Link Roundup!
When talking to the press gets you fired , even after your boss SAID YOU COULD:
Tippen was uncertain whether she wanted to publicly share the story of her firing, but she decided to because she feels increasingly desperate. She lived paycheck-to-paycheck during her two-plus years at the Days Inn, and now, she and her family are living off a recent tax refund check that won’t last past March. Tippen says she’s looking for another job but hasn’t found one yet.
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Part one of this story on an accidental hospital overdose and the technology that made it possible is absolutely gripping, part two should be up today but I am writing this in the past so I can’t link it:
At first, he was perplexed. But then he noticed something that stopped him cold. Six hours earlier, Levitt had given the patient not one Septra pill—a tried-and-true antibiotic used principally for urinary and skin infections — but 38½ of them.
Levitt recalls that moment as the worst of her life. “Wait, look at this Septra dose,” the resident said to her. “This is a huge dose. Oh my God, did you give this dose?”
“Oh my God,” she said. “I did.”
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Sometimes you have the greatest idea, like reading a bunch of threads about mistakes during Broadway shows and the way the actors dealt with them:
Well technically I saw the production in London where the mistake occured, but it was still funny. It was the night after opening night in London of WIW. During the graveyard scene in WIW, where Glyde (Oliver Darley) is lamenting the loss of his wife Laura, he is supposed to be singing to Mr. Farley (Edward Petherbridge). Well, Mr. Darley is singing away, but is singing to an empty wheelchair. Evidently, Mr. Petherbridge managed to miss his cue for the scene. So, while there were some lines for Farley in that section, Glyde was essentially singing to himself with no response from Farley. I was with a group of friends who also managed to get tickets opening night and so had already seen the show once. We began whispering to each other “Where’s Farley?” Of course, the actors went on as if nothing had happened, so another friend who did not attend opening night never realized a big oopsie had just occured. At the end of the scene, the actor who was playing Farley’s assitant/butler whatever, dutifully wheeled the chair off the stage. Rumor had it that Mr. Petherbridge missed his cue cause he fell asleep, but I don’t know if I’d hold much truth to that. Still, I bet someone made sure he didn’t miss another one.
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Have you watched Going Clear yet?? FREE TRAVOLTA, IT IS TOO LATE FOR TOM.
how you got the secrets to a better life when you dont even have the secrets to ending yuckmouth
pic.twitter.com/xif4HWd5Aq
— Tracy Clayton (@brokeymcpoverty)
March 30, 2015
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My all-time favourite book about SNL (I have read every single book and also all cast memoirs and biographies, so) is Dennis Perrin’s Mr. Mike: The Life and Work of Michael O’Donoghue , and it’s now available for the Kindle for FIVE DOLLARS, and it’s really something! I bought it again, bc before it was e-readable I literally gave my hard copy away to the very first person I met after I finished it.
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guys guys guys I went back to the gym yesterday for the first time since I was eight months pregnant, did my trainer’s boot camp, and it was AH-MAH-ZING, my ab muscles are gone like the passenger pigeon but it felt so great and my baby just sat nicely in his carseat under a table so he wouldn’t get hit by an errant medicine ball and watched and i am going again this morning and ughhhhh i love working out so much and jaya and matt are coming to visit me in a few weeks so they had BEST BRING THEIR SNEAKERS no it’s always optional to come to the gym with me, but everyone should experience the relentless positivity of my trainer once in their life
1) I love Edward Petherbridge.
2) I had a toast dream last night – I was reading an open thread and someone had said their mother was auditioning to be a reindeer voice in a cartoon, and as I replied, I thought to myself 'gosh, I've never typed 'good reindeer-voicing luck' before, and I probably never will again'.
That is all.
"good reindeer-voicing luck" — now canon.
I watched Going Clear last night and whoa! I'd read the stuff about Tom Cruise and Nicole Kidman back when it debuted at Sundance, so I thought I knew what I was getting myself into. Nope. I sat there in stunned silence wondering what in the actual fuck did I just watch?!? Free Travolta indeed. I felt so bad for him. That scene where he's on stage w/ the crazy leader and he looks distraught to me (unlike true believer Cruise). Also the part w/ his friend who escaped w/ her baby was heart wrenching. Powerful stuff.
I watched it last night, too! Terrifying. Unsurprising, because that's what cults do, but just the massive amount of awful was incredible. I'd heard bits and pieces of their history, but I'd never seen it all laid out in a coherent timeline before. Gripping and terrifying. Ugh.
Oh man, and the parts about The Hole and how basically everyone was fighting to stay there and be abused? Holy shit, that was just TERRIFYING. And all the people who were going on TV shows and saying that there was no abuse when they had literally just been let out of that place and were going to go back as soon as they finished…
Yes! And also everything about Hubbard, who was a psychotic nightmare person who probably needed serious legitimate help and instead went into hiding and created a bizarre cult. My face during most of the two hours was D:
Oh God, the part where they were reading what his ex-wife said about Hubbard and how he stole their child and what he told her he did to her? I was just watching with my mouth open and horror all over my face.
Yes, I figured he was not a good person, but "psychotic nightmare person" is truly the best description. The guy who took over seemed to be of an equal caliber of crazy. I wonder what will happen when the current leader passes.
That's the part that got me the most. The human brain freaks me out sometimes. If I didn't KNOW it was real, I would have definitely assumed that was lifted from a sci-fi novel. Horrifying.
I really hope one day Nicole will write a tell-all about Tom and their marriage and Scientology.
I would pay a disturbing number of cold, hard American dollars to read that. Or a Katie Holmes tell-all.
I'd really like to know what they have on John Travolta.
I don't have HBO so AS USUAL I had no idea this was already out, but I'm gonna have to see it asap. I read the book last year and was mesmerized/horrified.
Has anyone read Jenna Miscavige's memoir? It's on my near-infinite TBR list but I just haven't gotten to it yet.
I've touted it in comments threads before, but Clark Gregg's first interview on The Nerdist includes an actor's-nightmare story that is deeply, profoundly terrible. Gregg was understudy to Tom Hulce for the Broadway version of "A Few Good Men," but he hadn't been doing it long enough to actually know the role when an unexpected accident took Hulce out of the theater just before the matinee, and what followed was…oof.
The whole thing happening with the Ellen Pao trial is making me feel weird.
I haven't started officially working out since giving birth in December BUT I am high-speed stress walking all around NYC now that I'm back at work and toting my tiny baby girl to daycare, so that kind of counts. I love hearing about Nicole and her baby (your baby? your baby, nicole!) but am simultaneously so jealous that she can hang all day with her munchkin! I wish I was a cool internet writer and gym goer mom like you, grump grump, instead I work in bros-ville just like Ellen Pao and have to witness the plaintive eyes of my child as a door shuts her into daycare forever, boo.
Oh, man, I wish the US treated parents better! You deserve the damn near a YEAR most other countries give out, and we have a follow-up to our FMLA piece coming soon with helpful resources for people who suspect they should get more time away from Bros-Ville..
I know, having to leave her so helpless and dependent on me is breaking my heart. If her daycare providers mistreat her, I'll never know, since she can't communicate, and she can't help herself since she can't even crawl yet. It makes me so anxious.
Can't wait to read the follow-up piece. *waits attentively
Omg the BroadwayWorld thread.
On the Australian tour of Mamma Mia, at the Civic Theatre in Auckland, there was a city-wide power outage the night I saw the show.
It happened during the "Thank You for the Music" when Sophie is handing out the room keys to her "dads". There was a massive CLICK sound, followed by the lights going out but then the working lights came on, evidently via a generator.
The superb girl playing Sophie kept singing, even though there was no band under her, barely audible of course, due to no amplification, at which point the actor playing Harry, John O'May (Australian Theatre LEGEND), pretty much told her, "no, just stop."
The show was down for about 30 minutes.
"NO, JUST STOP."
ALSO this reminds me that everyone should read Ted Chapin's awesome book Everything Was Possible: The Birth of the Musical Follies because it's full of fading divas forgetting lyrics at tryouts in Boston, and dancers almost breaking their necks on the raked set, and hissyfits on top of hissyfits. I live for this drama.
Seconded. That book is fascinating.
"But…the show…must go on?"
"No."
After watching Going Clear, I am strangely curious about the requirements an organization has to meet to be classified as a "religion" by the IRS. What are those metrics for evaluation?A pinch of actual belief and a cauldron of crazy. This may be the many many many thetans inhabiting me that are doing the talking, but seriously IRS, pull yerself together. Totes not okay.
This is an interesting story, and it's addressed in the book Going Clear – the IRS did deny tax exempt status, and then gave it back essentially after a barrage of lawsuits that rendered them, the IRS, close to non-functional.
The book is an excellent if an obviously distressing read.
Because I like to torture myself by reading things that make me say, "WHYYYYYYYY" I just bought it. Can't wait.
"Enjoy"! I spent a truly horrified transatlantic flight reading it.
The IRS is actually in a weird spot in the US when it comes to religions, because we legally can't really decide which things "count" as a religion and which things don't; we don't have (or anyway we're not supposed to have), like, theological or philosophical criteria. Basically, the rules are that you have to call yourself a religion, and you can't be structured like an ordinary for-profit business (i.e., with ownership or shares or anything), and then the IRS sort of wings it, taking into consideration things like how many adherents you have and community service things and like that.
And with Scientology, as AVincennes says, they did cut them off at first (I expect probably because of the marketing for Ron Hubbards books; it's not strictly against the tax laws for the head of the church to receive an exorbitant salary, as long as its roughly as exorbitant as every other church head's salary), but then turned around after all the lawsuits, which they're able to do because of how flexible the laws are.
here by "we" I mean Americans, I do not mean to imply that I work for the IRS.
I knew a guy whose family had started a religion as a tax shelter (he was appointed a bishop, I think). From what I remember, the basic criteria for filing with the IRS were that you have a some kind of formal set of beliefs, you had to have a place of worship (not just your house), and you had to have regular gatherings of followers. So they would throw a party a couple times a year, give a speech, and that was that.
Speaking as a true red-blooded American, I'd happily give tax-exempt status to that guy over the Scientologists. Parties and speeches are infinitely preferable to mind control and taking all people's money.
An example of excellent humaning can be found here.
I'm flying on Friday and I am truly terrified. I know it's irrational, right? It's safer than being on a highway, but still. It will be just me and my two children and we're taking two flights to get to Florida. I would totally xanax it, but I can't and be responsible for them. Same goes for drinking. Anyway, this link was nice. Thanks.
That BroadwayWorld thread takes a daaark turn when someone brings up the list of all the people who have died during an onstage performance.
Yep, really wasn't ready for that this morning!
Did not click. :(
Best Broadway Mistake: I saw James Corden in One Man, Two Guvnors in 2012. It's a very silly, 4th-wall-breaking, interactive show, and I had a wonderful time. But this particular performance, the angry ghost of Thespis was not on the actors' side.
One of the running gags of the first act is that Corden's character is starving and nobody will feed him. He eventually started begging the audience for a sandwich and… well, someone gave him a sandwich. He wasn't sure how to respond to this, as eating it would take away his character's motivation for the remainder of the act, so he laughed and needled the audience member, then gave it to other actors on stage who ate it happily while continuing with the show.
Later, Corden is making a huge mess in the second act with a table full of prop food, and pieces of a rubber chicken went flying and fell down into the pit with stage lights at the edge of the stage. Corden needed the chicken for the next scene, and also "I'm afraid it will melt!" so he got down on his tummy and spent a few minutes fishing it out again.
Luckily it all just made the show funnier, and Corden was a good sport about everything.
I also saw Rent when it first opened on the West End in 1998 or so (with most of the original cast!) I got cheap student tickets which put me in the first or second row, craning up at the stage, but it was fun anyway. So there's a scene where Mimi decides No To Drugs and throws her drugs away. Well, I don't know what happened to her aim, but she power-threw them right at me, and her little bag of drugs smacked me right in the face. The actress looked at me in horror, and I mouthed "I'm fine" and she kept going. I kept the bag of fake drugs and pasted them in my scrapbook for the trip.
I'm a big theater-attendee but I mostly see non-musicals. I've seen a few goofs in those as well, though I think there are less opportunities for massive mistakes. Lots of muddled lines and accidentally elbowing other actors, etc. But here is a more dramatic story:
A few years ago Veanne Cox (who does a lot of DC theater, and I adore her) was in a great production of Twelfth Night at Shakespeare Theater Company that I saw a couple of times because I liked it so much. She played Olivia and wore the same dress in each scene, but in a different color (black = mourning, then getting lighter and brighter each scene until she is in white for her wedding.) It was a voluminous and long ball gown, and in the scene where she is in white proposing to Sebastian, she came running out and tripped over her hem, which threw her ass over teakettle. I mean, she wiped out. I saw her underwear. It looked painful as hell. The actor playing Sebastian ran and helped her up, but she looked like she was not doing so good. They made it through the rest of the scene, but I really doubted she'd come back for her final scene. She did, though, and carried it with grace. A total professional.
This is not technically Broadway, but I saw the Royal Shakespeare Company do The Comedy of Errors in about 2000 and Antipholus flubbed a fast paced exchange with Dromio and very charmingly ad-libbed "no, wait that's not right. I shall start again!"
Which was just a mildly pleasant memory until an actor with a familiar voice turned up on one of my favorite TV shows years later and RSC cast lists verified that Antipholus was none other than David Tennant.
Hey that's cool! I am very into the Arkangel audio series of Shakespeare's plays, and the one I have for Comedy of Errors has David Tennant as Antipholus. I wonder if it was that RSC cast you saw that did the whole thing?
Possibly? I honestly don't remember anything else about the cast other than Tennant (who I only remembered because of the flub and my favorite college professor – it was a study abroad trip- remarking how she found him attractive). But I think when I looked the cast list up there was only that one production of Comedy of Errors while Tennant was with the RSC.
I just saw One Man, Two Guvnors this year (although nowhere near Broadway), and the same sandwich thing happened! I think it might actually be in the script to have a plant in the audience with a sandwich.
….oooooor it could be a very bizarre coincidence and people regularly bring sandwiches into theatres with them.
So, did you KNOW!
That during the drought in California, the Nestle company can still take 80million gallons of water a year out of the Sacramento aquifer at the same cost as consumers pay for water in their tap?
That sounds pretty terrible to me!
http://www.dailykos.com/story/2015/03/27/1373887/ …
I would boycott Nestle, except that I've been boycotting Nestle ever since Dan Le Sac Vs Scroobius Pip's "Thou Shalt Always Kill."
Do you spell the word phoenix pheonix, regardless of what the Oxford English Dictionary tells you?
obviously
Some people are just nice.
The Nestle CEO has famously decreed that access to affordable clean water is not a basic human right, but obviously he'll take the wet stuff at wholesale to turn around and sell it at 4 or 5x profit.
(The longer I hang out in the corporate world, the less I like it.)
He's “officially” turned around on that after the backlash, but 100% bullshit that he's actually changed his mind and isn't just saying that so people won't boycott Nestle, because you don't get to be hte head of Nestle without also being some kind of fucking sociopath.
CEOs of US companies are LEGALLY REQUIRED to do whatever makes profit. Whatever it takes, or else they can be removed.
Not that he isn't a sociopath, but it's a good thing to keep in mind when the mind is boggling about what companies do in the name of profits.
The horrible thing is, it's not just Nestle. Arrowhead, Dasani, Aquafina and Crystal Geyser all get most of their water out of California. http://www.motherjones.com/environment/2014/08/bo …
this make me feel a lot better about being too cheap to pay for bottled water
It's not Broadway, but about two years ago, my parents got us tickets to go see Dreamgirls at the Signature theater in DC. We always went to go see a show at Christmas, and the woman playing Effie had been getting rave reviews. Well, they got us tickets to the Sunday matinee, and the understudy for Effie went on.
And she couldn't sing.
I don't know if she was sick or what, but the woman literally could not hold a note. As Effie White. In Dreamgirls. Her performance of "I Am Telling You" was actually physically uncomfortable. And the worst part was that obviously all the other actors knew it and they were getting PISSED AS HELL. Like, they were really, really angry, especially because she kept flubbing lines. My whole family was baffled and spent the whole ride home theorizing as to how you can possibly cast someone who can't sing to play Effie, and how there could literally have been no other option if she was in fact sick.
tl;dr saw a production of Dreamgirls where Deena was actually a better singer than Effie and the rest of the cast was Not Happy.
I saw a production of The Crucible once where the actress playing Abigail couldn't . . . well, act. It was pretty cringeworthy, watching her try and fail to threaten the other girls onstage, and they were all quaking and begging her not to hurt them, and everyone in the audience was like ". . . really? You're scared of her ?"
I've seen a LOT of bad acting in my time- in high school I used to review other high schools' shows- but the worst I ever saw was a production of The Three Musketeers where everything was period (dress, scenery, props etc.) except that the students had decided that it would be HILARIOUS to randomly throw in Anchorman quotes (this was in 2005 when quoting Anchorman was still a big thing). No joke. It was the second worst thing I have ever seen (the first was a truly awful original one act that was such a fiasco I almost feel bad talking about it).
I was in a production of Romeo and Juliet just after high school, and it became a running gag in the cast to try and force "what ho!" into every line we could. In our defense, we could not possibly have made the production any less low-budget and badly-directed than it already was.
Re: Scientology – I read this article (reprint) in the Walrus with my morning toast.
http://thewalrus.ca/scientology-attacks/
The guy who runs that hotel in Arkansas is scum. He is a sneak and a liar. It's getting to be like the bad old days out there, and even when a minimum wage hike does happen, a shit ton of Americans who are middle class or even low wage workers have imbibed the Koolaid to the point where they think it's wrong for people to make a living wage. Wtf America. You're so worried about people running us down, but you want us to keep the boots on the necks of those doing the worst. No amount of patriotic jingoistic bullshit is going to magically make this country a better place to live.
/end rant
Keep ranting! The present state of work in America is the number one source of flames on the side of my face. I really, seriously hope that we can keep up the public discussion on the issue, because the fact that our economy is built on the backs of millions of people who can be treated like dirt, who live with no job security, no benefits, no schedule, and no rights to protect them from scumbag employers like this, is fucking shameful and ought to be treated as a national scandal.
/vigorous nodding
I hope y'all are showing up to the 4/15 event in your city!! I am SO EXCITED for mine in the twin cities.
So, I was pretty excited about Trevor Noah but then I saw this:
http://www.pajiba.com/trade_news/about-those-prob …
and that led me to this:
http://pjmedia.com/tatler/2015/03/30/does-jon-ste …
And now I just kinda want to burn everything down. This is why we can't have nice things.
Oh that's just gross AND really lazy comedy.
Oof. I'd hope him going to a pro-Palestine rally wouldn't disqualify him from the job, but the "don't go down easy, just like jewish chicks?" EUGH.
I'm disappointed they didn't name a woman to take Jon Stewart's place :(
Not best impressed with Comedy Central's response either.
Comedy Central offered its support to Mr. Noah in a statement on Tuesday afternoon.
“Like many comedians, Trevor Noah pushes boundaries; he is provocative and spares no one, himself included,” the network said in its statement. The statement continued: “To judge him or his comedy based on a handful of jokes is unfair. Trevor is a talented comedian with a bright future at Comedy Central.”
I don't think it's exactly fair to judge a comedian on a selection of twitter posts. Twitter is meant to be a forum for trying jokes out, sometimes they work, sometimes they're terrible. Not everything will be gold. All of the comedians I follows turn out duds every once in a while and sometimes these duds are offensive. In fact comedians and writers I'm sure we all know and love have written things on twitter that offended multiple people and sometimes have even refused to apologize because they didn't find them to be as offensive as they were read to be.
All of this is to say that those jokes were terrible (both unfunny and offensive) but I don't think you can write him off entirely for that. He, as far as I know, doesn't seem to have incorporated those jokes into his stand-up routine, and there is no indication that making fun of women will be the core of his hosting gig. People aren't perfect, and are especially not perfect on a forum like twitter where there is a pressure to be funny all the time on a variety of topics.
ETA: I am not super familiar with Trevor Noah's work, so there's a chance I'm totally wrong and he is a raging misogynist in his act. If so, I apologize.
I've been following Trevor since maybe 2010 and his routines aren't 100% Free From Isms, but it does seem like it's worse on Twitter (who isn't, really). I do think I give him the benefit of the doubt sometimes just because I get the impression that there weren't a lot of older comedians around for him to learn from and you can tell that a lot of his earlier acts were pretty flying-by-the-seat-of-his-pants deals. I'm sure he will screw up in this new gig, but he really does have a lot of unique things to say and I hope he gets the chance to learn.
Just this last Christmas I witnessed an excellent stage recovery in a ballet. Went to an excellent performance of the Nutcracker. Everything going well, everyone landing their turns, etc. Get to the snowflake dance right before intermission. The snowflakes are all coming out for their first cue and the back row is supposed to slide into position and stop on a dime. Well, one poor back row snowflake slides in all right, and then keeps going and lands with a huge SMACK right on her side. I was sitting fairly far back and was shocked at just how loud a smack it was. And yet, like, half a second after she landed she managed to get right back up and on beat. In the second act, that same corps group came back out for a fairy routine and you could tell she was DETERMINED this time because she not only landed every step in the routine, but she was on fire with it. Massive applause. Gotta love a great recovery.
I really want to see part 2 of the overdosing article–I don't know what a dosage that high would do to anyone, but I really hope the 16-year old makes it through in the end (does the article indicate in part 1? I couldn't tell).
Also, in full disclosure: I work at Epic (the EHR used at UCSF, and they call it out specifically about halfway through the article), and I really don't understand the author's perspective so far in removing all accountability from the various HUMAN checks in place (a resident writes the order, which one would assumed would then be reviewed by the supervising physician, as well as the pharmacist, and then nurse administering the med) to blame the EHR in place–how could no one question a dose 38.5 TIMES the recommended amount? The computer doesn't administer the medication itself….
I agree! I am a pharmacist who works on the inpatient side of a hospital and I really want to know where the person who approved this was. I've used that system at a previous hospital and if I recall correctly there was still a human who had to approve it. Not to vilify; we all make mistakes and root cause analysis should be looked at to see how this happened to stop it from happening again.
The other thing that I'm not sure the article is saying well is that it's actually not unheard of for, say, an adult to get 193 mg of trimethoprim in a day; for severe infections we'll give doses of 15 to 20 mg/kg over the course of the day – usually 5 mg/kg every 6 or 8 hours.
The article says he was given 38.5 pills, which is 6160 mg of trimethoprim if I've done my math right.
It's also his weight in kilograms, which presumably is part of how the error happened. Though the screenshot certainly makes everything look ok to me, so either there was an error in the software or the UI is seriously flawed.
(I'm a computer programmer who sometimes does a little UI design, so I'm more interested in how the computer system screwed up than how the people who used it screwed up.)
I also have been scrutinizing that screenshot and am wondering where the error was triggered, because the bottom of the screenshot even says "administer amount: 1 tablet." My current guess is that there's something in how the dispensing algorithm was calculated – and I think you are likely to be right about where something got transposed.
Guess I'll be watching the site for part 2.
Maybe they've changed the screenshot? The one on Part 1 currently says "Dispense: 39 tablet" at the bottom (due to the 160 mg/kg vs. 160 mg total error).
That's in part two, which wasn't up before. The one in part one definitely says one tablet, because it's from before the doctor was forced to re-enter the order.
Having now read part 2, I guess the good news is that it wasn't an underlying programming error (which does make sense, because otherwise one would expect a lot more misfires), but WOW, the user interface design could be seriously improved there.
The alert problem is a hideous one, all across healthcare. Tailoring the right sensitivity and specificity for alerts is mind-numbing to begin with, multiplied by the sheer volume of them.
Agreed! I do think that expecting the hospitals to solve the alert problem through hundreds of settings is not a great approach, though.
Also agreed! Now we just need to find a better way….
You're right, and you were right in the math about what was administered – I was looking at that first screenshot when I commented and was also confused about what actually happened.
I practice mainly in an ICU environment and I can confirm that alert fatigue happens. Part of my job entails verifying orders physicians have put into the system before they're sent to the physical pharmacy for processing. More than half on a daily basis flag with a computer detected 'error' that actually isn't an error, like drug interactions that are more theoretical than clinically relevant and it's exhausting trying to keep up with the massive amounts of orders and flags that come up.
My curiosity about the pharmacist involved wasn't intended as looking for a source of blame, but more understanding what lined up to go wrong. Medication errors are scary and we work to practice a culture of looking for the cause of the mistake instead of blaming the human piece that failed; but we all want to try and understand where a different reaction could have caught something.
For example, should there be maximum dose limits set in the system, so that doses several times higher than the published maximum are grayed out? UCSF decided not to set such limits. The reasoning at the time was that, in a teaching hospital with lots of patients with rare diseases, many of them on research protocols, such “overdoses” would usually be okay. A system with hundreds of “hard stops” would lead to many angry phone calls from frustrated doctors to pharmacists, demanding that they override the block.
I hope they reconsider that decision. I would think you could put in the capacity for a doctor to override a system limitation manually if it was really needed.
However, it sounds like that might not have affected the outcome here. I'm a software tester. Many tests these days are automated, meaning someone writes code to check the performance of other code. But what happens if the test was coded incorrectly and indicates Pass when it actually should have failed? Recording the actual underlying behavior of the system, and getting A Human to check some of those actual results, is the only way to know.
The equivalent of not having a human doing some manual verification of results is apparently what happened in the article: medical practitioner thought she ordered one double strength Septra, but the system apparently did something else entirely, silently and without warning.
Since tablets were ordered, though, someone had to administer them. I'm with Lins in wondering about that aspect of this story, but it's amazing how often people will follow through on a direction because The System Said It Was Correct. I'll assume that those details are available in part 2, which does not appear to be up yet.
I'll also recommend Nicholas Carr's wonderful book "The Glass Cage," which is about the possible and myriad consequences of automating everything in sight. Carr correctly notes the many upsides of automation, as does the Medium article: sounds like error rates are way down on the whole. But boy, when errors do occur, they are whoppers.
This was the sense I got from part 1- overall errors are down- the previous 1 in 5 incorrect doses, but the ones that happen now are much much worse?
That's a really good point. Parts of this article got my hackles up a bit because they seemed to be saying "soulless machines are in our medicine!!" rather than "terrible user interface designs are in our medicine" or "machines are doing what we *say* we do instead of what we *actually* do" (both of which are reasons that digital systems are often more 'heartless' than human systems, but both of which can actually just be… coded better) — but I suspect you're right that a big part of the problem is also that, when things inevitably do go wrong, even though the errors are less common, they will be the kinds of errors a human wouldn't make on their own, so they'd be really big and really stupid-looking from the outside. And in medicine, that also means they're heartbreakingly, pointlessly dangerous.
I think part 2 is up now and it seems to be quite focused on 'terrible interfaces are in our medicine' as well as issues with human checking like interruptions, frantic workplaces and alert fatigue.
I'm not in medicine but I am in IT. We often find that people have very misinformed expectations of what technology is capable of. It is great, and can make things better, but there are still a lot of problems that have to be solved behaviorally or via policy, and trying to solve those issues purely with technological fixes is only leads to problems (especially when it does not work as expected).
Thus far I don't read that the author is holding anyone accountable (at least based on my own interpretation, which may have been compromised by my being on the edge of my seat while reading it), though I wonder if they can keep that up once the Rube Goldberg machine reaches the person who actually gave the 38.5 pills.
As a software dev with a keen interest in UX, I cannot wait for part 2. What went wrong? What steps could have been implemented to mitigate situations like this? The interactions between humans and computers are fascinating to me. :D
As a nurse, I also cannot wait. I'm quite familiar with snags in eMARs, but I cannot IMAGINE being the nurse who was like, "ok, I'm taking 38 pills out of the PYXIS (the computerized med cabinet)…now I'm scanning 38 pills…now I'm peeling EACH DAMN ONE out of its little blister pack…now I'm giving them all at once to a teenager" without questioning anything or looking anything up!
I'm also a nurse, and as much as we rely on the EMR to help catch errors, it is also our responsibility to be alert and aware of what we are doing. I cannot imagine peeling 38 pills out of their cases, an antibiotic no less, and not stopping to question what the hell was going on.
This is exactly my question–part two was released, indicating a machine also dispensed the pills, but who actually ADMINISTERED 38 tablets without pause or question??
Yeah, the thing I wonder about is the tech who is giving this kid 38 1/2 pills – I can understand not catching the physical size if you're pouring out a liquid dose, but the sheer absurdity of counting out that many of the same tablets has to strike at some point!
Errgghhh, my 6-week PP check is Friday and I'm surely going to be cleared for exercise and sex but I despair of ever finding the time for either ever again. How, when there is always a baby or toddler on me?? And having two kids is bush-league stuff, really. My grandmothers were just getting started with two!
Yup – I hear you and sympathize! the only useful advice I got was to NOT do other things. to the extent that you can, take the time you need.
Personal favorite fuckups that have happened in performances I've done:
– Someone set a car on fire in the parking lot next to the auditorium during a production of Into The Woods in high school. We did not have an adult to deal with the situation so my bright idea was to get everyone off stage IN CHARACTER as the witch while someone else tried to evacuate the 700-something person audience before something exploded.
– I did an adaptation of The Cyclops in college set in a frat house. I was the Cyclops. During the scene where I was blind, Odysseus would say something and I was supposed to chase him. One performance, he thought it would be funny to stand in the audience for part of that scene, so when I ran toward him I ran straight into the lap of some poor dude in the first row.
– During a production of Romeo & Juliet, I was supposed to kill myself with Romeo's knife, but I couldn't find Romeo's knife. I just pretended to stab myself.
– I did a production of Macbeth in the same tour as the aforementioned Romeo & Juliet. These were touring productions that we performed at 80-something schools, so every day we were in a new performance space and had to adapt. This particular show was in a cafetorium right after lunch so we had almost no time to set up or figure out the space. The guy playing Banquo, who was an asshole, decided he wanted to enter for the ghost banquet scene through the center of the back curtain, which was only about a foot away from the back wall. We told him this was a bad idea, but again, he was an asshole. When we get to that scene, Banquo was supposed to enter, but… he didn't. So we turn around and we see him trying desperately to find the break in the curtain. It took an embarrassingly long time. When he finally entered, Macbeth was so thrown off that he couldn't say his line (which was something to the effect of "holy shit there's a ghost in here!) but instead just pointed violently and made alarmed noises. And actually, I don't think we totally recovered from that. I just said the next line completely out of context.
– I wasn't in this show (and I didn't even see it) but there was a production of King Lear at my college and the guy playing Gloucester wanted his blindness to be super realistic so they blindfolded him so he couldn't see at all. In the scene where Edgar leads him to the edge of the cliff (that's supposed to be flat ground) the actor brought Gloucester waaaay too close to the edge of the platform, so when he jumped (and was supposed to land on the flat ground) he actually fell like 8 feet off the platform. Apparently, it made Edgar's concern VERY REALISTIC.
Re: car on fire, that's some dedication to your craft, right there.
Nicole, I am the sourest of sour-pusses when I go to the gym. I glare at anybody who looks at me twice. But I am also getting bored with my workout routine and would like to go to a trainer to get some new ideas. Here is the rub, I don't want to have to be friends with the trainer during or afterwards. Is this possible? Can I ask someone to not be super positive and happy and friendly with me?
I think your first goal is to find a good trainer, because that's not at all a given! Finding someone who can get on the same page with you as your exercise goals and not harass you about stuff you don't want them to (like how many candy bars you're eating) is the first step. Then you can worry about how to adjust their personality/attitude during the workout.
Yep, finding a good trainer first who is not OBVIOUSLY a bubbly sort, and then, generally-speaking, people who are client-facing are usually pretty good at mirroring you and taking their social/unsocial cues accordingly. If you are cordial but all-business and also "it's hard for me to carve out time to work out, so don't think I'm being rude if I jet out the door as soon as we're finished!"
At a regional theatre I used to work at there was a "dummy box" given out every year to the actor who made the goofiest/most obvious mistake the previous season. It was a pretty delightful treasure trove of egregious line failures, costume changes made entire scenes too early, and forgetting major props. The best was when you could immediately tell it was a dummy box moment as it was happening – like the time the guy playing Georg in 'She Loves Me' forgot the ice cream that inspires the song called… "Ice Cream".
One that wasn't dummy box status but was uproarious nonetheless – the guy playing Laertes in 'Hamlet' leaping into Ophelia's grave and letting out a fart loud enough that even we in the booth could hear it.
Shakespeare would have given that guy a standing ovation.
One of my favorite theater moments was at the Globe in London during a production of Macbeth. During the dinner scene when Banquo's ghost appears, a pigeon flew down onto the stage. The actor playing Macbeth then directed his "Avaunt! And quit my sight!" speech to the pigeon. It was glorious.
That cliffhanger on The Overdose! A math cliffhanger!
Part Two of The Overdose is up!
And of course there's a part three.
From my perspective on the computer end of the world, it looks like the thing that would have helped the most is if Epic did a lot more work to determine what the best settings are for things like when to show alerts and to make those best settings into hard-to-override defaults.
Of course, that would also add a lot to the cost, and there's the risk that Epic would be blamed if something bad happened that would have been flagged by an alert that Epic decided not to show. But the risk is still there, it's just that now it's being taken by the hospital rather than Epic, and the hospital doesn't have the expertise with this sort of system when they're first setting it up to get everything right. And even if they were experts on a type of system they'd never used, having hundreds of settings makes it likely that there'll be a mistake or a poor judgement on at least one of them.
It would also help if Epic provided guidance on policies – if the policy had been to ask the doctor to reconfirm the order, rather than to re-enter it, then this specific incident would have been prevented. Again, I think Epic would be in the best position to research what policies are best and to then provide that information to hospitals putting in their system.
The article is a bit misleading though–Epic does not make these decisions outright. The hospital makes the decisions, and Epic (and the hospital IT team) builds the system to their specifications–the entire process takes months/years (depending on the organization) and requires many, many discussions with physicians, CMIOs, and others (for medication alerts, as well as other clinical alerts). These decisions are not made in isolation, and are NOT made by the software vendor themselves. As for guidance on policy and best practices–this is something Epic provides in the course of making these decisions (because, you're right, hospitals don't always understand what they are/aren't asking for/agreeing to if they aren't familiar with the system), but ultimately here–at least based on parts 1 and 2–I don't think it's fair to blame Epic or alert fatigue. At the end of the day, no software system can prevent human error (it can try to minimize it, not entirely eliminate it). [Background: Epic employee]
Also, whatever policy is in place, I am sure it would require picking up the phone and making a call, rather than sending a (shorthand) text message–and then, overriding all alerts instead of addressing them–so whatever the policy is, there was a breakdown in execution here, as it was.
And it still doesn't account for why a person actually administering 38 pills of a single drug (and a pretty common drug, at that, according to part 1) without any question.
Obviously it's easy for me to say that Epic should do things differently, from way over here, based on one article. I'm sure they/you do as much as is reasonable given the real world constraints of time and budget and so on. But although the software isn't solely to blame, it does sound like a contributing factor.
You're probably right about the policy not being followed correctly, but it does seem that re-entering the dose was required by the policy, and that's where the mistake came in – in part, it sounds like, because the doctor had to replace the entry they made while they were focused on the patient and the patient's medications with one made while they had moved on to other things that had their attention. So I do think the policy sounds flawed.
As for alert fatigue, the final mistakes don't seem to have had alerts that were ignored, but that's because the alerts had been turned off. And the reason for turning off alerts was a fear of alert fatigue. If the software were better at avoiding meaningless alerts, that might not have happened.
Of course Epic isn't solely to blame for the alert fatigue, because it's partly the hospital that decides which alerts to keep. But Epic appears to be in a better position to possibly fix alert fatigue.
It has been a while since I worked for Epic, but I was on the app that runs med orders and alert fatigue was always a big concern for us. There was once an idea to have our staff pharmacists run through the individual alerts and try to do some better personalization/hierarchy building so that individual customers didn't have to do it. (They will never be able to deal with it on their own – there are tens of thousands of alerts imported into the system by the FDB/Medispan database, a load no hospital will ever even try to tackle.) My understanding is that the kibosh got put on this idea because releasing or altering clinical content would have subjected Epic to regulation by the FDA.
I think a third party vendor that was willing to take on the regulatory challenges could make bank by specifically focusing on alert modification in hospitals. But I think that would have to be that company's only job. It's an insane amount of data and requires very expensive trained clinical staff to assess properly. I don't think Epic will ever have the bandwidth to tackle it in a way that does it justice.
Ooh, yeah, I can definitely see how trying to avoid that regulatory issue would tie Epic's hands. That sucks, because like you said, there's no way a hospital could properly tackle the issue. And on the other hand, it does make sense to not allow that sort of stuff without some kind of regulatory oversight.
Thank you for the background information! Having been a patient who has seen some of these UCSF computer changes, this fascinates me.
The insane thing is that the person most likely to exhibit common sense is the sick, teenage patient who might have been able to comment, "Wow, I usually only take one of these. 39 is a lot!"
That's not a reasonable expectation for the patient but it's a sadly necessary one.
You are the best. <3
Noooo I have to wait until tomorrow to find out how everyone decided giving him 39 PILLS seemed like a good idea? I mean, I am admittedly no expert on the subject, and I know I've taken like, 10 of the same pills at once at the minor emergency clinic when they didn't have any with higher doses, but I am very interested to see how the pills actually got administered; 38 is SO MANY.
I agree. This is the detail that I'm hung up on. At one point a nurse had to physically give him pills, right? and think "Wow this is a lot of pills, a crazy big amount of pills. Maybe it's too much?"
There are a lot of reasons this could not have been actively questioned – a big part of medical culture that's trying to shift is the physician at the top pyramid and people in charge who have a 'my word is law' attitude. If that particular nurse had asked questions of people above her before about things like that and gotten completely shut down and shamed, she may have been reluctant to ask again when something looked wrong.
There's also the problem of trusting too much in the computer system, something we're all guilty of at times.
Yeah, that part I suspect is going to come down to trusting the computer and the system — if you know your computerized prescription system requires doctors to confirm multiple times that the dose they've put in is correct, and then requires the pharmacists to check with the doctors if it doesn't make sense to them, and the dose you're holding seems weird to you but you KNOW it's gone through that system so it must have been checked out and approved by the doctor and the pharmacist…
Part one says that the patient was taking on about 15 different medications. And part two says that the typical patient there has 10 to 15 medications. So they might be used to big numbers of pills. It seems like 38 would still be more than usual, but it might not register as a crazy big amount.
I had the same reaction when I got to the end of part 2. Like, "noooooooo tell me more 39 pills is still so many!"
THERE'S A PART THREE????
I didn't have a chance to watch Going Clear yet. Hopefully tonight!
I would pay so many dollars just to hear Tom Cruise's auditing tapes. Tom Cruise is fascinating to me. I want to know all his scientology secrets. Edward Snowden, where are you when I need you? Get us those secrets.
Just want to say that my boyfriend was raised a Scientologist; his parents met in the SeaOrg. We still get so many scientology pamphlets in the mail.
IT IS WEIRD.
*adds "go to the gym with Nicole" to list of things to do before death*
I'm pretty sure I've seen posts from The Toast's other two founders sayin "Nicole took me to the gym and now I'm dead."
ahhhhh why would you post part 1 of a story when we can't read the rest yet why
part 2 is up
but part 3 isn't up until tomorrow
Now I'm dying to know what happened… :(
That hospital overdose story is gripping, but I'm afraid this line throws the author's credibilty into question: "The computer symbol for swearing, #$@&%*!, was chosen because it’s the output when you’re trying to type numbers but you’ve inadvertently engaged the caps lock key."
1. On no keyboard that I have ever used does the caps lock key also lock the number row into swear-symbol mode. Try it: 449J4FJFE4JRE9J84983JG3P94G8J04JF40K. Nope.
2. A tiny bit of Internet research shows that this way of expressing swearing has existed since at least 1902: http://www.slate.com/blogs/lexicon_valley/2013/10 …
i have a german keyboard at work (I'm in the UK) and the capslock locks the number row on it. So maybe Europe?
They weren't typing on computers in 1902, they were using typewriters, where caps lock WOULD cause the numbers to shift as well as letters.
Fair enough, but he alluded to computers in the quote, and even if he meant typewriters, that still sets off my folk-etymology bull$#!t-o-meter. I can't find anything supporting this hypothesis on any reliable linguistics page (Language Log's posts on the subject say it was likely invented by comic strip writers: http://languagelog.ldc.upenn.edu/nll/?p=2457 ). Note also that one of the symbols used in the 1902 strip on the page I linked to was an anchor – not anything you'd find on a typewriter key.
…And the author has now removed that reference, so apparently it set off some other people's bull$#!t-o-meters as well.
The good news is that Part Three of The Overdose is up.
The bad news is that although I haven't read it yet, I have scrolled down to see if there is a Part Four, and there totally is.