Friday, May 12, 2006

Unconscious incompetence

To look forward, first look back.

The title comes from a slide graph I saw many years ago at a training event, which courses the progress of an individual or an organisation when learning to master a task. There are four distinct stages, with Capability as the X axis and awareness on the Y axis. Take the example of learning to drive.

When you are a young teenager, you are in a state of unconscious incompetence- you don’t know how bad you are at driving. You might know the principles of the controls but assume that it can’t be that hard to do as your Mum & Dad can do it.

Then comes your first lesson. Yikes! So much to remember! How can you possibly do different things with different limbs? You are now acutely conscious of your incompetence.

Over time, you learn how to control the car and develop road awareness. You have progressed into the competence category but you are still very aware that you have to do a lot of thinking in order to drive safely. This is particularly acute the day you pass your test and decide to venture out onto the motorway. (The day I did that, my exhaust fell off!)

Then, some 30,000 miles or so later, you are now able to drive competently and unconsciously. You change gear according to the conditions without needing to analyse which pedal to press. You can hold a conversation or listen to the radio without wobbling or nearly crashing into the car in front. A lot of the driving is on auto-pilot but you become instantly aware of any unusual hazard or potential obstruction. Now is the time to go on an advanced motoring course to cure you of any bad habits you have slipped into!

Now for another take on the word conscious/unconscious. As far as I am aware, I have only been unconscious twice in my life, both as a child having teeth pulled out. (They weren’t rotten, I just had an overcrowded mouth and it was to make room for my second teeth which otherwise may have emerged somewhat misaligned). Once was at an NHS dental centre in Slatyford (a Newcastle Suburb), the second time was in the Dental hospital in the centre of Newcastle. I was given gas both times and the experience was very similar. After being given the face mask, I was asked to count to ten and by about six my eyes were closing and the sound went all zingy and whiny. Shortly afterwards, I came round in a recovery bed with a stainless steel kidney bowl next to me and spat out a lot of blood. Even to this day, when I see kidney-shaped side dishes in restaurants, I think of losing teeth and bleeding gums!

Now, looking forward, I am likely to be made unconscious again as I have some surgery planned under general anaesthetic in the not too distant future. The surgery is actually rather trivial- I’m having a tympanostomy tube fitted into one of my ears, which has been giving me trouble for a number of years. This device also goes by the name of a grommet, something more associated with young Kids than blokes in their late 40s. The ear, nose and throat team will also do an exploratory of my sinuses in order to work out why my little eustachian tubes don’t equalise the ear pressure properly.

I have found some relief using a medical device called an Otovent, essentially a balloon that you inflate using your nose. By closing off the other nostril and swallowing whilst the air pressure is increased, the ears equalise as per landing in aeroplanes. The first time I used it my right eardrum did a huge double-thump like someone standing behind me with a big Bass drum, then suddenly my hearing was ten times better. Whilst it certainly gives relief, to the casual observer the sight of someone blowing up a balloon with their nose looks absolutely ridiculous. Both Karen and David could initially put me off my stroke by making a balloon deflation noise whenever they heard an inflation going on. (I’d immediately descend into fits of laughter and have to calm myself before trying again).

I have no idea when the surgery will happen, you know what the NHS is like. It is complicated by the anaesthetist wanting me to recover in a high dependency bed- as I have obstructive sleep apnea there is a slight risk that I could stop breathing post-operation and that would be more of an issue on a general recovery ward. High dependency beds are prioritised for those who seriously need them so I could easily get gazumphed by an urgent case right up to surgery time. Time will tell…


John said...

I've used the Otovent and found it very effective.

Shades said...

You don't need a prescription for an Otovent, either. Some Doctors I've met haven't heard of them and none of them offered to write a scrip for one.