Girl inflating a red balloon

Regular readers know my daughter is in the hospital. We are working on day 16 at this point, and know that we won’t be able to go home until day 19. Some of our delay in going home comes from an interesting communication issue.

Here’s the context: A lot of readers will know what a CPAP is–Constant Positive Air Pressure, a machine that, through a mask, puts a little extra pressure into your airway to keep it open and prevent sleep apnea. In turn, apnea occurs when some part of the normal breathing channel collapses, preventing normal breathing.

In other words, CPAPs stop snoring. Serious snoring. Life-threatening, brain-damaging, heart-attack-inducing snoring.

A Bi-PAP is like a CPAP, but it maintains the pressure at two different levels–a little less on exhale, a little more on inhale. It doesn’t breathe for the patient, the way a ventilator does; it just responds to the patient’s own breathing and gives a little help.

Without going into all the medical stuff, let me just tell you that our daughter has serious neurological problems that are slowly deteriorating, and so at age 11 she now needs that extra help while she’s sleeping. It is likely she will eventually need the Bi-PAP 24 hours a day, and maybe will eventually need a ventilator.

Back to the communication thing. We have known for nearly a week that our daughter would go home with a Bi-PAP to help her breathe more comfortably at night. We checked with our home nursing agency (our daughter has 24-hour nursing at home) to make sure the nurses had been “comped” (i.e., trained and checked for competency) on a Bi-PAP. No problem: all of them had been. It looked as if everything was in place for the day the hospital would send us home.

But then the medical equipment provider told the nursing agency that the actual equipment would be a ventilator, running on Bi-PAP settings. Suddenly, we couldn’t go home yet, since none of the nurses had been comped on a ventilator, and it requires three shifts of “shadowing” another nurse using a ventilator to get comped.

The doctors kept saying, “She just needs a Bi-PAP. The nurses are comped on a Bi-PAP. You can go home today.” And the agency kept saying, “She’s getting a ventilator. The home nurses aren’t comped on that.”

I actually listened to someone from each group going round and round about this, not angrily or anything, but just repeating the same things to each other over and over.

It suddenly struck me, and I interrupted: “I see what’s happening! The doctors and respiratory therapists are using the term ‘Bi-Pap’ to indicate a function, and the agency and equipment folks are using ‘Bi-PAP’ to indicate a specific machine. The nurses have to get comped on the machine, regardless of what function it’s serving.”

Silence. Then they looked at each other, and both said, “Yeah, I guess that’s right.”

A word by itself means nothing. Words are simply symbols that stand for something. One mapmaker might use little * symbols to indicate marshland, and another use it to indicate snow. You have to look at the key to see what it means. The problem arises when we think a symbol means the same to both parties, and they don’t even realize the symbol references different things, especially when those things are closely related. But little differences can make a huge difference in process. Like Bi-PAP competency, for instance.

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