Thresholds, Surgery, & a Galactic Eurasia

“A threshold concept can be considered as akin to a portal, opening up a new and previously inaccessible way of thinking about something. It represents a transformed way of understanding, or interpreting, or viewing something without which the learner cannot progress.” 

*** 
Although gynecologists pioneered laparoscopic surgery, general surgeons outpaced gynecologists in the early 1990s with the massively historic,profoundly wide-sweeping adoption of the laparoscopic cholecystectomy.  Medical historians place adoption rate of this technology-based procedure as high as 81% in the first three years after it was introduced. Based on the telling, 1989 to 1992 was a crazy and reckless time, worthy of a blog post all to itself. 
Contrast the general surgery with the gynecologic experience.  Although the first laparoscopic hysterectomy was performed in 1989 (the same year as the first laparoscopic cholecystectomy) studies as late as 2013 suggest that an overwhelming majority of hysterectomies continue to be performed in the classical, invasive manner. 
There are documented reasons for this. First, today’s gynecologists are sensitive to the ethical issues that arose during the free-for-all that was with laparoscopic cholecystectomy.  Second, laparoscopic total/supracervical hysterectomies offered a couple unique challenges that required specific technical advances.  These advances occurred, but much later.  They occurred alongside fairly conclusive evidence that laparoscopic hysterectomies, when performed by well-trained laparoscopic gynecologic surgeons, yield much better outcomes than classic hysterectomies in most situations.
So what’s the holdup? One major problem appears to be lack of access to effective professional development for older gynecologists not working in academic medical centers.  Or, in other words, real-time surgical support for gynecological surgeons as they move through the initial learning curve.
***
I graduated from my residency program in 2006, when the positive outcomes and technological advances for laparoscopic total/supracervical hysterectomies had just reached Middle America on a grand scale.  In my chief year of residency, the attending physicians were completing laparoscopic professional development programs, and when they returned they operated together and without residents.  They were not teaching the procedure yet because they were still learning it themselves.
And so I left residency for solo practice in rural America without the confidence to perform a supracervical or total laparoscopic hysterectomy on my own.  This was fine for 2006—it wasn’t really mainstream yet.  It was not, however, fine for 2008, 2009, 2010….  So I attended workshops.  I traveled to other hospitals to operate with laparoscopic experts.  I watched videos.  I read articles and studied books. But a good surgeon never performs a surgery if he or she cannot correct the potential complications (or call in other surgeons who can correct the complications) that might occur during the surgery.  In my remote town I did not have access to the real-time surgical support I needed during my learning curve, and so the learning could not ethically commence.  
Thus, I was professionally outdated less than three years after I left residency training.  And I could not find my way to a solution.
***
“As a consequence of comprehending a threshold concept there may thus be a transformed internal view of subject matter, subject landscape, or even world view. This transformation may be sudden or it may be protracted over a considerable period of time, with the transition to understanding proving troublesome.”


In the months after leaving medical practice, I struggled with my failure to solve my dilemma. 
And I struggled (hard).

Then, one summer day, I dropped the baby off at daycare and took my oldest daughter, then six, on a daytrip to the historic Jamestown settlement.  The living history replica of the Native American village and the English fort were perfect for her.  The museum, it turns out, was perfect for me—a postmodern experience celebrating multiple voices simultaneously.  How did people dress, eat, play, and trade in seventeenth-century Europe, Africa, and Virginia? Every exhibit juxtaposed artifacts from the three continents, allowing patrons to compare and contrast at every turn.     

My daughter was sitting quietly on a bench, captivated by a life-sized diorama, and so I let go of my maternal vigilance for a moment.  I love a museum—every museum and every artifact—and so I turned to a case of harvesting tools with interest. The African and European implements were similar.  They were also advanced in comparison to the Native American models, which presumably got the job done but probably with less efficiency.  With this still on my mind, my eyes wandered to an image of world trade routes, painted on a nearby wall.

And right there, standing right in front of a really big drawing of corn, I passed through a threshold.
With a surgeon’s mouth, my curses tumbled out slow at first and then with increasing fluency, creativity, and volume. I almost ran back to the beginning of the exhibit, forgetting my child who (thankfully) remained on her bench for this entire episode. I checked every exhibit case – yes, there were many similarities between African and European artifacts, and they frequently outshined Native American technologies in efficiency, ingenuity, and beauty.  
Africa and Europe and Asia traded.  They fought.  They developed, if not in collaboration exactly, then at least in dialogue with one another.  The Powhatan tribe, on the other hand, evolved in relative isolation.
To educational scholars, embracers of connectivism and connected learning, my moment probably seems dull, obvious.  But to a (ex) medical professional trained with an exclusive and almost militant attention to individual achievement, these farming implements, these trade routes were powerful.  They were surprise, regret, anger, sadness, resolution, resolve, and hope.  

The trade route phenomenon was a concrete link between “what happened” and to “how to proceed” with my life.
***

I’ve been reading a lot of Henry Jenkins and George Siemens recently, and I’ve been reading a lot about creativity.   As I process them, these works transport me to the Jamestown Settlement museum. 

It seems to me that we should identify the trade routes in our lives.  

Find your Amber Road, your Silk Road, your Triangular Trades, your Route 66, your Ice Road.  For me, Twitter is becoming one of my trade routes.  Then, once you are three-quarters ready, forge a unique trade route.  Make connections between people and concepts that make sense to you, even if they don’t make sense to anyone else—they will catch up to you sometime and connect the same dots.  The key to innovation is connecting usual things in unusual ways.

Go on, you can do it.  Go be a galactic Eurasia.
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