it’s valuable that they get to understand that sometimes they are not going to follow manuscripts’ descriptions, and that’s okay.
* The greatest number of questions came from one of the students in my E & M class, who I have really come to respect. He entered the program with a foreign masters degree and was initially anxious to get credit for the first semester of my class. I wasn’t sure, based on his record, whether he was actually well enough prepared, so I told him to register for the class, and after five weeks we could discuss it again. He seemed a little annoyed, but he complied. After the time I had specified (meaning, pragmatically, after I had graded the first exam), I was impressed with his performance and was prepared to pass him out of the rest of the class, based on what he evidently already knew. However, he decided on his own that he should stay in the course, because he felt that he was learning enough new physics and math to make it worthwhile.
The medical approach I liked on House most as a viewer was giving a patient a treatment and using their reaction for diagnosis. As a patient though I would prefer not to be put in this entertaining situation.
One big difference between the National Spelling Bee and the N Y Times Spelling Bee is that the latter does not penalize for wrong submissions.
Only thumbs up count.