Targeted Federal Government Shutdowns

Targeted  therapies are all the rage in medicine nowadays.

The Phantom suggests we target therapy for Congress.

Can we not identify the relatively small number of Congressional districts (shown above) from which the obstructionist/anarchist/arsonist Representatives hail and then simply shut down all federal services to those districts?  They don't want a Federal government anyway, let them live without it.

So:  No postal service, no Social Security checks, no Medicare payments, no FAA air traffic controllers for their airports...you get the idea.

Let those anti government imbeciles live without the federal government for a few months and as a condition for re admission to the Union, make them recall their T party Representatives. 

America The Grotesque

We once had style and grace in this country

The Phantom knows he is rapidly aging. 
 One sure fire sign of the winged chariot hurrying near is the perception that people have become more grotesque and taste putrefied.

Last night, the Phantom attended "West Side Story" at the Ogunquit Playhouse, a stunning production, with astonishing sets, wonderful voices and actors and music, the closest America has got to Andrew Lloyd Weber, not to mention Shakespeare.

Behind him, sat two octogenarians and when the first few bars of "Maria" were sung from the stage, they started singing along, like dogs picking up the howl. A few seats away, down the row, a woman madly texted on her smart phone, the screen glowing in the dark theater and on the other side of the aisle a man sat with his huge, edematous, naked legs protruding from beneath his shorts and flowered shirt. 

The Phantom looked around him and thought, "This is not 'West Side Story,' this is Fellini."

It's not just Maine.

The Phantom unearthed a photograph of his mother, caught by a street photographer as she walked down Fifth Avenue, circa 1940, in hat, gloves, handbag.  She looked wonderful. "Oh, you would never think of going out in public without gloves and a hat," she said. "It just wasn't done."  And the Phantom's mother was not from money--her parents were tailors, living in a fourth floor walk up. But she had style and she was impeccably dressed and fitted out.

This is not mother, but the point remains: Taste was not confined to the rich.

Over the years, Presidents at press conferences point to members of the press corps and call on them by first names:  "John," or "Judy."  Everyone is on a first name basis in America now.

To say, "Mr. Smith," or "Ms. Jones" is to be insufferably stuffy and distant and aloof or, heaven forbid, arrogant.

Heaven deliver America from informality. Look what it has wrought.

Now look at us.

You would not see this in Paris.

Even the Brits would be appalled.

This is America. This is us.

 

American Physicians and Multiple Intelligences

"This system results in rigid, time-based, non-learner-centered training...Some analysts have suggested that the average duration of medical training could be reduced by approximately 30%--partly by eliminating 1 year of medical school--without compromising physician's competence or the quality of care provided."
--Steven Abramson, New England Journal of Medicine September 19, 2013.

 One of the many things the Phantom admires about his dog is there is no future or past tense in his mind--he lives entirely, as far as the Phantom can discern, in the present tense.

When the Phantom reads and reacts to Dr. Abramson's article about shortening medical school, he is thrown back 40 years to his own experience in medical school, which can only be described as transformative, and he realizes nothing he has to say will be heard as anything but the plaintive ruminations of a man past his prime, stuck in 20th century thinking,  a use-to-was-er, destined for the trash heap of outdated, obsolete ideas and experience.

In some ways, the suggestion to eliminate the 4th year of medical school arises from the decision, motivated by the prospect of financial advantages for the university medical schools of the mid twentieth century, to no longer require specific clinical rotations for the 4th year--no more second rotation to the medical ward, to the surgical ward, to the obstetrical ward--but students could leave the campus entirely, go off to wander Africa, Europe, Asia, as long as their "program" received the very readily granted permission of some dean.  

Most medical students of his era, when queried about the value of that 4th year will say it was the best time they had since 2nd semester senior year in high school, which is to say, it was full blown fun in the fields of the gods of bacchanalia. Then, they will pause, get a funny look in their eyes and say, "But, you know I learned stuff...stuff I'll never forget, some of it was medicine."

What Dr. Abramson is saying, of course, with the phrase "time-based, non-learner-centered," is that simply requiring a student to spend time, a year, four years, before awarding a degree is unnecessary and backward thinking. If a student can learn enough material to pass his examinations in three years, two years, six months, then that examination is the measure of what it takes to be called, "Doctor." 

Of course, this sort of thinking has wrought huge changes in American medicine. If the exam is the only important thing, then it doesn't matter whether you've trained at Harvard or Columbia, or at The American Medical School of the Caribbean, at Guadalarjah, at the Ohio School of Osteopathy--if you can pass your exam, you are as well trained, knowledgeable and competent as the kid from Harvard.

And, for at least two decades, this sort of democratization of opportunity has been operative in American medicine. Unlike the prestigious, high paying law firms which limit their recruitment to Harvard, Yale and Stanford law schools, beyond a very few American faculties of medicine, the only thing that counts when doctors go looking for a job is whether or not they have the paper they need--have they passed their exams, got their licenses, a pulse, and can they speak enough English to find their way to the cafeteria.
 
Well over 90% of American physicians are not self employed, but are employees, and the corporations and groups hiring them do no "vetting," no evaluation of them personally. If they have the paper, they are hired, on short term (not more than 3 years, often one year) contracts and if they do well enough, in terms of producing dollars for the company, they will be offered a new contract; if not, they are sent packing to another job which will hire them on the same basis.

The problem, of course, is the concept of the "the test."  Is there any test which can be given and graded by machine, i.e., which is not essay but multiple choice, or some version of computer format, which can assess the multiple intelligences a person uses to acquire the ability to diagnose and treat patients?

The Phantom thinks of the time an eighteen year old woman was wheeled down the ward floor, direct admission from the Emergency Room, with her eyes rolled up into her head, as if she were fixed focused on the ceiling, weeping.  The wheeled chair passed a gaggle of medical students and interns at the nurses' station, and one of the interns, an Asberger's/ autistic type intern said "Better get a syringe of Benadryl. That's an occulogyric crisis. Someone probably gave her Compazine."  The Phantom ran off with a syringe of Benadryl, injected the patient and her eyes came down, like magic. The Phantom asked the intern how he knew that and he said, "There isn't much I haven't read about. I know everything in Harrison's [the standard textbook of medicine]."  There was the raw power of knowledge, not time spent, nor charm nor personality. 

But, fact remains, the Phantom had also read about occulogyric crisis occurring in children and adolescents given Compazine, but until he had actually seen his first case, it meant nothing to him and he missed the diagnosis. Once he had seen it, he would never forget it. And likely, that intern, who claimed he knew everything there was to know in medicine because he had read every word of every textbook, would never have known what he was looking at,  had he not spent enough time on the busy wards of The New York Hospital, and seen a wide variety of illnesses, drug reactions, and other clinical events.

As far as the Phantom is concerned, the most valuable stuff he learned as a medical student was not in his room with his books--and he spent plenty of hours there--but on that astonishing field of trauma and trial--the hospital, where 30 years of experience could be compressed into four years of trial by fire. It was time-based, to be sure, and it was not "learner-centered"--it was patient centered--but it was where the learner should have been centered.

Edith Windsor, Ariel Levy, Louis Menand, Eric Schlosser: All May Not Be Lost. Intelligence Survives.

Two extraordinary stories appear in this week's New Yorker.  In some ways, they are connected only by the binding of the magazine and by the superb writing, but they are connected into the insight they provide into a supremely dysfunctional democracy which is ruled, not by intelligence, but by groupthink.

The first story, by Ariel Levy,  is about the selection of Edie Windsor as the ideal plaintiff to challenge the Defense of Marriage Act, and the legal/social/psychological/cultural/political strategies integral to the presentation of that case to the Court, in particular to Antonin Scalia's court.

Ariel Levy

The second is a book, Command and Control  by  Eric Schlosser,  reviewed by Louis Menand about the occurrence of near catastrophes with nuclear weapons: among many were one in which  the Russians came within minutes of launching an all out attack against the USA because the Norwegians innocently launched a rocket with a weather satellite, and another,  in which a 19 year old repairman dropped a wrench socket down a shaft which nearly caused an explosion of a nuclear missile,   which would have leveled the entire state of Arkansas. These are but two of thousands of near catastrophes, some of which are recounted in what sounds like a must read/must not read book.

Eric Schlosser

Windsor and Spyer 

The story of Edie Windsor and the lawyer who selected her case is astonishing on many levels: 1. The description of Windsor's ardor for her spouse, the physical joy and intensity of their relationship, even as her spouse declined physically with multiple sclerosis  2. The portrait of what that disease does to a person 3. The oblique portrayal of true devotion on the part of one human being in behalf of another 4. The history of oppression of gays in America--there was a time it was illegal to have homosexual sex, and illegal to even dance in an erotic way with a member of your own gender. The whole story of the police riot at the Stonewall bar in Greenwich Village.  5. The elucidation about how Supreme Court cases in some instances are waged not as legal arguments, but as arguments about what the prevailing values of the nation are and ought to be.

This is an astonishing issue of a consistently high quality magazine. 
There is much talk about continuing education, and much marketing by universities to attract dollars from aging populations, but the institutions of the New Yorker, the New York Times and Public Television constitute a fifth estate of not so much of  intelligentsia,  as of reason.

It is a fragile estate, but an essential one. 

Amanda Ripley and The Dumbing Down of American Kids

Amanda Ripley, without any obvious qualifications other than intelligence, a liberal arts education and a desire to write about important topics, has generated a book and some worthwhile discussion about how Americans raise and mis-educate their kids.

I have not read her book about The World's Smartest Kids--I have only read the NY Times review and seen her interviewed on the News Hour. 

The important thing, in this global economy, is she has presented news from abroad--she tells us something about how other countries approach education. Poland, which has a diverse economic picture, with many impoverished children, has managed to improve test scores on what may be meaningful tests, to the point where they are far better than the United States. Finland, has soared to the pinnacle without assigning more homework, in fact less homework, than we typically do in the most competitive US schools. South Korea, always a top performer, scores high at the price of making childhood a misery for its children, and the return on all that effort is no better than the more efficient and thoughtful approach in Finland.

In all these systems, "teachers' colleges" have been eliminated. Teachers are drawn not from the bottom half of inferior educational institutions but from the elite of the educational system.

Of course, there are questions about exactly what each system accomplishes, about whether you can actually speak of the educational system in Finland as a whole, any more than you can speak of the educational system in America, with all its variability, but at least she is shining the light where it deserves to be shined: abroad.

Let us look at what other people do, rather than focusing inwardly.

One thing she notes, when pressed, is in other high school systems from Finland to Poland to Korea, there is no football team, no pep rallies, no cheerleaders, none of the "distractions" which characterize American high schools. Which is not to say there is no joy in those high schools--it simply is not institutionalized joy.

Whether or not our system is actually a better experience, in high school, is questionable. Most of the Phantom's friends do not remember high school fondly--although that may have to do more with memory than with the actual experience. The Phantom had to return to his own high school twenty years after he had graduated, to interview a student who was applying to his college alma mater. Approaching the school, the Phantom felt a bleak cloud settle in--high school had been a dark, sad time, filled with disappointment and failure. But once he walked into the hallway and saw teenagers in the same school colors, excited, flirting, between classes, the Phantom felt an old, unremembered rush and said to himself--Wow! I had such a great time here.

Many of us have the feeling we are not doing well here at home, in high schools,  no matter where in the US is home. Most of us do not have much basis for this feeling--memories, observations of our own children passing through. 

Let us inquire elsewhere. Let us be humble. Let us learn from others. 

Chimeras and Truth Stranger than Fiction

The Phantom has used the hyperbole that 90% of what he was taught in medical school turned out to be wrong, but he is beginning to wonder about whether this will turn out to be the exaggeration he thought it to be.

Today's New York Times has an article about new findings showing that not all our cells contain, as we were all once taught, the same genes (and their mutations) we were born with. In fact, it turns out, cells from other sources wind up in the DNA of some specific cells 

Now, it turns out women who have given birth to male offspring have cells with Y chromosome (presumably from their male offspring) in their brain cells; women have Y chromosomes in their breast cells. 

Apparently, cells introduced into an organism can migrate, implant like seeds blown in the wind and take up residence in host cells, mixing genes and propagating.

This poses problems for forensic matching of genes from a smear from the inside of a person's cheek to the sperm in a victim's vagina--if you get the wrong cells from the perpetrator he can look innocent. 

The bedrock notion, that genes are immutable hallmarks of the individual is now rocked.  If 90% of all genes in our body belong to the bacteria and viruses which coexist there with us, and the 10% we thought made us discrete individuals is changed by cross pollination, then what has happened to our basic concepts of genetic uniqueness?

Mr. Obama and the Terrible Swift Sword

History is the story we tell ourselves to feel better. 

But sometimes, it gets you into the wrong frame of mind.

Watching Roger Mudd on CNN talking about a book he wrote on  World War II, he mentions a U.S. Army general who said that when German or Russian or Japanese teenagers with guns appeared around the world, everyone shrank back in horror, because they knew rape, pillage and murder would follow.  But when American boys carrying guns stormed into Dutch towns, French towns, Italian towns, the people wept with joy, laughed and smiled, because those American soldiers carried liberation, Hersey bars and love.  We were the sunshine boys, dropping bombs of cheer and enlightenment from bumble bees.

The American soldier had no equal,  in his ingenuity, the general said. The American boy had spent his life under the hood of a car, tinkering with engines, so when his tank or his Jeep stalled, he had it fixed in a jiffy and he carried the battle forward.

Of course, this is the image of the good American we all love to conjure. If the Phantom had heard this coming from surveys of French civilians, Germans civilians, Italians, Greeks, he might believe it.  The German soldiers seemed pretty good at fixing their war machines and carrying the battle forward.  And the Russians...well, the Phantom seems to dimly recall something about the dread which which the Germans reacted to being sent to the Eastern (Russian) front, which met or exceeded the prospect of fighting the Americans. And it wasn't because the American soldiers were offering the German soldiers Hersey bars.

Americans, since at least the Civil War, if not before, have loved to think of themselves as the instrument of good, the exception to the rest of mankind,  who are out only for themselves and their own tribe. 

We carry God's terrible swift sword as we march on.  Glory, Glory, Hallelujah! 

It is this version of the white man's burden that kept us in Vietnam and Afghanistan too long, and it may carry us into Syria the same way.

The Phantom hopes we will find it in ourselves to be less exceptional and more modest and to allow the terrible swift sword to be given a rest. 

We got drones, and that's enough for now.

Atonement

Today is the Jewish day of "atonement."  Christians "repent"  or are "saved" but Jews, observant Jews at least, "atone."

Atonement, the word, carries with it meanings which go beyond regret, apology, a recognition of sin, but include some notion of setting things right, payment, making amends, doing something active to set things right.

There is also the aspect of expiation, which is contained in that Christian notion of being saved, casting out the poisonous things and being cleansed.

So there is a self serving notion in atonement; once you are cleansed of sin, you are healthier, better for it. You've undergone a ritual of purification.

There is a certain pleasure in wallowing in your inadequacies, of being sorry, because you know it's short term: At the end of the day, at sundown, you know you are going to be fed, be restored, be better than you were at sunrise.

But through it all, there is the sense of guilt. He who has no sin cannot atone. But we all must have sin. We have all failed to live up to some standard through the year. 

Children do not have to fast on this day, presumably because the ancient Jews knew children, who in those days were likely to be thin could not last a day without food, but also the thinking was likely "What sins do children have?" 

But children are rife with sin--they are, even more than adults, being told what they have done wrong, how they have failed--it's called "education." Children, more than most people are made acutely aware of their failings, being corrected, admonished to do things differently, to think differently.  They should be the ones really into atonement. You didn't finish your French fries and people are starving in China. You didn't clean your room or love your grandmother enough.  

Adults can rationalize their sins. You didn't pay your secretary what she was worth. But that's just part of business--driving a hard bargain is what makes a business profitable. Besides you can always bring Jim Crachett a Christmas goose.

For the Phantom,  the idea of fasting has had a certain appeal. Muslims fast sunrise to sunset during the month of Ramadan. Buddhist monks fast to purify themselves.  But fasting from sunset to sunset does induce a sort of suffering in 21st century America which takes one back to some more elemental existence. It makes one realize how strange our current American life is--after all, for most of man's existence on this planet, he was hungry, and many still are. 

Fasting can enliven the senses, create sympathy for those who are hungry, hungry in the physical and in the spiritual sense. 

But in some sense it goes back to the idea of answering for past transgressions. There's a great scene in The Godfather, toward the very end, when Michael tells his brother-in-law he has to "answer for" Sonny's death.  Of course, what that comes to mean is the brother-in-law has to pay for Sonny's death with his own life. 

And maybe that's what a day of atonement is all about, in the end. We know we will all answer, eventually.

Comments on The Phantom Speaks

The Phantom has received word that readers attempting to comment on the blog are thwarted by the security system which is meant to prevent spam messages from appearing in the comments section.

The Phantom was forced to do this when any blog containing the words "thrust" or "firmness" or any of a variety of other terms evoked an avalanche of comments suggesting readers link to websites selling male organ enhancement. 

The Phantom is happy to announce that comments on The Phantom's posts can be left on Hampton Mad Dog Democrat blog.  Mad Dog has come to the rescue.

Try the comment on The Phantom, but if there is trouble Mad Dog will accommodate.

John Sexton, Gordon Gee, Huck Finn's King and Duke; The American University as an Empty Husk

Gordon Gee

John Sexton

The King & the Duke entertain Huck and Jim

"The university moves in this corporate direction and then somehow expects the students to believe that they exist in this Utopian, non-economic world of education."
--Lisa Duggan, Professor, NYU from The New Yorker Sept 9.

There has always been a tension between the world of ideas, the spiritual world and the world of money. 
 In a long article in this weeks New Yorker, Rachel Aviv profiles John Sexton, president of NYU, and a clear picture emerges of a huckster, a soft shoe vaudevillian, who hugs people, rubs his students' shoulders, needs to be loved, while he spends university dollars prodigiously, sets up campuses in Abu Dhabi, throws no repayment loans and  mortgage supports around to attract what he considers star professors, while students drop out of NYU with great regularity because they cannot afford the rising tuition and costs--now around $68,000 a year.

Sexton likes phrases like, "The people who succeed and do not push on to a greater failure are the spiritual middle class," and "idea capitals" and, "We--humankind--find ourselves at an inflection point, a critical threshold," and we can "magnetize the talent class," and it all sounds like an artist standing in front of his canvas, at the gallery, explaining to his fans, "This is not just a black dot on a white canvas--this is an invitation to a spiritual awakening."

Academia has, for the past 50 years at least, been a place where professors made careers by shoveling a very thick bog of bull manure. But now, in light of financial considerations it looks less benign. Universities have become epicenters of national cynicism, justly so.

It was one thing when you told people a college education was good for them, and it was an investment of 4 years time during your late teens and early twenties, when you had the time, and you'd probably be happy you spent four years working on yourself.  But when the costs soared, and students were sold on four years acquiring enough debt to insure they could not buy a house until their mid forties, and when the universities shot the moon on their football teams and income from sales of team logos and ran weekly entertainment extravaganzas called football and basketball , well then the nasty dark edge of capitalism started to peek through those medieval robes and it didn't take four years of college to see through the steady drizzle of bull droppings to know where the stink was coming from.

Gordon Gee, former president of Ohio State, then Brown, then Vanderbilt, then back to Ohio State, was once asked whether he would fire the head football coach and he replied, "I was hoping he wouldn't fire me."

Of course, the joke was not really that funny--most of the big college football coaches have more power, make far more money  than the presidents of their colleges.  The football coach is not supposed to be the reason people go to college, or at least that was once true--it's not so clear that's still the case, in America. The spectacle of Joe Paterno DE-sanctification, does nothing to change that assessment.

So, our universities have been corrupted by big time sport and the money it brings in, corrupted by departments of feminist studies and gay and gender studies and by departments of anthropology where professors speak utter nonsense about cultural relativism, where The Spirit Moves Me And I Fall Down is presented uncritically as a sacred text, by professors at Harvard who try to launch themselves into the Rap music market under the cover of doing research and launching a new mode of communication, by allowing professors to use their university titles and offices to launch themselves on lucrative consulting careers, spending 2 days on campus and 5 traveling to "consulting" jobs or other boondoggles. 

European academies, Oxford, Cambridge, the Sorbonne, great German universities look across the Atlantic, at our packed, delirious  college football stadiums like some latter day Nuremberg rallies, at our infatuation with March Madness, and they ask:  "These are universities?"

Well, actually, no. They stopped being that a long time ago. 

This is all so reminiscent of the tale of the spider wasp:


 David Attenborough narrates an astonishing DVD, Life in the Undergrowth, about insects. One sequence begins, innocently enough, without any portent of the dark things to come, Attenborough's soothing, proper British voice carrying you along, as he describes the adaptation of a certain larva which attaches itself to the underbelly of a spider. 

In the beginning, it all seems innocent enough, as the spider weaves its lustrous web,oblivious to its papoose, riding along. But, as things progress, the spider becomes disoriented, is no longer able to weave, owing to a neurotoxin released into it's circulation by the larva, which grows larger and larger, gradually sucking the vital fluids from inside the spider until all that is left is an empty husk of what was once a spider, and then the larva discards the spider husk and transforms itself into a wasp.
                            --From The Phantom Speaks 2010

That is what American university is now--the empty husk. The spider wasp of avarice has hollowed it, burst through and flown away.

Struggle Versus It Just Comes Easily--The Learning Paradigm

NPR had another piece on the differences between Asian (in this case Taiwanese) children and American children when it comes to learning and struggling to learn.

Based on a Brown University study, it is postulated that in American culture, kids are taught they will be successful if they have the right stuff to begin with. If they are smart, this innate quality, likely genetically endowed, will drive them to be successful, to learn and succeed.  Taiwanese parents on the other hand tend to tell their kids that struggle is part of learning, something to be not just endured but celebrated, the stuff of character, of overcoming, of prevailing. 

Like most generalizations about cultural values, there are enough individual variations to make one wonder why we even talk about cultural norms, but in the case of anyone's attitude toward learning, this idea of valuing either struggle or talent is important.

The Phantom's brother had two sons. Given a new challenge, say shooting a basketball through a hoop, one son was always able to succeed almost immediately. The other son missed, and missed but he would stay out on the court, hour after hour until, after a week, the "less talented" son became far better then the talented son, who by then had moved on to lacrosse, soccer or baseball.  The "talented" son, for whom everything came easily, wound up becoming an architect, but when he saw what architects earn as opposed to the developers, he shifted to becoming a developer. He did what came easily, design, then shifted.  The persistent son became a surgeon. 

The thing about surgery is, it's ninety percent practice and persistence.  We all imagine the heart of the lion and the eye of the eagle, the steady hand, but actually, it's mostly just practice.

Thinking about his own education, the Phantom well recalls the difficulty he had--owing in some measure to an obsessive compulsive gene--with shifting tasks, especially on timed standardized tests, where he would get stuck on one problem, determined to solve it, rather than being able to just move on to the next.  In college, this tendency to ram his head against the wall kept him in the library long hours, and finally he made himself walk away form an organic chemistry problem, walk down the hall to the bathroom or the drinking fountain. He often found, when he returned to his study carrel, he could solve the problem.

This memory was sparked by what the Brown study showed: Given a very difficult math problem to solve, American students tended to give up after 30 seconds. Asian students worked for an hour, until the teacher stopped them.

The Asian parents told their children they were good to have struggled, because the important thing in the learning is the struggle. The American parents said, "Well, that's just not your thing."

But you can see American kids struggling to master difficult things at the batting cages, on the basketball court, on the single beam in the gymnastics setting. Learning to swim is the classic struggle.   Some kids may get in,  "like a fish takes to water,"  but none of them really swim without being taught systematically and there is usually some struggle there.

Likely, good education requires a lot of both:  You have to struggle, practice, fail, get better at most things which are worth doing, but you are likely to be more successful at basketball if you have tall genes and some of us can struggle with calculus forever and never really get it.  At some point, you have to know when to give up and move on to something with which you will have a better chance for success.

The kid who struggles must struggle in the right way--not just repeating the same thing over and over but coming back to look at the problem a new way, a fresh approach. Struggle by itself is not enough. Pounding against a wall is nothing to be proud of, unless you are pounding away in new ways, with an aim toward success.

The best coaches I remember spent a lot of time talking about the trouble I could expect in various situations, and how to overcome it. It would be a struggle, but there was always a new approach to get you past the difficulty. You expected trouble, and you called that "challenge."  If there was no way around the trouble, struggle was not worth it.

One of the best stories about the redemptive value of struggle comes from a former chief of radiology who tells about the time he chose a resident for his program, giving him a spot for which 170 other applicants had competed, even though this particular medical student did not fit the standard profile of academic success. Unlike most of the radiology residents, he had not had straight A's from kindergarten on, or the highest test scores.  He, in fact, had played football in the SEC, linebacker, but somehow he had managed to do well in his organic chemistry courses, and he kept up with his coursework and had good grades, not as good as some of the 170 applicants he beat out, but good.

He was also a very big person, and Black,  and when he sat in front of the screens where X rays were projected, in the "reading room,"  wearing hospital scrubs, occasionally he was mistaken for a janitor by some of the older, white faculty, who could not understand why he was not emptying the trash cans.

At the start of his residency, he was not a star. He missed things. He did not know some things other residents knew. But he was "coach-able."  You could correct him, and the next time he got it.  "Some of our residents were so unaccustomed to failure, when you pointed out something they missed, they would dissolve--the women into tears, the men into defensiveness."  And these super people progressed much more slowly. The football player got better and better, almost exponentially. By the end of three years, he was by far the best resident in the program. "That taught me something about the value of the standard measures by which we judge applicants," the chief said.

Of course, you need persistence in many fields, but you usually need more than that. It helps to be undeterred by failure, but it helps even more to use failure to make you better.