Always sniff the carcass before you say "yes".

Did you ever learn an important lesson from someone that has stayed with you for the rest of your life? I first met Farhad Sholevar in 1990. I had started working at Lehigh Valley Hospital after nearby Easton Hospital decided to close their psychiatric unit, putting me out of a job. LVH offered me a position as an Assistant Nurse Manager on their psychiatric unit.
Dr. Sholevar was one of the attending psychiatrists that I met when I started working there. He was born in Iran and had served in the Shah's army before finishing medical school and emigrating to the United States. He had completed a psychiatric residency and had moved to Allentown to open a practice.
LVH had three distinct psychiatric units (two adult and one adolescent) with a Medical Director for each who was salaried as a part-time employee. The attending psychiatrists were not employees, rather, they had "privileges" meaning they could admit and treat patients, and they made their money by billing the patients they treated. One of the attendings, who is still there, was famous for admitting and "treating" up to 40 patients between the 3 units (we had a total of 54 beds). You can imagine how much quality time he spent with each patient, but they loved him and he managed to rent an apartment in Paris every summer for a month to vacation with his family, and had over 2000 patients in his outpatient practice.
The attendings took turns being "on call" at night. They did not get paid to do so, but it was a requirement for them to take call as part of being credentialed to be on staff. The mental health statute in Pennsylvania was modified in the late 1980's to require that anyone involuntarily committed had to be admitted to a community hospital, rather than a State Hospital. This meant that hospitals having someone sitting in their Emergency Department who required psychiatric admission would need to do a creative job of "selling" the patient to another hospital's psychiatric unit. If a particularly challenging patient was sitting in our own ED, they oftentimes came to us because no one else would take them. It was not unknown for some especially undesirable patients to sit in EDs for several days before some hospital (sometimes quite far away) could be convinced to take them.
The title of this piece comes from a conversation I had with Dr. Sholevar when he was sharing with me his philosophy about screening referrals for admission when he was on call. I'm sure it had it's origins in Iran from his earlier days, but the idea behind it makes eminent sense. When one is faced with an important decision, it is always a good idea to ask questions, to "sniff the carcass" in case things just don't smell right. Sometimes you had to take the patient regardless, but you also sometimes could avoid a train wreck.
So, the next time you are contemplating buying a house or car, moving, taking a new job, getting married, or anything else that's important, don't forget to sniff the carcass first.

Turd Polishing

The title of this piece comes from one of my fellow Psych nurses in New Zealand who was labeling something that was a waste of time. My management training called it "non-value added"; my former attorney called it "mental masturbation." Regardless of what you choose to call it, we have all experienced it.
One of my favorite fictional examples of this is a Monty Python skit entitled "Cheese Shop". In the skit, a man enters a cheese shop and asks the clerk for a particular kind of cheese. The clerk responds that they are out of that kind, and what follows is a back and forth of requests for other types of cheese (Stilton, Colby, Venezuelan Beaver Cheese, etc.) answered by a litany of excuses as to why there isn't any (the van broke down, it gets delivered on Tuesdays, the cat ate it, etc.). Exasperated, the customer finally asks if there is any cheese at all in the shop and is told there is "not a scrap; we're deliberately wasting your time."
All of us have probably been involved in situations where we are in the virtual Cheese Shop having our time wasted (at least from our perspective). That being said, one of the life lessons I learned the hard way is that, if some Vice President has an idea, it's a good idea, no matter how silly you may think it is. If you have worked in a large organization, and you are far from the top of the feeding chain, you have probably experieinced some of these "Cheese Shop" moments, although it was probably not safe to point out your views on the situation.
An example of this from one hopital where I worked was the "Leader Greeter" program. The Chief Operating Officer came up with the idea (it was, of course, a good idea) to have managers and administrators "volunteer" to spend a half hour at the entrance to greet people when they entered from the parking garage. For something like this, you would hope that there would be some measurable outcome or other reason for doing it. Even when my cat licks himself between his legs, he has a reason (because he can). For this one, though, I couldn't see any value. If I was one of the people coming in from the parking garage, I would be thinking "Don't you have anything better to do with your time?" Interestingly, after the COO got fired, Leader Greeter apparently died a quiet death.
Unfortunately for you, unless you are near the top of the ladder in your organization, Turd Polishing is likely to be a normal part of your existance. You may not like it, you may not be able to avoid it, but at least you can reconize it for what it is and value it accordingly.

Lying Pig-Dog Weasels

Mom and Dad taught me not to lie to people. Even though it has limited my career, my integrity is more important to me. While I will never get to be Vice President of anything, knowing that people can and do trust me is much more important.
I remember being told in one of my management training classes long ago that sociopaths or people with sociopathic tendencies often became very successful leaders of profitable corporations. I guess to sometimes be successful, one has to make decisions that sometimes do not favor the individual employee. Many people may remember the CEO of Fletcher Allen Health Care, who was convicted of lying to regulators and was sentenced to a year in prison. I have worked for others who were equally, if not more sleazy; they just didn't get caught.
What these people fail to realize (or don't care about) is that, if they lie to us and we figure it out, we aren't likely to believe anything they say going forward. As a manager of 25+ years, this was an important lesson for me. If I were to lie to my staff, I would have no credibility, and this was something that was unacceptable to me. Think about it. Who would you rather trust: someone who you knew to be honest, or deal with someone who you wouldn't trust if they told you the sky was blue?
Oftentimes, managers may be placed in a position where the actual situation should not or cannot be disclosed for some reason. Face it; we are not always free to speak about everything. Some managers I know have gone the route of shading the truth. My approach has either been to tell you I am not free to speak about the situation, or to tell you "This is what I know as of today." You may not have gotten the true story, but you also weren't lied to.
Many politicians would seem to fall into the category of Those Who Frequently Tell Whoppers. I moved to Vermont from Pennsylvania. While I was in PA, I was amazed at how corrupt a political system could be. When I go back to visit relatives, and read the local newspaper, it is a rare occasion when I don't read about a State Legislator or staffer either being arrested, on trial, or going to jail for corruption. Politics seems to be less about public service and more about how one gets re-elected. Congress has an abysmally low approval rating for a reason: they earned it. I have never voted in my life, and I can't imagine ever doing so. To me, the system is broken, and, even though I can't fix it, I can choose not to participate in enabling it to continue on it's dysfunctional path. My wife tells me I have no right to complain because I don't vote. I feel I have every right to complain because I didn't do anything to make the system continue as it is.
Even though I am destined to go no further in my career than being a middle manager, looking at some of the negative role models in my life, I don't consider that to be a bad thing. Mom and Dad: Thanks for raising me the way you did.

If you want to keep your six-pack cold, put it next to my ex-wife's heart

We all probably have gotten into relationships that, if we had the chance to do over again, would have handled them differently, or perhaps not gotten into them in the first place.  The title of this piece is the title of a Country music song which, when I see it, reminds me of my first wife (I have been married twice so far).
My first wife is one who wants things to be her way, and who does not seem to tolerate disagreement gracefully. I don't recall this being an issue before the wedding, but it definitely became an issue after the wedding, and I eventually left, which she also did not handle well. She is, quite simply, a very angry person.
We had a daughter during the relationship. She is now 30 years old, married, happy and successful, and I am very proud of her.
At the rehearsal for my daughter's wedding, I thought it would be polite and appropriate to be civil with my ex-wife. When I said "hello" to her, and she ignored me, I knew that the passage of time had done nothing to change her attitude. When our daughter was growing up, and we were dealing with visitation, I found that my ex-wife would only talk to me if she wanted something. It appears that this continues today; she has not spoken to me since our daughter was in college about 10 years ago.
To give you an idea of how prickly she can be, my ex-wife has a twin sister. Sometime before my daughter's wedding, the two of them had a disagreement over something. My ex-wife stopped talking to her twin sister, and, as far as I know, has not spoken to her since then (it has been about 5 years). My daughter has ended up being the intermediary between them.
Unfortunately, one can only compromise with someone who is willing to compromise. If he or she is not, your only options are to give in (and be miserable), leave, or get into a fight which will have unpleasant results. I have no interest in doing 25-to-life, so leaving (and having her be angry with me for 30 years) was the best choice.
There are a multitude of coping mechanisms, and I have chosen repression as the primary one I use to deal with my first marriage. If you were to ask me when I got married, what was the church, who was the best man or maid of honor, or how long I was married before the divorce, I couldn't answer any of those questions and am not the least bit distressed that I can't. I also don't have any photos from the wedding. It may or may not be the healthiest way to deal with the situation, but it works for me.
I am not angry with my ex-wife, but I choose not to be like her or to be with someone like her. I have been married for 25 years to a wonderful person, so my life has definitely gone in a better direction.
Of the two of us, I have learned to make better and healthier choices, I am definitely the luckier one.

We may not know where we're going, but we're making good time.

The title is a quote from one of my favorites, Yogi Berra. When I think of this, I often think about the myriad of programs and projects that I have seen over the years that seemed to suffer from a staggering lack of cohesion, thought, or planning, or follow through. I have worked in health care for almost 40 years (I started when I was 16), so I have had plenty of opportunities, some of which will stay with me forever.
One hospital where I worked decided to adopt TQM (Total Quality Management). It is a system developed by a gent named Deming, and revolves around the concept of "Do it right the first time". The idea is that, if you can plan to be efficient and not have to re-do tasks, you can save money in a variety of ways (materials and labor). I took the class,along with throngs of other managers, was given a "Q" pin (which I never took out of the little plastic bag) and we were off. This was back in 1991 and, at that time, the hospital spent $3 million on the training. About a year and a half later, the entire program was quietly dropped. Why? There was no "champion" in leadership, no follow through, no real effort to organize the necessary effort. We basically learned that we couldn't do it right in the first place to save our lives.
Another program (at the same hospital) solicited ideas from employees on how to save money. Each idea was evaluated (you got a flashlight as a thank-you just for submitting an idea) and, if the idea was adopted, the employee who submitted the idea got a check for a percentage of the amount the hospital saved. The program was very popular with the employees, and hundreds of ideas were generated, some of them excellent. Many programs like this one, though, suffer from the Law of Diminishing Returns, where the longer you continue, the less effective it is. Programs such as this probably should have run over a defined period of time and then been discontinued. The hospital leadership, though, when the ideas petered out, decided to make submitting ideas a requirement for managers, and it was reflected on our annual evaluations and tied to any salary increase. Needless to say, my boss was not pleased when I pointed out that creativity is probably better when encouraged rather than mandated, and I learned an important lesson about shutting up.
A final example from this hospital was the famous Employee Satisfaction Survey. The administration decided to do a hospital-wide survey, and launched a huge campaign to communicate it and promote participation. They survey (allegedly anonymous) came to each employee in an individually addressed envelope. Each survey had a number on it (checking with others, I found the numbers were different on each survey, so the idea that it was anonymous began to be suspect). My suspicions were confirmed because, when I did not return the survey, I got an email from my boss right before the deadline reminding me to complete the survey. I realized I needed to return the survey to be politically correct, but I was not inclined to be helpful. Out of 100 questions, I answered 15 or 20, so they would got a returned survey from me, but not one that was statistically valid.
When the results were tallied, the administration withheld them because the feedback was so extremely negative, and they were totally unprepared to address the concerns in a meaningful way. Almost a year later, the results were released quietly, and managers were told to create action plans, few of which they had any authority to carry out. Overall, the survey was a huge flop. A lesson that administration hopefully learned was that, if you really don't want to know what's going on, and you don't intend to fix it, don't go there in the first place.
While not every idea is bad (I have been fortunate to have been involved in many good ones) there are some that should just be killed, but not all are. You have no doubt experienced many yourself from places you have worked, business you have patronized, screwball relatives, etc. The world is full of good judgement and bad and, while you want to escape the bad, sometimes it just isn't going to happen. Let's just hope the good outnumbers the bad. Some days, that's as good as it gets.

He looks dead to me.

I started working in health care when I was in the tenth grade, working as an orderly in the small hospital in the town where I lived in Pennsylvania. I worked after school and weekends and later, when I went to college, it was close enough that I could come home to work every weekend.
I had the opportunity to work with some very colorful people at that hospital, but the most memorable was a surgeon named Dr. Erskine. Although he was in his 60's at the time, one got the impression he was somewhere in his 80's. He had white hair and moved at a pace that reminded one of a turtle who was not in a hurry. Even though he looked like he could have operated on Moses, his mind was razor sharp and he had a great sense of humor. He also was having an ongoing affair with the hospital administrator, who started her career there passing out meal trays to patients and never went to college (but that's a story for another time). Here are two incidents that illustrate what a character he was.
My father and I were both volunteers on the local ambulance. We got called out one night to go to a house in town where the husband had died. Back then, the procedure was to transport the person to the hospital to be pronounced dead by a physician and then take the body to the morgue until the funeral home sent someone to pick up the body.
My father and I lifted the body onto the stretcher, put it on the ambulance, and we drove to the hospital.
I went into the Emergency Department to notify the nurse, who called Dr. Erskine in the On-Call Room. My father and I sat on a bench outside of the Emergency Department to wait. Awhile later, Dr. Erskine shuffled out wearing a lab coat over his green scrubs with his white hair sticking up in all directions and his glasses perched on the end of his nose. My father helped him up into the back of the ambulance where he took a seat on the bench opposite the stretcher.
Usually, when physicians pronounce someone dead, they will check for pulse and respirations, sometimes using a stethoscope or checking for a pulse with their fingers. Dr. Erskine apparently felt no need for any of this. He contemplated the gent on the stretcher for a few moments and announced, "He looks dead to me" after which he got up, walked back into the hospital, and went back to bed.
Another incident was related to me involving Dr. Erskine at the scene of a car accident. Dr. Erskine had been instrumental in developing the training program for Emergency Medical Technicians in Pennsylvania, and one day came upon a car accident on the Pennsylvania Turnpike. There were two cars involved, with at least one person injured. He got out of his car and walked up to the accident to help. As he arrived at one of the cars containing an injured person, he was shoved out of the way by a middle-aged woman who loudly announced, "I studied First Aid, I'll help him." Dr. Erskine stepped back for a few seconds, then quietly approaced the woman, leaned down, and tapped her on the shoulder. "When you get to the part of your book where it says 'call the doctor', I'm right here."
Dr Erskine passed away while I was in college (he died when he was on-call at the hospital). Even though this was over 30 years ago, these are treasured memories for me, and I thank you for letting me share them with you.

Never eat anything you can't lift.

The title of this piece is a quote from Miss Piggy of the Muppets. It came to mind after I made a trip to Costco this past weekend with my wife and daughter. Going through the food section, I continue to be amazed by the size of many of the items that are for sale. Six pounds of ground beef, three pounds of coffee, a gallon of salsa, two hundred garbage bags, seventy-two batteries, thirty dinner rolls in a bag, two pounds of trail mix, five pounds of hot dogs, and the list goes on. I was thinking that if I lived alone, a lot of this stuff would go bad before I finished it. For large families or smaller families with a lot of storage space, it can be economical to buy in bulk, but I also think that we often end up buying much more than we need.
Before I go shopping, I make a list of the things I need so I make sure I don't forget anything. Making a list before you go to Costco is a futile gesture, though, especially if you are accompanied by my wife and daughter. My daughter is home from college for a week and will be returning to Pennsylvania this weekend to do a 3-month internship, living in a rented cottage. As my wife and daughter went through the aisles, they amazingly found so many items that "would be nice to have at the cottage". Soon my original list of 12 items grew to 40+, and the cart was overflowing. While we defintely got some useful items, some of it was definitely "Impulse Shopping". I don't have to file for bankruptcy, but I definitely spent more than I intended. As I told the clerk at the checkout counter, coming in here was like being offered crack. It's a good thing I only go there 2 or 3 times/year.
I love my wife and daughter, and don't begrudge them for the things they picked out, but I'm also sure we would not have bought nearly as much if we had shopped anywhere else. Costco has a great business plan, though, with free samples everywhere, lots of fresh products, and a huge variety. They definitely know how to weaken ones' defenses, but I have no one but myself to blame.
Fortunately, it will be a long time before there will be any need to go back, so I have plenty of time to prepare myself and, when I walk through the door, to remember Miss Piggy's sage advice.