A snowball’s chance… where?

Remember when Goldilocks sampled the porridge in the three bear’s cottage? One was too hot, another too cold, but baby bear’s was just right. Well, when it comes right down to it, I think I am pretty well a just-right-baby-bear kind of person. In fact, until recently, I figured we all were… But, as it usually turns out when I declare my allegiance to one side or the other, I’ve just discovered I made the wrong choice. Again.

I mean, it just makes sense to split the difference, eh? Try to choose the middle of the Bell curve so you’ll have room to maneuver if -or in my case, when– you back the wrong horse. From the middle, you can always say you were actually leaning towards the winning side -which you can’t from across the room. I learned that as a child who was owned by a railroad family which moved every year or so to a different part of Canada.

When we lived in the Prairies, I tried to pretend I liked the cold, but apart from throwing snowballs at passing busses, or hurling myself down snowdrifts on a piece of cardboard, I actually hated winter -it was far too cold. And on each blizzard-filled journey to and from the neighbourhood school -we were expected to walk in those days, not be driven- I was bundled up in so many layers, and my face shrouded by a scarf wrapped around it a hundred times, I would sometimes trundle off in the wrong direction until my mother ran out to point me another way. I was quite young then, of course, and each time I hoped she was coming to tell me school had been cancelled; I soon realized that in Winnipeg, they only cancelled classes if one of the rivers flooded.

The summers were not much better there -but they were even worse in the parts of Ontario where we ended up on our next several migrations. Put simply, even if you discounted the mosquitoes, the black flies, and pollen, and were careful not to step on snakes, or wander through poison ivy, or for that matter, follow the dog through the bush and end up having your mother pull ticks off your arms and legs when you got home, it was far too hot. Far too muggy. We couldn’t have afforded an air conditioner in those days -even if they had been invented- so I had to fight my brother to sit directly in front of the household’s only fan; and never behind him, because, well, my brother smelled like a gym-bag when he perspired.

But, I had always felt there was a credible argument for compromise. And, let’s face it, with temperature, it’s probably easier to don a coat or a sweater if it’s a little chilly, than to start stripping down if it’s too hot. I mean, I know you can’t please everybody, but I always thought that my compromises could stand the rough and tumble of any contrarian opinion. Until, that is, I bumped into the article in the Smithsonian Magazine that reported on a study published in PLOS One by researchers Tom Chang and Agne Kajackaite: https://www.smithsonianmag.com/smart-news/chilly-rooms-may-cool-womens-productivity-180972279

Their work suggested that ‘cold temperatures can negatively impact women’s cognitive performance.’ It would seem that ‘Temperature systems in many modern offices follow a decades-old model based on the resting metabolic rate of an “average male,” which is typically faster than a woman’s metabolic rate. Faster metabolisms also generate more body heat, which in turn means that women are often left shivering in the workplace.’

Now, we’re not talking Antarctic conditions in the room, or anything, and the performance differences measured were not Trump-resigns-under-pressure headlines, for sure, but nevertheless differences there were: ‘An increase in temperature of just 1.8 degrees Fahrenheit was associated with a 1.76 percent increase in the number of math questions that female participants answered correctly—which may not seem like a lot, but it is nearly half of the four percent performance gap that exists between male and female high school students on the math section of the SAT … Increasing the temperature by 1.8 degrees Fahrenheit also boosted women’s performance on the verbal task by around one percent. Men, on the other hand, performed more poorly on the math and verbal tests in warmer temperatures.’

But wait a minute here. ‘[W]omen’s enhanced cognitive performance in warmer environments seemed to be driven by the fact that they were answering more of the test questions; the dip in male cognitive performance, on the other hand, was linked to a decrease in the number of questions answered.’ Uhmm… Isn’t that a little like equating absence of evidence with evidence of absence? (I always enjoy using that aphorism whenever I can fit it in.)

Anyway, I have no reason question the results and I have to say I was further softened by one author’s explanation that ‘the students might simply have felt better, which in turn prompted them to exert more effort.’ Fair enough -that’s something a Winnipeg kid would understand -it’s hard to concentrate with a scarf wrapped around your face, or wherever.

There may be a little more work to do in resolving the so-called ‘battle of the thermostat’, however.  ‘[T]he pool of participants [543 students from universities in Berlin], though large, was made up solely of college students. The research is, in other words, not representative of the age and education level of the general population.’ Still, ‘the study suggests that dismantling the “thermostat patriarchy” is about more than fostering women’s comfort—it’s also a question of productivity.’

Too bad they couldn’t have done a study like that during a Winnipeg blizzard when I was young and wrapped. But then again, the sample studied -male or female- would have been horribly biased: only those of us who actually made it to school would have survived to take the test. And, who knows anything about those whose mother’s weren’t watching the direction their little tykes were pointed when they left the safety of the house? Could we use the ‘evidence of absence’ thing again…?

The Slow Cooker

Dare I comment on the speculum?

It is a very underrated item, when you think about it – I mean, if you think about it… Uhmm, considering its job and everything… Ask any gynaecologist. Like shoes, one size does not fit all. In fact, continuing the analogy, there are many shapes and designs: long ones, short ones, wide ones, thin ones, metal ones, disposable plastic ones… And of course, uncomfortable ones that seek to transcend all categories.

Some doctors seem to specialize in one type or another, oblivious it would seem, to basic engineering mechanics, acolytes of the school where Function is a slave to Need –unchanged, some would say, from the glory days of Papanicolau where just seeing the cervix was deemed a success. Old habits die hard though, and so the equation is usually solved by asserting that benefits are worth two times more than discomforts. A handy, if unnecessary, deception if only because it is a justification rather than an explanation. A deafness -another barrier which does not encourage compliance except, as with some dentists, in extremis.

But I like to think that I have a specular selection from which I can choose the least uncomfortable member and am quick to point out that I have endeavoured to match Size to Need rather than the first item I happen upon in the drawer.

I long ago abandoned the disposable plastic speculum in favour of their autoclaveable metallic parents largely because of the greater selection of styles to minimize discomfort. True, never having had to endure what for some must be an unwelcome embarrassment, I nevertheless hope I am sensitive to the anticipatory dread that a gynaecological visit must engender. And I am a male; I would have nightmares…

But for all its putative advantages, there is one major downside to metal when compared to plastic: temperature. More specifically, temperature difference. I do not pretend to understand the physics of why they are always cold but personally, I suspect the First Law of Thermodynamics as defined by Wickipedia: The increase in internal energy of a closed system is equal to the heat supplied to the system minus work done by it. Think about it. The speculum is usually closed while it is in the drawer -and I must confess I do not heat my drawers- and of course its not doing any work in there either… An icicle just waiting for an opportunity.

So for years I have depended upon the hot water faucet in the sink to warm up my choice of speculum; unfortunately I am several floors distant from the boiler so running the water is usually interminable and makes us both uncomfortably aware of our respective bladders. No, the tap is not the answer. But I am a gynaecologist, not a plumber.

I used to joke about my inadequacies and I was getting quite good at innovative excuses. Too good: laughter may assuage anxieties and diffuse tensions, but it slowly and inevitably becomes too valuable an excuse to abandon. Especially when no other solution presents itself.

But although I may not be an engineer, nor a thermodynamicist, some of my patients are. Okay, one of them is.

One winter, when pipes were freezing everywhere in the city, a pregnant patient and I were forced to endure a spectacularly long faucet session. It was the beginning of her third pregnancy and I needed to do a Pap smear. Pregnancy, however, does not easily admit of prolonged personal water storage, and so after a few minutes she was becoming visibly agitated with the wait.

“For god’s sake, doctor, why don’t you just use a cold clamp and get on with it?”

I smiled and walked over to the drawer in the examination table and pulled out a speculum. “Here’s why,” I said, letting the ice cold device touch her leg. “And it’s called a speculum, not a clamp…”

“Should be called a specicle,” she said and giggled, careful not to attract the attention of her already disquieted bladder. Then she sat up suddenly and asked me to leave the room while she got dressed again.

After I went into my office and busied myself with paperwork, the roil of tap water suddenly stopped and I could hear doors opening and closing, and bare feet slapping hurriedly along the corridor leading to the waiting room. After a few minutes she reappeared and sat down across from my desk looking dishevelled, but relieved.

“You have to do something about this,” she said, her lips trying valiantly to smile through her blushing cheeks. “It was the same in the last pregnancy…” She considered it for a moment. “No, I think you were actually able to get the thing warm before I had to leave…”

“It was summer then,” I added after riffling around in her chart for a moment. “But you’re right,” I said trying to put on a professional face. “Maybe I should keep a kettle on the boil in there…”

Her eyes actually enlarged when I said that so I shrugged to diffuse the suggestion.

As a result, the large eyes rolled and the barest hint of teeth surfaced for a second. “What we’re aiming for is warmth, doctor. Tepidity. Not tea.”

Tepidity? I rather liked that word and vowed to try to slip it into a conversation some day. “Well, you’re a mechanical engineer aren’t you?” For some reason I had written this beside her name on the chart.

She nodded mischievously, the light from my desk lamp glinting in her now narrowed eyes. “You mean like I could apply the Second Law of Thermodynamics to your speculums?”

“I thought it was The First Law…”

“There’s a First Law?” she said and laughed so hard I thought she might have to leave again.

*

And then, as time passed, I forgot about specifics and reverted to humour to deal with the inevitable delays in warming the instruments. Forgot, that is, until almost a year later when she arrived for the first visit after her baby had arrived.

After the usual peek at the inconsolably crying baby her worried husband was carrying, the somewhat belated congratulations and then apologies for not being on call for the birth, and her assurance that all had gone exceptionally well, she sat back in her seat. Almost smugly, I thought.

I scanned her chart for a moment. “We never did do the…”

“The Pap smear,” she said, interrupting me as if she’d been waiting all along for me to bring up the subject.

Suddenly I remembered. “Do you want to visit the washroom now? Before I turn on the hot water, I mean?”

She shook her head and glanced at her husband. “I’m fine, thank you.” But her face lingered on him when he stayed sitting. The baby was quiet now, so I thought maybe she was just silently congratulating him. “I think Jennifer needs changing. Is it okay if we change her in the examination room, doctor? Now they were both smiling.

“Of course,” I replied. “Just let me know when you’re ready and I’ll come in.”

They disappeared into the other room wheeling the baby carriage with all their supplies, and closed the door. It is a rather thin structure, the door, and I could hear them whispering and giggling; the baby seemed to be sleeping through the procedure. Amazing.

“You can come in now,” she said after a few minutes in a too-loud voice -the voice of a child who has just hidden some cookie crumbs under the table.

I opened the door and saw her husband sitting quietly on the little chair I keep in the room. I could see the baby fast asleep in her stroller and the mother sitting on the edge of the examining table. There wasn’t much room in there at the best of times, and with the husband, the baby and the carriage, it was like being in a crowded elevator.

I smiled at her and headed for the sink to turn on the hot water.

But I had to thread my way past husband and stroller so before I could make it to the sink she said, “You know I was thinking about it after my little problem with that last Pap smear…” I stopped and turned to her. “I think it was the First Law after all…”

It took a moment for it to sink in. “Ahh, you mean the temperature of the speculums.” She nodded. “Well, it was just a guess,” I said modestly, and meaning it.

“So, I thought I’d correct that and actually apply the Second Law.”

“Uhmm…”

“Closed system,” she said and laughed, pointing to the sink.

Her husband leaned back so I could see more of the counter. And there, proud as Punch, was a Slow Cooker -a Crock Pot- plugged in and partially full of water. There was even a speculum in it.

“Water’s probably not at the correct body temperature yet…” she said and smiled. “But it’ll do for now.”

I walked over to the counter and dipped my finger into the water, speechless for a moment. And then it came to me: “Not quite the correct degree of tepidity, you mean?”

I could see her smiling; she knew it was her word. “I mean, I don’t want to see a kettle in here,” she said and settled back on the table.