Accountability and the Burden of Bureaucracy

Bureaucracy often blurs accountability, requiring a touch of common sense as one waits outside for safety issues.

The signs tell you a lot. Laminated and taped, each proclaims rules that might’ve made sense at some point.

There are arrows contradicting one another. Doors remain locked—”temporarily” often implies forever. Between you and your goal, there’s a desk manned by someone whose job is to ensure you don’t accidentally go astray.

Hospitals showcase this well.

Endless checklists multiply. Protocols double up. There’s no clear responsibility, yet everyone seems certain about what you shouldn’t be doing. Hospitals often amplify the tendency for people to congregate, judging one another for a sense of safety that isn’t really there.

This is a common issue for caregivers. Not out of choice, but because care often requires us to engage more deeply with a system that prioritizes procedure over insight. By the time we reach the desks, we’re already on edge, and our patience wears thin.

I remember being at a large teaching hospital with my wife, Gracie, getting ready for a nine-hour surgery. We were staying with friends nearby. She had already checked in, and the surgeon had specified where I should go, allowing me to be with her before surgery.

After 40 years in nursing, I’ve learned a thing or two. I no longer have that naivety; I understand the terminology, can ask informed questions, and handle the grimmer sides of medical situations with ease. That familiarity usually gives me confidence in pre-operative care, recovery, or ICU settings.

But the real challenge is navigating the system.

From the parking lot to the patient, you face a minefield of desks, checkpoints, screens, and policies, often manned by people who lack knowledge about your medical history.

That day, I found myself in the hospital during Gracie’s surgery, in the midst of all the COVID-19 protocols—what I now view as a sort of bureaucratic holy day.

It was incredibly cold in Denver that morning. I can handle the chill in Montana, but Denver’s cold is a different beast. After trekking a long way from the parking lot to the emergency room, I was reluctant to be sent back outside to navigate the bitter weather once more.

At the emergency room security desk, I shared my wife’s name and stated, “I’m here for surgery.”

The guard glanced at the screen and replied, “Please use the front door.”

“It’s already shut,” I said. “The surgeon directed me here.”

“You should use the front entrance,” was the response.

I tried again, slowly, but got the same answer.

So I asked, “Ma’am, where did I lose you?”

She repeated her earlier instructions.

Years ago, I might have argued. I would have cited instruction manuals and asked for a supervisor, all to no avail and raising my blood pressure in the process.

But decades of caregiving taught me that arguing usually leads nowhere helpful.

Instead of escalating things, I opted for a different approach. I faced the unyielding wall of bureaucracy with an unexpected calm.

With an absent-minded look—thanks to my hair—I adopted a deadpan face and calmly said, “Ma’am, I’m board certified in cranioproctology. You’ll be expecting me before surgery.”

She blinked and her eyes widened slightly, then waved me through.

I realized later that my last name likely added weight to the credentials I had just invented. Even nonsensical statements seem to gain gravitas with proper punctuation.

I made it on time for pre-op, smiling to myself.

For the record, cranioproctology isn’t a recognized medical specialty, except perhaps in Washington, DC, where the demand seems chronic and widespread across government buildings. My services, while perhaps desperately needed, remain informal.

Caregivers deal with plenty of real emergencies. There’s no need to stir up new conflicts by turning every bureaucratic roadblock into a fight. We may not change the system, but we can alter how it draws us into its chaos.

Not every hurdle deserves a confrontation. Sometimes, it’s better to keep a straight face and reserve your energy for what genuinely matters.

A bit of humor, a calm demeanor, and the ability to sidestep others’ craziness can greatly enhance a caregiver’s peace of mind.

Maybe I’ll try this approach at the post office next time—or, God forbid, TSA.