Jason Byassee: The confession manifesto
Others at Call & Response have already written about Atul Gawande’s new book “The Checklist Manifesto: How to Get Things Right,” but having just finished it myself I couldn’t resist weighing back in. Gawande is selling something strikingly unsexy. He has reams of data that checklists save lives, both in surgery and in finance. If he was peddling an expensive new drug or some angle on the next company about to go big, you can bet hospitals and investors would be buying. But a checklist?!
My favorite moment in the book is when Gawande reflects on why we don’t use checklists in situations in which they have been proven to save lives and fortunes:
It somehow feels beneath us to use a checklist, an embarrassment. It runs counter to deeply held beliefs about how the truly great among us -- those we aspire to be -- handle situations of high stakes and complexity. The truly great are daring. They improvise. They do not have protocols and checklists.
It’s an Augustinian point Gawande makes here, though I doubt he would describe it that way. For Augustine, the most dangerous sin is pride. Pride doesn’t just put us in the place of God, running the cosmos, judging who is righteous and who wicked. Even worse, it’s false imitation of God.
We are creatures meant to imitate God -- the right way. We are meant to imitate God’s humility. God’s life among humans is that of a fleshed human being, one of God’s chosen people, the Jews. We religious types tiptoe on high to catch a glimpse of the majestic God unsusceptible to the vicissitudes of time, knowledge or power. But stretching up, we trip over the crucified slave at our feet. All humanity imitates God in one way or another. The church means to by imitating his humility. The proud imitate his grandeur. This latter option does not go well.
In the book’s final chapter, titled “The Save,” Gawande shows the sort of humility Augustine would be proud of. Sure, Gawande has run around the world the last few years, trying to convince hospitals from the wealthiest to the poorest (one US hospital he mentions has a budget twice the size of the whole nation of Tanzania) that checklists save lives in surgery. But did he really need one himself, Dr. Atul Gawande?
Nah.
Until he did. He’d never had trouble removing tumors from endocrine glands until one day when he, oh, severed a patient’s vena cava. You need this blood vessel -- it returns all the blood to your heart. The patient’s blood loss was “terrifying.” I found what Gawande did more terrifying still: He slashed open the man’s chest and belly and began squeezing his now-stopped heart to pump blood to his brain.
You know how this story is going to end: The checklist saved the man’s life. Going over it beforehand, Gawande mentioned that the tumor was close to the vena cava so the surgical team should have sufficient blood reserves nearby. The nurse checked. They didn’t. So she got them. When they needed the blood, it was there. Good thing. The man lost three times as much blood as he had in his body.
The result wasn’t good for the patient -- he lost vision in one eye, a wound he will bear his whole life. Nevertheless he agreed to let Gawande tell the story. He knew he is one of the lucky ones. One saved by a checklist. I imagine there will be others, saved not only by this manifesto, but by one surgeon-cum-writer’s willingness to tell others about one of his most terrible failures as a physician. His confession of this failure as a professional may prove to be one of his finest acts as a human being.
Augustine would approve.
Jason Byassee is an executive director of Leadership Education at Duke Divinity.
So before we can think or act
So before we can think or act outside the box, we had better make sure we can check off every box that pertains to the situation. It's like being able to improvise on the drums. You have to master what they call the rudiments and continually use them as your touchstone if you want to be creative.
I'm grateful for
my colleague John James' post on this here: http://chi.divinity.duke.edu/2010/03/complexity-and-essence.html#comments.
I made a to do list. I make
I made a to do list. I make these all the time, so nothing new. I started by putting someone’s name and then added some notes under the name about what I needed to do. I did this will several people before I realized how helpful this list was going to be. I normally make my list and it contains items like check and return email, write a letter, check time for appointment next week. All important tasks that I am paid to do. Thanks to my first item on the list, that day, – I wrote my list of relationships and what I needed to do to help that relationship.
The world of ministry administration is often filled with people who like me, who have more interest in the people we serve and the conversations we have than the computer administration that keeps organizations running. I like to do lists and I generally like the days I “get stuff done” by sitting at my computer, and yet…I long to see a direct link of working with people again.
Writing my to do list differently, people first, task second helps me remember each person I am serving and helping by the task. It seems simple, and yet it has turned by to do list into a prayer and relationship base. And since it is hard to cross someone’s name off the list when the task is done, I have a list of names of folks I help directly or indirectly at the end of the day.
Structure
A checklist is maybe a word with a cold sound, but we need structure sometimes to help our daily tasks, especially when we want to help others.
You can create a checklist in your own personal way, it just has to be a tool to visualize routine or goals on paper.
Blood
He lost three times the blood that was in his body? How is that possible?
Cause they were pumping more in
I reckon
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