I broke the news about the failed generator. Our last hope had failed us, and we were now on our own. “Well, we have an extra hour because of the battery,” he started hopefully. “After that…” His voice trailed off. We both knew what he could not put into words. After that, his patient would die within a few minutes. The clock of doom had restarted, and there was barely more than an hour left. I looked down at my shoes. “Let’s talk about your other patients,” I offered. The ones we can save, were the words I did not say.
This was my lowest point of the Sandy experience, the depth of my despair, the moment when all hope was lost. As I have shared previously, the death of a patient from a system defect is just as devastating to a hospital leader as is a fatal error to a responsible physician. It is an indefensible lapse, an unspeakable calamity – a never event. Still, it sometimes happens. On rare occasions, despite our best efforts, our systems betray us and harm our patients. Thus, we must make every conceivable effort to prevent such an occurrence.
But in this case, for the first time in my leadership career, I had an advance warning that a system defect was about to take a life. The institutional gap, lack of electrical power, was evident. The impact on the patient was equally clear – a straight line from input A to outcome B. And the time course was immutable. We were down to the last hour.
In effect, I had a sneak preview of the movie that was about to play out about the unexpected demise of this cardiac patient caught up in a most unfortunate coincidence of timing and bad luck. I knew exactly when the patient would take his last breath, yet I was powerless to stop it. Unable to rewrite the script. Impotent against the irresistible force of fate. Above all else, I was sure of one thing. This patient would not last the night.
From The Ailing Nation, Chapter Nine: Coalescence
Superstorm Sandy was in many ways like every other major weather event our hospital had ever endured. Indeed, we had well-established processes for sheltering in place, serving simultaneously as a hospital for our patients and a hotel for our staff. On the other hand, no other storm had ever knocked out all of our power as well as the fuel supply to our generators, leaving us on the brink of disaster. And this particular patient, dependent on an electric-powered cardiac assist device, would last barely minutes when our generators ran out of fuel. Not to mention all of our other patients who were dependent on life-sustaining electrical equipment. At the time, Sandy was the greatest challenge our hospital had ever faced and it would take the full alignment of all our staff, working in concert, to avert a catastrophic outcome for our patients. Our response to Sandy was a lesson in collaboration that cut across departments, disciplines, and ethnicities, producing a great lesson for national leaders: Coalescence.