We are finished with the 3-Ringed circus here at MD Anderson and are headed home soon, baring some unforeseen anarchy.  We had a colonoscopy scheduled for this morning at 10AM which was pushed back to 12PM then moved forward to 11-something-er-other.  It was subsequently canceled on the table due to lack of prep.  All the hours of prep wasted and suffering through hunger and indignities in vain.  I’m extremely frustrated with the situation and am struggling not to direct my anger toward any specific person.  So far so good, though.  I think my lack of killing someone is something called “maturity.”  It’s very unsatisfying.

The situation we are in was brought about by a common failure of big business – lack of communication between silos of functionality.  Hospitals, using the types of business structures described in the classic Harvard Business Review article Organization Design: Fashion or Fit?, are a Professional Bureaucracy.  These types of businesses depend on highly skilled workers (doctors and surgeons) who are given a good deal of autonomy and who require a large support staff (nurses, PAs) to keep things moving efficiently.  Each unit may function smoothly internally but cross-silo communication can be a challenge.  If too many experts (doctors), or agents of those experts (nurses), get involved with passing directives to the customer (or patient) then little important nuggets of information tend to get lost, like proper prep requirements for a colonoscopy.

Regardless of the degree of failure of the staff here, I accept the lion’s share of the blame for this fiasco.  This isn’t our first colonoscopy and the needs of GI team are pretty simple.  We really didn’t need the staff to point out what we really already knew needed to be done although their insistence would have helped keep us motivated.  But I didn’t push Maggie to drink all the fluid quickly and so, when midnight rolled around and half the bottle was left, we both agreed that we’d just drink it in the morning.  However, come the morning, the staff told us that we could drink nothing.  The result was that a prep that was inadequate.

In the past Maggie and I have had many disagreements on what amount of procedural prep is overkill.  Well, this time it bit us squarely in the ass, pun intended.  What a waste of suffering, time and energy.  Who knows how much money was tossed down the drain in the process.

Despite the aborted procedure, we at least verified that there didn’t appear to be any further blood in her colon.  That’s good, at least, for that was a major concern.

Maggie’s eating her first meal in 30 hours, breaking her fast.  Once she’s done and if no surprises pop up I will begin aggressively pushing toward getting us out of here and on the road.