I started an “EVS Journal” back in 2020, when I worked in environmental services in the operating room of a small community hospital in west-central New Jersey. I ended up posting the first three entries of the Journal here at Policy of Truth (1, 2, 3), but posted the majority on Facebook under a private setting, largely to avoid repercussions at work. I’ve decided to start posting edited versions of them here, for whatever interest they might still have.

EVS Journal #4
December 4, 2020

A dispiriting day in the OR. It had nothing to do with the case load, which was moderately heavy in a normal way, but arose from something I’ve so far avoided mentioning in my daily missives here: the War Between the Shifts. I trained on the day shift (8:30-5) but now work on the night shift (technically, 3-11:30, but more like 3 to midnight). Each shift has a different supervisor, but the de jure supervisor of the day shift outranks the de facto supervisor at night.

For weeks now, the two supervisors have been at odds over workload. The day shift supervisor is “baffled” (his word) at the night shift’s apparent lack of productivity. The night shift supervisor is certain that the day shift is literally shifting the burden of its duties onto the night shift. In other words, each side accuses the other of free-riding on the other. Since free-riding means trouble with management, each side accuses the other of creating trouble with management. And trouble there’s been.

The tension has been building for weeks, and given my circumstances–a newbie with dual loyalties to each shift–I’m part of a tug-of-war between the supervisors. It’s a very unpleasant and demoralizing place to be. I mostly avoid it by working my ass off so that I myself am above reproach, but that doesn’t always work.

It didn’t today. The altercation between the two parties took place, naturally, at the change in shifts. Each side wanted me to side with it against the other. In fact, each side wanted uninvolved parties besides me to take sides, which induced these various uninvolved parties to flee the scene and “find” other urgent things to do. No shortage of those in the OR, and no shortage of places to hide.

I normally take a certain pride in being able to joke about anything, no matter how inappropriate or grotesque, but can’t easily joke about this, because I find the situation contemptible, and contempt doesn’t play well as humor. It’s contemptible to watch two grown adults settling petty scores by wielding lame arguments at each other of the kind I taught my Critical Thinking students to avoid. Also embarrassing to watch two wanna-be environmental services prosecutors waving “gotcha” cell phone photos at each other like a pair of aspiring Perry Masons in scrubs. But that’s what’s happening here.

“Yes, we stocked the womens’ locker room. You want proof?” 

According to the day shift, the night shift is using the cover of darkness–meaning the relative lack of supervision at night–to sit around in the break room eating Saltines and watching HGTV. They’re doing the bare minimum asked of them, terminally cleaning the OR’s six operating suites, but leaving undone a long list of pending, ancillary tasks: cleaning the OR’s core operational center, cleaning the scrub rooms, cleaning the bathrooms, cleaning the locker rooms, cleaning the de-contamination room, replenishing the scrubs, etc. “Things are not getting done.”

According to the night shift, the day shift is full of shit. In fact, it’s the day shift that’s not getting things done. The day shift is the easier shift, more heavily staffed, with easier work to do. The day shift has four workers; the night shift, two. The day shift merely does quick turnover cleanings of the OR suites, whereas the night shift does the deep terminal cleanings of those suites. Actually, unlike the day shift, the night shift does both sorts of cleaning: officially, it does deep terminal cleanings, but emergency cases often get added to the OR schedule at night, and those cases require quick turnovers. The same suites then have to be deep cleaned. So that’s almost twice the work, all on the night shift. Instead of taking the initiative to tackle pending tasks on the to-do list, the day shift just seems to fuck around a lot, then complain about what’s not getting done at night. Ever noticed how all of the holiday and birthday parties in the OR take place during the day?

The day shift sees some red herrings in that argument (or would, if they knew what a “red herring” was). Emergency cases, huh? Recall that the so-called “night shift” leaves at 11:30 or at worst, midnight. Technically, the “night shift” is really an evening shift, not a literal graveyard shift. Well, emergency cases come in after midnight, don’t they, after the so-called night shift leaves for the “night”? And who cleans those but the day shift? So let’s not exaggerate the late night “emergency case load” that the evening shift takes on. Taken absolutely literally, it’s the day shift that handles emergency cases both day and night.

Day shift argument in three sentences: The pace is a lot faster on the day shift. That’s when shit really happens in the OR. Nothing really happens at night.

Night shift argument in, well, a single declamatory paragraph: The lift is a lot heavier on the night shift. The night shift is when all of the unfinished business of the day shift has to be resolved, all the cut corners, all the missed blood spatter and bone fragments and debris that people were too “in a hurry” to detect or clean. The night shift is when all the 70-100 pounds of used mop heads have to be taken to the basement, at the last possible minute of the shift, to be hauled away and cleaned. Nothing happens at night? Ever dead lift 100 pounds of mop heads? Let’s see you make that happen, you little day shift pansies.

Go ahead. Find the flaw. I’ll wait. 

And so on. Put on the spot by both parties, I try to talk them out of the more outlandish things they’re saying, but you can’t talk to dogmatists who adamantly refuse to listen. So I mostly sit there in uneasy silence, absorbing their angry insinuations, neither rebutting nor agreeing, just assuming a Sphinx-like posture that says and reveals nothing but comes across as cowardly evasion. You can’t win when everyone’s set on losing.

What’s sad is that I find both parties admirable in their own way. They’re both dedicated, hard-working, and talented at what they do, and (when separated) enjoyable enough to work with. But put them together, and you get a mess.

What’s obvious is that they’re both barking up the wrong tree. The real explanation for the conflict is that EVS is chronically understaffed. It’s understaffed because staffing costs money, and the hospital doesn’t like spending money, at least not on “low level” staff doing low level things like sterilizing the OR. Since they refuse to spend the $13 or $14/hr (plus benefits) it costs to hire another one of us, understaffing becomes the norm, just as it was when I was a university professor. Neither side can see that. Why not? In large part, it’s a classic case of ethnicity versus class. These guys are good at ethno-cultural miscommunication, but bad at labor solidarity.

Correct, neither of the two supervisors is white. One is black, the other Filipino. Both are resolutely deaf and blind to the claims and style of the other. They’re divided by a subtle ethno-cultural difference–Harlem vs. Mindanao–that neither of them detects or understands, much less knows how to articulate in a productive way. Black Supervisor always sounds belligerent to Filipino guy, no matter what he says and how he says it. Filipino Supervisor always sounds supercilious to black guy, no matter what he says and how he says it. They miss one another’s verbal cues. They stumble over the oddities in one another’s syntax and semantics. “What’d he say?” “What was that?” “Is he being sarcastic right now?” “Is he mocking me?” “What the fuck is that supposed to mean?” “Why does he always sound like he’s lying?”

Every round of recrimination ups the ante of the last one and opens up new opportunities for conspiracy theorizing (that I get to hear from both sides). Neither party has the slightest sense that the ethno-cultural baggage they bring to the scene might be subverting their communicative intentions in maladaptive ways. Neither party has any sense that the other party might be doing the same. Neither can imagine that their ways of processing the world are a function of their upbringings, that these upbringings are radically different, that while they nominally speak the same language, they speak it in ways that mislead as much as they convey.

It would strike day shift guy as outlandish to be told that it’s relevant that night shift guy grew up as an ethnic minority in Mindanao. It would strike the night shift guy as outlandish to be told that it’s relevant that day shift guy grew up in Harlem in the 70s. What does all that sociology have to do with the OR? Not even HR could tell them. In short, no white people were hurt in the making of this workplace melodrama. The white people in the vicinity mostly, wisely, fled the scene and let the POCs duke it out, but not before everyone in the OR got a tasty bite of non-white Kulturkampf on the half shell.

I don’t claim any expertise in healthcare policy beyond the immediate issue of hiring another pair of hands in our OR. On that point, both diagnosis and prescription seem pretty obvious to me. Understaffing is stressful for us, frustrating for the clinical staff who rely on us, and ultimately, dangerous for patients. Understaff an OR, and people cut corners and leave things undone. Speechify all you want against it, but it’s inevitable.

What seems obvious to front-line workers doesn’t seem obvious to office-bound higher-ups. Hospitals, they’re constantly telling us, face sharp financial constraints that require another dose of austerity. “We have to recoup the revenue we lost during the last COVID wave.” I don’t know. It seems hard to believe that the addition of another $14/hr EVS guy is going to break the bank, but that’s the party line at Surgical Services, just as it was at Academic Affairs when I taught my 5:5 or 5:6 or 6:6 course loads at Felician.

Forget surgery. You could eat a meal off that floor! 

The bean counters say they need to uphold the financial integrity of the institution, but with numbing regularity, that nostrum seems to flout the integrity of front-line operations. I can’t prove that they’re wrong, but I doubt they can prove that I am, either. The truth is that we’re opaque to each other. Our labor isn’t visible to them any more than their numbers are visible to us. Neither of us appears in the calculations of the other. The standard textbooks in health care finance don’t mention EVS. They don’t mention hospital-borne infections. The don’t mention pandemics, and they don’t mention fairness, either. It’s a lot to omit.

The governing norm, as I’ve said, is austerity. When a norm exacerbates the already-existing tribulations of scarcity–for instance, during a pandemic–you get conflict. When the conflict fails to focus on the underlying cause, it focuses on side issues. When it focuses on side-issues, both sides come to develop an investment in irrationality. Where conflict is irrational, and the contestants feel invested in both the conflict and the irrationality, they come to take whatever opportunities for irrational conflict present themselves, and run with them. If the contestants belong to different ethnic groups, they’ll inevitably come to treat their ethnic differences as fuel for the fires they want to set. Repeat this often enough, and it blows up in everyone’s faces. Meanwhile, the underlying problems go unidentified and unresolved.

It occurs to me that people outside of a hospital setting would be horrified to see the degree to which crucial parts of the hospital, like the OR, are crippled by in-fighting and miscommunication. One thing you learn from working in an OR is that at a very basic level, people around here have no idea how to listen so as to understand one another, talk so as to be understood, or identify the prejudices and stereotypes they have that impede effective communication. The problem has been well-studied in the academic literature, but is largely unknown to the average person–including the average health care worker.

This is not something that can be fixed by more on-the-job training, or by vocational training of the sort that critics of higher education so ardently and ignorantly love. It’s not something you can fix by piling up a dozen Coursera certifications, or through demonstrated proficiency in the latest techniques in surgical tech, sterile processing, or infection control. It’s the kind of long-term, slow burn result you get from a certain kind of multicultural education, but only if you do it right, and only if you invest sufficient time and resources in it from kindergarten through college. And even that’s not a guarantee of success. Nothing is. But failing to do it is essentially a guarantee of failure.

If a multicultural society isn’t willing to invest resources in a serious form of multicultural education, it should reconcile itself to having ethnic conflict explode across the land. What it shouldn’t do is engage in the pretense engaged in by so many critics of higher education: that we can solve our problems by the invocation of frictionless magic, or that our problems all originate with democratic politics, so that if we dial back democracy, we dial back rancor and live in tranquility.

Consider the case I’ve just described, and ask yourself how any of that makes even the slightest sense. The problem I’ve described requires the inculcation in both warring parties of a propensity for mutual understanding sensitive to cultural difference. The market doesn’t provide that unless people make a point of insisting on it. “Democratic politics” is not what explains the rancor in my example, unless what you mean is workplace politics of an ineliminable kind. Once you grasp this, you see that so many critics of higher education are selling us all a dangerous, delusional bill of goods.

Mutual understanding doesn’t come on the cheap. It doesn’t happen without effort directed specifically on task. If it isn’t deliberately cultivated within the educational system, where do these self-styled critics of higher education or multiculturalism think it’s going to come from? I guess that’s a question that they can afford to leave unanswered.

Multicultural dialogue ca. 2020

When I reflect on my days as an educator, I can’t help thinking of the War of the Shifts as a missed pedagogical opportunity. I spent almost the whole of my twenty-six year career in higher education teaching Gen Ed–general education in the humanities. People in the university’s marketing department used to sell Gen Ed by convincing would-be students that the skills we taught in the Gen Ed classroom transferred seamlessly to the work setting. Much of that was empty talk that many of us regarded with suspicion and resentment. It sounded too much like an attempt to sell the humanities by turning it into something it wasn’t, namely vocational education.

I now see, however, that it wasn’t entirely wrong. There was at least one thing we taught in Gen Ed that no one else was apt to teach, but that desperately needing learning: not a discrete, commodifiable skill, but the generalized practical intelligence needed to identify complex problems, and the skills required to communicate possible solutions to them. Only gen ed courses–courses in history, economics, political science, sociology, philosophy–will teach you that a fixation on ethnicity can impede a proper understanding of class. That insight is the one that breaks the log-jam in the conflict I’ve described here. Subtract all that from the equation, and what you get is some version of the War between the Shifts–confused alarms of struggle and flight, where ignorant employees clash by night.

After two months on this job, I find myself wishing that I could take what I’ve learned and re-teach all the Gen Ed I ever taught, knowing what I now know. What would I have done differently? In one way, nothing. In another way, everything. I would have taught exactly what I did teach, but at an exponentially higher level of intensity. I now see that I was on the right track. I just wasn’t traveling it at the right speed. I should have hit the gas and gone faster.

Take class participation. I certainly encouraged class participation when I taught Gen Ed, but never really insisted on it. I probably should have insisted. I now see that getting students to talk about Rawls or Nozick or Walzer or Marx–about distributive justice generally–would have helped at least some of them do a better job of talking to each other about, say, workload issues in the workplace. It’s not so much that anything in those authors really transfers smoothly to anything that happens in the workplace. On the contrary, little of it does. It’s that learning how to talk about distributive justice in a classroom might have helped talk about it in a break room. The rough spots and obstacles to communication are pretty much the same in both places. What students needed was more constant and more intense practice at negotiating those rough spots. I wish I’d given them more.

Take the expression of conflict itself. I certainly encouraged the free play of conflicting views in the classroom, but was probably too careful to keep the expression of conflict within “safe” bounds. I should have drawn wider bounds. I think I tried too hard to make the classroom a safe space, and let’s face it, tried too hard to be the People Pleasing Gen Ed Professor that everyone wanted to take. For whatever it’s worth, I succeeded at that: it’s not an exaggeration to say that I was probably the most popular instructor in the School of Arts and Sciences. But I definitely wasn’t the best.

When I was a grad student, my mentor used to say that a popular professor was probably doing something wrong. He was right in my case. I kept my job at Felician for thirteen years, but at the price, to some degree, of infantilizing my students. When conflict arose in the classroom, I made sure that it was directed at me. Otherwise, I made sure that good feelings prevailed. But that was a mistake. Good feelings don’t always prevail in life. People have to come to terms with that fact, and my students didn’t, at least in my classroom.  I should have immersed them in a bitter cauldron of bad feelings and forced them to deal. Too much of what I served up was dessert.

A final, tricky issue is more directly related to ethnicity–multiculturalism. I taught a largely urban minority-majority population, and so, worked hard to find the nameless mean between multicultural cheerleading and civilizational chauvinism. The task often seemed overwhelming, a perpetual matter of avoiding the extremes without ever hitting the mean.

What’s involved in hitting the mean? You want to avoid relativism without dogmatizing against it. You want to allow for moral realism or objectivism without indoctrinating students in it. You want to insist that some norms are universally applicable while calling out lazy stereotypes masquerading as “objective moral judgment.” You want to sing the glories of “the West” without minimizing the crimes of “the West.” You want to sing the glories of “the West” while questioning the existence of “the West.” You want to stress what human beings (or living beings) have in common, without slighting the differences between them. You want to insist that everyone is capable of the same virtues and vices while acknowledging that some enjoy privileges that others don’t. You want to do justice to subtlety but don’t want to get lost in over-complexity. And of course, you have fourteen weeks to pull this off, interrupted by holidays during which more grandparents will die than you ever thought anyone had.

I now wish I had thematized ethnic conflict in a more explicit way, particularly conflict of a kind that multicultural educators are reluctant to deal with–the kind that doesn’t involve white people lording it over POCs. I guess there’s a bit of rear-view mirroring here, but I wish I had given my students the resources to handle an angry dispute, decades after graduation, between an African American from Harlem and a Filipino from Mindanao, regarding which OR shift (if any) is free riding off of which, and how to prove it. Actually, what I wish I’d done is give them the resources to see through that illusion. Not sure I ever managed that. Maybe next semester.