A Decade Ago I Personally Tested the Hawaiian Medical System’s Competence

Originally published 10 years ago in the CADDI Quarterly Newsletter: “lean-ISD” in the Spring of 2000.

Edited slightly from the original.

Thursday, February 10, 2000
I just got back from a February vacation in Hawaii—a day early. I hate when that happens. Just had to cut it short.

I spent most of my vacation being very concerned with competence—human competence. I was also concerned with the competence of the environmental assets with which humans interact. I was seriously concerned. It was, at times, a matter of life and death. I hate when that happens, too. Vacations shouldn’t be so seriously concerned with competence.

We planned our early February warm weather trip to have some fun in the surf and sun…as opposed to a cold weather trip to ski in the snow of the Rockies. This early February trip coincided with Valentine’s Day, and some typically very cold Chicago weather. Surf and sun usually win out in heavily weather-weighted decision criteria. At least they did this last time.


Off to a Bad Start
The trip began with a competence issue. The travel agent screwed up (a technical term) the original plans by not asking for a deposit on time and by not using the credit card account numbers already in the system. As a result, flight plans had to be changed and I wasn’t happy. There were other little things that were not quite right. Hence my concern with incompetence.

With the recent air disasters, I was concerned about fleet maintenance competence, pilot training and testing competence, and I can’t forget the baggage handlers. Then, the car rental counter staff. Many vacations have gone very poorly when these areas of competence are at issue.

The wife and I spent the first two days in beautiful Honolulu right on Waikiki Beach. After the long flight from Chicago, the sun and sounds of the pounding surf were very relaxing. After three years of Navy life back in the mid 1970s, I just can’t go to that state without stopping by the Arizona Memorial to pay my respects. No one should. It is sobering  experience. I thought of the competence of the U.S. sailors, soldiers, and marines stationed at or near Pearl Harbor in December 1942. I also thought of the competence of the decorated heroes from across racial boundaries, even way back then.

Then, I was concerned with the competence of the serving staff and chef preparing my shellfish meal at the oceanside outdoor restaurant as we toured Oahu for the day. Hoping for competence.

On day four we flew to Maui, where we were to spend another seven days at a very nice resort.

More pilot and maintenance competency being personally tested here by the tourists. And, then we personally tested limo-driver competence, followed by front desk, bell services, and finally room services competence.

Looking for Competence
The next two days on Maui were spent relaxing on the beach, catching some rays and planning “what will we do with our limited time without running ourselves ragged?” We saw the whales playing at sea from our villa window and again from the beach lying under the umbrellas, sipping from cups embellished with little umbrellas and fruit. “Bartender competency tests complete. Care for another?” The wife smiled.

We planned a helicopter ride (with video) of the entire island. Would the pilot be competent? What about their maintenance crew and their suppliers? Is the snack food okay?

We planned a snorkeling trip. How competent is that crew in life saving and emergency procedures, in teaching snorkeling techniques, and in driving the boat?

We planned a drive to Hana that would take us over 56 one-lane bridges and a night luau at Lanai. My driving competency would be tested as well as the wife’s patience.

We gladly left off golf, diving, horseback riding on the beach or in the mountains, tennis, sailing, and dinner cruises from the competencies we would test. Enough is enough. Otherwise we were going to need a vacation from our vacation. Sadly, there wasn’t enough time. After these two days of carefree planning with pure relaxation, we were ready to explore paradise at a relaxed pace.

Sunday, February 4
Just before returning to our villa on Sunday afternoon, we walked into the water to splash around. A big wave came up and as it passed, I dove into it back toward the shoreline. I was going to body surf back to the shoreline just as I had watched dozens of competent kids and grownups do all afternoon.

The signs along the beach walkway had said to never turn your back to the ocean. Many signs. Many warnings. I did not competently understand their true meaning. It turned out that I was incompetent.

As I dove into it, the wave hit me high and the undertow hit me low. Remember the cartoons of characters being tossed in a washing machine?

They spinned and tumbled. So did I.

I immediately lost all feelings in my arms after my head hit the ocean floor. They hung limply by my sides, floating listlessly, all akimbo in the aftermath of my spinning and tumbling cycle. My eyes opened despite the salt water. My mind raced.

Which way was up? Which way to shore? Was I going to drown? The undertow was powerful, it could take me out to sea. In a weird, slow-motion speed my thoughts flashed to the controversial Super Bowl commercial of Christopher Reeve getting up from his wheelchair and walking.

I was scared. Very scared. Why did I flash on that?

This can’t be good. A diving experience came to me and told me to slow my breathing down, way down. I did. Competently.

My arms were useless. I could not motion with them and push myself around. All I had going for me were my legs. They were off the ocean floor but sinking down and would soon touch. I understood the potential of the undertow to carry me away from shore and back out to sea and the need to get planted and then push with my feet. But I needed to get oriented and directed back to shore. Which way to the shore? Which way out to sea? When will my feet make contact?

When they did I pushed myself ahead in the direction I was already facing. I couldn’t turn around easily. My arms floated up and down at my sides with the action of the waves. I could see the surface of the water above me, it was a foot or two away. I watched silently as the surface steadily lowered itself to meet my waiting face with each step I took. The top of my head broke through first as I steadily pushed myself forward with my feet. My arms hurt. Pain shot up and down. It felt like a giant charlie-horse.

When I broke the surface, my scream for help was only a whimper. My wife heard it but didn’t sense an emergency. Luckily, she was looking for me when I didn’t come up right away. She approached me as another wave rolled over me. I said, “My arm.”

She wasn’t sure what I was saying or asking for. Another wave rolled over me and when it subsided I again said, “I’m hurt, pull me out. Help.”

She gingerly grabbed my arm and started to help me out, but now she was afraid to hurt my arm. I was still speaking quietly, and softly. It wasn’t the hysterical scream I was attempting. I just didn’t have the energy. What I wanted, of course, was for her to grab my arm, yank me directly out of the water, drag my wet body onto the beach, cover me with a million warm blankets, and then make the pain go away. And to do it quickly. Very quickly.

Someone else ran up, grabbed the other arm, and helped walk me onto the beach where they laid me down. They laid me on the sand. It was the beginning of a long, serious, chain of competences, and I was not a drill. I was a real test with serious consequences.

A few moments passed.

Official Nurse Questions
I was looking up into the upside-down face of a woman who claimed to be a nurse. She asked me a bunch of official nurse questions. Nothing stupid.

I told her that my arms were on fire, pain shooting up and down each one. I was cold, shivering.

She told me to lie very still as she cradled my head in her hands and held me very tightly. She explained what was going on and explained why I could be feeling what I was feeling. Very competent.

There was talk going on around me—I needed to be moved because the waves were coming up. They talked about putting me on a board and getting my head stabilized, getting more blankets, and calling the security staff and the ambulance.

The talk continued. Much of it sounded very competent to me as I lay there on the beach. Someone sounded like they knew what they were talking about. The nurse insisted that no one was going to move me. Competence with a bark.

A man appeared in my view. He started poking me and asking questions. Familiar questions. A doctor from the Mayo clinic. Again sounds good, sounds competent!

I did whatever he told me to do. My competent nurse and my doctor were going to make it all better. I was going to be a very good boy. I was going to be a very competent patient! Whatever they wanted was theirs. Their wish my command.

Oh the pain! My hands! My arms! And I was freezing. I probably wasn’t going to die, but I knew I could be seriously messed up: messed up already or messed up later, depending on how we collectively handled it from here on out. Competently or incompetently.

They rolled me carefully and placed a board under me. Then they braced my head in some sort of restraint. When I tried to help in the roll the nurse ordered me to stop helping and to relax. I relaxed. I could and would do whatever she told me to because I was scared. Very scared.

I was scared that I was going to paralyze myself by doing something stupid. I was scared that someone else’s stupid mistake would paralyze me. I was scared that I would never be the same again. “I am a control freak and I am out of control here,” I thought.

This isn’t just some control freak freaking out over where the logo gets positioned on the letterhead. This is my spinal cord that we are messing with! Let’s be so competent that someone is going to want to write this one up and give everyone medals to everyone later for being so competent.

Lucky me that the resort had a function going on and that there seemed to be dozens of people, including some doctors on the beach. I either ruined their party plans, or got their juices flowing before their beach bash. Sorry if I ruined your party, guys.

I was being attended to by not just one, but by two competent people. Let’s face it: absolutely no one gets to be a nurse without jumping through a whole bunch of complicated, serious, performance- based education and training and certification “hoops.” And we all know what doctors have to go through, even though we don’t really have a
clue about the specifics. But we know it’s a lot. And it’s damn serious. And then we trust them to be competent.

No One-Minute Doctoring Training
Their training and education and certification processes are real, no phony-baloney, fad-junk that all too often pervades my own industry. I am a training and development consultant. I understand the difference between performance competence and butts-in-seats attendance. I’ve seen some really bad foo foo.

But, not for these guys. No one-minute doctoring manuals were used in their development showing that being competent is as easy as 1-2-3 or A-B-C.

Let’s spend 60 seconds here discussing spinal cord injuries and what to do if it happens on the beach. Next week, we’ll cover what to do if it happens in your own backyard. It’ll only take a minute.

The security staff guy leaned into my view and asked me some questions. Then the fire department guy asked a lot of questions. They were the same questions I’d answered twice or three times already, but I thought it would be good to play along. Humor them. Maybe they’re trying to see if I keep my story straight. Maybe this is a test of my competence.

A buzz started that the ambulance was here. More uniforms appeared in my peripheral vision. My nurse disappeared. My doctor told me what was going to happen next. I was cold, shivering, and beginning to lose touch with the details of what was going on. But it was OK. I could relax.

They picked up my board, set it back down on the ambulance gurney, and wheeled me up the sidewalk to the waiting ambulance. There are some things that I forget now about that jaunt. Somewhere in there I was getting stuck with needles, and thankfully, there are things I am fuzzy on. The pain was there but the edge was off. Way competent, dudes!

I spoke toward the face hovering over me as the ambulance carefully traversed the parking lot and exited the resort grounds. I was going to ask, how much longer as a joke, but seriously, “How much longer?” About 30 minutes was the reply.

During the ride to the hospital, the ambulance EMT was busy being competent in things EMTs need be competent. Radio calls were made, forms gathered and completed, and questions asked. She asked me familiar questions and wrote down the answers. The same questions over again. This must be good. Those must be good questions because
everyone finds it useful to ask them. The same ones. They’re all well trained, they ask the very same questions. But still, it seems somewhat inefficient, and irritating.

Process Improvement
Maybe if we all got together tonight, after the quick look over in ER and they patch me up and send me back to the villa, we can compare notes and develop a process map of both the current and future-states and show how we can streamline this little operation so that no one has to waste their time asking the same questions over and over again.

Maybe if you all got palmtops (not the fronds, the handheld data devices), you could wirelessly transfer data using infrared at each handoff just as you each handed me off. Then, all of the right questions could be answered once and sent on ahead, and you could shoot me up with something just to let me sleep my way into and all the way through this little escapade. And, when I wake I’ll feel all better. But keeping me up just to ask me the same darn questions over and over again is making me tired and cranky.

Hey, maybe I am getting a little tired and cranky here. I’m freezing and all my blankets are all wet. My suit is wet and full of sand, and my tailbone is being crushed because I’m not moving it one bit off the spot it is jamming itself into, because I’m afraid.

Afraid to straighten out my back in the slightest and move one millimeter off this hard board. My head hurts too, where it is digging itself into the board. And I’m afraid to lift my head off that spot. And then again, the pain in my arms is still killing me, so to speak. But I’ll be alright. I can take it. Again I ask, “How much longer?” Ten minutes is the answer.

“You’re an EMT right? What kind of training and certification are required?” I inquired. Got to keep myself busy. Got to keep distracted. Oh look, another example of serious competence through serious T&D&C. That long huh? That’s great. Oh, and continuous education, too. That’s nice. How much longer please? Oh.

Excuse me. I’ve got these sharp pains running up and down my arms. Actually, now it’s only from the elbows down and doesn’t include the little and ring fingers of either hand. Ah! Progress so soon, Mr. Wallace. Everything is going to be A-OK. Just a few more minutes now.

I’m feeling continuous waves of tingles, a million funny bone whacks, up and down my arms. And feeling droopy…feeling tired…sleepy. I watch the blue skies and green trees up through the window in between flashes of glare. More turns now and we slow to a halt.

The back door opens. The gurney is being pulled out and I both hear and feel the gurney legs and wheels pop back into joint as I am lowered to the ground. We wheel away. Palm fronds and blue skies are my straight up view. Hawaii is so beautiful from any angle.

Then the blue skies turned abruptly into ceiling, white ceiling with dirty cable runs and then a doorway. Then in the entranceway, decorations of some sort were visible from my straight up view. My head wasn’t going to turn itself in any direction other than straight up for anything. Eyes ahead we called it in the Navy. I could do that.

Just Like the Movies
The ER was just like in the movies and TV. People rushed up and asked me questions, the very same questions as I had been asked before. I patiently answered them because I knew the answers were important, because the questions were important as a means to the end of getting the answers.

We weren’t playing games here.

But now my doctor approaches. “Hi, I’m Mark,” and he’s yelling to others about CAT Scans and x-rays, and he wants it now! Others are plugging me with hypodermic needles and others are plugging me into medical equipment. And if he’s got to operate now he wants to know it now. Now. He leans into me as we rush down a hallway, “Mr. Wallace, how are you doing?” he asks. “Here’s what we’re going to do…”

It was two nights and three days of a lot of round-the- clock competence. Complicated competence. Technical and interpersonal competence.

Things happened as they told me they would. The shifts in the locations and severity of my pains were predicted and realized. The schedule of staff and services (including those pain shots every two hours) was performed just as they had explained.

My helpers were professional, caring, and competent. I have no complaints, only praise for my hosts during my unplanned stay.

Thank you for being so competent.

I’m at home now. Just trying to get all the tingles out of my system as I type at the keyboard. Taking a lot of hot baths. And a lot of pills. We see the local doctor, a specialist, tomorrow. More doctors and nurses. I am feeling better, much better.

Coming down off the drugs is nasty. That, too, was predicted.

I can now see a complete recovery ahead for myself.

I am both older and wiser, I’m sure. I hope. This too shall pass. I will read the signs much more carefully, much more competently.

Oh, the pain—it is still with me. And the competence— it’s still back there waiting for the next victim of the undertow.

Human competence. I’m especially concerned with that today. And, thankful for it, too.

# # #

A footnote from a decade later, February 28, 2010:
The experience use to create patches of skin that would go “unfeeling” for minutes or hours. That pretty much ended about 2-3 years ago.

Read the signs. Think of “Context.”

Put 2 and 2 together.

Be careful going into the water.

Another footnote from a decade later, February 09, 2020:

I’ve been in the T&D Biz for 40 years now. And I catch myself thinking of this incident – and the doctors and nurses on the beach and at the hospital that day, 20 years ago – who had committed to memory “what to do and how to do it” for immediate Performance.

There was NO TIME FOR PERFORMANCE SUPPORT to guide their Performance.

Thankfully, they knew what to do and how to do it already.

# # #

3 comments on “A Decade Ago I Personally Tested the Hawaiian Medical System’s Competence

  1. Pingback: 20 Years Ago Today – I Ended Up In a Hawaii Hospital – Because I Misunderstood the Signs | EPPIC - Pursuing Performance

  2. Pingback: Weekend Reflections | EPPIC - Pursuing Performance

  3. Pingback: Signs – Signs – Everywhere There Are Signs « EPPIC – Pursuing Performance

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