Warning: This poem includes intense angst while troubleshooting a recent mishap. Please consider your tastes and headspace before clicking through.
"Responsibility and Accountability"
After the disastrous visit with Shiv,
Dr. Bloch went through the meticulous ritual
of scrubbing his hands and blowing them dry.
Then he retreated into his office.
The wood veneer on the floor and
the soft eggshell color of the walls
made it a comfortable refuge. A vase
full of flowers stood on his desk, sent
by a former inmate who felt that Dr. Bloch
needed more uplifting things in his life.
It was nice to think that he had
done somebody a bit of good.
Dr. Bloch ran a hand over his desk,
the smooth cool surface soothing
under his touch. Then he sat down,
the thick foam and sturdy fabric of
the office chair cradling his tired body.
He felt like they'd had a wrestling match
in the infirmary, instead of just an argument.
He was also keenly aware of how lucky
he was that Shiv respected the principle
of medical neutrality even when provoked.
The boy could have stabbed him
at any time, but hadn't done so.
In fact, Shiv hadn't even touched
anything in the infirmary -- at least,
not that Dr. Bloch noticed -- which was
unusual for him, and perhaps worrisome,
given his established habit of fondling
sharp things with his superpower.
That wasn't something Dr. Bloch
would put in the paperwork, but
it was something he'd remember.
He opened the patient file,
called up the relevant forms,
and began writing his report.
He noted the context of the problem,
the symptoms that Ambrose had
reported and the ones that he had
observed himself, his best guess
at a diagnosis, and the treatment.
He also recorded Shiv's bitter refusal
to contribute anything to the process.
Dr. Bloch was steadfastly honest about
what had gone wrong (almost everything)
and what had gone right (acceptance
of painkillers, and not much else.)
Then he brought out some forms
for patient feedback, including one
with a big blank cloud for adding
further comments, put them into
a file and sent that to Shiv.
Dr. Bloch even attached a note
encouraging Shiv to draw instead of
write in the space, having heard about
the art therapy and Shiv's improvement
in responding to worksheets that way.
The past was past; Dr. Bloch couldn't
go back and fix that wreck of an appointment.
He could, however, offer Shiv a chance
to express his displeasure in healthy ways.
With a little luck, Dr. Bloch might even get
something he could use to prevent
the same thing from recurring.
Not for the first time, he worried
about Shiv's future. The boy hardly
seemed to believe he had one, but
Dr. Bloch was all too familiar with
the challenges of continuity in
health care after release.
Where could Shiv turn after he left prison?
His actions, which ranged from neutral
to downright hostile, implied past mishaps
in medical care with few if any successes.
Shiv hated asking for help, or even accepting
it if offered by someone else, and this incident
had probably just made that worse.
Dr. Bloch looked at his viewscreen and
sighed. There was no point in delaying
the inevitable. He put in Dr. G's number.
On the third ring, Dr. G answered
and the viewscreen showed him in
a handsome office of his own. "What
can I do for you?" he said cheerfully.
"I think we dropped our boy on
his head," Dr. Bloch confessed.
"What happened?" Dr. G said,
leaning forward. "Did he fail
the challenge? I didn't get
a notification for that."
"No, but I think it's related
to that," Dr. Bloch said.
"Give me a minute to flip
the privacy switch," Dr. G said,
and did so. "All right, I'm listening.
Start at the beginning, please."
"You already know the beginning,"
said Dr. Bloch. "You challenged Shiv
to a waiting game. Well, that made him
antsy enough that he mentioned it to
Ambrose, who decided to help Shiv
find a pleasant distraction."
"What kind of distraction?" said Dr. G.
"Ambrose put together a sensory bin full of
plastic pellets and sharp things," said Dr. Bloch.
He realized he was tapping his pen against
his desk, and made himself stop.
"That sounds promising," said Dr. G.
"I chipped in an obsidian scalpel blade,"
said Dr. Bloch. "I keep a set for dealing
with tough guys, sometimes it'll slip through
their defenses without needing the kind of
zetetic gear that I really can't afford."
"Shiv must have loved that,"
Dr. G said with a smile.
"Ambrose indicated that he did,
but then Shiv started showing
migraine symptoms, and Ambrose
brought him to me," said Dr. Bloch.
"I did what I could for Shiv, but he
wanted no part of that, and it
just turned into a disaster."
Dr. Bloch went on to describe
the whole mess, not sparing
anyone's blushes, even his own.
"Was Shiv aggressive?" Dr. G said.
"Did he try to hurt anyone, or even
intimidate them with threats and
belligerent body language?"
"No, quite the opposite," said Dr. Bloch.
"He turtled up and resisted interacting
at all. He answered most questions in
a monotone, if that much. My God, he
can be such a brat when he wants to."
"That sounds like withdrawal,
not brattiness," Dr. G observed.
"He found a puddle on the way here
and dragged his shoes through it,"
said Dr. Bloch. "I never heard
such a racket, and you should
have seen poor Ambrose trying
to hide inside his own sweatshirt."
"All right, squeaking his shoes
was bratty," Dr. G agreed. "As for
the rest of it, compare that to
nonverbal signals of pain."
Dr. Bloch sighed. "I know, I know,"
he said. "That's how we figured out
something was wrong in the first place.
Shiv kept insisting that he was 'fine,'
but he looked miserable."
"The more uncomfortable someone gets,
the harder it becomes to maintain control,
or even basic manners," said Dr. G. "I think
we should be grateful that nobody got injured.
Soup meltdowns can have ... high casualties."
"This wasn't a meltdown," Dr. Bloch said.
He'd seen those. He rated them by how many
mops it took to clean up the mess. He hadn't
even needed one mop for this occasion.
"It sounds like the beginning of one,"
Dr. G said. "Fortunately you let Shiv go
before he completely lost his grip."
Dr. Bloch winced. "Fair point," he said,
"but I can't just ignore the boy's health.
We're obligated to take care of him."
"I think that you and Shiv need
to talk about better ways of meeting
your respective needs," said Dr. G.
"Another round of this is too risky."
"If he'll tolerate that discussion at all,"
Dr. Bloch said. He looked around
at his shelves for some inspiration,
but nothing seemed to help.
"I think Shiv will be more than
willing to complain once he
settles down," Dr. G said.
"He kept saying that he wanted
to be left alone," Dr. Bloch recalled.
"Then give him that now," said Dr. G.
"Better late than never. It'll help."
"I'm worried about him," Dr. Bloch admitted.
"He's usually so alert and active, I hated
to see him all balled up like that. You know
how he has that habit of running his power
over every sharp thing in reach? I'd swear
he didn't touch anything in the room
this time, and I don't know why."
"Hmm," said Dr. G, tenting his hands.
"That is not a very good sign."
"I still don't understand what went
wrong in the first place," Dr. Bloch said,
spreading his hands. "They really were
just playing. What in the world happened?"
"I can't be sure without more information
that we don't have, but I can make
an educated guess," said Dr. G.
"How long was that session?"
"They took a two-hour slot because
Ambrose wanted to distract Shiv for
as long as possible," said Dr. Bloch.
"That would do it," Dr. G said cryptically.
"Have you ever heard of overstrain?"
"It sounds vaguely familiar, but I
can't place it," said Dr. Bloch.
"What does it mean?"
"Superpowers are like any other ability,"
Dr. G explained. "If someone exercises
too hard, they can get muscle cramps.
Use a superpower too hard, or too long,
and you get overstrain -- with symptoms
like a headache similar to migraine."
"But why would that hit him so hard?"
Dr. Bloch wondered. "Shiv isn't new
to his superpower, he's had it for years."
"He has, but think about how he uses it,"
said Dr. G. "One, he attacks people during
a fight, which tends to end very quickly.
Two, he fidgets with it, off and on for
a few minutes. This could easily be
the first sustained effort he's made,
so he didn't realize that it could hurt."
"That could explain it," Dr. Bloch said.
"So what's the treatment for overstrain?
Or was Shiv right, and we should have
just sent him back to his cell for a rest?"
"Treat the symptoms. You can't do anything
for the root cause, they just have to sleep
it off," said Dr. G. "But you know how
ordinary painkillers barely take the edge
off a migraine? The same is true even
for migraine medication with overstrain.
Most drugs have little effect, because
the pain isn't physical, it's metaphysical
that just refers down to a physical level."
Dr. Bloch rubbed his hands through
his short, graying hair. "Please tell me
there's something that does work."
"Blue chamomile," said Dr. G.
"That's a key reason why it is the
go-to first aid supply for soups.
It actually soothes superpowers."
"The warden will never approve
something that controversial,"
Dr. Bloch said bitterly.
"I know, but if he keeps blocking things
that people need, then he's going to get
himself sued," Dr. G said. "Blue chamomile
is legal in Nebraska, I checked. Shiv would
have a case on withholding medical care even
if it wasn't legal, because it's a known treatment
and the only one that works on certain problems
that soups have. Withholding a legal drug and
causing avoidable misery? Slam-dunk case."
"I wouldn't care if it only affected the warden,
but I worry more about Shiv," said Dr. Bloch.
"He just looked so miserable, and there
wasn't a damn thing I could do to help.
How do I even begin to fix this?"
"Give him space until my next visit, and
I'll see if I can help you work it out," said Dr. G.
"Shiv needs to see how ethical people handle
mistakes and disagreements. I know that
this situation is frustrating for everyone, but
it does give you an example to show him
responsibility and accountability. Be honest
with him. Address what went wrong and ask
how to fix it. I don't think it's a lost cause."
Dr. Bloch straightened his back and
lifted his chin. "I'll do that," he said.
"Meanwhile, I can send you some material
from Soup to Nuts about superpowers and
their safety tips," said Dr. G. "We simply
don't have much solid information yet on how
to take care of soups, but we're working on it.
I'll give you the best that we've gathered so far."
"Thank you," Dr. Bloch said fervently.
"I've read some of the SPOON handouts,
but they're so ... stuck on superheroes,
and that's not who I have to treat."
"Supervillains do need different
handling in some ways," Dr. G agreed.
Dr. Bloch smiled. "It's been an interest
of mine for a while, tangentially -- you may
have heard that I'm working with a team
to figure out who's likely to develop
Super-Immunity from Aegis."
"I think that topic is in safe hands
with you," Dr. G said. "So don't lose
hope, and don't beat up on yourself.
Things go wrong. That's inevitable.
What matters is how you respond."
"I'll keep that in mind," Dr. Bloch said.
"I'm glad I could help," said Dr. G.
"If you need anything else, just --"
The low woop-woop of the door alert
interrupted the conversation.
"I have to go, someone needs me,"
Dr. Bloch said hastily, and Dr. G
nodded as they ended the call.
The bounce was back in Dr. Bloch's step
as he headed out to deal with whatever
new challenge had brought someone here.
* * *
"When there's no one you can point to, or when something goes wrong, it's your fault -- that level of responsibility and accountability is pretty interesting."
-- Matt Mullenweg
Automatic hand washing stations are popular in medical facilities. This one has knee panels for front controls and also has top controls. It is possible to make all-in-one stations that soap, rinse, and dry hands; those are just starting to appear in local-America, but are more common in Terramagne-America.
See Dr. Bloch's office.
Medical neutrality is a complex principle intended to protect the free access and practice of health care. It means that health workers are considered nonpartisans in conflicts and are not to be harmed. In return for this safety, they are obligated to care for all casualties regardless of affiliation. T-America does much better at respecting this than L-America does, even among supervillains. Dr. Bloch doesn't know yet that Shiv has limits on medical neutrality and has gotten beaten up more than once for lashing out at quacks who hurt him.
Feedback forms are helpful in improving performance if they are designed well and taken seriously. More-verbal people tend to prefer forms with space to describe things in their own words. Less-verbal people usually want forms that are short, simple, and can be filled out by ticking boxes. T-American facilities often offer a variety so people can find something suitable. Dr. Bloch has thoughtfully selected forms suited to Shiv's preferences as known. Here's a place that offers a whole list, including this one that uses smileys. This one uses bubbles to fill in. Another option is providing space for very short written replies. A large blank space may be used for written or illustrated feedback. So if you use feedback forms, try to offer a range of options for people who express themselves in different ways. The more fluently people request, receive, and process feedback the more they can improve their skills.
There is a crucial difference between tantrums and meltdowns; a tantrum is a deliberate manipulation, while a meltdown is a loss of control. Shiv squeaking his shoes was deliberate mischief; his resistance to unhelpful treatment was reasonable; but his withdrawal was a symptom of impending meltdown. This is especially a concern for soups because exceptional senses can make them vulnerable in ways similar to sensory processing disorder, and many superpowers can only be controlled to a certain point -- they tend to break loose if the person is threatened or stressed enough. Understand how to prevent and handle tantrums and meltdowns.
Pain is complex, existing more in the brain than the body. Referred pain happens when a problem in one area misroutes the signal to a different location, such as a throat infection feeling like an earache. Psychological pain can refer down to the physical level, and so can mystical problems such as overstrain. That makes it a lot harder to treat effectively.
It takes courage in order to be honest, because honesty has consequences as well as benefits. This is part of what makes Dr. Bloch good at his job. Here are tips on how to be more honest.
Mistakes are inevitable. It is vital to understand how to handle problems and view mistakes as opportunities. In health care particularly, intolerance of mistakes can kill people and frank discussion of them saves lives. It's easy to get distracted by whose fault it is. The more fluently people request, receive, and process feedback the more they can improve their skills. Know what NOT to do when things go wrong, as well as how to respond effectively. This detailed guide to handling medical mishaps has some concepts that generalize well to many other contexts.
Don't beat up on yourself. It does no good, and can do a lot of harm. While decent people naturally feel bad about screwing up, this is the not the way to fix it. There are ways to stop beating up on yourself. If you can't stop, try asking yourself these questions. If self-blame is intrusive ideation rather than voluntary for you, which happens with many mental conditions, then you may need to work on this obliquely by addressing the underlying issues instead of trying to stop it directly. In that case it's likely to be a symptom rather than a cause. It's not your fault if you have brain weasels that scream nasty things in your head.
Responsibility and accountability are equally important in working effectively. There have been some interesting studies which suggest some moral awareness among animals as well as humans, including the ability to distinguish between accidental or deliberate harm and a propensity to punish the deliberate more than the accidental. Understand how to be responsible, be accountable, and create a culture of both.