Saturday Blueprint on Injury
Another late-night trip to Accident and Emergency with my daughter and a bit of reflection on the experience.
"A ship is safe in a harbor, but that is not what ships are built for." - John Shedd
If you’re not making mistakes, then you’re not making decisions. — Catherine Cook
Another late-night trip to Accident and Emergency and a bit of reflection on the experience.
One of my Dad-duties is being the parent that takes the kids to A&E when they hurt themselves. I’ve been twice with my middle daughter and have recently now been back with my youngest daughter, Thea.
The injury this time was caused when Thea, who is 4, was running around with a pen in her mouth. One of the other children shut a door in her face which drove the blunt and rounded end of the pen deep into her upper palate, creating a pen-sized hole. I’ll spare you the picture of the wound, but I did manage to take a good one that would come in useful later.
My wife was working at the time so I did my best. The bleeding stopped shortly and that gave me some relief. Perhaps disaster was avoided, and so I began to put the kids to bed. When my wife came home she took one look in Thea’s mouth and said that the pen-sized hole is so close to her carotid artery that it needs proper examination and perhaps closing up. This is the benefit of being married to a doctor.
So at about 9 pm, after Thea had fallen asleep, I packed a quick overnight bag just in case and loaded a very sleepy 4-year-old into the car.
On the car journey, Thea was awake and starting to get scared. She was that vulnerable and brave kind of scared. Talking about what she was thinking and worrying about but in that brave way of doing so by confronting the issue directly.
The Accident and Emergency department was probably quite normal for a Friday night, but we found a seat and Thea slept on me while we waited. I’m always struck by that ability for young children to sleep literally anyway.
The wait plays on your mind, but more so when you are married to a doctor who knows each and every morbid complication, however remote. My wife would remind me of the myriad ways a human body can fail due to a remote set of circumstances that whilst unlikely do affect some with misfortune.
In the waiting room, surrounded by the injured and the sick, and cradling my scared and tired child, I received extracts of papers on the chance of blunt trauma near the carotid artery leading to cerebral ischemia, whatever that is. No thanks, but I’ll take my ignorance that brings with it bliss, please.
After we’d been triaged it was eventually time to go through to the ward and see a specialist. At this point, I couldn’t wake her at all. She was in such a deep sleep.
It was comical because her head kept lolling around and she was like a bad cartoon of someone who couldn’t be roused. There was no way the doctor could examine her in this comatose state.
Fortunately, I turned to my phone and shared the earlier photo with the doctor, who then sent it to his consultant for a second opinion.
After a time I was on my way, carrying a fast-asleep child and an antibiotics subscription back to the car in the dark. A kind couple let me go ahead in the queue for the ticket machine because they had seen me with a young child, and it was now nearly midnight.
And so a Friday night in A&E passed into memory. I have to say it reminds me how grateful I am for my own health and vitality. And there is a National Health Service to provide care to all without bias. As much as the NHS is criticised it is there for when you need it.
🕹️ Negative Feedback
As an engineer, I know that all stable systems need a negative feedback loop. It would be remiss of me not to mention this in relation to the recent experience of the pen, the daughter and A&E.
Think of a car and it’s steering. If we are trying to keep to the road (which I hope we all are!) negative feedback provides that stability. As your car starts to veer off to the left, you turn the wheel to the right, in the opposite (negative) direction, to course correct. This is negative feedback. The car steering is a simple example of a system, but all systems that exhibit stability have these negative feedback loops. It’s evident that if your car was veering left and you turned left you would amplify the error and so end up in the ditch. Positive (reinforcing) feedback is devastating when you want a stable system.
Why am I labouring this? Because a child getting injured is a good example of negative feedback. For the system that is a child navigating their environment, we actually want these non-fatal reminders that provide some course correction. Injuries like these are stabilising. They provide beneficial and essential negative feedback.
The surest way to know to avoid touching fire is to get burned.
The opposite of negative feedback is positive feedback. That’s the realm of runaway chain reactions, of prompt criticality, of cars in ditches. A system with no feedback would be the fate of the leper - who can’t feel and needs to constantly visually check for wounds so they don’t inadvertently bleed to death without knowing.
Framing taking my child to A&E in the context of system negative feedback is one way of looking at what might seem like a bad day and seeing the good, the benefit. I don’t want my children to experience pain, but I know that if they never did that would be a worse fate. The art (and luck) of parenting then is to prevent catastrophic injuries, but welcome minor injuries with open arms. If they can freely experience small pains they can safely keep to the road. My job then is to be mindful that being overprotective as a parent is unhelpful when the goal is enabling a child to experience and learn and ultimately navigate the world as an adult with stability and independence.
There needs to be an asymmetry in safety devices - protecting against fatal mistakes with an iron fist (always wear that bicycle helmet!) but letting small mistakes provide their valuable feedback.
Keeping with the cycling analogy, stabilisers are a common safety device for a bike, but actually, while they might decrease the frequency of an accident, they increase the severity. They make the system more unstable. They reduce the frequency of beneficial negative feedback.
I will leave the systems thinking thought piece there, but it’s a fascinating way of looking at the world. And of course, I get helplessly excited about causal loop diagrams and other such geeky tools to comprehend this messy life so probably best not to get me started!
It’s a pleasure writing to you. Have a great week. 😊
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The Saturday Blueprint is a weekly newsletter every Saturday on health, vitality and philosophy by Nick Stevens.
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