Affirmative Action

Author Tony De Maio

Once upon a time in a land far far away, there was a small community. One day, the administrator of the hospital retired and moved away. The town looked for a new administrator and finally found one working for the Veteran’s Administration. John was well recommended by his superiors, the FDA, and other federal agencies. It was said that he was “on the fast track”, and “ahead of the curve”, and that he was “well connected”. John did very well on the interview, but later, no one could quite remember just what it was he said. He had many degrees, but they were from schools that no one had ever heard of. He assured the directors that the schools were quite specialized schools–that’s why they were unknown to all but the top echelon of medical practice. Few DOCTORS even knew the names of these schools. John got the position.

The first thing John did was to proclaim that all promotions would be from within. As a first “test case”, he promoted Mary from a practical nurse to a registered nurse. Mary was quite pleased. She took classes at the local college. She worked hard, asked questions, and studied late into the evenings. Eventually, she obtained her Master’s degree in nursing. Mary was heralded as the example for the future. Her name was brought up often in discussions of how affirmative action and upward mobility worked well. Folks would often start their discourses with, “Remember Mary…” long after Mary had left the hospital.

John gave a dinner party for the hospital directors. He gave them glowing reports on how the hospital was doing. The dinner went over so well, that it was made a monthly affair. After awhile, the “business” of the hospital never quite made it to the agenda of the monthly dinner. John was voted “citizen of the year” by the town business community.

Bill then promoted the cook to head dietician. The cook was well pleased. He started to take classes at the local college, but decided it was too much trouble. Besides, he knew as much at those “eggheads” did. Look at how much better Mary did than the folks that had taught her.

The administrator then promoted several nurses to doctors. They were less expensive than doctors and were not so hard to get along with. The doctors always complained about the rooms being dirty or the nurses untrained. Not only did he promote the nurses to doctors, but he also prohibited the doctors from practicing in “his” hospital. Having no choice, the doctors folded up their practices and went elsewhere. It was no real loss; the hospital established a clinic to replace them.

From the outside, the hospital looked like an ideal place to work. Sure, you started low, but they trained you to be a doctor or nurse–and the pay is great. Of course it wasn’t too good by a doctor’s standards, but it was terrific by a gardener’s standards. If you wanted to get in, you had to start low, but the sky was the limit. Remember Mary?

On the inside, things were a bit different. For the most part, the staff was surly and had no confidence in their abilities. They thought that they were “entitled” to a promotion/raise because they had spent many years at the hospital. They believed they were experts in how the hospital “really ran”, since they had been there so long; and that somehow this knowledge compensated for their lack of medical knowledge. They also believed that any raise/promotion they obtained was at the whim of the hospital administrator–thus it was very important to “go along and get along”; to “tell management what they wanted to hear”; to follow ”company policy”; and to not “make enemies”–except of those who were out of favor. They “disappeared” often, and ducked the assignments they didn’t know how to perform–which was most of them. They were always “too busy” to take on a new task or help someone else. The accepted phrase was, “My plate is full.” It was not a close knit group. The staff members believed that everyone was in competition for the same promotions and everyone was quite critical of everyone else—perhaps backbiting is the correct word. Morale was low. Smiles were rare.

Then one day it happened. The head surgeon went into the office of the administrator, bowed his head, and said, “I’m afraid it’s happened, sir. I think we’re going to have to go outside for a brain surgeon. Mack just retired. I’ve asked around and no one wants the job–not a carpenter, waitress, nurse, cook, janitor, or gardener. Not even one of the other doctors. I’ve even offered fifty thousand dollars a year.”

The administrator says, “I’ll take care of it.” Bill goes to Johns Hopkins and talks to the head of the program. He explains how he is running a small hospital and needs a brain surgeon. He can’t pay much, but life in his community is “good”. The head of the program brings in a young man named “Sam”. Sam graduated just last week. When all was said and done, Sam had a contract to work at the hospital.

Sam showed up two weeks later and checked in at John’s office. They chat, and John suggests that Sam take his time “getting acquainted” and “sit in” on a few operations and discussions. Sam thinks that’s a good idea.

About three weeks later, Sam drops in on John and asks to speak with him. He asks, “What is the experience level of the staff here?” He is assured that all have vast amounts of experience–many in excess of 25 years with the hospital. Sam then asks, “What is the education level of my colleagues?” John replies that all have at least a Master’s degree, and most have a PhD, in addition to the doctors having the MD degree. Sam shakes his head and walks out.

About three weeks later John performs an operation. By most standards, it is a simple operation, but it failed and the patient almost died. Sam was quite concerned because one nurse assistant did not know the names of the surgical instruments; the other nurse did not know the names of the parts of the brain upon which he was operating, and the third nurse never showed up. The anesthesiologist was 45 minutes late, the operating room had dust and dirt all over, the room had not been cleaned up from the last operation, the surgical tools were not sterilized, and the sheets used for the patient were dirty and probably being reused.

Sam went back to see John. He began, “I’m concerned about some of the practices I see going on.” John tells him, “You’ve got to remember that we are not a rich teaching hospital with lots of grants. We do things in the ‘real world’ that you’re not taught about in school. I’m not sure you understand our ways–which may be a bit different, but remember, you’ve only been here less than 6 months and are quite inexperienced. What could you know about our way of doing things?” Sam says, “Well, I know that you are using plastic disposable needles over and over again without sterilizing them–and the same with surgical instruments.” John replies, “Of course. We CAN’T sterilize them. If we attempted to sterilize them, the heat would destroy the plastic. Also, in case you don’t know, surgical instruments are quite expensive, and we’re a bit short of them. We don’t have time to sterilize them between operations. Besides, we can’t find anyone to do it. No one on our staff likes that job—and the union says they don’t have to do it.

Sam says, “Well, I know that the mortality rate for this hospital is three times the state average.” To which John states, “Of course, we take in many ‘hopeless cases’ from around the state which the other hospitals have given up on.” Sam then states that the nurses in his operation did not know the names of the parts of the brain or the surgical instruments. John replies, “We have our own names. One set of names is as good as any other. Perhaps you should be a little more tolerant and learn OUR names since you are working here. I know you’re upset because you almost lost your patient, but you shouldn’t blame others for YOUR failings.”

John then states that if Sam continues, he will not be liked; that he has little experience with the real world, and he should learn from the experienced staff at the hospital. Word gets around to the staff that Sam is not a “team player”; that he looks down on them and is arrogant. The staff starts to avoid him—in some cases, they are outright rude.

John does some investigating and determines that all the degrees of the staff are from mail order universities; that although, as stated, the head nurse has 25 years experience with the hospital, the first ten years was as a waitress and next ten was as a cook. Since being promoted, she has taken one course (women’s history) at the local college. The rest of the “professional staff” is similarly qualified.

Sam goes back to John and presents his case. John makes it clear to Sam that the hospital “celebrates diversity” and believes in affirmative action and upward mobility. He also states that “college isn’t the only way to learn”, and tells Sam the story about Mary. He further tells Sam that all the professional staff is competent since he trained them himself; that he was a pre-med student at Johns Hopkin’s when Sam was in diapers. He had to drop out because of the lack of money, but he did have a medical background which he uses to train the staff. He then presents a list of all the medical associations to which he belongs.

Sam goes to the newspapers, but they refuse to investigate. They are too busy reading the news releases that come across their desk to look into it. They tell him, “My plate is full.” Besides, John was citizen of the year (again) last year, so the charges couldn’t be possibly be true. As he leaves, Sam glances at the diplomas hung on the wall of the newsroom and realizes that they from the same schools as he has seen at the hospital. He idly wonders if he is in another hotbed of upward mobility and affirmative action.

John receives a call from the dean of Johns Hopkins to inquire about how he is doing. Johns starts to tell him when the dean interrupts and says, “I received a call about you, Sam. We don’t want our students to get reputations as troublemakers, do we? It will be very difficult to place students in the future if that happens. I’m sure you understand, Sam.” Sam replies, “This isn’t a hospital, it’s a hospice.” and slams down the phone. The dean thinks, “Maybe the boy does have psychological problems like John said.”

Sam then goes to the medical association, and is introduced to the head person–Bill. Sam is assured by the head of the local AMA office that John is totally competent; that Bill has known him personally for twenty-five years. As a matter of fact, John was extremely helpful, perhaps instrumental, in Bill getting his present job. The charges are so serious that Bill agrees to investigate.

Bill calls John up and says, “What about this hell raiser Sam?” John says, “Well, he’s good technically, but he just doesn’t fit in. He’s managed to alienate most of the staff. He thinks he’s better than the rest of us because he went to Johns Hopkins. I’d like to keep him, but he’s creating real morale problems for us. It’s been particularly bad since he almost lost his first patient and tried to blame the rest of the staff for his mistakes.” I’m afraid it would be best if he left.

Bill says, “John, he says all your staff’s degrees are bogus.” To which John replies, “Not YOU TOO. Bill, when did we ever start to judge competence by the name of the university you graduated from? You know better than that. You talk to the people, interview them, find out what they know. Once in a while, you make a mistake like I did with Sam, but you do the best you can. Sometimes you give someone a break. Remember Mary?”

Bill says, “Yes, I remember Mary. I was always surprised you two didn’t tie the knot. What happened, anyway.” John replied, “Oh, we were quite close until she got that promotion. Then, she seemed to change. I guess we just had different ways of looking at what it takes to get ahead in this world.”

Bill finished with, “I guess you’re right. Gawd save us from the young Turks that think they know it all. Golf still on for Sunday?”

Needless to say, Sam didn’t stay around too long–the hospital did. What SHOULD be said is that Sam had a very difficult time securing another position. He didn’t have too good a reputation as a “team player” at his first job. He also achieved a reputation of thinking he “knew better” than those with many more years of experience than he. It was also said that he didn’t listen too well, that he was “arrogant”. However, far more deadly to his success was his lack of appreciation and support for affirmative action and upward mobility.

This entry was posted on Saturday, November 7th, 2009 at 2:18 am and is filed under Authors, Economics, Politics, Tony Demaio. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.