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.