When Something Breaks

I'm sitting in a hospital cardio unit right now waiting for an MRI to see if there is some underlying reason my heart is behaving like a 3 year old string of cheap Christmas lights or if it's just random 2020 foo. It's more than a bit scary that everyone from my best friend to every nurse on the floor here through to my cardiologist all agree that I must not leave the range of the telemetry. It's oddly reassuring that other than ensuring I don't go out of the range of the jumper cables, no one really is paying me the slightest attention. Such is the way when the problem is a random electrical switch going bad.

The experience is making me think about expertise and 'latency'. My cardio pointed out that doctors, nurses and their families are frequently the ones who take the longest to come in to get a diagnosis. The problem is that these are all people who know too much. I've experienced a wide range of symptoms since mid-March which in hindsight seem pretty obviously related to a progressively gimpier heart and ... quite simply... lack of oxygen to the brain. Tight chest with pain and difficulty breathing? Must be a panic attack, I mean after all it's 2020 and I'm in my basement in isolation after flying home next to a covid patient. Hard out case of the sads? Obviously lack of work and focus and seriously people who isn't depressed this year? Tiredness? Get out more, eat better, get some exercise. Random dizziness and weakness? well it happens when I have a hot flash so probably something to do with menopause. Each time, we had a really valid reason to dismiss the symptom. We had an excellent explanation and a path forward to resolve it. We knew too much. We might have continued on this path until quite literally my heart stopped for good, but I also have people in my life that didn't have all this back story who took one look at me on the ground and said, "Go to the hospital." Okay. Fair enough. It was a bit melodramatic flopping over in a meeting.

I can't help but wonder if this expertise latency, however, is a concept with broader application. We could think of this as a variation on boil the frog. As conditions change in small ways, we find a way to explain each and every marginal deterioration. This principle can apply equally to any complex system from aircraft to marriages to organisations. Because we believe we understand each change, we do not look any farther. Our confident understanding enables us to granularise a very big problem into many tiny ones, tackling each separately. On the one hand, this feels nimble and adaptive. Rather than dwelling on some intellectually, emotionally or physically overwhelming Big Hairy As Problem, we deal with what we have in front of us and get through the day. On the other hand, by failing to conduct any root cause analysis, new symptoms keep popping up and leave us frantically playing a game of problem child whackamole.

Now I don't want to confuse this with the Rule of Three. The Rule of Three is a sailor's axiom that says if three things go wrong -- even if they are completely unrelated -- drop the hook and don't move. Pilots and doctors know this as a cascade of failure. The idea is that when something goes wrong, we lose confidence, we start to get anxious and make more mistakes. If we don't stop, breathe, and give ourselves space to recover, those mistakes can build and build on one another until the entire system fails. No, what I'm offering is a second type of system collapse. Expertise latency is a failure to identify a root cause because our overweaning confidence that we 'know what is happening' prevents us from really examining and diagnosing an underlying problem until it is potentially too late.

I think we can also safely connect this to the Google studies regarding diversity. Teams which have a high degree of expertise and who are 'super stars' all from a similar background and education are able to form teams and solve problems quickly. However, over the long run, they are inevitably beaten by diverse teams with different backgrounds who take longer to storm and form but can solve more problems of a broader variety and complexity. These diverse teams just have more angles to look at a problem.

Expertise is tremendously valuable. Having DrC and Nurse Carol in my life and being an information omnivore about my own health are inherently good things, not just because DrC and Carol are wonderful people. But in this case, having two young work colleagues who know absolutely nothing about depression, menopause, and healthcare say quite clearly, "Toast, you're broken, go to the hospital" was the extra diversity I needed in my life to avoid a system failure. The problem isn't that I'm a 50 some year old woman struggling in 2020. The problem is both deeper, more significant, and, paradoxically, much easier to fix.

"When solving problems, dig at the roots instead of just hacking at the leaves." ~ Anthony J. D'Angelo