All Fall Down

All Fall Down


Leonard Zwelling

Things need constant care. I learned that the hard way as an administrator. I was constantly touching base with my managers as to how projects were progressing, what problems they were encountering, and how the morale of our personnel was at any given moment. What were the managers’ needs in time and resources? That was my immediate concern every day, all day. Then it was fulfilling the needs of the faculty. Were we doing our job of service with a sense of urgency? That was my question to myself every day.

I met with all of the managers every week. No exceptions. I kept a running list of all of the issues facing my office and made sure to get updates on every one at our weekly meetings. I also had monthly meetings with the entire staff of my office unit by unit. That way they saw me and I saw them. They knew I cared about what they were doing and I did. That was how I saw managing—mentoring and resourcing.

This all comes to mind in the wake of the condominium collapse in Miami. How could a structure that stood for forty years disintegrate during the night? And it wasn’t just one tower but two. And it was the ones facing the sea water that collapsed. I wonder if there was some less than adequate construction and less than vigilant inspection. Don’t you? Information is trickling in every day and what has come to light suggests at least some people were aware that the building was in trouble.

Fortunately, this kind of disaster is rare in America short of natural disasters like tornadoes and earthquakes or acts of terrorism. There is also the occasional work site accident when a crane tips over and takes a building with it. But for a high rise building to self-destruct in the middle of the night someone had to miss something. A manager was not doing his or her job. Oversight was lax. Someone blew it.

Why should we be surprised?

There had to be human error involved in the origins of the novel coronavirus whether at the open air wet market or at the Wuhan Institute of Virology. That bat virus didn’t enter the human race all by itself. We helped.

Similarly, the January 6 insurrection did not take place in a vacuum. Mr. Trump encouraged it. The Capitol Police were caught flat-footed and various domestic terrorist groups used the Internet to organize the attack.

But my favorite example of lack of vigilance involves modern medicine.

It seems to me that the young doctors of today are enamored of technology and protocols in lieu of thinking as a way to approach a patient. In some ways so was I as I did a history, physical exam, lab work, EKG and chest x-ray on every patient. No exceptions. Why? Two reasons. First, I wanted a baseline level of data at the outset of my care for anyone. Second, I always amazed myself with what I was able to find when I looked. This was brought home to me in the Eugene Leland Memorial Hospital emergency room where I moonlit when I was an oncology fellow at the NIH. Once, by doing a thorough cardiac exam on a patient with “stomach flu” I picked up a case of asymmetric septal hypertrophy. Another time it was an undiagnosed patient with Von Recklinghausen’s neurofibromatosis. That diagnosis was simply made by asking about the strange skin lesions on the patient who also told me of a sibling with brain cancer. So in a way, I was resorting to an algorithm to care for patients, too, but it wasn’t CT scan for belly pain before a physical exam then admit patient to hospitalist.

All I am trying to convey is that the essence of professionalism is taking care by both algorithmic approaches and the constant use of the intellect.

Soon we are going to learn that either, the building design in Miami was flawed, or the design was good, but poorly executed by the builder, or the inspections that should have detected erosion in the steel frame were inadequate or worse corruptly influenced. Write whatever story you like. That building did not fall down by itself. Someone is to blame. And missed cancer diagnoses that are routinely corrected at MD Anderson occur because the experts are there taking their time and taking care. There is no substitute.

Being good is neither innate nor routine. It takes work as any professional in anything will tell you. The same is true with architecture. Something went very wrong somewhere with that building in Miami. Let’s hope that someone can figure it out and many of the missing turn out to have not been home.

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