Can We Keep You Safe?

Yes! And if we do our job well, you won't even notice.

“A spider’s web is stronger than it looks. Although it is made of thin, delicate strands, the web is not easily broken. However, a web gets torn every day by the insects that kick around in it, and a spider must rebuild it when it gets full of holes.”

From the dusty corners of our attics to tree branches that cross our walking trails, spider webs are ubiquitous. And because they are so common, these tiny miracles often pass unnoticed. The purpose of a spider’s web is, of course, to catch dinner.

Perhaps the most well-known spider webs are those formed in the beloved children’s book, Charlotte’s Web. The protagonist of the book is the affable Wilbur, the runt of a recently delivered litter of piglets. As you may recall, Wilbur is destined to be culled until Farmer Zuckerman’s early rising daughter, Fern, intervenes.

“Fern was up at daylight, trying to rid the world of injustice. As a result, she now has a pig. A small one to be sure, but nevertheless a pig. It just shows what can happen if a person gets out of bed promptly.”

Wilbur and Fern develop a deep friendship, and all is well until one morning they learn that Zuckerman still plans to send him to the slaughterhouse. An all-out effort to save Wilbur’s life is launched by the animals, led by the crafty but bloodthirsty spider Charlotte. Each animal has a role to play.

Charlotte, for example, admonishes Wilbur, who is in the depths of despair after learning his fate, that he must stop bellyaching and gird his loins for this important task. Wilbur’s job is to project strength and intelligence.

“Gain weight and stay well—that’s the way you can help. Keep fit, and don’t lose your nerve.”

Meanwhile, Charlotte plans to use her nightly web work to draw attention to Wilbur’s attributes. She is confident that it will be successful because she notes:

“Trust me, Wilbur. People are very gullible. They'll believe anything they see in print.”

But where will Charlotte get the words? She is a loquacious arachnid, but she was born in a barn.

The task of word-retrieval falls to the selfish rat, Templeton. He must go to the county fair and retrieve adjective-filled advertisements. To entice the recalcitrant rodent, an old sheep recounts the feast that awaits Templeton who finally agrees to go.

Fern, Charlotte, Templeton, the old sheep. They all contribute to the important task of saving the life of their beloved friend.

Treating patients in radiation oncology also requires teamwork. Soup to nuts, optimal patient care depends on the collective effort of individuals working toward this goal.

In the wee hours of the morning, for example, radiation therapists warm up machines and perform daily quality checks, ensuring another day of safe treatment delivery.

Nurses flip on exam room lights and check that supplies are restocked and ready.

Front desk staff respond to the deluge of phone messages and begin the tedious process of obtaining prior authorizations.

Dosimetrists weave together beam angles and segments to form intricate isodose curves.

Physicists orchestrate in the background, clearing a fault on the machine and performing quality assurance testing on IMRT plans while others break for lunch.

Doctors return from tumor boards, scarfing down sandwiches at their desks while drawing tumor volumes, approving films, and tackling documentation in the EMR.

The author of Charlotte’s Web, E.B. White, is best known for his children’s books, but most of his career was spent writing essays for The New Yorker.

In 1959, White updated the revered writer’s reference, Strunk (and White’s) The Elements of Style. On page 76, he instructs writers to “avoid the elaborate, the pretentious, the coy, and the cute.” He also encouraged aspiring authors to place themselves in the background of the story, not front and center.

Incidentally, this advice was consistent with White’s personal approach to the spotlight. A colleague, for example, remembered White climbing out a window and down a fire escape rather than give an interview to a journalist who was waiting in the lobby. Like the spider he created and shared with the world, White believed the writing wasn’t about him.

The provision of safe radiation oncology care is not the responsibility of any single person. The ideal patient experience depends on an invisible web of cooperation. Like good writers, we must weigh the benefits AND the costs of the elaborate, the pretentious, the coy, and the cute. However, with all the glittering technology that surrounds us, this can be a difficult task.

An elaborate plan may garner awe, but if it cannot pass QA, what good is it?

A physician’s heroic effort to cure cannot be attempted if the patient does not have consistent transportation to treatment.

An innovative patient position glowingly sold from a conference podium falls flat without the input of radiation therapists who must reproduce it every day.

In the setting of patient directed care, patients receive safe, expert and complex radiation treatments every day, all around the world. If all bring their best, each treatment is so expertly delivered and seamlessly performed that the contribution of each team member fades into the background, leaving only the patient experience of a job well done.

Nobody, of the hundreds of people that had visited the Fair, knew that a grey spider had played the most important part of all.

***Note: Garth Williams was the illustrator for Charlotte’s Web. He kept the original drawings until his death. His family presented them for auction in 2010 where many sold for tens of thousands of dollars. The photos in this post are from MyModernMet.

On my mind…