IN THE BUBBLE JOHN THACKARA - witz cultural

110 Chapter 5
We were seen rather promptly by a nurse, and then by a doctor. She took
one look at Kate’s bump and said she had to be admitted. Within an hour
she was in a children’s ward on an intravenous feed of industrial-strength
antibiotics. She had mastoiditis, an infection of the bone behind the
ear. Increasingly stronger drugs, and then combinations of them, did not
work. Kate’s temperature soared above one hundred and stayed there.
The mastoiditis begat bacterial meningitis. It looked—and was—very bad
indeed.
And the doctors were unsure what to do. Two different teams were
involved: pediatrics and surgery. The pediatricians wanted to stick with
the drugs; the surgeons said drugs would never cure the infection and
wanted to operate. Both groups of doctors consulted endless charts and
test results, but they examined Kate a lot, too. People looked at her eyes,
or her hands, or would lay a hand gently on her head. In Kate’s cubicle,
the medical people were gentle and respectful, but out in the corridor, and
back in the staff room, they would argue, constantly. They would pore over
crumpled printouts from online research someone had done earlier. They
would look at the endless test results. Boy, did they argue. For us, as
parents, these arguments added to our terror. In Britain, senior hospital
doctors, and especially the godlike consultants, barely speak to parents, let
alone share their doubts with them. At St. Vincent’s, we were involved in
every twist and turn of their perplexity and concern.
In any event, the drugs never worked, Kate got weaker, and the decision
was made to operate. A team of twelve people spent eight hours clustered
around a hole in Kate’s head less than two inches wide. Whatever it was
they did, it worked. They saved her life, and I had had a crash course in collaboration,
tacit knowledge, and work design that I would not recommend
to anyone.
So what did I learn? The first thing Kate’s story taught me was that the
flesh and blood of the doctors and nurses was just as important as Kate’s
flesh and blood. Medical knowledge is embodied. Having formal knowledge
in your head is not the same as having it in your fingertips. Doctoring
is a physical and fleshy thing. We therefore need to design work situations
that enhance tacit and embodied knowledge, rather than pretending that
they do not exist or do not matter. The other thing I learned at St. Vincent’s
was that matters of life and death foster great collaboration and that
this collaboration can take place in featureless corridors lit by neon and
lined with beige linoleum.