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Wednesday, July 2, 2014

NY Times: The Self-Promotion Backlash

New York Times:  The Self-Promotion Backlash, by Anna North:

InvisiblesFrom “building your personal brand” to “stepping up your social media presence,” we’re constantly inundated with advice about how to promote ourselves. But some are saying that the pressure to self-promote could, ultimately, be hurting us.

In his recent book Invisibles: The Power of Anonymous Work in an Age of Relentless Self-Promotion, David Zweig profiles a group of people whose jobs are behind the scenes in some way (a guitar technician and a United Nations interpreter, for instance), and who derive satisfaction not from public recognition, but from the internal sense of a job well done. These “Invisibles,” as he calls them, are often extremely fulfilled in their careers, and they may have something to teach those of us who feel we have to constantly promote ourselves to succeed. He writes:

“We’ve been taught that the squeaky wheel gets the grease, that to not just get ahead, but to matter, to exist even, we must make ourselves seen and heard. But what if this is a vast myth?” ...

The Invisibles offer “an alternate path to success” — they got where they were not by courting attention, but by working quietly and extremely carefully toward something bigger than themselves. “The work they do is always in service of a larger endeavor,” he explained. And they show that at least for some people, “when you focus on excellence and good work, that actually does get recognized in the end.”

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Unfortunately, Invisibles can find themselves trapped in a terrible catch-22 when the arena in which they're working takes a turn for the worse. The very autonomy that they sought or at least didn't mind works against them when a problem arises that needs to be exposed and openly fought.

When that happens, they face what is for them a terrible choice: give up their invisibleness to fight that evil or hunker down and do the best they can in bad circumstances. And since raising attention something isn't what they normally do, if they act, they may do so badly.

I know. Years ago, I worked at a top children's hospital that was pioneering the use of central lines in children being treated for cancer with a line that had invented by one of our physicians. It was an incredibly kind innovation, one so marvelous it’s still in wide use today over thirty years later. It spared very sick children the horrors of being poked, often several times a day.

Unfortunately, the proper kind of IV pump to accompany that line had yet to come into common use. If a nurse, coping with complex IV regimes, often in a darken room at night, forgot to move an air sensor to the proper line, disaster could follow. As one health hazard periodical reported in 1985, “Many fatal instances of air emboli in patients with central venous catheters have been reported in the literature.”

I worked nights assisting the Hem-Onc unit’s nurses and enjoyed being an invisible doing very important work and doing it well. While it was not part of what I was supposed to do, I added checking for mistakes that could lead to a central-line air embolism to my list of things to do. On two occasions on night shift, I found an IV line pumping air into a child and on a third occasion I found that the air was only a foot away.

The hospital was aware that was a problem. It was life-threatening, brought incident reports, and triggered a year-long move to replace every IV pump in the hospital with one that didn’t have a separate air sensor. What the hospital did not do was train it nurses to make sure the problem came to an end even with the old pumps.

That wasn’t hard to do that, simply apply the old carpenter’s principle of “measure twice, cut once.” Every time a change was made to a child’s IV, trace the fluid flow from the bag to the patient, checking every point along the way. I did precisely that every night I managed those IVs when the nurse I was working with went on break and I never made a mistake. Knowing I was operating outside my ‘approved’ list of procedures, I was very careful.

The final straw for me as an invisible came after I transferred to day shift on the teen unit. I was walking by the room of a 16-year-old girl with leukemia when I heard her begin to cough the peculiar, tickle in the throat cough that often indicates an air embolism. I rushed into her room, confirmed that she had air in her central line, and with one smooth sequence of moves turned off the IV pump and put her into a safety position to keep those deadly bubbles away from her heart or brain. When a resident arrived a few minutes later, all he added to my care was oxygen to clear out the bubbles more quickly.

What bothered me most about that event were two things. I’d dealt with so many air-in-line emergencies (that was the fourth), that responding to one had become a reflex. On the other hand, the nurse I was working with that day told me that, if she’d been in my place, she wouldn’t have known what to do. Bitterly learned experience had taught me what to do. The hospital had not taught her what to do.

Note what was happening. I was an invisible doing a particular part of my job extremely well. I spotted those flaws and dealt with them quickly, professionally, and often invisibly. And note that dealing with IVs was not even on my list of responsibilities. And yet at the same time, those most responsible for those IVs weren’t being trained to prevent or deal with air embolism in central lines. The only fix the hospital was implemented was that year-long shift to a better IV pump.

Yes, there are excuses. We were literally the leading edge in this technology. We invented it. We were the first to put it into widespread us. Not long ago, I read an account of leukemia treatment at a large east-coast children’s hospital two years later than my experience. They’d yet to adopt central lines in their treatment. As the first to adopt, we were making mistakes. But looking back I realized that we weren’t learning enough fast enough to deal with the risks we were creating for our children. None of those I cared for that had an air embolism died. But one, a sweet and quiet nine-year-old girl, did suffer a stroke the next day that was almost certainly connected to her embolism.

Now for the kicker. Did I go public with what I, as an invisible, was seeing? I’m afraid I didn’t. I worked very hard to catch this problem with the kids I was caring for. Every time I entered a child’s room, I flicked on a flashlight and checked their IV. I also got incredibly good at spotting and responding to a central-line emergency.

But what I didn’t do was give up my invisibility to make trouble and push the system to make changes, particularly in nurse training. I was a bit too tied up with being invisible to risk being controversial.

For those who’re interested, I’ve detailed that entire experience and others in a book I recently published. I could have easily tweaked the title to My (Invisible) Nights with Leukemia.

—Michael W. Perry, My Nights with Leukemia: Caring for Children with Cancer

Posted by: Michael W. Perry | Jul 2, 2014 6:46:40 AM

If Mr. Zweig really believes his thesis, shouldn't he have kept it to himself -- or at least written the book anonymously?

Posted by: Jimmie | Jul 2, 2014 11:08:42 AM