“The Gardener’s Year” by Karel Čapek is not a “How-To” book by any means, rather it’s a reflection of what it is to be a gardener. It is a short book of 160 or so pages, comprising 26 chapters, filled with humorous insights about gardening over the course of a year, with simple cartoon-like illustrations by his brother Josef. It won’t teach you much about gardening, there are many other books that will do that, but it will help you understand why gardeners love gardening so much.
Čapek is better known for having coined the word “Robot” appearing in his play “R.U.R.” first performed in 1921. The “Gardener’s Year” published later, in 1929, by which time Čapek was firmly established in his reputation as a writer, affording him the means to keep a modest garden of a quarter acre in a Prague neighborhood, sharing it with his brother Josef. In this interwar period, shortly before the Wall Street crash of 1929, it is estimated that some 50-65% of Czechs used their gardens for growing food; or if they could not afford a garden, they could pay a minimal rent to lease an allotment. The Capek brothers, therefore, were fortunate indeed to be able to maintain the garden described in the book; a garden featuring numerous perennials, bulbs, a rock garden, and a greenhouse.
Every chapter brings the reader fresh ways of looking at gardening. Čapek writes about the things that you didn’t know you already knew, and experiences that you’ve probably felt but couldn’t put into words. He tackles each subject with genuine insight. Consider the chapter “The Blessed Rain.”
The hissing downpour stops, as if one pulled a string; the earth shines with silver vapour, a blackbird shouts in a bush and plays mad pranks; we also want to kick our heels, but instead we go out with bare heads to breathe in the fresh and sparkling humidity of the air and earth.
The book’s chapters are filled with garden imagery like this, making it the ideal bedside book to read before you turn in. And if you suffer from insomnia and can switch on the light without disturbing the dog, you might want to read a chapter or two to divert your mind from whatever woke you up.
Writing as he did a hundred years ago, about a climate and soil unlike that of New England’s, it may seem that some of his ideas are no longer relevant; his description of how to eradicate green-fly would certainly not pass muster these days. But bear in mind that he writes this to poke fun at the marketing of simplistic panaceas, not dissimilar to what one might find a Tik-Tok influencer promoting (and with equally futile results)!
For this there are various powders, preparations, tinctures, extracts, infusions, and fumigations, arsenic, tobacco, soft soap, and other poisons, which the gardener tries one after the other, as soon as he notices that on the roses the green and succulent lice have seriously increased. If you use these expedients with a certain care, and in due quantity, you will find that the roses sometimes survive this destruction uninjured, except the leaves and buds, which look somewhat blasted, while the plant-lice thrive under this treatment so that they cover the twigs like dense embroidery.
Čapek takes great delight in making fun of problems that will be familiar to all gardeners; be it poring over seed catalogs and ordering far more than you can use; the pursuit of a unique specimen and, having found it, searching in vain for a place where you can plant it; or turning the soil and having to fight with the roots and rocks and assorted debris. Consider the life lessons he draws from his gardening; as relevant today as they were then.
The man who is the owner of some yards of land, and is growing something on it, becomes in fact a rather conservative creature, for he is dependent on natural laws a thousand years old; do what you will, no revolution will hasten the time of germination, or allow the lilac to flower before May; so the man becomes wise and submits to laws and customs.
This is a book that you’ll want to own and lend out to other gardeners. Although available on Kindle and softcover, I recommend you buy the hardcover edition. It’s a small book with ribbon marker, solidly bound on high-quality paper. You can find new and lightly used copies on your favorite used book site.
Discharge day! I slept poorly again and felt slightly nauseous as a result. I managed the coffee, cereal, and wheat toast, but couldn’t face the bacon and eggs! Maureen arrived while I was getting things ready for packing up. I had already signed the discharge papers with the nurse, so off we set! It’s been over a month since I was last home, but I feel so much better prepared for it than the last time I was discharged. At Spaulding we ironed out the kinks for getting into the house and manage the stairs and practiced it several times. Trixie was happy to see me, and I was honored by having her show her excitement by peeing on the garage floor.
This is my last full day at Spaulding. It was a really good move to come here for all the PT and OT, and good nursing care. The food was pretty good too, but I don’t have much of an appetite today after my rough night. Yesterday, I was officially promoted to independent care, meaning that I can get myself out of bed, use the walker to get to the bathroom, sit in the wheelchair and move around the room. It’s still difficult and I don’t have much stamina, but it’s what I’m going to have to do at home without the nurses and PCAs around to help me. At home, Maureen has set up the trundle bed in the front room on the ground floor, so I don’t have to tackle stairs for a while.
Maureen came in at her regular time of 11 am when I was already scheduled for PT. I had mentioned to Zaya that I’d like to practice walking and using the wheelchair outside, so we went over to a specially designed therapy trail that has different walking surfaces and slopes. The architects that designed Spaulding thought of everything!
Mr. Doutch, Thank you for reaching out and providing this valuable feedback from a patient perspective. It is uncommon for us to receive this type of feedback directly from a patient and it is appreciated. We will ensure this is circulated to appropriate parties for review. Best wishes, Kevin
We’ll see where it goes and if they want to do anything with it. But note the “Dangerous Assumptions” listed on my blog.
Maureen came in early at 10 am for caregiver training. We did bumping up and down stairs, with transfer from the wheelchair, via the exercise step, to the floor, and back again. Then we went out into the parking lot and did the transfer into the backseat of the car, and back again. Returning to my room, Chris took off the brace so that he could ace-wrap leg to reduce the swelling. Maureen watched and will need to do it at home.
Got an attack of my old enemy, Proctalgia Fugax, in the middle of the night, probably brought on by the bumping up and down the stairs. Neither the PCA nor the nurse knew how to respond. I asked for a small heating pad to relieve the cramps, but they didn’t have any. So, I was in quite a bit of pain until it eased off by itself, and I was able to get back to sleep.
There’s a monitor hanging in my room instead of the usual TV. It can function as a TV, of course, but it does a whole lot more. Some of it well, some of it not so well. The most important feature, in my view, is that it also displays patient information: information that the patient needs to see, as well as information that nurses and PCAs need to see when working with the patient on a day-to-day basis. This feature is intended to replace the whiteboard that is still, for now, also hanging in my room. Here, I want to focus on the patient information piece. We’ll start by considering the “As-Was” of the Patient Whiteboard, then consider the “As-Is” of the Patient Information Screen.
Patient Whiteboard
The whiteboard has the following sections and subsections. Refer to the image below for how these sections are laid out.
Static Information
Room #
Room Phone #
Patient Name. An entry field for patient’s name. In my case, the name that I prefer to be called by has been written in.
CARE TEAM. A series of fixed positions in the care team allowing for actual names to be entered.
MD (doctor)
RN (nurse)
CM (case manager)
OT (Occupational Therapist)
PT (Physical Therapist)
SLP (Speech Language Therapist)
TR (?)
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MOBILITY. Three fixed mobility types, allowing for specifics to be entered.
Bed Mobility
Bed to Chair Transfer
Ambulation or Wheelchair
DIET/SWALLOWING/COMMUNICATION. Three fixed fields, allowing for specifics to be entered.
Diet
Swallowing
Communication
ADL. Assisted Daily Living. Three fixed fields, allowing for specifics to be entered.
Toilet Transfer
Bathing
Dressing
SAFETY. Three fixed fields allowing for specifics to be entered,
Safety e.g., Fall Risk
Precautions
Equipment
OTHER.
DAILY SCHEDULE / DATE
In my case, most of these fields have not been entered, and even if entered, they have not been updated. In particular, someone has entered an MRN (Medical Record Number) in the OTHER section, but’ it’s not mine. I can only assume that it’s left over from a previous occupant. Also, in the DAILY SCHEDULE field, the dietician wrote in the phone number for the kitchen,
Patient Information Screen
The monitor appears to have a 16×9 display, I measured it from my bed using my iPhone Measure app, and got a dimension of 43” wide and 23” high which actually makes it a couple of inches wider than you’d expect with that ratio. The screen has the following sections and subsections. Refer to the image below for how these sections are laid out.
TV and Generic Information
This section occupies the top left corner of the monitor screen, with dimensions 30.5” by 17”. Accounting for measurement errors, this is consistent with a 16 by 9 ratio for broadcast TV. The section accounts for approximately 50% of screen real estate. When not displaying TV there is static picture of patients on modified bikes, overlaid with the following sections. Clicking each section yields available options.
tv & Movies
my Health
my Meals
my Care
my Comfort
Patient Interface
The remainder of the display is further broken down into sections with information specific to the patient.
Static Information
Patient Name
Location (Spaulding)
Room #
Room Phone #
Today’s date and time
Est. Discharge Date.
Care Team. A partial list of the people and their positions in my care team. The doctor assigned to the care team is unlikely to change over the course of the patient’s time at Spaulding, similarly, the person assigned as Case Manager is also unlikely to change. Other positions, however, change multiple times a day – usually three times a day corresponding to shift changes. The dynamic positions are identified by first name, initial, position identifier. The only dynamic positions that I’ve seen are RN and PCA. They are very helpful to me as I can greet them by name, and it also helps me remember if I’ve met them before. This window has two subheadings:
Care Team Includes: There is space for three positions, one of which is assigned to the doctor. The remaining two list the PCA and RN
Case Manager: Space for one name
Today’s/Tomorrow’s Appointments. Usually labeled Today’s Appointments, but at 6 pm each day, it switches to Tomorrow’s Appointments. This is a schedule of PT and OT appointments. For each appointment, there are two rows. There is only space for two appointments, although on most days I have three. The space limitation is addressed by the window scrolling every few seconds to show the rest of the list. At 6 pm each day, it switches to Tomorrow’s Appointments.
Time, Therapy Type (example: 2:00 PM – 3:00 PM, PT)
Therapist. Name, as first name, last initial. There’s only space for one name, although some appointments may have two if a student or a new therapist is being mentored.
My Diet Specifics of the patient’s diet, using the IDDSI (International Dysphagia Diet Standardization Initiative) levels to specify drink thickness and food textures.
Diet: example: Dysphagia
Solids: example: Regular (IDDSI 7R)
Liquids: example: Thin (IDDSI 0)
Safe Swallowing: Only applies to patients who have problems swallowing. In my case this entire section is blank.
Mobility/ADL (Assisted Daily Living). This window has multiple entries. It’s not clear if they are fixed sections or dynamic; I suspect fixed. The sections on my display are:
Bed mobility: Describes ability and precautions for transfers from bed to walker and wheelchair.
Toilet Transfer: Describes ability and precautions for accessing the toilet.
Bathing/Dressing: Describes ability and precautions
Safety: Blank in my case
Precautions: Overall precautions. In my case it refers to the ROMAT (Range of Motion as Tolerated) of my left and right legs.
Equipment: Blank in my case
As-Was versus As-Is
Most of the sections are the same in the Patient Whiteboard and the Patient Information Screen. The advantage of the screen is that it is more easily and consistently updated.
In particular, the Mobility/ADL section allows for more detail that it is important for the changes in nursing and PCA staffing to view. In my case, the section has a little pink leaf icon (at least I think it’s a leaf, but a pink leaf makes no sense) in the top right corner. I asked one of my PCAs what it meant. He laughed and said, “no one knows!” I asked Sara, an OT though, and she said it meant “Fall Risk” and that 95% of patients had it on their displays. The reasoning for the leaf icon is quite a stretch. It’s using the homonym “Fall,” as in the season (leaf → fall, geddit?) to alert the staff that the patient is a Fall risk.
One advantage of the old whiteboard is that it allows for on-the-spot corrections and additions by the staff if they see an error or omission. In practice, however, they rarely make corrections. The whiteboard is not used much, and it’s hung in an awkward place for nurses to access, to the side of the bed. Another minor advantage of the whiteboard is that it can display additional information that the screen is not set up for. In my case, a nurse wrote in my preferred name and the phone number of the kitchen. There are, however, some disadvantages. There’s no automated checking that the information is correct. There’s information on mine that’s out of date. Also, someone had written an MRN (Medical Record Number) on it that is not mine. Presumably it was for a previous occupant.
Possible Improvements
The Patient Information Screen has several areas that could be improved. What seems like an odd quirk at first is actually a necessary design feature, namely that the ON/OFF button on the patient controller does not actually turn off the display. It just turns off the top left 50%, devoted to TV and Generic Information. The other 50% of the display has important information, so it’s always on and cannot be turned off, except by unplugging it. The section does dim in the evening, but it’s distracting when you’re trying to sleep.
My overriding concern is that the design is trying to jam two things together that are very dissimilar. The TV and Generic Information display is the same for all patients and can be turned off and on. We can design for the use of real estate because we know that the size of each block will not change, and it’s not a safety issue if it’s turned off. Conversely, for the Patient Interface, designing for the use of real estate calls for dynamically resizing windows. This is because the types and amount of information will be different for each patient, and subject to change multiple times a day. In the As-Is design, however, the patient information windows are relegated to fixed sized windows clustered around the bottom and right edges of the screen.
For example, the Today’s Appointments window is probably the most important information for a patient, but it occupies a mere 5% of the overall screen and is not large enough to fit all the relevant information. The kludgy design implemented to overcome this limitation is to cycle the screen to show different sections of the overall schedule. It would also be nice to see what tomorrow’s schedule is, but I have to wait until 6 pm to see this. The information in this section ought to be, but apparently isn’t, synchronized with PT and OT visits in the Epic Patient Gateway.
The second most important window to me is the Care Team window. Two of the roles listed here (Doctor and Case Manager) will probably not change over the course of a patient stay, whereas the other roles (RN and PCA) will change several times a day. It’s helpful for the patient to get to know the staff that they interact with on a frequent basis. And yet, this window is also relegated to a mere 5% of the overall screen. Moreover, since two of the positions are static information, they might be better placed with the other Static Information window, positioned in the lower left corner.
Over on the right side of the screen, the My Diet windows appear to have a blank row. It’s not clear why it needs to be there. Also, in my case, the entire Safe Swallowing window is blank. If it were to swap places with the Today’s Appointments window, you’d be able to get at least three appointments listed. The Mobility/ADL window, being space constrained, has a bunch of acronyms. In my case, I counted 16 of them. The use of acronyms may be all well and good for the trained staff who are the primary users of this information, but let’s not forget that the patient is also an important participant in their own recovery, and they should also be able to understand and act on the information; this is made much harder by the reliance on acronyms.
Solution Options
I’m coming to the end of my two week stay here, so I’ve had plenty of time to think about how to address my major concern that the patient interface needs major improvements. Any solution will need to address the fact that there’s simply not enough screen real estate, and what space there is in the current design is limited by not being able to use dynamic window sizing. So here are three possible solutions to lack of space.
Ditch the attempt to combine two incompatible information displays on one screen, and use two different displays. These could be hung stacked, side by side, or totally separated. That way you open up more possibilities for the design of the patient interface, with static windows when the information is static, and dynamic windows when the information is dynamic.
Hang a single screen in portrait mode and divide into two regions. One region could be TV in 16:9 aspect ratio with generic options below. The second region would be a rectangular space for patient information.
Keep the current layout, but provide a patient option to resize the area devoted to TV and Generic Information. Patients would have the option to make this area LARGE (the As-Is size), MEDIUM, or SMALL. When set to these last two options, the Patient Interface section would resize the dynamic information windows, especially the Care Team and Today’s/Tomorrow’s Appointments windows.
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