Hospital Post 13: The Return of the Surgeon

He's here to announce that Ed can leave tomorrow morning.  But not much else.

Unfortunately, we had a little confusion about whether the pain meds were given and Ed ended up without having any for almost 13 hours (they're on a 6-hour schedule).  So now he's a little behind again on the pain.  Ed thought they'd given it to him at the end of the early morning shift, just before I got here.  I thought that the new shift would have known that it wasn't given to him yet at 7, even though that was when he was due.  The chart does not show any pain meds given at 7 am.  But the nurse just asked him when she came on whether he was in pain, and at that time, he said no.  It's not entirely clear to me whether I should give more credence to the chart or to Ed's memory; either one is capable of being wrong...the former regularly, and the latter mostly just at this moment.  But there you are: it's a tough system to get working harmoniously, I'm afraid.

One of the reasons for that, I suspect,  is that the nurses are not 'systems thinkers'...instead, they don't, e.g., check his bracelet every time they give him a medication.  (Only a few times the first day has that happened, and never since then.)  They are trained by life to rely on their memories and their sense of personal responsibility is my guess.  To keep asking/checking his name when they know his name because they remember his name may well seem bizarre: bureaucratic silliness.  But if you understand it as a system response instead of about whether you in fact are capable of remembering his name from hour to hour,then you could bring a different attitude to it.  You're doing it to reduce errors, not because you're not able to remember somebody's name.  But to understand that you are part of a system, as opposed to somebody making an individual difference isn't the American ethos, I fear.  Being a part of a system is something we give a negative value to, whereas individual initiative and responsibility are the positive values.

So, in any case, it sounds like all things being equal (which they never are), we head for P.R. tomorrow, where the living may well be a little easier.