Living and Working in Love Canal

I'll begin by looking back at the night. I slept pretty well, no complaints. Dreams, yes, always, but nothing I can pull out for a subject. Ok, so then what, well while I was meditating, I got to thinking. Yes, I know I'm not supposed to do that, but it's hard not to, and besides it's OK as long as you realize you're thinking about something else. That way you can stop. It's part of consciousness and staying focused on the present.

So I was thinking about now versus before, when I was working and I remembered conversations I had with other people at work. Mostly doctors, anesthesiologists, really that's who I worked the most with. I remembered thousands of times, taking a mental step back from a situation and thinking to myself, this is just crazy, who works like this, really?

Except for brief periods, like maybe Christmas Eve, the pace was fast and there was always pressure to catch up, do more, be more places at once. Danger was inherent in the situation; it was an operating room, an OR. A kitchen is a dangerous place when you're cooking a big dinner, but an OR, well, you get my point.

Now occasionally there were situations that were nearly out of control dangerous, and a few times they really were out of control. New variables appear and the deck is reshuffled mid-hand. I was in an open heart surgery once when a 6.8 earthquake struck and we all stood still while the building shook and floor shifted beneath our feet and the walls cracked and parts of the ceiling fell, and we all braced and looked at the each other waiting to see what would happen next. That's maybe an dramatic example but it wasn't the most dangerous situation that I ever experienced in an OR. But if you work in an OR, it's expected. It's one of the reasons you do risky things like operations in the operating room. It's why it all exists.

My point here is, even, and especially, during those times, everybody concerned tries extra hard to focus and do the right thing. Always, do the right thing. Do the wrong thing and somebody gets hurt, you get in trouble, maybe lose your job or career.

When you're young it's exciting. You can thrive on the pressure. It makes for exciting stories; for the first year, maybe. But it doesn't take long to realize the real job is to get used to making all the procedures and decisions, whether they're standard or way off the beaten track, flow in a seamless, even, professional sequence that begins when you start your shift and moves constantly and safely until you end your shift. This is the pattern you hope for, year after year, for decades.

It sounds easier than it is because so much of it is in your apparent attitude. You must stay calm and professional and lucid no matter the situation. Sometimes this takes on the appearance of walking and talking calmly through a burning house. Because even on a day where everything goes well, you're under Production Pressure. The pressure to do more, faster, cheaper, and safer with sick and injured humans.

Here are the basics. An operation or surgical procedure on a person is called a case. It may be simple or it may have several parts. The patient may be otherwise healthy or some degree of unhealthy and possibly injured as well. The term Operating Room or OR refers to both a single room where a surgical procedure is performed and a group of these rooms as a unit in the hospital. Each room has a list of assigned cases that make up its schedule. So an OR schedule for a room is a list of cases that are planned for a room. A room's schedule may change significantly over the course of a day. New urgent or emergent cases are "added on" to the schedule as necessary. Those cases are called "add-ons." Most large OR's have many add-ons in a day and may run rooms for two or three shifts during the day, meaning that it's not unusual for some individual OR's to run 24 hours a day, one case after another.

Because add-ons continue to occur and they involve people who desperately need a surgical procedure, the staff must move as quickly as possible through each case so that the next case can be done. A single surgical procedure involves many individual jobs and all of those jobs must be performed as close to perfect as possible.

The administration has to control costs so they don't want staff on overtime, so you must finish your room's schedule before the end of your shift. If your room finishes its schedule on time or early, it may be able to do some of the add-ons.

So it goes like that. One case after another, with this pressure to produce more, more, more. All the time more. All of the individual jobs that make up a team in the OR are hard. There are no unimportant or unnecessary tasks in the OR, and I'm speaking of hospital staff here. Most of the jobs require a lot of training and a lot of concentration to perform correctly. Now picture you're fighting a daily battle to do a difficult job perfectly, to take care of a patient, who is, by the way, sometimes awake and naturally scared out of their mind, and added to this there is Production Pressure, pushing to be more efficient, do the cases faster so you can do more cases.

I'd like now to address the human angle of all this, from the staff viewpoint. I'm not blaming anybody for anything, I'm not asking for sympathy. After all this is the job. I'm just making observations after 40 years or work.

This is how I view taking care of a patient for a surgical procedure. From A to B. From the beginning of the procedure to the end. In a simple procedure, there may be 500, 600 steps and checkpoints you have to cross or make. It's like the Iditarod, you go from A to B. You can't skip anything because that's like closing your eyes and driving off the track.

So you work with these other people say four or five per OR, plus all the resources, that's another 10-20 people and equipment, from 100 pieces to 1000's, literally, as a single operating room group, that's the cast and props. All for this one procedure on one patient, whose situation is unique to them. Unique usually doesn't mean singular in the world throughout history, but unique in combination.

Take a single standard deck of playing cards. Shuffle them and deal a 5 card hand, like in poker. Do you know with that 52 card deck there are 2,598,960 different combinations possible. That means you could deal 2.6 million hands without seeing the same hand twice. A human being has way more than 52 critical variables, and those variables must be considered in combinations to determine their importance, and the human variables are constantly shuffled and not static. You may start a procedure with the patient having no unusual heart problems and 5 minutes in, a heart block develops.

By its nature, surgery is a setup for something bad to happen and everyone there is expected to fix it, as it happens, and produce a happy ending, always. That's the expectation. The number in this example here doesn't actually matter, but if you put 2 million people in a room (big room, huh) and give them chairs and a cup of Koolaid and play music for 2 hours, chances are someone in that room is going to drop dead during that 2 hours, or at least fall over. That's probably true for 1 million people, or for 100,000 people. People spontaneously fall over and die. Statistically, it's a weird deal, individually it's not such a surprise but it's part of the basis for the need for an emergency response system in your fair city.

Now consider instead of a chairs, music, and Koolaid, your plan is to cut every one of those people open and remove something they're better off without and then close them up. Otherwise, it's the same 2 hours and the same random group. You think it increases the risk? Now picture that you're one of the people in the room that chose that kind of thing as your job, and you're supposed to do that job as perfectly as anyone could. That's really the standard, as perfectly as anyone could. You have to cover every one of the 600-10,000 points during the procedure and also deal with anything else that may happen, because shit just happens (and believe me it does). Now consider that your managers and administration are constantly haranguing you to go faster, go faster, go faster, but, of course, be safe, but be safe- FASTER!

When you finish that procedure, you need to hustle and do another and another and another. Yeah, get your break and lunch too. When you finish, you go home and rest up and get up the next day and do it again, but this time, you really need to go faster, and you're wasting stuff too. Keep in mind, it's a really good idea to act as normally as you can at home and the grocery store, your job has nothing to do with anyone else out there, it's not their fault or problem.

The next hurdle is that, tonight or this weekend, you need to stay close to the phone so that if the hospital calls you, you have 30 minutes to get to work and start another perfect case and do it faster and stay until you finish or someone else takes over, and, here's a twist, if they call you in on Sunday night, you'll need to stay and work through Monday, all day maybe, and, of course, it has to be perfect. Fast and perfect.

Aside from the management and peer pressure to work fast and perfect, most people, who choose to work in this ridiculous place, do it because they actually want to help people, to learn and to do a good job. Many aspire to be the very best they can and make countless, continuous, small personal sacrifices to the job, and when something bad happens to a patient and sometimes it does, just because bad things happen, the people there take that home with them. It's like a tattoo, but of shame, and you can't have it placed on your butt where you can't see it, it goes on your hands, in front of you, to remind you what happened.

It's not like watching someone break their leg  or seeing a bus run over someone, because you were one of the people who were expected to make the happy ending. And, if there's any chance that you had something to do with the bad ending, you carry that with you too, a bigger brighter tattoo. You didn't have to make a mistake, maybe you just could have moved faster or worked better, or maybe you missed one of those 2000 checkpoints and it led to something bigger, you carry that with you, and it's a sick feeling. Like you missed a fly ball and someone died.

Every year you have to write an annual performance review on yourself and others. You're supposed to write your professional goals for the next year, five goals at the beginning of each year and at the next annual review you're supposed to review last year's goals and write new ones for the next, and on and on. When you're new, you write lofty shit like, taking classes to increase your knowledge base and as you get older maybe you write about going to conferences and stuff like that, but for years my number one annual goal was "To not hurt anyone." I was serious. You can't do that kind of job for long before you screw up and someone gets hurt. You feel terrible, you beat yourself up, but you have to go back the next case or day and do it all again and do it better. I've screwed up, everyone does. It happens more when your younger and have less experience. The older you get the more you've been burned and the more careful you are.

Then normal tendency is to become more careful with time, and that's good, to a point, but it's also a problem if that's all you do. Because the environment is naturally dangerous, and you have to operate in it, there's only so many ways to make it safer from your standpoint, you can only slow down so much, you can only avoid so many dangerous parts before you become paralyzed and that doesn't work. So you push down your fear and do the best you can.

After years, you work within your own pressurized cylinder. You look around at the older people in the crew and, if they're still showing up every day, you know they've worked out some kind of compromise within themselves.

Because of that, it is a highly toxic environment to work in. I'm certain that the blood levels of stress hormones like cortisol are just through the roof. There are a lot of jobs with high stress, but few of them last for decades. Most of the time, the staff live in a love/hate relationship with their co-workers. It's a lot like working as a guard in a dangerous prison where they keep cutting the guard staff. All the time being told to go faster and work with less. It is a constant process that staff is reduced to save money, reduced staff without a reduced workload, just means that fewer people do more per time unit. Now, remember that "workload" here means "people having operations".

Here's a fun fact. While all the staff is very aware that they're working on real people, it's a paradox that during any crisis moment in surgery; you (the patient or loved one), do not, ABSOLUTELY DO NOT, want the OR crew to be thinking of you (the patient) as a real human being with loves and hates, with relatives who cherish and count on you, with your own unique social and personal history or future. It would guarantee the worst possible outcome. Personal involvement or consideration works for situations that need slow careful consideration, like a jury. In an emergency situation, detachment alone works, not only to analyze a complex situation, but to respond with a fast, coordinated efficient manner to resolve it. It is very much like watching a miracle when you see it. If you are ever in a position to stand back and observe a professional OR crew respond to real emergency, it is awesome, really awe inspiring. I'm not talking about being personally involved, but being able to watch quietly as it unfolds. It's a three-act play of unimaginable power taking place, unannounced, in front of you, and lasting anywhere from seconds to minutes.

It does not look the same from the inside. It's impressive in retrospect, but your focus keeps you from seeing the really miraculous big picture. It's the difference between being inside a tornado and living through it, and watching one go by in front of you. I'm sure there are lots of jobs that have these moments, but I count myself lucky to have been able to appreciate this many, many times over the years. I wish I had the skill to adequately describe what it's like, to watch a seasoned crew work a situation in which so many things are going wrong, so quickly. As you watch it seems that there is little, if any, hope of a patient surviving for the next minute. If you were a spouse or sibling of the patient, you'd be convinced you were watching their death, and the shock and grieving would begin. But then, beyond belief, the crew quietly makes all the right moves, almost like magic, to find the way out of the puzzle. Like an airplane, in flight, coming apart, while you watch, and somehow the crew keeps everything together enough to land. Of course, it's not magic or a miracle, it's the system and the people and the training. But still, it's left me, many times, standing alone in an empty room, after everything's over with my hands shaking so badly that I thought I was having a stroke. I'm sure it's not good for you.

As you get older, you learn to ignore more of the pressure, the constant refrain from administration to go faster, but you can't ignore the constant reductions in staff. When your staff is cut, you cover more work, you cover more call time, meaning you spend more time at home waiting to be called in to work. That means less leisure time, more stress at home, less sleep, more sickness and calling in sick is frowned upon by your peer group because it, once again, increases their workload, making them sick, etc.

We joked that they reduced staff to increase efficiency, so that, eventually, when the last of us were laid off, there would finally be 100% efficiency.

I guess I went the long way around with all this I was just thinking, as I meditated, about the difference between now and then, when I worked. I started as a technician in the operating room in 1973 and finally retired in about 2014. For 40 years I worked in that toxic environment and made a lot of mistakes, and did a lot of things right. I remember everyone I hurt and everyone that had a bad ending. I still carry all that with me today. While I no longer have to answer the phone in the middle of the night and go into work mode, I dream about it and wake up every hour or two. I dream about being in bad situations and feeling lost and inadequate, I dream about worrying that I'm going to screw up and hurt somebody.

I do not miss that work, and now I wonder how I lasted as long as I did. I do not understand it. I think of the good people still doing it, and they are good people, and feel like I should warn them that it's no way to live a life. But I can't do that because they're probably better at dealing with it than I was. They may have a way to balance the stress with the good parts, and there are good parts, mainly with people. You take a job like that because you want to be a part of a machine that helps, while you have to accept that your position makes you a possible agent of harm. The downside is very down and I'm glad it's over at least in the active sense. While they fade, those feelings never leave. They're like tattoos, or scars.

More later,