Excerpt 4: from Chapter 9

It was around three o’clock in the morning on a January night in 1978. A young man, not yet in his twenties, had just walked into the emergency room at Brigham and Women’s Hospital in Boston. He was tightly pressing a bloodstained shirt against a deep cut above his eye. Deborah Prothrow-Stith was only a third-year medical student at the time, midway through her surgical rotation, and her task this particular night was to practice stitching up patients. While she took care of the man, he told her what had happened. He’d been at a party and some guy he barely knew had offended him. One thing quickly led to another and suddenly they were squaring off amidst a ring of onlookers. Seconds later a knife flashed across his face. An inch lower and his eye would have been history. Instead, it was gleaming with anger. When Prothrow-Stith was done he turned to her and spoke words she would never forget: “Look, don’t go to sleep because the guy who did this to me is going to be in here in about an hour and you’re going to get all the practice stitching you need!”
Then he left.

That experience was an epiphany for Prothrow-Stith. It led to an insight that propelled her right into the intersection of two completely separate fields— violence prevention and health care. What is fascinating about her story is not just the specific idea that struck her that January morning, but how she managed to realize it. She paved the way for an entirely new field, but it was a path littered with failures and mistaken assumptions. Her experience is not an exception for realizing intersectional ideas. Since quantity of ideas leads to quality of ideas, we should pursue many ideas. This, however, leads to the inescapable paradox that in order to be successful at the Intersection, we must have many failures. The solution to this paradox is to incorporate failures into our overall execution plan. In other words, we have to execute past our failures. Just ask Deborah Prothrow-Stith.
 
Failures and Success
I met Prothrow-Stith in her office at the Harvard School of Public Health two and a half decades after the incident in the ER. Today, she is associate dean of the school and a star among those looking for strategies to prevent youth violence. Like many of the people I have met for this book, she is full of purpose and energy. Her voice is strong and her manner infectious, and I found myself smiling, worrying, and laughing with her while she told me what happened that night so many years ago.
 
The Insight
“I fell asleep soon after he left,” she says, but she felt a dark sense of foreboding. Although what she had done to help the patient was medically correct, it seemed that more violence and injury was about to happen. Yet, there was no recourse to prevent it. There were no protocols, no procedures. In fact, it seemed strange to even worry about it. After all, what business did a physician, much less a medical student, have worrying about violence prevention? Her job was to stitch ’em up and send ’em out. The police took care of the rest.

But what would have happened if, say, the man had arrived after an attempted suicide or a drug overdose? First they would have pumped his stomach and declared him medically stable, and then determined whether or not he was still a danger to himself. If the man at that point had said, “Now don’t go to bed, because I’m going home to take some more pills and I’ll be right back here,” it would have set in motion a range of systematic interventions. Physicians even have the power to force hospitalization if a patient is deemed a risk to himself or herself. The more Prothrow-Stith thought about it, the more she realized that physicians often got involved with prevention of harm by attempting to change patient behavior. She and other physicians pushed people to wear seatbelts, to eat right, to exercise, to avoid risky sexual behavior, and to avoid many other lifestyle hazards. But at that time they didn’t do anything to prevent violence.

Yet it is clear that violence is a health hazard. A pretty obvious one at that. But it was an issue addressed primarily by the law enforcement field—health care workers had nothing to do with it. Prothrow-Stith never did find out what happened to her patient that night, but the experience opened her eyes. There was an intersection between health care and violence prevention. No one had explored this intersection before, so she decided to take it on.