When. Daniel H. Pink

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      2.

      AFTERNOONS AND

      COFFEE SPOONS

      The Power of Breaks, the Promise of

      Lunch, and the Case for a Modern Siesta

      The afternoon knows what the morning never suspected.

      —ROBERT FROST

      Come with me for a moment into the Hospital of Doom.

      At this hospital, patients are three times more likely than at other hospitals to receive a potentially fatal dosage of anesthesia and considerably more likely to die within forty-eight hours of surgery. Gastroenterologists here find fewer polyps during colonoscopies than their more scrupulous colleagues, so cancerous growths go undetected. Internists are 26 percent more likely to prescribe unnecessary antibiotics for viral infections, thereby fueling the rise of drug-resistant superbugs. And throughout the facility, nurses and other caregivers are nearly 10 percent less likely to wash their hands before treating patients, increasing the probability that patients will contract an infection in the hospital they didn’t have when they entered.

      If I were a medical malpractice lawyer—and I’m thankful that I’m not—I’d hang out a shingle across the street from such a place. If I were a husband and parent—and I’m thankful that I am—I wouldn’t let any member of my family walk through this hospital’s doors. And if I were advising you on how to navigate your life— which, for better or worse, I’m doing in these pages—I’d offer the following counsel: Stay away.

      The Hospital of Doom may not be a real name. But it is a real place. Everything I’ve described is what happens in modern medical centers during the afternoons compared with the mornings. Most hospitals and health care professionals do heroic work. Medical calamities are the exceptions rather than the norm. But afternoons can be a dangerous time to be a patient.

      Something happens during the trough, which often emerges about seven hours after waking, that makes it far more perilous than any other time of the day. This chapter will examine why so many of us—from anesthesiologists to schoolchildren to the captain of the Lusitania—blunder in the afternoon. Then we’ll look at some solutions for the problem—in particular, two simple remedies that can keep patients safer, boost students’ test scores, and maybe even make the justice system fairer. Along the way, we’ll learn why lunch (not breakfast) is the most important meal of the day, how to take a perfect nap, and why reviving a thousand-year-old practice may be just what we need today to boost individual productivity and corporate performance.

      But first let’s go into an actual hospital, where doom has been forestalled by lime-green laminated cards.

      BERMUDA TRIANGLES AND PLASTIC RECTANGLES: THE POWER OF VIGILANCE BREAKS

      It’s a cloudy Tuesday afternoon in Ann Arbor, Michigan, and for the first (and probably only) time in my life, I’m wearing hospital greens and scrubbing in for surgery. Beside me is Dr. Kevin Tremper, an anesthesiologist and professor who is chairman of the University of Michigan Medical School’s Department of Anesthesiology.

      “Each year, we put 90,000 people to sleep and wake them up,” he tells me. “We paralyze them and start cutting them open.” Tremper oversees 150 physicians and another 150 medical residents who wield these magical powers. In 2010 he changed how they do their jobs.

      Flat on the operating room table is a twenty-something man with a smashed jaw badly in need of repair. On a nearby wall is a large-screen television with the names of the five other people in hospital greens—nurses, physicians, a technician—who surround the table. At the top of the screen, in maize letters against a blue background, is the patient’s name. The surgeon, an intense, wiry man in his thirties, is itching to begin. But before anybody does anything, as if this team were playing college basketball at the school’s Crisler Center two miles away, they call a time-out.

      Almost imperceptibly, each person takes one step backward. Then, looking at either the big screen or a wallet-size plastic card hanging from their waists, they introduce themselves to one another by first name and proceed through a nine-step “Pre-Induction Verification” checklist that ensures they’ve got the right patient, know his condition and any allergies, understand the medications the anesthesiologist will use, and have any special equipment they might need. When everyone is finished introducing themselves and all the questions are answered—the whole process takes about three minutes—the time-out ends and the young anesthesia resident cracks open supplies from sealed pouches to begin to put the patient, already partly sedated, fully to sleep. It’s not easy. The patient’s jaw is in such dreadful condition, the resident must intubate him through the nose instead of the mouth, which proves vexing. Tremper, who has the long, slender fingers of a pianist, steps in and steers the tube into the nasal cavity and down the patient’s throat. Soon the patient is out, his vital signs are stable, and the surgery can begin.

      Then the team steps back from the operating table once again.

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