Marlot Kuiper

181 Checklist as ‘hub’: On routine interactions At one of the first observation days, I am shadowing the gate-keeper, 19 who is anaesthesiologist at Plainsboro. Some delays in the program already occurred when we’re only halfway. The schedule is tight. I join the anaesthesiologist to the holding to pick up our next patient: A middle- aged woman who comes in for a coloscopy, since the surgeon suspects colophonies cause her pain symptoms. Already from the corridor, we can hear the woman panicky shout: “I’m nót going!” Apparently, the nurse who prepared the patient for the surgery at the holding, just told her that general anaesthesia is a must. Something she is terrified of. An extensive conversation with the anaesthesiologist starts in which he tries to comfort the patient and convince her of the necessity of anaesthesia. “I’ll die!” She screams. “I’m sure I will!” The anaesthesiologist points to the patient chart that indicates: schizophrenic affective disorder. This mental disorder can make patients suffer from unrealistic fear. However, how unrealistic fear may seem, patients cannot be forced into surgery. But when surgery gets postponed now, it will only lead to more trouble later. More than fifteen minutes pass by, but ultimately the anaesthesiologist manages to persuade the patient. She gives her consent and we bring her to the operating theatre. When we arrive there, the surgeon is already annoyed. “What took you so long?!” Before the anaesthesiologist can answer, the patient says: “I changed my mind, I don’t dare!” To which the surgeon replies: “Are you kidding me?!” As a consequence, the patient starts to cry and the anaesthesiologist bows towards her to calm her down. After a couple of minutes, the operation can eventually proceed. The anaesthesiologist hisses to the surgeon: “You almost ruined it all!” The time-out is performed in a tense atmosphere. The surgeon does not hold the checklist in her hands while she checks for the patient’s identity and the intervention. The anaesthesiologist nods to confirm the items. 19 For more reflections on the role of the gate-keeper I refer to the Intermezzo about the gate-keep - er and the methodological chapter of this dissertation 6