Once out of ICU, the patient goes to what is called, “step-down care”.

Interruptions, adjustments and all the life-support attachments are reduced. Monitoring is still 24/7 in real time, though.

Staff, and the attitudes are different too. No more extreme urgency, although the patient can experience a serious episode of any given nature, at any given time. Staff is highly trained and ready for any situation.

We experienced such an episode. Everything seemed normal – then it wasn’t. Something was terribly wrong, and had I not been there, it would have gone unnoticed. It was only the fact that my husband was in mid-sentence that I noticed the difference. Monitors didn't pick it up.

I summoned the nurses, and a team was brought in to assess.

One nurse repeated, “everything is at therapeutic levels, it should be okay.”

However, evaluations were made quickly by the specialists, and the episode passed. Everything was okay.

We just didn’t know why it happened.

A protocol was put in place; certain steps had to be followed.

Testing was done and everything was normal. Everything was okay. Follow-up plans were carefully laid out.

I witnessed that there was a different level of expertise, urgency. ‘Should’ really have had no place in step-down, yet it was used - as an asnwer.

There are different levels of expertise in all workplaces. When it relates directly to quality of life, we rely on the experts. But, when something ‘should’ be a certain way, it doesn’t mean it is.

I don’t take should for an answer because things never go as they should.

Plan, document, follow-up and re-adjust as you move forward.

It isn’t life and death – or even quality of life when you’re turning out a project for a client. But when someone invokes ‘should’, ask them if they’d bet their life – or perhaps just their paycheck – on it.

Routine projects usually aren’t. Approach every project as if your paycheck depends on an optimal outcome. Because in reality, it does.