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

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

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

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

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 currentand
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 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 xrays,
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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