This is Really No Big Deal
I spent the weekend on an emergency trip to CA to visit my little brother Kevin, who's in the hospital with a burst appendix. It's a little worse and a little more complicated than that, but it looks like he'll be OK.
He's in the UC Davis Medical Center, where my family's been spending an awful lot of time lately. Last year my dad had one of his kidneys removed there, on account of a tumor they found inadvertently (and very luckily) during a routine checkup. As if that weren't bad enough, a few months later he stopped in again because he had a terrible stomach ache; an hour later he was in open-heart surgery, getting a triple bypass.
And now his 17-year-old son Kevin is spending another 2 weeks in the same hospital, for the second time in the last 2 months. They're really getting to know the place.
I was chatting with my dad (who also goes by Steve Yegge) while Kevin was sleeping. Dad mentioned he'd written a letter to the hospital staff after his bypass surgery, and that it had made quite an impression on them. At least one of the nurses told him she'd cried when she read it. The hospital director sent Dad a personal reply, saying his letter was being used to drive a massive new program to improve the patient experience at UC Davis Medical Center.
I figured it was your typical grumpy irate-customer letter; Dad's been known to write them before (and so have I). But it turns out to be something altogether different: it's his retelling of his bypass-surgery experience, written in gentle good humor, specifically from the perspective of a patient, which is something hospitals probably don't see very often.
It's a good read, and only takes about ten minutes. I'm posting it here because I think you might like it, and because I think it has some lessons we can all take away.
First lesson: the pen is still mightier than the sword. A thoughtful, carefully written essay can carry great weight. It can be a greater impetus for change than any number of email exchanges or hallway conversations. If you want to make an impression on people, an essay still appears to be the most powerful way to do it.
Second, I think Dad's experience is (unintentionally) a metaphor for our Amazon customers' experience. We're all working on this huge, well-oiled machine, and when things go wrong, we respond quickly and professionally. We have tickets, and order backlogs, and charging errors, all manner of bugs and issues that we fix daily. But I'll bet you're rarely thinking of them as customers as you do your prioritizing and triage. A hundred broken orders might seem like a very small number, but that's a hundred people whose lives are impacted to some extent.
Finally, it's a pretty sobering reminder that you need to monitor your health and take good care of yourself. It's easy to forget about your health as the weeks and months roll by here at work. But get those checkups! Both times my dad went to the hospital last year, it saved his life.
Here's Dad's letter:
An Open Letter To The Medical Staff
Of UC Davis Medical Center
by Steve Yegge
This is really no big deal...
As a 53-year-old husband and father, I am the proud new owner of one of your latest 2003 Model Triple Bypasses. I'd like to share with you the story of my brief stay at the Medical Center, as well as what I've learned from the experience.
It all started out innocuously enough. I was out running some errands one afternoon late last month, when I decided to stop by the Emergency Room to register a complaint about some severe heartburn that I couldn't seem to kick. With tons of people in the waiting area, I suspected I might be there awhile. But, I was pleasantly surprised to be ushered into the back room as a VIP. The attendant said something like, "This is really no big deal. We just want to make sure that it's not your heart." What I heard him say was, "You just said the magic words, Gonzo, to bypass all those losers in the waiting room and go to the head of the line."
Before you could say, "An apple a day...", I had the uneasy feeling I was being wired for light and sound. I said to the nurse, "I can't help but notice that you've just hooked me up to a Chevy engine analyzer." She responded with something like, "This is really no big deal. This is an EKG that will monitor your heart function." What I heard her say was, "Settle down, Big-Boy, we're going to see how many volts we can pump through your chest before you black out."
Things get a little confused at this point as there was a flurry of activity thereafter and I was rolled into a holding cell with a coat rack next to me. Another nurse hung a sack on the coat rack and started swabbing my arm intently with grain alcohol. She then produced a needle from somewhere - presumably a holster - and started slapping my bound arm with her other hand. Slightly alarmed, I said, "What's that?" She said something like, "This is really no big deal. I'm just starting an IV." What I heard her say was, "If I'm not mistaken, if I leave this rubber thingy around your arm long enough, and then jab you with a needle, you'll pop. Let's find out."
No less than forty-seven doctors came in over the next half hour and asked me the same questions about my heartburn, frowned, and then left. Finally, a woman who was obviously in charge came in and told me she was going to do an angiogram. I said - with something more than trepidation - "I'm hoping that involves Maalox."
The most notable things here are as follows. My wife says that I always call angiograms "anagrams". Now, I know what an anagram is, but I wasn't too sure about angiograms. As I recall, the doctor said something like, "This is really no big deal. We insert a tube into your heart to see how it's functioning." What I heard her say was, "Quit your bellyaching, Numbskull, or we won't use Novocain on your ribs."
At this point, for the sake of brevity and ease of reading, I'd like to substitute the term 'TIRNBD' for the phrase 'This is really no big deal'.
The doctor went on to say something like, "TIRNBD. But, I need to tell you all of the things that could go wrong." The list seemed to go on forever and ranged from gout and rabies, to my head exploding, after which she said something like, "Sign here in triplicate - just for our records." What I heard her say was, "Prick your finger and put your mark on this puppy, Loser. You won't be able to do so after the fact."
Feeling a little more than confused and nervous, I was surprised when a woman came into my cell and said she was my Social Worker. I thought, "Wow! A guy with indigestion gets a Social Worker! What do you suppose they give the guys who are going to have a brain transplant or something?!"
The Social Worker said something like, "TIRNBD. But, is there anyone in the waiting room that I could speak to?" What I heard her say was, "Can I notify your next of kin?" When I responded that there was no one out there, that I had driven myself to the ER, she looked at me in momentary disbelief, blinked twice and said something like, "Oh. Well, is there someone I can call?" What I heard was, "I hate giving the survivors this kind of information over the phone."
Someone jerked off my shoes and pants - without so much as a kiss on the cheek - and proceeded to swab me with red Coolaid. I said to the closest medic, "Excuse me. But, I can't help but notice that you're shaving my testicles. With abandon! You started out with my chest. But, you seem to have worked your way down into the nether regions, as it were. And, as much as I appreciate the gesture, if I could get you to concentrate on something closer to my clavicle than my sacroiliac, we might both get out of this with our reputations intact." I went on, "I should point out that at any moment someone is likely to come running through that door with a flask of Milk of Magnesia and a teaspoon and we wouldn't want to give them the wrong impression here." She responded with something like, "TIRNBD. I'm just preparing you for the angiogram." What I heard her say was, "We failed to mention that the tube we stick in your heart is actually 36 inches in diameter."
I was wheeled into a room where no one would touch me without putting on rubber gloves and a mask, which was slightly disconcerting. And, I was laid out on a bench the width of a sawhorse. Someone said, "Count backwards from..." and that's the last thing I remember.
I awakened some indeterminate time later, attempted to clear my head, and took stock of the situation. I had more pipes and wires coming out of me than a Borg warrior. My first thought was, "Man, these anagrams are more complex than I thought!" I tried to reach up to pull a few pipes out of my face and discovered that I was hogtied to some kind of a large chair. About a day later, and after numerous attempts, I was able to convey to the nurse in attendance that I wanted to write something on a tablet.
He loosened my restraints somewhat, gave me a pencil and pad on which I wrote - without any reservation whatsoever - "I'm a little scared." He ciphered it for awhile and then said something like, "Oh. You're scared. Well, TIRNBD. You've gone through the hard part. You're in recovery now." What I heard was, "Too bad, Cowboy, I'm holding the ropes."
Each passing day, someone new would come in and say something like, "We're going to be removing XX tubes from your body." I would respond with the mother of all understatements, "I'm a little nervous." And, they would invariably say something like, "TIRNBD. You may feel a tug and it may be unpleasant for moment, but that's all." What I would hear is, "Find a leather belt to bite down on, Bubba, cuz this one's gonna make your eyes water."
I was moved to the sixth floor somewhere. And, over the next several days, plague and pestilence was visited upon me in the form of psychological torture - or at least, that's what I thought at the time. As an example, a nurse would come in, day or night, and say, "I hear you're a hard stick"; meaning, "from which to draw blood". I would respond with, "I may be running low. Is there a test for that?" And, she would say something like, "Well, TIRNBD. We'll try to get it in one." What I would hear was, "Don't hold your breath, Bad Boy, there are more needles where this one came from."
Another example of the psychological torture was the night nurse coming in every four minutes to shine a bright light in my face and say, "I need to take your vital signs." I would respond with, "No need. I can tell you categorically they are diminishing rapidly." She would say something like, "Well, TIRNBD. It will only take a moment." And, the phrase "TIRNBD' started to sound very much like "Well, tough luck, Bonehead" - at least to me.
About day five, the apparent Lead Doctor came early, shook me awake and said, "I'm going to remove the pacing wires from you now." I felt cold and said, "I'm very nervous about this." And, he responded (without eye contact) with something like, "TIRNBD. It will only take a few moments." What I heard him say was, "I'm going to give these wires here a jerk and see if I can yank them out of your chest without your heart popping out at the same time."
On day six, I was exhausted and elated at the same time. I was going home. I was actually standing at the window looking out to the parking lot for my wife's car - longingly - when the point of the angiogram into my femoral artery burst and began to fill my groin and leg with blood. I fell back on the bed, hit the call button, and was attended immediately by a nurse, then the cardiac doctor, and finally a vascular surgeon. He said something like, "TIRNBD. Happens in a certain percentage of cases. But, we'll have to close that with some superglue and keep you another day." I managed to hold off crying until everyone was gone and my wife had arrived.
The next morning the cardiac assemblage of doctors swept through, gave me a once over and said something like, "As far as we're concerned you can go home." What I heard was, "Don't get too excited. We're just students here, Stinky."
Later that morning, the vascular assemblage of doctors came in and gathered around my bed. The head one said something like, "We're here to check the healing progress of your femoral artery." What I heard her say was, "I'm going to expose your genitals for the amusement of myself and my colleagues here because I can't think of anything more humiliating to do to you at this particular time." When I didn't respond, she proceeded with the examination.
When the first set of hands touched me, I jerked involuntarily and she asked, "Is it painful?" I said, "It's tender. But, I'm just a little skittish about the number of stethoscopes in my crotch at any one time before noon." They finished speaking - in tongues, I think - and she said, "Well, as far as we're concerned, you can go home today."
Elation! Again! I was going home! I was overjoyed. But, the feeling was short-lived. The Lead Doctor came in about an hour later and said, "Everything looks good. I'll get the vascular and cardiac teams in here for a final look." I said, "They've already come and gone. Both said I could go home today!" He responded with something like, "Well, let me make sure everyone is on the same page." What I heard was, "TIRNBD."
Distraught is too simple a word to describe my feelings. It was closer to panic. I began to hyperventilate. I couldn't stay another day. I wouldn't stay another day. I got up and sat in the furthest corner of the room away from the bed. When the nurse came in to take my vitals and draw blood, I refused. I didn't want to be touched. They called for a Staff Nurse and I pictured Nurse Ratchet and a couple of Bouncers walking through the door at any moment.
The Staff Nurse - not at all like Nurse Ratchet, as it turns out - presented herself and said something like, "We haven't received your discharge orders from the doctor yet. The process after that for leaving the hospital is minimal and can be expedited." What I heard her say was, "Get back in that bed before I slap you silly, Bonzo. We've got more work to do on your pitiful body."
When I didn't respond, she asked, very simply, "Is something wrong?" My eyes started to water and I said, "Well, let's just take stock of the situation here, if you have a moment.
"I came in here a week ago with a tummy ache. I was then shunted off into some Orwellian nightmare that just kept getting worse. I was asked if I had a 'living will', sawed up from head to toe and my parts rearranged.
"I've got a sore in my nostril from one of the pipes you stuck in me and a sore in my mouth from another one. I've had pipes in my abdomen, some kind of a pencil holder stuck in my neck, a pipe in an indiscreet place I'd rather not talk about right now, and jumper cables hanging out of my chest.
"My body and legs look like a 1,000-piece Freddy Krueger puzzle. I haven't had a bowel movement or a shower in seven days and look here, I've got two IV's capped off in each arm, for a grand total of four IV's. But, when someone needs another blood donation, they come in and stick me again! My arms look like dried prunes.
"I've suffered sleep deprivation and have taken enough Percocet that it's 50-50 whether I'm really talking to you or to a bed pan. I want to go home. I need to go home" I pleaded. "And, another thing", I added as though it were the final indignation. "My underwear is missing!" My hospital gown felt cold and wet on my body.
With a little coaxing, she brought me around to at least taking my morning medication and promised she would expedite the process at all costs - which she did, in fact, accomplish.
When my wife arrived I was a basket case. I insisted that she not leave my side. At each point in the paperwork and departure process when someone would say something like, "Do you understand this so far?" I would hear, "You're not done yet, Wimp Boy." And, I would then look at my wife to see if we understood.
By and by, my wife sprang me from the joint and I fell sound asleep on the way home in the back of our vehicle with the wind on my face. It was about two days before I was back to my normal surly self again...
I've learned a few things from this adventure. The first thing is that my legs look pretty darn good when they're shaved - which is disturbing to me on several levels. Another is that once having gone through bypass surgery, one should avoid sneezing at all costs.
More importantly, I've learned that the professionals at the Medical Center are incredibly talented and manage to operate the facility like a well-oiled machine. They take the most complex problems imaginable and turn them into a series of discrete parts, each of which is addressed with its own formulae and solutions. The result is an astonishingly sound methodology for managing an enormous number of patients with such diverse issues.
If there is something that I would hope the Medical Center personnel could learn from this brief iteration of my story, it is as follows. Within each step of these medical processes and procedures, the medical personnel that touch the lives of the patients, do so for only very brief periods of time - sometimes as little as a few minutes. But, these patients are not simply cogs in the machinery of this well-oiled machine. They hurt and are tired and are very often frightened. Take care that you treat them with dignity and respect for their condition. Because, this really is a big deal.
As a postscript, I went to my two-week/20,000 mile check up with the surgeon, who had a medical student with him that looked to be no more than a child. Being only slightly apprehensive, I thought, "Oh well, how bad could it be?" I laid flat on the exam table, closed my eyes and exposed my new contusions, abrasions and wounds to their - on average - reasonably experienced hands.
After they had strummed me like a cheap banjo, the surgeon asked her to remove the couple of stitches that were still in my chest. She said she had not performed that particular procedure and asked how it was done. He grabbed a handful of tools and materials, and my eyes popped open when he said, "This is really no big deal..."
Steve Yegge is recovering in Shingle Springs, CA and can be reached at firstname.lastname@example.org
(published Oct 20, 2004)
Your dad is a pretty tough guy. An articulate too, for a man who doesn't know an angiogram from an anagram. In the UK the expression is "Now, this is nothing to worry about...." just in case either of you are over here and want to know what to look out for.
Posted by: Martin at October 21, 2004 08:09 AM