Sunday, April 12, 2015

Moving Pianos

One of the first legitimate jobs I had was moving furniture with my grandfather.  He had been doing it since the days when it was referred to as a "dray line".  His only truck was a 1933 Diamond T and by the time I was in high school he was on his 6th engine and I think that each engine had gone for 150,000 miles.  I was probably in my senior year in high school when he asked me to show up and help him out on the job.  I usually worked with two other guys - my Uncle Bill and a guy who worked with my grandfather for many years - Elwood.  Bill and Elwood were both in their 50s and usually looked pretty tired.  My grandfather was wiry and in his early 70s but no longer did any heavy lifting.   When he walked he was bent in two different directions.  From behind it looked like his torso was walking next to where his hips and legs were located.  Occasionally we were joined by my Uncle Carl who was in his 20's and very physically fit.  Despite that mix of personnel, we took on jobs that I would never consider at this point in my life, even though at the time it seemed like a job I could get into and make a career of.

My grandfather's dray line was preferred delivery service for a local appliance store.  That means moving stoves, refrigerators, and freezers and making sure that they are delivered and set up in pristine condition.   My grandfather was a perfectionist and always reminded us that he had never paid out an insurance claim for damaged appliances or furniture.  One of my early lessons was just how demanding customers are.  We were delivering a refrigerator freezer that weighed about 300 pounds.  After carrying it up about 20 steps to a long porch and across the threshold and into the kitchen without a glitch, the homeowner told us he wanted it dropped through a 4 x 4 foot hole into the floor and into the basement.  The only way down that hole was a ladder.  It meant that one of us would need to slide the unit through the hole and the two guys in the basement would have to catch it.  Elwood looped a piece of rope around two of the casters and lowered it over a piece of padding.  Bill and I caught it and lowered it to the floor.  Even though the entire process only took about 15 minutes we were covered in sweat and not very happy at the end.  It felt like we were just lucky that nothing bad had happened.  That usually explained all of the swearing along the way.  The volume of the swearing usually indicated which one of us was at the breaking point.

But the real problem for us in those days was pianos.  Everybody thought they wanted their kids to play a piano and it took a few years to discover that was not going to pan out.  At that moment we were called to move the piano to the house of the next child prodigy.  My grandfather saw himself as an expert in moving pianos.  We had specialized equipment for moving pianos like pianos trucks for upright pianos.  The upright piano had to be carefully wrapped to prevent damage to the finish and then we could affix a piano truck to each end, tighten the straps and it was fairly maneuverable until we had to lift it.  In some cases we had to move grand pianos and that would typically involve the local college going up a winding staircase for three or four floors.  During one particularly heavy grand piano lift we recruited about 10 college students to keep a rope taught that was affixed to the piano as we slowly moved it up the stairs.  Their job was to prevent it from falling back on us if we lost control carrying it up.  I came away from those jobs realizing that moving pianos was grueling work.  The first time I heard the term "heavy lifting", I understood it as a metaphor and a physical reality.  But was it more than that?

By my late-twenties,  I already knew that the practice of medicine could be physically exhausting.  I would come home from work as a resident or intern and collapse on the floor.  I had just spent 36 hours in the hospital and for at least the last 12 hours of that time, I was falling asleep while I did documentation.  All of the notes were handwritten in those days.  When I finally snapped out of it,  my handwriting would just slide into an incomprehensible scribble when I fell asleep.  One of the medicine residents I worked with had a novel solution to the problem.  In those days I was writing the equivalent of 10 point font.  He went in the other direction.  He wrote as large as he could possibly write.  I marveled at some of his notes - 4 words per line and 4 lines per page.  Sixteen words per page!  I know that he took a lot of heat from some of the attendings.  But he was doing 15-20 admissions per night in an acute care hospital on an Internal Medicine service.  My first lesson about work in medicine was that sleep deprivation and overwork can be as exhausting as heavy physical labor.   There is no way that my grandfather would have expected  us to work as much as interns and residents in the 1980s.  In fact, if my grandfather would have survived that long I am sure he would have had something to say about the working conditions.  

Part of the rich tradition of medicine from that era was that at some point - you completed residency training and moved on.  You realized that there was a whole world out there that did not depend on interns and residents staying up all night long taking care of acute medical problems under the dim fluorescent lights of the hospital.  Like everyone else I moved on and one day about 15 years later, sitting in one of my morning team meetings on an acute care psychiatric unit - I realized I was still exhausted.  I had listened to my social worker tell me that she had tried to get a patient out to local facilities and had called 25 of them and they all turned her down.  She spent her whole day on that one task and we had another 19 patients.  I listened to the usual battles with people trying to send us patients that we could never discharge.  I listened to the passive aggressive comments of county social workers and screeners who were also no help.  I listened to the complaints of our own administrators, blaming us for not being able to work faster and get people out faster.  That is difficult to do when you get absolutely no cooperation from anyone.  I looked around the room at staff who were angry, frustrated, tearful, and burned out.  We clearly had to deal with a lot of people who were supposed to be helping us provide care but they were hurting us.  It was 9 AM and we had not talked with any of the patients yet - the people we were really there to help.

And then I realized, this is just like moving pianos.  Well - moving pianos in hell maybe.  But I said it out loud to my team.  I explained the premise.  I asked them to envision me with a piano on my back and the forces tipping me one way or the other.  In the moving business we would say: "Tip er to me, tip er to you." to make the necessary rapid adjustments.  

I think a few people got it.  I looked over at my OT and she was smiling.

And for a few minutes - the mood in the room was lighter.

George Dawson, MD, DFAPA

Supplementary 1:

The implicit second lesson is that the constant warfare against managed care companies, administrators of all sorts, probate courts, and county bureaucrats is more fatiguing than moving pianos and it leads to burnout on a grand scale.  It is why when I ran into one of my mentors in an airport a few years ago and told him that I was quitting inpatient work after 23 years he said: "3 months wasn't long enough?".

If I had to rank the fatigue factors listed here over piano moving I would say they are:

constant warfare against the people that are supposed to "help" us > overwork > sleep deprivation

They are obviously not independent of one another and in fact the order above could also be viewed as a casual chain of events.

Supplementary 2:

Even though I was not moving furniture at the time, furniture movers everywhere must have rejoiced when the electronic keyboard started to appear.


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