1: Darlene worked as a nurse in a neonatal intensive care unit, or NICU, near Dayton, Ohio.
One day as she walked past an incubator, she sensed something was wrong.
“All of the machines hooked up to the child showed that her vitals were within normal ranges,” Charles Duhigg writes in Smarter Faster Better.
The nurse caring for the baby didn’t seem worried.
But to Darlene, something seemed off.
“The baby’s skin was slightly mottled instead of uniformly pink,” Charles notes. “The child’s belly seemed a bit distended. Blood had recently been drawn from a pinprick in her heel and the Band-Aid showed a blot of crimson, rather than a small dot.
“None of that was particularly unusual or troubling,” he notes. “The nurse tending to the child said she was eating and sleeping well. Her heartbeat was strong.”
Darlene opened the incubator and looked closely at the baby. The infant was awake and made a slight grimace when Darlene touched her, but she did not cry.
“There was nothing specific that she could point to, but this baby simply didn’t look like Darlene expected her to,” Charles explains.
“Darlene found the attending physician and said they needed to start the child on intravenous antibiotics.”
The doctor ordered the antibiotics and several tests.
“When the labs came back, they showed that the baby was in the early stages of sepsis,” Charles writes, “a potentially fatal whole-body inflammation caused by a severe infection.
“The condition was moving so fast,” he notes, “that had they waited any longer, the newborn would have likely died. Instead, she recovered fully.”
2: Beth Crandall was a researcher who studied how nurses decided which babies needed care and why some were better than others at noticing what mattered.
She interviewed “nurses who were calm in the face of emergencies,” Charles notes, “and others who seemed on the brink of collapse.”
Beth was most interested in a small group of nurses who were especially good at noticing when a baby was in trouble. “They could predict an infant’s decline or recovery based on small warning signs that almost everyone else overlooked,” Charles observes.
“It was like they could see things no one else did,” Beth said. “They seemed to think differently.”
Both nurses had access to the same information. But only Darlene realized there was a problem.
“When she asked Darlene to explain how she knew the baby was sick, Darlene said it was a hunch,” Charles explains.
3: But as Beth asked more questions, the evidence suggested a different explanation.
“Darlene explained that she carried around a picture in her mind of what a healthy baby ought to look like,” Charles notes, “and the infant in the crib, when she glanced at her, hadn’t matched that image.
“So the spotlight inside Darlene’s head went to the child’s skin, the blot of blood on her heel, and the distended belly. It focused on those unexpected details and triggered Darlene’s sense of alarm.”
The other nurse noticed something entirely different.
She “didn’t have a strong picture in her head of what she expected to see,” he shares, “and so her spotlight focused on the most obvious details: The baby was eating. Her heartbeat was strong. She wasn’t crying.”
Darlene didn’t have more information. She had a mental picture that helped her recognize which information mattered.
A NICU, Charles notes, “is a mix of chaos and banality set against a backdrop of constantly beeping machines and chiming warnings . . . heart monitors and automatic thermometers, blood pressure systems and pulse oximeters—that are ready to sound alarms the moment anything changes.”
With so much information, it can be hard to notice what really matters.
“The other nurse,” Charles observes, “was distracted by the information that was easiest to grasp.”
So what allowed Darlene to see what the other nurse missed?
More tomorrow!
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Reflection: Think about an area where you have significant experience. What are you able to notice now that you might have completely missed years ago?
Action: Pay attention today to a situation you know well. Before reacting to the most obvious information, ask yourself: What doesn’t fit with what I expected to see?
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