For a couple of annoying years I did the wedding MC circuit. Always the MC, never the embarrassing interloper. This is not something I enjoy. The MC gig is the one you get when you’re not so important to the couple that they want you involved for the truly meaningful bits, but they know you well enough to be fairly certain you’ll stick to the rules. You know not too dark, not too insulting, light on the nudity. I’ve recited bits of self-written sonnetry and memorised bits of foreign language diatribes. And in my pursuit of the level of “drawing an occasional smirk and no walk outs” I’ve come to greatly respect actual comedians. Be they improv superstars or super scripted performers, I stand in awe of all. And I have come to this conclusion:
Everything I need to know about my work, I can learn from Jerry Seinfeld.
Building Cricket Cages
He’s not everyone’s cup of herbal strained foliage dregs, but I’ve been a fan since the early days of the sitcom. A while back I came across this profile from the NY Times Magazine (bit of a longread). The thing I found most interesting is not just that he keeps bashing away at it to feed an obsession. The fascinating element is his obsession with approaching perfection, be it in the door mechanism of a 1957 Porsche or continual whittling away to create the perfect bit. Seinfeld crafts his jokes over more than just a couple of sessions – he keeps at it over years. Take as an example the joke about the marriage game of chess with the board made of flowing water and the pieces made of smoke. The key to the joke delivering was drawing a board in the air. Some years after he started performing it.
It turns out that he’s describing pretty much the process of being an anaesthetist (alright, there’s a bunch of really easy gags to make right about there, so I’m just going to wait patiently while you run through them…
… done? OK, moving on).
I’m not talking so much about the patter most of us work on to try and win the patient over. We only have a few brief minutes before patients, in a place of exquisite vulnerability, put their trust in a stranger. The routine for kids can be particularly challenging and confronting to hopes of retaining dignity in the workplace. Of course, most comedians probably don’t have the option of turning up the sleepy gas to make the heckling stop.
The real similarity is in the pursuit of ever incremental steps towards the perfect anaesthetic. Anaesthetists can obsess over the smallest detail of every element of what they do to try and produce the perfect parameters. A discussion of taping in a cannula can take up a leisurely lunch on a day off. It’ s a slow march towards small moments of perfection. To build the cricket cages that Mr Seinfeld reveres.
Building Perfect Research for the Side of the Road
I had another MC gig a while back. This time at a conference (a whole different type of angry after that one, but that’s for another day). One of the speakers in the session was the principal investigator for a trial of an automatic chest compression machine for giving CPR to patients suffering cardiac arrest. What followed was a seriously impressive presentation of how to strive for the cricket cage when doing prehospital research.
The prehospital environment is by its nature messy. It isn’t a pristine lab where elements are easy (well, easier) to try and control. There’s often a bit of dodging the stuff that’s flying while trying to get the job done. Trying to manage this is a big challenge for a researcher trying to perform high quality work in a place defined by chaos.
The investigators for this study, the CIRC trial, published their study design a while back in Resuscitation.
A big flaw they’d identified in previous research comparing the machines with people doing CPR was the possibility that those getting compressions hadn’t received good quality CPR, particularly as measured by amount of time actually receiving the vital compressions. So they set about addressing it. Across the 3 participating countries, they put more than 5000 prehospital providers through a standardised 4 hours training program. They then had them undertake exams to prove they were up to scratch. Then each centre had a period where their ability to deliver on the protocol was assessed before they were allowed to recruit. Follow-up assessments of quality and regular re-training were also part of the script. It’s not in here, but in the presentation the good Dr Wik also mentioned that every included patient had the duration of time and depth of CPR measured directly (including by transthoracic impedance).
The result – more than 80% of the time that patients were being treated in either the machine or manual compression group, they were receiving effective compressions. As compressions are vital to success of CPR, this is really important. And it’s around 20% more efficient than any equivalent prehospital study in the area has ever demonstrated. It’s staggering. It’s the sort of result anyone prior would have said was impossible.
I’m actually not going to get into the results (basically equivalent between the two groups, with lots of reasons given). The standout feature was the level of effort required to overcome the challenges of the setting. If we want to build an excellent research project, looking cool in flight suits doesn’t remove the need to be absolutely rigorous in getting the data.
So now we’re building our cricket cages, or examining the door of the Porsche. Before we even get going we know we need to simulate our jobs on ovals and in upturned cars, design our education plans and test our ability to collect the data reliably. It couldn’t be more vital to a good idea to get our script right, to test it out and whittle away to make it astounding. We might not reach perfection, but we should at least aim to make the Norwegian guy jealous. And if anyone feels like chipping in a 1957 Porsche Speedster for the simulations, we will make good use of it.