dal niente

Tag: caring

Masters of Business Administration

[Yel] laughed out loud, so I asked her what was so funny.  Apparently, two of the operating room attendants (orderlies), were scheduled suddenly for two full weeks of work.  But that’s so out of the blue, and she was sure they weren’t informed, so there’d be problems– since they’d most likely have prior commitments to another unit.  The two ORAs have been working here longer than I have. but like me, they don’t hold permanent positions.  Because of this, they both recently joined another unit that could offer them more stability– people have to eat, you know.
“Je les ai dit,” Yel explained with disgust, “don’t give priority to here– because here, dey are users.  Quand ils t’ont besoin, ils t’appellent, mais si ils don’t need you, that’s it– you’re out, garbage, who are you!”
It’s true, and it is disgusting that a company like this makes it into the Montreal Gazette as one of the Top Employers in Montreal.  If you read this artcile, there’s a lot of important people from the MUHC smiling and stuff.  The McGill University Health Centre provides some incredible benefits for it’s employees.
But waitaminit.  You mean to say that all the good things that I have going for me as part of my work contract were just handed to me by the MUHC?
Aren’t all these things– like maternity leave, a pale yearly salary increase, educational leave, disability leave, pension and health coverage– aren’t these all things that our unions had to fight tooth and nail to wrest out of the MUHC’s labour-busting despotism?  The MUHC didn’t give us these things… they’re just taking credit.
Turns out also that they’re not going to give me time off to study law.  I mean, chances are, I wouldn’t end up working there again, ever– but it’s not like I was asking them to pay me during my leave.  As it stands, I’m already only scheduled whenever someone is sick– that means the random call at 7AM once a week or two.  I don’t have a scheduled work week.  And even when I’m making almost no money at the hospital at this point, they won’t allow me to take an unpaid leave of absence, and are telling me that if I’m going to school for three years– I have to resign?  I guess I shouldn’t be surprised.  The last time I went to school after working years at the Montreal Chest Institute (also part of the MUHC network) I was also forced to resign when I decided to take a year off to work in Korea, years ago.  And, as a matter of fact, they rehired me with open arms upon my return– but, they tried to erase my years of seniority.
Frankly, it’s their loss.  To be honest, after years of service at the MUHC… how many is that total? 6 years? I grew up working with the MUHC while I was in school, and I always gave them my best.  But after years of it, I can simply say fuck them.  I believe that the work done there is important– but just because they’re a hospital and they have, prima facie, noble goals doesn’t stop me from saying that the administrative structure and the exploitation built into it is absolutely disgusting.
Not everyone is bad, of course.  But the whole of the MUHC’s organizational structure is plagued with intermittent patches of bad attitude that trickles right from the top– there’s a territorialism, a sinistry about how there is no transparency for the important decisions, and that those who are favoured for managerial positions have more business sense (and personal ambition) than caring.
Elections are coming up in Canada, and traditionally, though I have leanings towards the NDP, I can make almost as good a case for not voting– because no matter who is in charge of this country, their fundamental response to problems is to allocate or restrict funding.  That doesn’t work.  To approach the management of a country simply in terms of fiscal considerations doesn’t make it to the layman.  Different party leaders, both at the provincial and federal level, have come and gone– when is the last time one of those transitions had a direct impact on what goes on in the hospital?
Some parties have said they’d spend more on public health care, some were saying they wanted to go the route of public– either way, the people in charge of hospitals haven’t changed, and the way that we run things on the front lines have changed according to the visions of individuals on boards of directors– not in the government.
So what do we need government to do?
We need it to step off the deffensive.  We don’t need a government who takes our tax money, and just decides how to use it.  We need a government that envisions a sense of nationalism, and works to build it by influencing culture.
The whole reason why money is so imoprtant is because of it’s solvency.  That’s exactly the problem.  A new government comes in– but whatever their goals, the executors of them are able to use the money in ways not intended, because there is no underlying direction to that.  The government is all about budgets– and their budgets are scalar quantities, not vector ones.
On the other hand– I think that people need to stop bitching abotu wanting more money– instead, how about asking for respect?  How about asking for culture, or pride?  How about asking for a sense of community?
The modern world separates most into two categories: the mercenaries, who go where the money is good, and try to convince themselves that this is what life is about– and the dogs, who kill eachother over table scraps.  Why not work to be a family?

Hospital Culture

“This kid weighs… like… 57 pounds. Are they nuts?” asked the nurse.
“Which part?” asked the resident impatiently, without looking up from the chart.
“Adolescent femur nails? Look at the size of the kid. We can’t use those on this kid, the nails are bigger than his frikking femur.”
“Well, that’s what’s in the order, I don’t think…”
“Well, Doctor [X], I’m saying– when a kid has a broken femur and you want to put it back together with a nail, you don’t use a nail that’s bigger than his femur. What do you think?”

It’s not that I hate doctors. It’s just that, more than any profession I see at the hospital, they tend to be the one that is populated by the most assholes and idiots, especially the newer residents.

When you’re a resident, you’re new the the hospital. The nurses you are dealing with might not be doctors, but they’ve likely been there for years longer than you– possibly lifetimes longer. So when residents feel that asshole urge to sound smarter than a nurse, they should probably just shut the fuck up, because they’re wrong anyways. Wrong on one hand because sometimes they don’t know what’s going on, and wrong always on another hand because simply, you’re never right to treat a nurse as if you’re smarter than them.

There’s lots of literature on the culture of the medicine– but it boils down to the basic free-for-all culture of liberalism that says that if you have the bigger salary, you’re probably entitled to a bigger opinion or exemption from basic manners.


If you really asked me to honestly tell you, a hospital is a terrible place to work at. It’s an absoultely thankless job– the only way I survive is because I’m a chronic optimist, despite what you might be lead to believe by my incessant bitching.

The way the system is set up is that it relies on the benevolence and dedication of workers to the idea of healthcare. That is to say, you’re dealing with good people who want to make a difference in the world. However, the system takes advantage of these people to be the glue of an infrastructure that is fundamentally broken. If you just paid people to do their jobs at a hospital, it wouldn’t work.


Why is it so broken? Well, because the system is basically throwing money at problems without putting in place effective policies. There’s money to be made in health care– if I really, really didn’t want to work, I could show up at work, work for 1 out of 8 hours of my day, and charge another 4 hours overtime– and I wouldn’t be caught. You’d pay your taxes, I’d get my paycheque. If I was a bad person. Unfortunately for me, I’m not.

The sinistry of our system is that it ruins good caring healthcare professionals– it turns them bad. It offers them poor support or little incentive to cooperate. If it weren’t for the people who are terminally do-gooders, this place would burn to the ground. It would burn to the ground and while it happened, you’d see hospital workers on nearby rooftops all playing their fiddles.

I’m paid bi-weekly, and they failed to pay me the correct amount due on my cheques for the last two cheques. This issue has yet to be resolved. Basically: I work overtime to get stuff done because of short staffing and retarded, circular procedures, and for the last month, the hospital has been withholding money from me because of administrative errors. That’s bullshit. I say without exaggerating that I’m an excellent worker– when there’s work to be done, I do it. I go beyond my job’s mandates. And they can’t even deposit money that’s owed to me?

Last week, my manager cancelled one of my shifts the day before. She didn’t even tell me about it– one of my coworkers sent me a text message to warn me. When I asked my manager why, she basically explained that since I was a part-time employee on-call, she could cut my shifts the same day if she wanted to. Bullshit. I spoke to the union, and according to our collective agreement, that’s not legal, and as a result, I’m entitled to a full day’s pay! The union is taking care of the situation on my behalf at this point.

But that’s what I’m talking about. Now I ask you– if you were in my position– what is the incentive for you to do well at your workplace? Sure– you could say you want to help people. But this isn’t a volunteer organizatin– I’m a professional, and I expect to be paid. If make me jump through hoops, what are the chances that I’ll be the person who will go through that extra 5 minutes of work that helps save someone else 1 hour of work the next day? Where is the culture of enjoying the workplace because it’s a good place to work?

Healthcare in Quebec is suffering massive budget problems– but it’s not just the management. It’s the morale. If leadership fails to inspire and set the pace for a workplace of transparency, cooperation, and forward-mindedness, if we have no unified vision– if, on the contrary, we have opression, disrespect and unprofessionalism– we’re going to waste shitloads of money. Employees will work slower, just to get through their day. Employees will steal. People will not give a fuck unless it becomes directly their problem.

[Zanshin] asked me what I think about Montreal’s plans for the new Superhospital ( http://www.canada.com/montrealgazette/news/story.html?id=39b18411-0a5a-4606-b94b-5cf0bb40a23d ). The Children’s Hospital that I work at is one of the hospitals set for closure and integration into the main campus.

One one hand– the idea of a superhospital, four or five times the size of my hospital, is an impressive idea– but it also reeks of administrative pestilence. Of all the hospitals I’ve worked at, each one has suffered from internal communication failures for non-technological reasons– how much more for if you scaled operations to for a site entire factors bigger?

But I have my fingers crossed. Definitively, I think it’s impossible to overhaul current administrative practices at my hospital. Impossible. Our only chance is to burn the whole system down, and start fresh– which I hope is what will happen with the superhospital.

Keep your fingers crossed– but don’t hold your breath. This is a timeless tale.


Time: 15:40 Nov 27, 2009
Location: @ work (yes, during sunlight hours!)
Batteries: 90%
Morale: 😉

I’ve been basically telling everyone at work today that I’m going to Ninja Assassin after work finishes at 22:00.  I mean, it’s a big deal.  This movie has been a long time coming-I haven’t seen a big budgeted Hollywood movie that centered around ninjas for perhaps a decade.  That Chris Farley movie doesn’t count. Ninja Turtle movies get an honorable mention, but I’m looking for something with humans.  Not that I’m a racist or something, but while I love turtles, they’re not human. It’s just not the same.


Time: 15:40 Nov 27, 2009
Location: still @ work
Batteries: 80%
Morale: 😉

Today started off as pretty quiet, but it’s quickly gotten really fubared.  It went from a 1 hour or so wait for category 4s and 5s at around noon, to a 9 hour wait for cat 4s and 5s now (at about 7pm). I’m working as the Fasttracker today, which, I’m sure I’ve mentioned, is my favorite job.  It’s a long 11-hour shift, but it kinda balances out because I don’t that many direct responsibilities.  That’s not to say that there isn’t work to be done– it’s just that the FT coordinator is usually on support duty.  FT is it’s own independent little department that has almost nothing to do with the rest of Medical Emergency (MER) or Surgical Emergency (SER) from an administrative point of view, since we have our own rooms, our own coordinator (me), computers, office and communications systems.  However, oftentimes what happens is that FT slows down because there aren’t enough patients to see, and that’s when I basically help out MER and SER as much as I want, but without having to take responsibility since MER and SER both have their respective coordinators who are calling the shots.

Fasttrack patients as so named because, in theory, they can be handled quicker than the average patient.  These are the sorts of patients who show up with cases that realistically aren’t worthy of emergency medical attention-they need medical attention, just not the emergency sort.  A kid who has a sore throat or a cough are a few common examples.  For that kind of thing, you just need some cough syrup or whatever.  These patients, when seen, are mostly told to do something really simple and the plan of action is mostly reassurance from a doctor.  There are plenty of over the counter meds that you can get at a drugstore that do the trick nicely, so many of them don’t even leave with a prescription.  Unfortunately, because common colds are, well, so common, you’ve got tons of patients who display these symptoms and they really bog down the system.  Yet, you can’t exactly say to a patient “you’ll be fine, go home” because legally, if they come to a hospital and want to be seen by a doctor, they are entitled to.  Yay Canada.

So, FT exists as a special sort of taskforce whose job is to weed these low priority cases out of the system while fulfilling our legal obligation to the public.  Only a doctor can prescribe anti-biotics or whatevs, so we have an FT doctor whose essential job is to just see patients with uncomplicated symptoms quickly.  In and out.  Wheras a typical MER or SER category 4 or 5 patient is usually in the department for about 20 minutes from the time that a doctor first sets foot in a room (not to mention the amount of wait to get into a room), an FT case can typically be seen in under 5 minutes with a good FT doctor, and the wait times for FT cases are usually significantly less than MER or SER.

As a result, there is typically a huge volume of FT patient traffic in a short time, sometimes dwarfing the numbers of MER and SER.  Just because most people who come to a hospital simply don’t need to be here. They become FT patients.

As a direct result of the high patient volume, an FT coordinator is assigned. That’d be me, today.  When I was first hired here, I used to do almost exclusively FT shifts.  That was nice in one way– easy work.  But brutal on the sleep, since each shift was at least 11 hours, and I’d often do 4 or 5 shifts in a row.  Nowadays I do the odd FT once or twice per month, but it’s nice to come back to my roots.

What I mostly like about FT is the independence from all the mess of MER and SER.  Physically, you’re disconnected from them becase we operate in a different wing, so you don’t induce any environmental stress by things that aren’t your problem (which you normally would if you were in the main department).  Also, you’re afforded a lot more administrative and medical maneuverability, since FT basically consists of one doctor and one coordinator. You get to know the doctors personally a lot better like this.

So, though I say that we’re kinda fubared today, by ‘we’ I mean ‘they’ since I’m only as fubared as I want to help them out of their situation.


I’ve got a few more hours of madness left. And then: Ninja Assasin.

For those of you wondering, my expectations for this movie are, contrary to what you may think, very low. Abysmally so.

I expect this movie to be so bad that it’ll be great, actually.

Need I Ask

I shouldn’t need to, but there are a lot of situations where people wait for me to go through the formalities.
For some reason, me going through the mendacity of that whole process makes them feel more as if I care.  When, in truth, me caring is independant of me asking, except insofar as when I see that someone wants to talk but is waiting for me to ask, in which case if I care enough I will go through the trouble of that formality.
And then there are cases where I judge wrong and my good intentions lead to no good results.

Good intentions always need messengers, but then again, you know what happens to the messengers sometimes.


When you press, the shutter opens up for a moment, exposing the film to light for a moment.  How long this moment is depends on several things– you can change settings manually of course, but for the most part, it has to do with the automatic metering done by the camera.  It decides how much light to let in.  How good something looks in black in white is all about contrast.

It’s not that pessimists are better than optimists or vice versa.

But they are insufferable.

Nobody wants to squint at a photo that’s over or underexposed to the extremes.

There are a lot of beautiful things in the world, but in a world with problems that need solving, naivety and immaturity are not included on my list.

I will abstractly allow that children should be children… however, though adults can remain young at heart, they should only do so in tandem with a growing understanding of their place in the world.  We enjoy a lot of freedoms and safeties– as children, our parents tend to provide things like this for us.

But as we grow older, I feel that we owe it– not just to our parents, but to the world (specifically, outside of our families)– to do right things so that this can trickle on to the next generation.  Being a child is about finding beauty in the simplest things– but even a child knows when things are ugly.  The unavoidable, progressive act of growing older is about developing the tools to take control of those things that are beautiful and ugly in life. 

The difference between an adult and a child is the way that they deal with their situations.  A child is based on emotions and wants, and has little consideration of needs because they’re usually automatically provided by someone older.  An adult should be able to take all of the child’s wants (including the child within themselves) and be able to affect them through the use of reasoning– an adult doesn’t cry, for example, when he doesn’t get chocolate– he learns to accept that he can’t always have chocolate, or that he needs money to buy chocolate, or that he can ask someone for it, or that there are better things out there.  Being an adult is all about having options and making choices, taking into account reasoning.

It is about developing an increased understanding of one’s impact on the group.

Do we owe a group?

And if we do, how do we pay it back?

I would argue that we do owe a group.  Every little thing, even the safety we have to walk on the street, it’s not something we earned– it was just given to us (at least, as North Americans reading Xanga).  At who’s expense?

Someone always pays for the luxuries we have.  To draw a stretch, wars in the middle east existed because we want to drive cars instead of ride bicycles.  I’m not saying that you put a gun to anyone’s head– but for every choice you make on a day to day basis you set either set in motion a chain of events or subscribe to a chain that is already in motion.  The child doesn’t know these things– the adult, if he/she doesn’t, should.

And it’s not that I’m telling you to start looking up international politics.  I’m simply asking you to care, in a non-superficial way.

It is very possible to care in a superficial way.

Don’t care just because it’s fashionable.  Don’t care for just the easy things.  Don’t care just because it makes you feel warm and fuzzy inside.

Caring has a lot to do with doing what’s right in spite of difficulty, pleasure or reward.

If you can’t understand that, then you’re just a child, looking out for his/her own pleasure.

If that’s the case, go back to Eden.   The rest of us have work to do.