hen I walked through the emergency room doors on Tuesday morning, I realized that the next time I walked out, hopefully within 48 hours, I would be without a gallbladder and nursing 4 puncture wounds in my abdomen. I have known for about 4 years that I have had gallstones, but for the most part they have been benignly bobbing about in my gallbladder, producing short lived symptoms when they temporarily block the duct connecting the gallbladder to the intestine. But last week, they snugged into the duct a little too securely, and I knew that a trip to the ER was in order. Although I was grateful to have the opportunity to saunter into the ER of my choosing, I could not help but give a shiver as I entered the complicated, maddening and ridiculously expensive health care system that I dislike so much, and knew immediately that I was going to rip through our high deductible in short order. Anticipating lengthy delays, I grabbed the Sunday NY Times crossword puzzle and a pen to keep me company.
I must have hit the ER at an opportune time, since I was escorted into the inner bowels of within 15 minutes, where one of the first questions was, “On a scale of 0 to 10, where is your pain, if 0 is no pain and 10 is the worst pain you could possibly imagine?” Perhaps I was overthinking it, but the question seemed very tricky with potentially long lasting repercussions. First, the scale was open-ended at the top, limited only by my imagination to conjure up exquisite pain scenarios, fueled by too many grisly movies, including the recent Casino Royal movie where a naked James Bond is sitting on a caned chair, except all the caning has been removed. So presumably, I could never self rank my pain as a 10. Also, I thought the best strategy would be to start low to provide upward mobility in case the pain got worse. But how low should I go?
I was eagerly anticipating the IV morphine that was coming my way and thought my response might influence the dosage. I had overheard the ER doctor telling the surgeon that I was “really nice.” I was so flattered, but knew that I was falling into the classic doctor/patient relationship where the stricken, vulnerable patient tries to ingratiate herself to the life-saving doctor by trying to be the perfect, low maintenance case. When I timidly asked about the experience of the surgeon on call, the ER doctor told me that he would have no qualms about letting the surgeon operate on his own family, which sounded like the sales tactic that stockbrokers use, i.e. “this stock is so great that I even bought some for my mother.” As a further testament to his experience I was told that he was well known for his expertise in Whipple procedures. Okay, a Whipple procedure, now you are talking about a heroic procedure involving the removal of the head of the pancreas and the attached piece of small bowel, coupled with an elaborate reworking of the plumbing around the liver. In comparison, a cholecystectomy (i.e. removal of the gallbladder) would hold as much interest as a gnat on a windshield.
When I was working in the surgical pathology department, we would receive all the big bits and tid bits that were removed at surgery for microscopic examination. Each morning, I would scan the OR schedule to see what would be coming my way. Typically there were a couple of gallbladders, but these took less than 5 minutes to process. I would open them up, extract the very gooey and tenacious bile fluid, count the stones, perhaps commenting on the size of the largest, and then take a small slice of the gallbladder itself to examine under the microscope, mostly to permanently document that yes, indeed, the surgeon removed the correct organ. However, a scheduled Whipple procedure sent a frisson of excitement through the pathology department, and I knew that I had to be on my game to meticulously examine the surgical specimen and sample all the margins to make sure that the surgeon had not left some tumor behind. Occasionally the surgeon would accompany the specimen to the laboratory to make sure the specimen was oriented correctly – typically he would be totally jacked and eager to revel in the glory of his surgical expertise.
In contrast, a cholecystectomy is the type of surgery that pays the bills, but it is not an intellectual or technical challenge. But still I wanted the surgeon to be interested and motivated, the type of instant BFF who would insist on using a sharper scalpel. Years ago I met an orthopedic surgeon who had focused his entire practice on repairing knee ligaments, and I asked him how he kept the surgery interesting – this was probably at the same point that I was tired of processing gallbladders in the pathology lab. He said, “I operate on patients and not the knee, it is the people that make it interesting.” Well this was a challenge for me; I had met the surgeon for less than a minute so I could not rely on my charming personality to make his life interesting. It seemed that the only way to ingratiate myself was to provide a very credible pain assessment to demonstrate that I was neither too stoic nor a wussy and hysterical malingerer.
Once again the nurse asked me, “On a scale of 0 to 10, where is your pain, if 0 is no pain and 10 is the worst pain you could possibly imagine,” but this time she was preparing the morphine syringe. I felt like asking, “How do most other people rate their gallbladder pain?” and then pick something in the mid range – I have never wanted to be an outlier. But I also had the little problem of the Sunday NY Times crossword puzzle on my lap, which I was fitfully trying to complete – not successfully since the pain was at the very least distracting, but occasionally I did manage to fill in a few squares. This scenario seemed inconsistent with a high pain level. I tried to juggle all these factors as Nurse Morphine wielded the syringe of blessed relief. “I guess my pain level is a six.” This strategy seemed to hit the right notes, as the nurse said, “Well okay, I will give you 4 mg of morphine instead of 2 and then more if you need it.”
I felt a flush and a few clenched muscles as the morphine went in, and a strange sense of relief as my body seemed to separate itself from my mind and I floated in a dazed limbo. I swam in and out of random thoughts, but suddenly found that I was able to perfectly focus on the crossword puzzle, even though there was no way I could pick up a pencil. The Sunday Times puzzle always has a theme to it, and one of the big breakthroughs in doing the puzzle is the Aha! moment when you crack the theme. In a moment of morphine-induced clarity, I realized that the theme involved a word starting with the letter “a” followed by a double consonant; one of the consonants was dropped to produce two words with a new meaning, for example the word “affair” would become “a fair.” The clue that I had been struggling was “mechanic’s task,” and the answer became obvious, as if it was written on the insides of my eyelids. The original phrase, “evening attire,” became the answer to the clue - “evening a tire.” Nick finds these crossword themes annoying contrivances, but I find them clever and delightful.
As I was wheeled into surgery, I realized that this was the second time that a group of strangers had opened the lid to take a peek inside my abdomen, and I was a bit jealous. I would have liked to take a look at my innards, inspect my glistening liver, slinky intestines and homely spleen, so I thought at the very least I should ask for a memento. “Can you please give me some of my stones,” I asked? My surgeon, who looked a little bit like the Peter Sellers character Clare Quilty in the 1960s movie Lolita, agreed. And in a flash they had snagged the gallbladder using instruments inserted into four small incisions and out it came. A day later, I strode out of the hospital, down one organ and looking like I had been in a fight with an icepick, but ready, willing and able to press ahead.
So here I sit with a small plastic cup containing two of my human pearls – one about three quarters of an inch in diameter and almost perfectly round, and the other about a quarter an inch and faceted from pressing up against something smooth and hard. The large stone is actually quite pretty, dark green tinged charcoal color studded with white crystals, a mixture of cholesterol, bile salts and bile pigments. In fact, I have a necklace containing two beads that look a little like my gallstone. One is made of some sort of burnished deep green resin, the type of color that catalogues give ridiculous names to – like summer seaweed, and the other is a glass bead that has splotchy bits of tar on it. This description is not doing these beads justice, because I have actually gotten frequent compliments on the necklace. My current plan is to contact the artist and ask her to add my gallstone to the necklace.
- - - - - - - research has always had difficulty in assessing pain,
Because it is hard to know whether to believe patients when they complain.
For example, did a gallbladder that was obstructed and inflamed
Justify the level 6 pain rating that I - - - - - - - ?
What if my pain was not a 6 or a 7 but somewhere in between,
How about a - - - - - - - point if a 6.5 is what I really mean?
Full of anxiety and apprehension, I ultimately decided on a middle of the road six,
And it worked because - - - - - - - down as soon as I got my morphine fix.
Click here for answers
Chapter 4: SAT – The Reveal
t has been one month since I took the SATs and while awaiting my scores I have been interested to learn more about its history. It turns out that the SAT test was an outgrowth of the IQ tests that were first developed by Binet in 1905. France had recently made a commitment to offer education to all of its children and the test was designed to identify children with significant learning disabilities so that they could receive special education. In other words, the IQ test was designed as a way to extend educational opportunities to everyone, as opposed as a technique of identifying elite students. Additionally, Binet stressed the diversity of intelligence and the certain impact of environment.
In this country, those caveats were largely ignored; the IQ test was initially used on a large scale by the military before WWI to identify potential officers. The SAT perked along at a low level until it received a big boost from the Korean War when the government announced that college deferments for active service would be based on SAT scores. The idea was that the education of future scientists who could contribute to the war effort should not be interrupted. Some soldiers were certainly assigned to units reflecting known skills – i.e. doctors served in the medical corps – but this program deferred soldiers based on their potential worth (judged by their SAT scores) to a potential job that could be potentially useful in a future war effort. The bottom line was that you didn’t want the next Albert Einstein killed in a trench somewhere.
One of the early champions of the SAT was a Harvard dean named Henry Chauncey. He was infatuated with standardized testing in general, and thought that the SAT could be a great leveler that would serve to extend elite educational opportunities to those outside the usual students drawn from East coast boarding schools. His belief in the objectivity of standardized testing seems hopelessly naïve, given the obvious flaws in every step of the logic train: 1) that you can define intelligence; 2) that you can produce a number that would reflect that intelligence; 3) that you can determine this number by a multiple choice test focused on math and vocabulary; and 4) that the test produces consistent results across genders, cultures and ethnicities.
One of the persistent criticisms is the inherent bias in the test, particularly in the reading sections, where questions ask for interpretation of the dreary reading passages. The SAT has to include questions with a range of difficulty in order to distinguish the bright from the average mind. One way to introduce difficulty is simply to make both the questions and the answers more ambiguous. And there is bias in the way the SAT decides which questions are easy or difficult. In every SAT, there is a section which experiments with new questions; these questions do not count toward the final score. A question is considered difficult if only those students who get a high score on the “real” part of the SAT answer the experimental questions correctly. Therefore, this circular definition reinforces any bias that favors students who have undergone coaching who presumably are scoring higher; these students are the final arbiters of what is considered difficult. The other simple way to introduce difficulty is to just make the test longer so that not everyone can finish it – so at this point the SAT is testing speed, which is an interesting criteria for aptitude.
And then of course there is the subjectivity in grading the essay section. The SAT essay is graded from a low of 1 to 6. Grade 6 is defined as an essay with “clear and consistent mastery with an effective and insightful point of view.” Grade 5 is defined as “reasonably consistent mastery with a effective (but not insightful) point of view, and so on. The SAT states that their scorers are rigorously trained on sample tests that some sort of expert committee has judged as 6, 5, 4, 3, 2, 1, etc. While it is probably possible to come to some agreement on the extremes, the 6’s and the 1’s, the consistent discrimination of the intermediate zone, i.e. 2-5, where most essays will lie, just has to be more problematic. I am just not buying the SATs breezy assurance of objectivity and the cross checking of scores among multiple scorers. Another criticism is that good writing depends on thoughtful consideration of a topic and the ability to revise, two aspects that are clearly not part of the SAT essay, where a topic is sprung upon students who are writing with 25 minute shotguns pressed into their temples. Finally, the SAT makes a point of stating that facts are not checked. Therefore a student can cheerfully state that the Civil War began in 1842 without getting dinged.
The College Board’s steadfast assertion that the SAT cannot be coached is self-serving and silly. Prep courses like the Princeton Review make millions of dollars in training students to think like the SAT so that they can answer the ambiguous questions. In fact thoroughly prepped students can often answer the reading comprehension questions without even reading the passages. The Princeton Review is absolutely gleeful about outsmarting the SAT; its president tells its students, “The SAT is bullshit, let’s blow these assholes away.”
My indignation has risen as I have gathered more information on this cruel and stigmatizing hoax, and I would love to lambast the SAT. But my message would be more convincing if delivered from a position of power, for example, an 800 ft. mountain. So brings me to the question of how I did, and this is the first question that everyone asks when they hear of this experiment. Truthfully, I don’t really want to know, but this is a story, and the story needs to have an end. I can foresee several possible scenarios:
1. The test is totally invalidated since I made additional errors in gridding in my name or number of the testing center on the score sheet.
2. When I skipped those annoying math questions, my answers got misaligned, resulting in totally random answers.
3. I could have held my own with middling SAT scores, which I could claim was a satisfying result, but these results would also feed into the conceit of the SAT who could claim that they had a test-retest reliability that extended over decades.
4. I could have hit it out of the park. From this vantage point, it would be a pleasure to totally dismiss and diss the SAT.
5. I could totally bomb out.
And of these scenarios, which would I feel comfortable in sharing? I am generally pretty agreeable about humiliating myself, but I think that there are some statistics that people feel more private about – for example, nobody goes around asking or telling people their IQs, which are not far from the SAT. I found two interviews where the guest expert on the SAT was asked what his scores were; one said around 1500, which of course is a very high score and made me think he was pretty cocky, and the other said that it was a private matter, which made me think that maybe he was ashamed of his scores. I went into this project thinking that it was just a lark, but now, with the scores imminent, I have to admit that I do have some ego riding on this. I still recall with disappointment my high school scores, and perhaps I have put myself at risk by secretly trying to make amends. It is disenheartening to realize that your high school intelligence – either under or over achievers - is pegged to standardized test scores. Underachievers have the gift of untapped potential and can always improve if they just pull it together, whereas the word overachiever has a negative whiff to it. We overachievers (not test undertakers) are operating without the safety net of untapped potential and can only go down. At any moment Toto could go skittering across the floor and pull the curtain away revealing that I was no Wizard, I was just an overachiever and that my nice plump GPA was a fluky sham.
My friend Dick said, “Let’s make this interesting, I’m willing to put a little money on the over/under. I bet you get under 600 on the math due to disuse atrophy, and over 700 on the reading. Well I can triumphantly report that he lost the bet. Reading: Wow an 800! Math: I got 48 out of 56 correct, which put me in the 90th percentile, which translated to a score of 680. This leaves me in awe of the students who get 800. Writing: 650. It looks like they hated my essay, and my scorn for Standard Written English did me in.
So what have I learned? Well one thing the SAT has taught me is that every good essay must have a concluding paragraph. So here it is. I could not find one redeeming factor about the SAT. It does not test aptitude – how could a timed, multiple choice test possibly – it is not a great leveler, due to the persistent cultural biases, and the ability to prep – and it is not a strong predictor of college success. The validity of the predictive value of the test is its raison d’être, but the data only shows that the SAT test predicts a small fraction (8-15%) of the variability in freshman test scores. This means that about 88% of the time the SAT results are no more predictive of first year grades than a role of the dice, and whatever predictive value the test does have, it dissipates by sophomore year. At yet every year, Americans spend more than $100 million dollars on the test itself. So why do we persist in this folly? For one, colleges get the scores for free, but if you asked them if they would budget 100 million dollars for SAT information, they would surely decline. Secondly, they can use the SAT scores to confirm their status as an elite institution and possibly attract more highly qualified candidates. Finally, the SAT sucks them in by giving them additional demographic information about their students. For me, it was an interesting experience and I am pleased with my scores, but if it were not so expensive I would be tempted to take the Princeton review and “blow those assholes away.”
Reasons Why the SAT is Bullshit
It is a test that is culturally biased, stigmatizing and - - - - -
Especially since it doesn’t really predict how well you do in school,
When everyone practices and preps hoping for Ivy League success,
The most likely result is an bleeding - - - - - from anxiety and stress.
Only the ETS benefits, rubbing their greedy hands with unfettered glee
As they rake in filthy - - - - - from students’ admission fees.
Click here for answers
Chapter 3: SAT Game Day
ctober 9th, 2010 – SAT game day for me. I turn to the chapter in my prep book that gives me very detailed instructions on what to do just prior to the test:
“On the night before the BIG DAY, find a diversion to keep yourself from obsessing about the SAT. Maybe stay home and watch some of your favorite television shows … Or talk for hours and hours on the phone about a subject other than the SAT … In the morning take a shower to wake up and then eat a sensible breakfast. If you don’t usually eat breakfast, don’t gorge yourself on test day, because it will be a shock to your system … Make sure that you bring at least three number 2 pencils and bring the calculator that you are most comfortable with … Wear layered clothing … Bring a fortifying snack.”
I try to follow their advice to the letter; my only deviation is to take my shower the night before. Fortunately, our house is well stocked with No. 2 pencils, since the previous Christmas Nick had broken our vow not to exchange gifts and had given me a gross of pencils to do Soduku with. But I have noticed that some of them have defective leads, and so after sharpening, I test the lead to make sure that it doesn’t jiggle like a loose tooth. Two pencils are rejected on this basis. Next I test the erasers to make sure that I won’t be cursed with one of those inexplicable erasers that produces a smudgy streak, thus tragically despoiling my SAT answer sheet. I eliminate another pencil on this basis. Now for the calculator. Forty years ago there was no such thing, but perhaps we were allowed to bring a slide rule or abacus. The only calculator I have ever used is the oversized one Nick uses to balance the checkbook, so I throw that in my bookbag.
It turns out that the testing center is across the prairie that abuts our backyard, then across the railroad tracks to a little trail in the woods that opens up onto the high school driveway. So the most efficient way for me to get there is to ride my bike, which seems very appropriate for this high school experience. I have to carry my bike across the railroad tracks, and I carefully make sure that there is no oncoming train – a fatal mistake that a student made last year in this very spot. As I circle into the school, I see large minivans dropping students off, but no bike rack. I finally ask a security guard and he looks at me quizzically and says, “Don’t you know, students don’t ride bikes any more, we don’t have any racks.”
At this point I am feeling very silly, and it occurs to me that I could have reduplicated this experience by taking a timed test at home using a practice test. However, I also want to experience the anxiety and energy of the mix of students - those with poor grades whose parents are hoping for impressive SATs so that they can confidently say, “Her teachers just don’t get her - those who need top SAT scores to fulfill their parents’ aspirations for their Ivy League alma mater (especially since an early promise on the soccer field did not pan out) - those whose parents risked stigmatization to identify a subtle learning disability adequate to qualify for extra time – those juiced on juiced Adderall - and those effortlessly brilliant students where the SAT is an unnecessary footnote to an already glittering academic career. But when I walk into the room, I feel none of that. My fellow test-takers merely look resigned to spending three hours on a gorgeous fall morning slogging through irrelevant math problems and tedious passages.
The room is deathly quiet and then the proctor stands up and starts reading instructions in a nasal monotone reminiscent of Ferris Bueller, “Good morning, Welcome to the SAT, where you will have the opportunity to show your readiness for college.” I find it very audacious for the College Board to attempt to position the SAT as an “opportunity,” as if this hated test is a privilege rather than a dreaded imposition. The proctor goes on to explain the various features of the upcoming lock-down mode and then instructs us to fill in the answer sheet with our name and other identifying information. During my practice test, I had noticed my biggest liability was careless errors due to impatience, so I decide that I will practice patience by carefully checking over my name, birthday and testing center. Unbelievably, I find two careless errors. I had spelled my name wrong, by mistaking a “Q” for an “O” in the very faintly printed boxes, and I had keyed in my birthday incorrectly, by assuming that the first number in the grid should be a “1” and not a “0,” thus indicating that I had been born 1058 years ago in 952 instead of 1952. Not an auspicious beginning.
First off we have 25 minutes to write an essay on whether or not funding for the arts should be maintained in high schools. I think of the thousands of students writing on this exact same question and the squads of high school and college English teachers who have to read them all, a seemingly excruciating task, particularly since the essay is graded according to grammar, punctuation and organization, and not necessarily creativity. But I have great faith in creativity. One of our favorite family games is the dictionary game, where a word that no one knows is selected and everyone makes up a plausible definition. A single word prompt like “dapifer” can produce such definitions as “someone who spread rumors on a sinking ship,” an “African parasite,” or an “ex-slave converted to Islam.” While the constraints of the SAT are designed to suck the life out of creativity, I hope that occasionally it can still peek through. If I were grading the essays, I would immediately give a top score to anyone who could rise above the straight laced requirements of the SAT and show even a glimmer of creativity. I decide to write my essay on imagination as the defining element of the human brain, and to dismiss the arts is to squander nature’s gifts of our precious frontal lobes.
And then off we go into the multiple choice questions. I get hit with a math section right out of the box, and about half way through I encounter an inane problem about calculating the total number of hours studied based on the average number of hours studied per week across different years of high school. I recognize that they are really testing me on my ability to read a table and translate average hours per week to total hours per year (factoring in holidays), but I find the context so utterly stupid that I make the executive decision that I am too old for this, and I just skip the question - first time ever that I have ever deliberately skipped a question on a multiple choice test. Then there is a grammar section, where I am given four different options to correct a poorly written sentence. I immediately get frustrated because I I know that I can come up with a fifth option that is much better. At our break, I realize that about 90% of the students taking the test are Asian, and that English is their second language. I am immediately impressed that they can master arcane English grammar.
I am pumped and ready after our break, because I think that my sweet spot – vocabulary – must be next. There are a few vocabulary questions, and then I plunge into reading comprehension – a very long paragraph on some crack pot idea called “Pleistocene Rewilding,” where African elephants would be introduced to the United States as a stand in for Woolly Mammoths. Section after section, and there is only a smattering of vocabulary. I sadly realize that vocabulary is no longer a prime focus of the SATs. Another couple of math sections where I feel very naughty in wantonly skipping questions I don’t like – then finally, “Time’s up, put your pencils down.”
So how did I do? Who knows, particularly since there are multiple possibilities for humiliation. I could have made have additional spelling errors on my last name, misaligned my answers on the answer sheet, could have been reckless and careless, or maybe I naively assumed that I could relearn long forgotten math skills. Maybe I peaked at age 18.
I had this unrealistic hope that if I stayed focused and didn’t flub,
I could wear the SAT - - - - - - of greatness in the 1600 club.
But careless mistakes have been my undoing and - - - - - -
That have always undermined my most noble intent.
I clearly don’t have the patience to win this - - - - - - game
Particularly if I can’t even spell my own last name.
Click here for answers
Chapter 2: SAT Prep
asked the question as a high school senior and I have tried to answer the question as a parent. “Why do we have to learn this stuff? – I am never going to use it for the rest of my life.” As a parent I tried to explain that Greek history was more a question of intellectual curiosity and critical thinking. However, math stood out stood out as a universal life skill, so I felt somewhat confident as I delved into my first SAT practice exam. The first few algebra questions were within reach, solving some simple equations, and I also dredged up the ability to solve a quadratic equation. But by problem 10, I realized that the Geometry that I loved with its adorable little proofs has had absolutely no part in my life for the past 40 years. None – total disuse atrophy. Who among us remembers that alternate interior angles are congruent, or that the sum of the angles in a polygon are 180(n-2), where n= the number of sides? I found myself rummaging through the deep recesses of my gray matter in a flailing attempt to revive long forgotten skills. It reminded me of the ending of the first Indiana Jones movie, when the curator puts the box containing the magic stones in a vast and dusty warehouse.
At problem 13, I experienced a reflexive collective clench of various anatomies – heart, throat and points south. Word Problems – and these appeared to be unchanged over the past 4 decades. There was the cyclist overtaking the runner, the one about two people working at different rates, and the question is how much time it will take them to finish the job together, the one about how much time it will take to fill a leaky swimming pool, and recipe questions about how to dilute a solution using ingredients with two different concentrations. The only novelty of these questions was the SAT’s nod to cultural diversity. Instead of featuring Tom, Dick and Harry, now there were ethnic names, such as Ahmad, Miguel, and D’Shawn.
My SAT prep book tried to convince me that the SAT was not out to trick anyone, but I’m not buying it. The multiple choices always included the most common wrong answer, playing on students’ comfort in finding answers that matched theirs. And then the other little trick was to add a sneaky extra step to the problem. For example, if the crux of the problem was to solve for “x,” brilliantly wielding multiple mathematical principles, the problem would then, as an afterthought, ask for the value of 2x. Of course you can bet the “x” value would be among your options. Okay, I’ll agree that this is nothing more than reading the question correctly, and I certainly wouldn’t want my airplane pilot to forget to multiply by 2, but I found this just really annoying, especially since I fell for this trick (2x+1)n times.
On to the reading sections. I felt more confident here, especially since I regard my vocabulary and general trivia knowledge as one of my most valued possessions. On the standardized test for medical school admission, there was a section called general knowledge, presumably to make sure that potential doctors were not total geeks. I distinctly remember a question about Sol Hurok. I did not exactly know who he was, and was not exactly sure what an impresario was, but was completely sure that they were one and the same. General knowledge was the only section I did well on and I appreciated the fact that it was culturally biased in my favor - going to school on the east coast and reading the New Yorker were a definite advantage. As I hit the vocab section, my confidence soared further when I discovered that the SATs had eliminated the dreaded analogies section, where you not only had to know the definitions of four words, but also the relationship between words in the absence of any context. They have now replaced this section with sentences that are missing a pair of words. I sailed through this section, though I think that the word “treacly” only lives on in the SAT or maybe in some Jane Austen novels.
The sections on grammar were more problematic, since there is no possible way to reduce the living organism called English to grammar rules. Here is a helpful tip from the SAT prep book:
Use the past perfect for an action begun and completed in the past before some other past action.
Example: “The foreman asked what had happened to my eye.”
Explanation: In this case, ‘what happened’ would be incorrect. The action asked and the action had happened (past perfect) are used because one action (regarding the speaker’s eye) is “more past” than the other (‘the foreman’s asking’).”
So, you really need to rely on the sound of the sentence, but spoken English is a chasm away from written English, especially since the reference point for the SAT is something called “Standard Written English.” The idea behind SWE is that uniform usage among all English speakers will avoid any misunderstandings. Now that is one ambitious agenda, and the shadowy arbiters of SWE seem to be frozen in time. The prep book states that according to SWE, the word “mad” can only mean insane, therefore, “I am mad at you” is incorrect. You need to say “I am angry” and then there are other rules about whether you can say “angry at,” “angry with” or “angry about” depending on the target of your wrath. There is another section that provides a “draft” paragraph that you are supposed to fix. The samples were so wretched that I just wanted to scrap them all and rewrite them from scratch. One thing I know about myself is that I would much rather fix my own mess rather than someone else’s, a point most vividly illustrated by my revulsion in changing another kid’s diaper.
Finally, I reach the reading section, and nothing has changed. The paragraphs are as relentlessly boring as I remember. The SATs try to find topics that nobody is familiar with to create an even playing field, but the result is that the paragraphs are so boring that you want to cry out in agony. One paragraph did happen to discuss the potential causes of Alzheimer’s disease, which I happen to know something about, and I must say, the questions appeared to be written by someone who didn’t know what they were talking about, which may be a more general problem. Over the years of reading medical literature and writing reports, I have found that one of my study skills is the ability to stay focused, so you would think that I could manage this reading comprehension section. However, the key difference is that I have been lucky enough to be interested in what I read, which is a very different skill than staying focused on a topic that I couldn’t give a shit about, like the elements of a Corinthian vs. Doric column. The ability to maintain focus in the midst of utter tedium – that is the skill that the SAT evaluates. However, I hope that this is not a necessary college skill – if you pick your courses well, college should be all about intellectual curiosity and not dreary boredom.
I recall an envious comment about the newsman Walter Cronkite, who in the early days of TV, could broadcast hours and hours of presidential conventions through the mind-numbing details of caucuses, platforms and stump speeches. “Walter has a good ass for conventions.” Perhaps the same should apply to the SATs – you’ve got to get your ass in the seat, settle in, stay calm and go on to the finish line, and perhaps there will be a reward beyond the SAT, like becoming the “most trusted man in America.”
But if the SATs are mind-numbing, that means that going through the prep courses is repetitively numbing - more than the average person can bear. Maybe that doesn’t have to be the case. I am working on a scheme to teach basic math principles (once I learn them) and reading skills using more relevant material; these skills could then be transferred to the real test so that you would only have to be tortured once. My product will be titled the SexAT - hopefully a title like than would fly off the shelves, purchased by parents who will do anything to motivate their children. Last week the Wall Street Journal provided a list of the most common reference books purchased in the US. SAT prep books were listed at number one - a $214 million dollar market. If I could get just a piece of that …
Here is a sample math problem from the SexAT:
For his 18th birthday, Billy’s grandmother, who still likes to talk about her experiences at Woodstock, gave him a bag of condoms. She said with a wink, “You are a young man now, so whatever happens, just make sure that nothing happens.” Billy had made a vow of abstinence at his church group with Agnes, and so he gives 5/6ths of the condoms away to his friends Rex, Ace and Primo. He keeps the rest for himself, because years of boy scout training have taught him to always be prepared. Today at homeroom, Agnes intimates that she would be willing to break her vow during prom weekend, but when Billy looks in his bureau drawer, he realizes that his brother Rod has taken the four that he had been saving.
Question: How many condoms did he give away?
Ah, geometry was my favorite, I loved each and every - - - - -
And I knew never mix a metaphor or let a participle dangle.
But that was 40 years ago, and now I must be a diligent sleuth
In the dusty recesses in my mind where I can - - - - - geometrical truth,
I will try to draw on life experience to enhance my atrophied smarts
But I will still need the patience of an - - - - - to endure the reading parts.
Click here for answers
Chapter 1: SAT Do-Over
t has been almost exactly 25 years since I last heard, “Time’s up, drop your pencils.” I was taking the final pathology boards, marking the end of my 9 years of medical training. As I put down my No. 2 Ticonderoga, I promised myself I would never take another standardized test. I had endured the multiple choice questions of the PSATs, SATs, ACTs, MCATs, and four different sets of medical boards. In addition, throughout medical school, all the tests consisted of multiple choice questions. The dubious goal of my medical school was not necessarily to train insightful physicians, but instead to train us to pass the medical boards on the first try, since a high success rate was apparently a sign of educational excellence.
Therefore, every test in medical school exactly duplicated the boards – an endless parade of the evil variant of multiple choice questions – the multiple/multiple choice questions where you essentially had to correctly answer four questions in a row to score one correct. I can still remember the answer options, A: 1, 2, 3 above; B: 1 and 3 above; C; 2 and 4; D 4 only. Later on, I was the author of continuing medical education material, and somewhat vindictively decided to use the same question format. I soon got a call from the editor who said, “Will you quit the multiple/multiple choice questions – everyone hates them – just make the questions as easy as you can so that everyone can pass!”
I was always a pretty decent student based on hard work and good study habits, but I carried the burden of not being a good test taker. This didn’t really matter in medical school since once you got in, all you had to do was pass. But the MCATs and SATs, these were high stakes affairs. I was always jealous of those classmates whose SATs scores exceeded their class grades. I don’t remember what my scores were exactly, but I do know that they devalued my class grades. It was pretty obvious why – my general impatience meant that I tried to answer the questions to the dreary reading passages without reading the material.
I was pondering these ideas as I was wandering through the movie store, and spotted a homemade flyer offering SAT test prep from the “Ivy Insider.” Based on his email, which ended in “brown.edu”, I guessed that this was a kid leveraging his status as an elite Brown student. In the 1970s, the SAT was certainly considered important, but I don’t recall any frantic prepping. The only things I did were to make sure my pencils were sharp and had a good eraser, that the alarm was set, and that there was somebody around to give me a ride to the test center. Now parents invest money and egos in prep courses and individual tutoring in the hopes of skyrocketing SAT scores. As I contemplated the offerings of the Ivy Insider, I wondered what the effect of 40 years of life experience might be on the SAT test – was I smarter than I was at 18, or would a 40 year hiatus of math and grammar doom any efforts? There was only one way to find out – sign up and take the SAT again.
I went on the SAT website, thinking that a college degree might disqualify me, but that was not a problem. I was asked what grade I was currently in, and the options included 7th-14th, but there was a box that said, “not currently in high school.” This seemed like an honest answer so I checked that. In a separate part of the form they asked when I graduated from high school and 1970 was nowhere to be found. I called the help line and a nice young man walked me through the process, never asking the obvious question of why a 58 year old was taking the SAT. My husband, in fact, said that he would rather have a root canal, but then he actually did have a root canal and found it relatively painless, so he revised his thinking and said that he would rather have a rope burn. Given the high stakes of the SAT, I was expecting some elaborate form of identification, perhaps involving a fingerprint or retinal scan, but for $47 dollars I was given an admission ticket and told to show up with a picture ID.
My next step was to define the ground rules for this experiment, specifically what type of preparation would be permissible – would I go in absolutely cold, do a little self help, or call on the services of the Ivy Insider. The SATs have been continually criticized for being biased (both culture and gender biased) and not predictive of students’ college performance, but regardless the SAT persists as a standard hazing ritual for high school seniors. Additionally, critics point out that prepping or coaching undermines the point of the test by teaching test taking skills so that students can “game the system.” Well, here is where I disagree - if there is one thing that I have learned in the past 40 years, it is the importance of understanding process, “gaming the system” if you will, and I would argue that this is a basic life skill. Starting as a freshman in college, you need to understand the system to get the best classes, negotiate for better grades, or work the lottery system to get a decent dorm room. When I was a freshman, I found a junior who was taking a semester abroad. I asked her to participate in the dorm lottery with me as her roommate and then tell the school that she would not be returning. The plan worked perfectly – after she announced her departure, I got the preferred room of an upper classman, and then was able to select my own roommate.
Gaming the system is an essential strategy for everyday things – like buying airplane tickets. You need to know the airline pricing strategy before you can develop your purchasing strategy. The pricing strategy makes sense once you understand the airline's agenda. Specifically, there is a golden window of reduced airline tickets about 4-6 weeks before the flight. Before that time, the airlines know that they have the anxious traveler who will be willing to pay a premium. After this time, they have the last minute traveler by the short hairs, and they can charge outrageous prices. In the golden window, the airline company realizes that they have empty seats and start to lower the price, and all you have to do is monitor the situation for the optimal fare. One time I had to fly from Chicago to Minneapolis for a last minute business meeting. The cost of this round trip ticket for a 1 hour flight was more than the price of the round trip ticket I had recently bought for London.
Before I start any project at work, I stop to consider what the process is – who the players are and their individual incentives. Otherwise, it is like sending a batter up to the plate without telling him that he does not need to swing at every pitch. The SAT should be no different. If prepping is considered gaming the system, then bring it on. Why shouldn’t the SAT reflect how well students can apply testing strategies? The format of the SAT suggests some very basic strategies. In each section, the questions go from easy to difficult, but each correct answer has the same weight. So the first basic tip is spend more time on the easy questions – you don’t want to muff these questions in a rush to spend more time on the more difficult questions. The second basic tip is that easy questions have easy answers, and the hard questions are often more difficult “gotcha” questions, where there is some twist in the way the question is worded. Therefore, in the hard section, if the answer looks too easy, it is probably wrong. I would argue that real bias is that the SAT does not publish these testing strategies for everyone to understand to create a level playing field. However, the profits of the prepping industry are difficult to ignore; on the SAT website, one can purchase the “official” SAT study guide for $81.94.
So if I am assuming that my life experience counts for anything, I will not take the test “cold,” but allow myself some prepping to understand the testing strategies. (The ulterior motive here is that I don’t want to totally humiliate myself.) I will forego the Ivy Insider, but will self-prep with a SAT review book. My test date is October 9th, plenty of time to dust off moldering algebra and grammar skills. As the SAT website says, I had better “hop to it.” (Is that a cliché, simile or metaphor?)
The following fanagram has two sets of 4-letter anagrams, one noted by asterisks (*), the other with dashes (-)
Every fall is a * * * * of passage that the College Board holds - - - -
It’s the SAT that students must take their senior year.
It’s high stakes for those who aspire to colleges in the top * * * *
Because they only accept students scoring in the stratosphere.
So the following are some testing strategies to help you succeed,
First keep your focus when you have all those boring paragraphs to - - - -
Second, don’t muff the easy questions, so double check the answers you chose,
And don’t worry if you * * * * out in the hard questions, you can skip those
Third, beware, the SAT will - - - - you to make the easy pick,
But always be on the look out for a sneaky “gotcha” trick.
Click here for answers
My Brother Charlie
y parents were married in 1950 and three and a half years later they had three children, my older brother Ralph, me, and my younger brother Charlie. When Charlie was around two years old he developed a very high fever and was rushed off to the hospital. The doctor told my parents he had polio. Sometime around that time it also became apparent that he was not learning to talk and everyone seemed to assume that even though he no had no other physical problems, his inability to talk was related to polio. Throughout my childhood and into adulthood when asked about my family I would say “my brother Charlie had polio and that’s why he doesn’t talk.” I remember my mother saying in retrospect that she was always so grateful that Charlie was undemanding as an infant, and could sit in his own world for hours in his playpen. Although it seems so obvious in retrospect, I never heard my parents mention the word autistic. I had been so ingrained in the polio/doesn’t talk scenario that I didn’t realize that he was autistic until several years after I had completed medical school. The sad truth was I never really thought about it.
Part of the reason that I never questioned Charlie’s polio is that when I was about 8 or 9 Charlie moved to Lochland, a residential facility in Rochester, New York, and there was probably a good 20 year period when I never saw him. I have very hazy memories of Charlie before he moved out; I don’t recall wondering why he didn’t go to school with me, why he didn’t have friends over, or what he did all day. Recently we got our old family movies turned into DVDs and I was surprised to see Charlie totally mixing in with the rest of us. (Of course the movies had no audio). There was Charlie looking for Easter eggs wearing shorts pants, a sport coat and a bow tie, Charlie riding a tricycle, and blowing out candles on a birthday cake. I cannot even imagine the growing anguish of my parents as they realized that even though Charlie was so normal in many ways, he would require life long care.
For several years when Charlie was first at Lochland he would come home for summer vacation. This was great because my mother always rented a trampoline for the summer that we could all use. I remember Charlie jumping by himself for hours, sometimes suddenly yelling the syllable Geee (with a hard G)!! and then laughing at some secret joke. He was also a good singer and could wordlessly sing various show tunes my mother would send him. This was also the time when we would watch the Ed Sullivan show on TV, which often seemed to feature odd circus acts from Eastern Europe. One that I remember was a bunch of guys wearing white stirrup pants with suspenders, who balanced spinning plates on the tops of long poles. Well, Charlie seemed to have the same skills. He could jump on the trampoline while twirling a wet washcloth on his index finger. No one else in the family could do it. He could also do the same thing with a Frisbee, and I think that he was pretty good at a hula hoop. Charlie was also an enthusiastic eater. I remember that he would grab a canister of Redi-Whip from the icebox, squirt it directly into his mouth and then laugh. It was obvious that he had a pretty good sense of humor.
One of the great mysteries of Charlie’s mind was that although he could not communicate he understood everything and was perfectly capable of doing household chores, such as emptying and loading the dishwasher. One day my mother asked Charlie to take out the garbage. We had two garbage cans outside; one was an incinerator at the edge of the driveway and the other one was a regular garbage can right out the back door. Charlie seemed to mistake the incinerator for the garbage can and lit the garbage can on fire. I remember the day distinctly. I was getting dressed for school, and in fact was wearing a pink and yellow candy-striped pair of culottes that I had made myself that perfectly matched my pink sweater. I looked out the bathroom window to see the fireman raising an axe as the flames licked up the side of the house. There were pools of water in the driveway. My father was wearing his going to work clothes which included his felt hat and my mother was standing in the bathrobe she used to wear while she made us all breakfast. Although they were standing with their backs to me, I could see their body language of deep sorrow.
After this incident, my parents decided that coming home to visit was too disruptive for Charlie. While they visited him four times a year, I don’t think any of my siblings saw him for decades. Now I wonder why my parents did not take one of us on each of their visits to Charlie, but on the other hand I am also ashamed to say that I never asked to go. Charlie moved to different residential facilities along the way and spent some time in Florida. When that facility collapsed, my parents even tried to set up their own facility in Florida, called “Great Days.” I noticed these efforts with only passing interest, and I am even more ashamed that I did not pitch in to help on a daily basis. It was very clear that my parents loved Charlie and that he was part of our family, but I think that my parents were trying not to burden us with his care. Perhaps they knew deep in their hearts that it would be our turn soon enough. Ultimately Charlie ended up back at Lochland. Finally one August about four years ago I made my first visit to see Charlie at Lochland. It was the last visit for my mother, whose heroic efforts to compensate for her eroding mind were beginning to show cracks. Shortly after this visit, Alzheimer’s disease overwhelmed her and she never saw Charlie again.
Lochland is housed in a magnificent estate overlooking Seneca Lake, one of New York’s Finger Lakes. As we walked up the steps, I began to hear odd noises - some yelling, inappropriate laughing and then Charlie’s characteristic Gee! Charlie came up and hugged my mother briefly saying, “Muma, muma, muma.” I said, “Hi Charlie, I’m your sister Bobbie,” and gave him an awkward hug, in part because I was startled to notice that Charlie and I are virtually identical twins. This was something that I did not appreciate in all the photos that we had of Charlie, and it was eerie looking into his faraway eyes to see a sort of warped version of myself. Charlie was clearly pleased to see my mother since he knew that he would get some treats, but he soon he wandered off, retreating into his own world. We were left standing in the huge living room of this old mansion surrounded by other residents and staff of the house.
I took a deep breath. Glancing at my watch, I realized that our visit was less than 15 minutes old and it was already clear that we had to start killing time. I turned to the woman next to me and struck up a conversation. I had a such pleasant chat with Cameron that I assumed that she was one of the staff people. All of a sudden she leaned over to me and said, “Wait right here, I want to give you a present.” She rushed back and presented me with a load of hangers that she had decorated (sort of) with different colored yarn. Oops, first mistake, turns out that she was a resident. There was another sloppily dressed man standing awkwardly in the corner who looked like a resident. Later on I realized I was making dangerous assumptions when I saw him driving the Lochland van.
That morning I met with Charlie’s psychiatrist and for the first time I formally heard that Charlie was autistic. Later that day we met Charlie’s “advocate” a woman named Charlene who was supposed to be especially attentive to Charlie’s needs. My parents had been singing the praises of Charlene for several years since she would frequently take Charlie to her home for dinner or even on vacation with her family. Now that I belatedly knew that Charlie was autistic, it didn’t make complete sense to me to change his routine and environment. Sure enough, Charlene would report that they had a great outing, but that Charlie had broken something, like her computer, and then Charlene would send my parents a bill. Charlene suggested that we take Charlie out for dinner to the Sizzler steakhouse. This seemed equally crazy – why would you take someone with virtually no impulse control and an infinite appetite to an all-you-can-eat buffet? This was my first initiation into the sandwich generation and it was the most stressful meal of my life. Charlie would continually try to slip out of the booth and hit the dessert line again and again, and then yell when I tried to stop him. My mother wasn’t sure where she was either; she would get up but then not remember where we were sitting and I would lead her back to our booth. At one point I was retrieving Charlie when he startled another diner by grabbing his lemon meringue pie off his plate and then laughing mischievously. Charlene was trying to show off how well she controlled Charlie by continually jabbing her index finger into her forehead to get his attention but this strategy clearly wasn't working. It was merely incidental that the food was predictably wretched.
The next day was Charlie’s birthday - I think that it was his 50th birthday. Charlene had arranged a birthday party at her house, inviting all the residents of Lochland plus a variety of other disabled adults. Charlene’s husband was one of these enviable guys who could fix anything, but the consequence of this great talent was that his yard was strewn with appliances – there were dishwashers, lawn mowers, cars and an RV all in various stages of repair or disrepair. Charlene had really gone all out and made many different casseroles, all of which seemed to have mayonnaise as the principle ingredient. She had laid them all outside and as the bright sun relentlessly beat down I began to see oil pooling everywhere and the mayonnaise getting that nasty gelatinous look. The yard was now filled with people either in wheelchairs or staggering around, Charlie had no clue that this party was for him and just wanted to eat the dripping and drooping cake that was on display, I had lost track of my mother and I didn’t want to make the same blunder of mistaking a staff person for a resident.
I was utterly exhausted when we finally reached the soothing, relaxed atmosphere of the airport. We happened to fly over Buffalo and I got my first glimpse of Niagara falls. I leaned over to point this out to my mother, who only noticed the fluffy clouds and commented that she thought it was odd that there would be so many snow drifts this time of year. I also saw that when she tried to do the crossword puzzle she just added extra boxes if her word didn’t fit. I thought about all the times that she had made this trip by herself and how she had somehow assimilated all this sadness into her life, and how she had spared the rest of her children from this burden. I vowed that I would not view my care of Charlie as burden, but consider it an opportunity to spend time with my brother in a beautiful part of the country.
I have had some missteps in the past five years, but by and large I would have to say that I am learning visiting Charlie, if you don't mind having your heart broken from time to time. I have discovered a National Wildlife Refuge some 20 minutes away that has fabulous birdwatching. I took Charlie on a walk there on my last visit, and even though he peed in the middle of the trail, I was actually happy to realize that he was smart enough to know that was acceptable in the woods. There is a great yarn store in downtown Geneva that I always stop by. We no longer take Charlie out for dinner, but go to the grocery store and let him pick out something special to have back in his apartment. One time we made a cake together and he did a masterful job of licking the bowl, then washing it and putting it back on the shelf. Charlie loves watching the movie “Sound of Music,” and occasionally when he sings you can catch snippets of “Edelweiss.” One night as we were watching he curled up on the couch and put his head in my lap. I gave my 55 year old look alike brother a head rub just the way our mother did so many years ago.
What's in a Sandwich
When someone says sandwich, I used to think of peanut butter and jelly,
Or maybe pastrami on rye from the corner - - - -.
Or the Earl of Sandwich who spent - - - - days in luxury’s comfortable lap.
His friend Captain Cook made him famous by putting his islands on the map.
But now mostly I think that sandwich is the generation that I'm currently in.
And I - - - - if I told you that sometimes this doesn't stretch me a bit thin.
