MGH appears well run, which is not to say that there are times when I have been dissatisfied. Above all, of course, is the need to ensure safety of the patients and freedom from obstacles to that purpose. The parts of the organization that I come into direct contact with are the nursing staff, the facilities in the ward, and the people that maintain those facilities. There are also the doctoring teams, and at the top, the superstar specialists and surgeons. In some ways, running a hospital must be like managing a sports team, a rock star, or an airline. They all have a clientele that is willing to repeatedly spend a lot of money to receive their services, and they must maintain their reputation for excellence. It costs a lot of money to maintain these services and reputation. The bottom line, however, must be that safety is essential, while the budget for safety and the financial benefit is impossible to measure. Back to the nursing team then, I am somewhat surprised that, unlike most major hospitals in the Boston area, MGH does not have a nurse’s union and it appears that management actively discourages it. An entry in Wikipedia reads as follows:

The vast majority of MGH’s thousands of registered nurses are not represented by a union. While sister hospitals in the Mass General Brigham (MGB) systems […] have nurses represented by the Massachusetts Nursing Authority, MGH nurses have historically voted against unionization.”

The entry goes on to notes that 88% of physicians voted in 2025 to unionize, but that Nurse Practitioner and Physicians Assistants are predominantly non-unionized. Reading some additional  articles it seems that the board fears reputational loss, which in turn lessens the ability to attract top-rated staff, and overall loss of management control – both of which I understand. What I do miss, however, is the apparent lack of specialized training and a reliance on on-the-job training. This latter method, although essential part of training, carries the risk of instilling sub-optimal practices simply because they are easier to use. It also encourages the acceptance of work-arounds leaving the obstacles in place. For example, the nurses frequently complain about the new suction pumps used with the Jackson-Pratt bulb drains that pull liquids from the site of the surgery. In my case, I have two bulbs and sets of tubing that work with a single suction pump. The new pumps apparently have more features than the old pumps, but they set off alarms multiple times a day. The alarm is particularly discordant, and seems to have based on the sound made by a vuvuzela. This is obviously an annoyance to the patient, but it is also a distraction to the nurses who may be engaged in other tasks requiring their concentration.

It seems that the pumps were introduced using a train-the-trainer. Nurses also do not have any channels for expressing their frustration with the device. I was also disappointed when I mentioned the applicability of safety management systems in healthcare to Nick, my nurse for the day. He had never heard of the work of Jim Reason in this area. This was a change from my experience as a cancer patient at Brighham and Women’s 20 years ago. There, the physician team and nursing team did know about him, and his work developing the famous swiss-cheese model. Pushing further, I asked him if he had read anything by fellow Bostonian, Atul Gawande. Nick just asked if he was born here? (He wasn’t. He was born in Brooklyn, NY). Bottom line, I think that I would like nurses to recognize their calling and the role that they play in healthcare. As I’ve said many times since I’ve been here, I’d like the person asking about “where does it hurt?” and “what’s my pain level?” to actually have experienced pain themselves.

I’ve been reading up on my surgeon, Santiago Lozano-Calderon. SLC as I’ve referred to him here, or ‘Santy’ as members of his team call him. I see that the orthopaedic oncology area in which he works incudes the evaluation and treatment of primary benign and malignant tumors of bone and soft tissue, as well as metastatic bone disease. It’s an area where we don’t have all the answers and difficult to make precise diagnoses. It is eminently reasonable, that six weeks after my first appointment with him, I still don’t have a diagnosis.