Not that long ago I was administering an examination in one of my classes. I like to use short answer questions because it requires that the student demonstrate more understanding than the typical multiple-guess format. This type of format also reduces the possibilities of cheating since it is much more difficult to read handwriting from a few feet way than it is to see which bubbles have been marked.
This one day the examination was in full-swing; everyone was worrying or writing. Some were probably doing both. I was at the front of the classroom and decided to sit. I was seated a few feet from the front row of desks. There was one student in the front row; he was right in front of me. It was a rare thing to have anyone in the front row, especially during exams; but he was there. I was looking through a book. He was "thinking," and then writing.
I don't remember just how much time passed before I noticed that this front row guy was sitting with a peculiar posture. His arms were on the desk and his head was hanging. It was a familiar posture for regular class as students fell asleep listening to my provocative lectures. It was not, however, a normal posture during exams. I was curious.
Within a few moments of watching this student I noticed a glow coming from under his desk. The desks were like table tops. They didn't have any front or sides on them. So, I am seeing this glow and thinking that this is not normal. Was he watching television? Was he an alien with special reproductive organs that glowed to attract mates? It was only a few seconds before I recognized that it was a Palm Pilot.
I leaned forward and asked the student, "What is that?"
Without any hesitation, he said, "It's my Palm Pilot."
I then asked him, "What are you doing with it?"
Again, without hesitation, he said, "Sometimes I use it to play games."
I thought, "What a non sequitur," and then in that question/demand tone of voice I said, "Why don't you turn it off?"
He said, "Okay," and the light went out.
Now, the dilemma: I can confiscate the Palm Pilot immediately and take the exam from the student, or wait. If I interrupt the exam, and he is somehow innocent of cheating, I have injured him. If I confiscate his Palm Pilot, which probably has other personal data on it, I run the risk of invading his privacy, which is beyond the scope and privilege of my investigation. If I take his Palm Pilot and it gets damaged while in my possession, I have more liability. I decided to allow the student to finish the exam and keep the device in his possession.
I required that he stay in the room until the last student had left the exam. I then told this student with the previously glowing crotch to follow me to my office. As we were walking down the hall I noticed that he was doing something with the device in question. I suspected that he was trying to delete any incriminating information. I told him to turn the device off and leave it alone until we reached my office. He complied.
Once we got to my office I asked him to explain what was going on. He didn't hesitate to confess to cheating. According to school policy, merely having the device in class, even turned on, did not constitute cheating. It would have been deemed irregular testing taking behavior until proven otherwise. Without his confession or the discovery of information that would have helped him in the exam, I would have had a difficult time escalating the charge to cheating. His confession made all of that moot. I didn't need to prove anything.
It took a real short circuit for that student to attempt using his device with me sitting only three feet away, especially sitting at a level where I could hardly help but see the glowing screen. Perhaps it was mere stupidity, or desperation. Perhaps he didn't think that the screen created a glow. It was funny because it was so blatant, and risky, with me so close at hand.
The decision regarding the penalty for his actions will be left for another time. There was no humor in it that I can see at this time. There was only the difficult question about how we should view this cheating behavior with regard to someone training to become a health care professional.
Sunday, March 25, 2007
Friday, March 23, 2007
Cultural differences
I worked in health care education in the 1980s. From time to time we would have a visiting scholar on campus. That generally attracted attention and the students really liked the sense of freshness. Somehow hearing the same thing from a stranger was more powerful that hearing it from resident faculty members. There were, however, times when the visitor was really the expert.
One particular visitor to our campus taught and practiced at a university in eastern Europe. He was a very interesting man with interesting theories about the muscular function of the body in response to minimal brain injury. I tell you this because it is at the heart of the story. His visit included a series of lectures and demonstrations. The lectures were very similar to how they would have been presented by one of our resident faculty members - perhaps with the exception that nearly all of the students listened. The demonstrations were, however, quite different than the way we usually did things.
During one of the demonstrations, the visiting professor asked for three volunteers to serve as his models so that he could point out just what he was trying to explain. Three young men raised their hands and were invited to the front of the room. With no fanfare or hesitation, the professor very matter-of-factly told them to strip to their underwear. He said it like one would ask someone to pass the potatoes at dinner. He did say "please," but it was the kind of "please" that a high school principle would use when asking, "would you please tell me what you are doing in the restroom with those cigarettes?" The "please" was superfluous; and, in that case, the answer was obvious.
The three young men looked at each other with surprise as they blushed. But, they took off their clothes. Now, there were three guys standing nearly naked in front of sixty or seventy people (young men and women) who were all secretly thanking their lucky stars that they hadn't volunteered. The professor proceeded to poke and prod each of his models as he attempted to explain how the body responds to his theorized brain function. The young models were getting used to being meat puppets and were beginning to relax. But then...
The professor asked the models to turn around so that their backs were to the audience. They all smiled and made faces at their friends as they began turning to face the wall. The professor continued with his presentation pointing to this muscle or that low shoulder on his live dummies. Then, without notice and without missing a beat, he pulled the underwear of one of the models nearly down to the guy's knees. You can imagine the response of the audience - shock, gasps, laughter, and real relief that it wasn't them. The model was freaked. His counterparts looked over at him with that "holy shit!" expression as they stood there waiting to see what would happen to them. It was as if they were in front of a firing squad seeing their friend go down, and then waiting for their bullets.
Meanwhile, the professor continued to poke and prod his meat puppet's buttocks as he had him bend from side to side etc. All the while, the model was praying that there was not a frontal demonstration coming next. Fortunately for the models the demonstration ended with only that rear view. It was funny enough. We just didn't do that here in America, at least with the same casual, we-do-this-all-the-time attitude.
I admit that I, too, was glad that I hadn't volunteered that day.
One particular visitor to our campus taught and practiced at a university in eastern Europe. He was a very interesting man with interesting theories about the muscular function of the body in response to minimal brain injury. I tell you this because it is at the heart of the story. His visit included a series of lectures and demonstrations. The lectures were very similar to how they would have been presented by one of our resident faculty members - perhaps with the exception that nearly all of the students listened. The demonstrations were, however, quite different than the way we usually did things.
During one of the demonstrations, the visiting professor asked for three volunteers to serve as his models so that he could point out just what he was trying to explain. Three young men raised their hands and were invited to the front of the room. With no fanfare or hesitation, the professor very matter-of-factly told them to strip to their underwear. He said it like one would ask someone to pass the potatoes at dinner. He did say "please," but it was the kind of "please" that a high school principle would use when asking, "would you please tell me what you are doing in the restroom with those cigarettes?" The "please" was superfluous; and, in that case, the answer was obvious.
The three young men looked at each other with surprise as they blushed. But, they took off their clothes. Now, there were three guys standing nearly naked in front of sixty or seventy people (young men and women) who were all secretly thanking their lucky stars that they hadn't volunteered. The professor proceeded to poke and prod each of his models as he attempted to explain how the body responds to his theorized brain function. The young models were getting used to being meat puppets and were beginning to relax. But then...
The professor asked the models to turn around so that their backs were to the audience. They all smiled and made faces at their friends as they began turning to face the wall. The professor continued with his presentation pointing to this muscle or that low shoulder on his live dummies. Then, without notice and without missing a beat, he pulled the underwear of one of the models nearly down to the guy's knees. You can imagine the response of the audience - shock, gasps, laughter, and real relief that it wasn't them. The model was freaked. His counterparts looked over at him with that "holy shit!" expression as they stood there waiting to see what would happen to them. It was as if they were in front of a firing squad seeing their friend go down, and then waiting for their bullets.
Meanwhile, the professor continued to poke and prod his meat puppet's buttocks as he had him bend from side to side etc. All the while, the model was praying that there was not a frontal demonstration coming next. Fortunately for the models the demonstration ended with only that rear view. It was funny enough. We just didn't do that here in America, at least with the same casual, we-do-this-all-the-time attitude.
I admit that I, too, was glad that I hadn't volunteered that day.
Thursday, March 15, 2007
Punctuation: {"! .} - ], ? ;"[
20 years ago I was sitting in a meeting. Our organization was in the midst of a significant change effort; and we were making real headway. It required weekly meetings with all levels of the organization. This meeting was full of discussion about the past week's successes and challenges. Everything was a work in progress. Nothing was deemed a failure; only a work in progress.
I was notorious for making comments that were considered out of context or somehow goofy. I worked with a great group of people who understood me and tolerated my "outbursts." I enjoyed their tauntings for weeks after something that I said.
This particular meeting was not unsual. Eight to ten of us were sitting around the table. Someone made a proposal and it was passed around the group in discussion. At some point, and I don't know just when that was, I decided that I thought the idea was good enough to implement. Our custom allowed participants to state their opinions in such a way that they were like "trial closes" in the sales world or attempts to "call the question" in Robert's Rules of Order linngo.
I decided to attempt the trial close and made a statement. Based upon how we phrase things in english, I said, "If it works great, it could be good." I intended to say, "If it works, great! It could be good." Everyone looked at me in that special way such that I could read their expressions - "what!!!!! Of course, you idiot, if it works great, it will be much more than good!"
Simply moving the comma to follow the word "works" would have changed everything. People still tell that story on me. Somehow it makes me feel good when they do because it causes me to reflect on that time - all because of a small little mark placed between this two words rather than that two words.
I was notorious for making comments that were considered out of context or somehow goofy. I worked with a great group of people who understood me and tolerated my "outbursts." I enjoyed their tauntings for weeks after something that I said.
This particular meeting was not unsual. Eight to ten of us were sitting around the table. Someone made a proposal and it was passed around the group in discussion. At some point, and I don't know just when that was, I decided that I thought the idea was good enough to implement. Our custom allowed participants to state their opinions in such a way that they were like "trial closes" in the sales world or attempts to "call the question" in Robert's Rules of Order linngo.
I decided to attempt the trial close and made a statement. Based upon how we phrase things in english, I said, "If it works great, it could be good." I intended to say, "If it works, great! It could be good." Everyone looked at me in that special way such that I could read their expressions - "what!!!!! Of course, you idiot, if it works great, it will be much more than good!"
Simply moving the comma to follow the word "works" would have changed everything. People still tell that story on me. Somehow it makes me feel good when they do because it causes me to reflect on that time - all because of a small little mark placed between this two words rather than that two words.
Tuesday, March 13, 2007
BONG!!!
Recalling my hospital days reminded me of another story. It is funny to me because it revealed my naiveté at age 25. After a year and a half I decided that medicine was not what I wanted to pursue. There was a job opening in a middle management position at the hospital so I thought I would try that. I knew nothing about administration and nothing about managing people, which I would have to do to some degree. 'Following my bliss' was something that Joseph Campbell would suggest to me years later. The only 'bliss' I had heard mentioned had to do with marriage, and I didn't see much of that around.
Consider the following as if you were watching an episode of The Office.
One day a nurse from my unit called to tell me that some lab tests were performed on a patient, but had not been ordered by the doctor. She said that it was a mistake and that I should call the lab and have the charges taken off the bill. That sort of stuff was part of my new job. So, not knowing that things don't ever come off the bill in a hospital, I said, "sure, I'll just call the lab." I should have heard the flutter of little Clue Fairy wings about my head; but I didn't.
I called the lab and explained the situation to the guy who answered. He said, "you'll need to talk with Sister Honorata about this. I don't have the authority to do it." That should have been my first clue to what was coming. I had a serious Clue Fairy deficit in those days. This hospital was run by an order of Catholic nuns from Germany. I never asked just why they were all from Germany; but they were.
Sister Honorata came to the phone and I explained what had happened. I expected her to say, "I wonder how that happened. Of course we will take those charges off the bill immediately." Instead, the conversation went like this (Imagine her with a strong German accent and me with a massively incredulous Clue Fairy deficit voice):
Sister H: "We can't take those charges off the bill."
Me: "But Sister, the tests were not ordered by her doctor. It was a mistake."
Sister H: "Well, somebody has to pay for them."
Me: "But, Sister it was a mistake. The patient shouldn't be the one who pays for our mistakes."
Sister H: "We did the tests, who should pay for them?"
Me: "Sister, it seems to me that since we made the mistake, that we should absorb the loss." I should have been getting the clue by then, but nooooooooo.
Sister H: "Well, we don't do that."
Me: "But, Sister, business ethics requires that we be responsible for our mistakes, not to mention that this is a Catholic hospital."
BONG!!!!! What was I thinking??? I had had years of Catholic school. I knew that reason was not something that you used with a nun if you were in a one-down position. I am sure that the Clue Fairy was screaming into my ear, but I couldn't hear it. I was too consumed with my idealism and frustration with what seemed so obvious. This is not a nun-bashing story - she just happened to be a nun. It is interesting to look back at a person whose vocation espouses dedication to higher spiritual issues acting out values indistinguishable from any businessperson concerned with the bottom line rather than ethics or legalities.
Needless to say, I didn't get the charges taken off the bill and Sister Honorata was not happy with me. But I thought that I would surely prevail. After all, I was right. I didn't realize that I was skipping off to Happy Land with the Grim Reaper at my back.
The next day, I got called into my supervisor's office. He was a nice guy about seven years older than me. A family man working on his future. He tried to reason with me about my perspective. Then he said, "you don't bite the hand that feeds you." Having sufficiently admonished me, he finally let me out of his office. My head was spinning as I thought to myself, "was this the way of the world, merely the façade of integrity?" Anyone watching from the outside would have been laughing at my idealism and lack of experience with the "real" world.
Over the next week or so, I had accumulated quite a list of the same problems with other patients. I wasn't looking for them, the nurses just kept calling me with them. One day I was called into the Assistant Administrator's office. He told me that he had received a memo with my name at the top in bold type. He was not as concerned about the story as he was about me taking this story outside the hospital. I assured him that I had no intention of going to the media, but that I was very frustrated by the situation. He suggested that I make that day my last; I did.
This story is humorous to me for its polarities - what people say they stand for and what they actually do in their lives. You can imagine me running around all serious about it and about making things "right," while the rest of the machine was moving along, business as usual, with this little gnat (all self-important) buzzing around being a nuisance. I didn't know that there was a label for Sister Honorata's behavior. I do now - the Knowing-Doing gap or Espoused theories versus Theories in Use.
If you are interested in this kind of thing Chris Argyris from Harvard University has written about espoused theories v. theories in use for decades. You can Google either topic and find numerous references.
Consider the following as if you were watching an episode of The Office.
One day a nurse from my unit called to tell me that some lab tests were performed on a patient, but had not been ordered by the doctor. She said that it was a mistake and that I should call the lab and have the charges taken off the bill. That sort of stuff was part of my new job. So, not knowing that things don't ever come off the bill in a hospital, I said, "sure, I'll just call the lab." I should have heard the flutter of little Clue Fairy wings about my head; but I didn't.
I called the lab and explained the situation to the guy who answered. He said, "you'll need to talk with Sister Honorata about this. I don't have the authority to do it." That should have been my first clue to what was coming. I had a serious Clue Fairy deficit in those days. This hospital was run by an order of Catholic nuns from Germany. I never asked just why they were all from Germany; but they were.
Sister Honorata came to the phone and I explained what had happened. I expected her to say, "I wonder how that happened. Of course we will take those charges off the bill immediately." Instead, the conversation went like this (Imagine her with a strong German accent and me with a massively incredulous Clue Fairy deficit voice):
Sister H: "We can't take those charges off the bill."
Me: "But Sister, the tests were not ordered by her doctor. It was a mistake."
Sister H: "Well, somebody has to pay for them."
Me: "But, Sister it was a mistake. The patient shouldn't be the one who pays for our mistakes."
Sister H: "We did the tests, who should pay for them?"
Me: "Sister, it seems to me that since we made the mistake, that we should absorb the loss." I should have been getting the clue by then, but nooooooooo.
Sister H: "Well, we don't do that."
Me: "But, Sister, business ethics requires that we be responsible for our mistakes, not to mention that this is a Catholic hospital."
BONG!!!!! What was I thinking??? I had had years of Catholic school. I knew that reason was not something that you used with a nun if you were in a one-down position. I am sure that the Clue Fairy was screaming into my ear, but I couldn't hear it. I was too consumed with my idealism and frustration with what seemed so obvious. This is not a nun-bashing story - she just happened to be a nun. It is interesting to look back at a person whose vocation espouses dedication to higher spiritual issues acting out values indistinguishable from any businessperson concerned with the bottom line rather than ethics or legalities.
Needless to say, I didn't get the charges taken off the bill and Sister Honorata was not happy with me. But I thought that I would surely prevail. After all, I was right. I didn't realize that I was skipping off to Happy Land with the Grim Reaper at my back.
The next day, I got called into my supervisor's office. He was a nice guy about seven years older than me. A family man working on his future. He tried to reason with me about my perspective. Then he said, "you don't bite the hand that feeds you." Having sufficiently admonished me, he finally let me out of his office. My head was spinning as I thought to myself, "was this the way of the world, merely the façade of integrity?" Anyone watching from the outside would have been laughing at my idealism and lack of experience with the "real" world.
Over the next week or so, I had accumulated quite a list of the same problems with other patients. I wasn't looking for them, the nurses just kept calling me with them. One day I was called into the Assistant Administrator's office. He told me that he had received a memo with my name at the top in bold type. He was not as concerned about the story as he was about me taking this story outside the hospital. I assured him that I had no intention of going to the media, but that I was very frustrated by the situation. He suggested that I make that day my last; I did.
This story is humorous to me for its polarities - what people say they stand for and what they actually do in their lives. You can imagine me running around all serious about it and about making things "right," while the rest of the machine was moving along, business as usual, with this little gnat (all self-important) buzzing around being a nuisance. I didn't know that there was a label for Sister Honorata's behavior. I do now - the Knowing-Doing gap or Espoused theories versus Theories in Use.
If you are interested in this kind of thing Chris Argyris from Harvard University has written about espoused theories v. theories in use for decades. You can Google either topic and find numerous references.
Sunday, March 11, 2007
Naïveté
Setting the stage
I was sitting around thinking about funny things that have happened at work over my life time and this story popped up. I was working in a regional trauma center in the Midwest in the early 1970s. I had recently graduated from college with a degree in psychology when the grand idea of entering medicine came to me.
So, I decided to get a job as an orderly in a hospital. I thought it would give me a chance to see the machine from the inside. The Personnel Director told me that there was on opening in the Trauma Center (an Emergency Room Plus), AND that it paid more per hour - $2.05 instead of $1.95. For that kind of money I jumped at the opportunity! It turned out to be an experience of a life time.
This was a 900-bed teaching hospital. We had doctors, residents, and medical students all over the place. The Trauma Center served about a fifty-mile radius. I worked the 3-11 pm shift and we were swamped nearly all day every day during that time. As a Trauma Center we saw the worst stuff. Since I was a college graduate I was soon doing all of the stuff that the nurses were doing except dispensing medications. Consequently, the head nurse would schedule one less nurse on the shift when I worked.
Most of the time, from 3-11 pm, I was the only orderly in the hospital. Occasionally during the summer there would be the son of one of the doctors working with me. This person would be going to college somewhere and needed a summer job. He would end up mostly running errands while I got to do all of the cool stuff.
Oh yeah, the story
One day a young girl who had been injured in an auto accident was brought into the Trauma Center. She was unconscious. As was usual with this type of case, she was taken to one of the outpatient surgery rooms just across the hall from the rooms where the usual ER patients were seen. There were nurses, staff doctors, orthopedic residents, neurology residents, internal medicine residents etc moving around the room with this girl at the center of their attention.
The typical scenario for this type of thing is that the patient is lying on a surgery table in the center of the room. Since the patient is unconscious and unable to assist with information, all clothing is taken off so that the doctors can perform the necessary examinations and the nurses can hook up the various IVs and other equipment. After these traumas you never know what has been injured or what will need to be done, STAT! I always found it interesting that having a naked unconscious body there on the table did not have the same effect as seeing that same person asleep naked on the beach. This patient was just another object in the room; and she was the main object.
Here is the setting for all of this: we are in a surgery room with an unconscious patient (stable at this point) and all of the really immediately serious decisions have been made. Outside this room is the hurried world of all the other emergency room situations. There are adults and children wailing in the waiting room, people holding makeshift bandages over cuts on their faces while giving a staff person their insurance information, people lying on gurneys in the hallway coming from or going to the X-ray department, and much, much more including a demented old woman lying on her gurney constantly, mindlessly, and rapidly saying, "Help, help, help, help, help, help, help..."
In one of my forays back and forth, I stopped to see if I could assist this lady. I bent forward a little and asked, "Can I help you, m'am?" She stared up at me for a few moments, and as she looked right into my eyes she said, "Help, help, help, help, help, help, help..." I had never encountered dementia before. A little confused, I took off to finish my task.
So, the hustle and bustle had now cleared the surgical room where the girl from the auto accident was lying. The only people left were a surgical resident, a nurse, a new orderly (about 20-years old and very inexperienced with the world), and me. The resident had just arrived and was examining this young girl. Although still unconscious, she was considered to be outside any immediate danger. It was now very quiet in the room, with all of the calamity that I mentioned above just outside the door.
The resident asked, "How old is this girl." (By her physical development, she looked to be at least sixteen or seventeen years old.)
I answered, "The chart says that she's fourteen."
Without looking up from the patient, as an aside, he replied, "She is a very healthy looking fourteen-year-old." (Clearly his comment came from surprise at her physical development at such a young age)
The young orderly, without hesitation, said, "That's probably why she is doing as well as she is."
The resident looked at me with that inquisitive look like, "Am I in the Twilight Zone? Did he really think I was referring to her physical health?" Then he exchanged glances with the nurse, who just shrugged her shoulders as she shook her head and rolled her eyes.
Her expression said, "Yep, you're right. That's what he said."
It was such a interesting juxtaposition of potential life and death with the humor of daily life. In the quiet of that room, after the real emergency decisions had been made, this brief exchange, and this young orderly's naïveté, was recorded in my memory; and remains after 35 years.
I was sitting around thinking about funny things that have happened at work over my life time and this story popped up. I was working in a regional trauma center in the Midwest in the early 1970s. I had recently graduated from college with a degree in psychology when the grand idea of entering medicine came to me.
So, I decided to get a job as an orderly in a hospital. I thought it would give me a chance to see the machine from the inside. The Personnel Director told me that there was on opening in the Trauma Center (an Emergency Room Plus), AND that it paid more per hour - $2.05 instead of $1.95. For that kind of money I jumped at the opportunity! It turned out to be an experience of a life time.
This was a 900-bed teaching hospital. We had doctors, residents, and medical students all over the place. The Trauma Center served about a fifty-mile radius. I worked the 3-11 pm shift and we were swamped nearly all day every day during that time. As a Trauma Center we saw the worst stuff. Since I was a college graduate I was soon doing all of the stuff that the nurses were doing except dispensing medications. Consequently, the head nurse would schedule one less nurse on the shift when I worked.
Most of the time, from 3-11 pm, I was the only orderly in the hospital. Occasionally during the summer there would be the son of one of the doctors working with me. This person would be going to college somewhere and needed a summer job. He would end up mostly running errands while I got to do all of the cool stuff.
Oh yeah, the story
One day a young girl who had been injured in an auto accident was brought into the Trauma Center. She was unconscious. As was usual with this type of case, she was taken to one of the outpatient surgery rooms just across the hall from the rooms where the usual ER patients were seen. There were nurses, staff doctors, orthopedic residents, neurology residents, internal medicine residents etc moving around the room with this girl at the center of their attention.
The typical scenario for this type of thing is that the patient is lying on a surgery table in the center of the room. Since the patient is unconscious and unable to assist with information, all clothing is taken off so that the doctors can perform the necessary examinations and the nurses can hook up the various IVs and other equipment. After these traumas you never know what has been injured or what will need to be done, STAT! I always found it interesting that having a naked unconscious body there on the table did not have the same effect as seeing that same person asleep naked on the beach. This patient was just another object in the room; and she was the main object.
Here is the setting for all of this: we are in a surgery room with an unconscious patient (stable at this point) and all of the really immediately serious decisions have been made. Outside this room is the hurried world of all the other emergency room situations. There are adults and children wailing in the waiting room, people holding makeshift bandages over cuts on their faces while giving a staff person their insurance information, people lying on gurneys in the hallway coming from or going to the X-ray department, and much, much more including a demented old woman lying on her gurney constantly, mindlessly, and rapidly saying, "Help, help, help, help, help, help, help..."
In one of my forays back and forth, I stopped to see if I could assist this lady. I bent forward a little and asked, "Can I help you, m'am?" She stared up at me for a few moments, and as she looked right into my eyes she said, "Help, help, help, help, help, help, help..." I had never encountered dementia before. A little confused, I took off to finish my task.
So, the hustle and bustle had now cleared the surgical room where the girl from the auto accident was lying. The only people left were a surgical resident, a nurse, a new orderly (about 20-years old and very inexperienced with the world), and me. The resident had just arrived and was examining this young girl. Although still unconscious, she was considered to be outside any immediate danger. It was now very quiet in the room, with all of the calamity that I mentioned above just outside the door.
The resident asked, "How old is this girl." (By her physical development, she looked to be at least sixteen or seventeen years old.)
I answered, "The chart says that she's fourteen."
Without looking up from the patient, as an aside, he replied, "She is a very healthy looking fourteen-year-old." (Clearly his comment came from surprise at her physical development at such a young age)
The young orderly, without hesitation, said, "That's probably why she is doing as well as she is."
The resident looked at me with that inquisitive look like, "Am I in the Twilight Zone? Did he really think I was referring to her physical health?" Then he exchanged glances with the nurse, who just shrugged her shoulders as she shook her head and rolled her eyes.
Her expression said, "Yep, you're right. That's what he said."
It was such a interesting juxtaposition of potential life and death with the humor of daily life. In the quiet of that room, after the real emergency decisions had been made, this brief exchange, and this young orderly's naïveté, was recorded in my memory; and remains after 35 years.
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