Here at B&W they have a series of color codes that they announce over the speaker system. This afternoon, as I was dozing, they announced a code “grey,” which lasted about twenty minutes, followed by a code “blue.” The codes refer to various levels of patient emergency. Immediately following the announcement of the code the level of activity in the ward increases, but I’d never really figured out what the codes meant and I’d never asked. I was reluctant to ask, I think, because I knew that there was a fellow patient involved, and I didn’t like to pry, but my curiosity got the better of me so I asked Dr. Zuckerman and my nurse Eileen. After all – you’re in a hospital and there aren’t a lot of secrets in a hospital.

It turns out that “grey” is security – perhaps a family or patient has gotten into an argument with the nurse, or a patient has wandered off. “Blue” is serious. It means that a patient is in crisis and calls for the immediate assembly of the team. This afternoon when it was called it was accompanied by a call for some piece of medical equipment that I didn’t recognize. Here are some of the other codes that I remember:

• Red: Fire in the building.
• White: Bomb Threat.
• Pink: Possible baby abduction IBaby girls only?). I’ve never heard this, of course, but apparently babies over Children’s get little transponder bracelets, like the one that Martha Stewart had to wear, that trigger automatically when they leave the area.
• Amber: Local disaster – expect an increase in the number of patients. Reminiscent of the helicopters flying in on MASH.

There’s also a green, which is also bad, but I forget exactly what it is.

Chemotherapy has to be one of the simplest treatments there is. I mean, there’s no cutting involved and the only piece of equipment needed is an IV pump. OK, sometimes you have the intrathecal which is a bit tricky, but for the most part a patient could administer it himself/herself. OK, so you’ve got to mix the chemo up correctly: too much boomslang skin in the potion and you’re a gonner! You also have to monitor the blood and urine, and patient physical condition to check what to do next, but I can foresee the day when more of the treatment and process is automated than at present. What this means for the design of system safety is that chemo ought to be one of those treatments that can be made very safe.

Reading the IOM report “To Err is Human” (2000) this morning I was struck by the fact that the statistics on the number of patient deaths resulting from medical error – estimated as high as 98,000 per year in the US in one study – were not further broken down further. Some further studies were cited, focusing on narrower areas, but there is obviously a lot of work still to be done on classifying diseases and treatments, and developing taxonomies of root causes of medical error. Over in the aviation safety domain, we engineers rail at the difficulty of developing defining precise hierarchies of aircraft and engine make/model/series, and developing useful taxonomies of systems and root causes of error. Aviation has made more progress in classifying its domain than medicine has, and I’m not altogether sure that this is solely because medicine is vastly older and more complex than aviation; I suspect also that aviation engineers are by nature more ready to measure their world. Aviation has always been an engineering discipline: medicine is still frequently referred to as an art. We need both engineering and art.

[later]

They’ve just called another code blue, this time with a location in the hospital lobby. It’s been a busy afternoon. I suppose the color blue was chosen deliberately because it’s a neutral color but once you’re in the know, it doesn’t disguise anything; it means another life in crisis. Sitting here is hospital after several days at home, I am brought back to the realization of how much misery there is in this world, and it makes me realize how I value life.