Our Malady: Lessons in Liberty from a Hospital Diary

by Timothy Snyder

My wife turned forty during her second pregnancy, which triggered an American protocol for labor to be artificially induced by her due date. These protocols make little sense: it’s not age as such that matters, but certain conditions that become more likely in women with age. In large matters and small, machine protocols get between patients and their caretakers. The computer programs are about billing, and so fail to account for basic human needs. Doctors and nurses who get used to following protocols retrain themselves to ignore the actual patient. When I was in the hospital I noted some examples of this in my diary. I took medications on a schedule. I wrote down the times and doses, partly because I had lost trust in the system, partly because I wanted to sleep at night. I was allowed to take acetaminophen every six hours for pain. I would ask the nurses not to wake me at night simply because six hours had passed. Sometimes this worked; sometimes it didn’t. When I would skip a dose, I would try to explain that the schedule should reset, and that my next dose could be at any time, rather than six hours after the scheduled time for the dose that I had not taken. Sometimes nurses went along with me, sometimes with the screen. I might in the evening have three medications to take, one at 10:00, one at 11:00, and one at midnight. A savvy and motivated nurse would alter the timing of the doses during the day so that, after a couple of days of nudging, I could take all three p...