“Clusterfuck” was the term of endearment used to describe a Medicare quality improvement Web project called MedQIC (pronounced “med-quick”) that I worked on in Baltimore during 2004. While I must credit Max, the project’s snarky systems analyst with a Fu Manchu and a devilish glint in his eye, for being the first to aptly label MedQIC as a clusterfuck, it quickly became a moniker all of us on the project used frequently and affectionately. Max lasted barely a month on the MedQIC 2.0 team, namely because he called it as he saw it, and, well, “it” was undeniably a clusterfuck.
Clusterfuck came out of the military as did the acronyms SNAFU (Situation Normal All Fucked Up) and FUBAR (Fucked-Up Beyond All Recognition). All come from what I presume is a growing military lexicon to describe a situation where everything is going wrong and only getting worse. There is no hope for salvage or redemption.
I don’t know exactly whom to credit for coming up with “dead-quick” for also describing the MedQIC effort. That term came into being during the first pathetic incarnation of the project a few years earlier. Also, a team member once mistakenly called it “dead-dick,” but we didn’t bother correcting him.
The MedQIC team’s biggest problem was that we were trying to build a Web site with having no idea what the users, Medicare health care professionals, needed. Did they even want to download Medicare quality improvement tools and resources off the Internet? We didn’t bother asking and just built the damned thing, the second version of it, as fast as we could.
Coincidentally, the same type of phenomenon was occurring in Iraq. Our beloved United States had invaded and occupied a country without having any idea how its citizens would react or want to move forward after we knocked out Saddam Hussein. No one in the Bush Administration had bothered to ask, and the whole thing turned into one hell of a FUBAR costing more than a trillion dollars and tens of thousands of Iraqi lives, not to mention the thousands of Americans who were killed or disabled.
Simple lack of leadership was a major complicating factor for Son of MedQIC. The project was led by a middle manager from Medicare, a Ph.D. in psychology, who had no idea how to build a Web site, but at the same time, was desperate for MedQIC 2.0 to be her last hurrah before she retired. In addition to being incompetent, the woman was prone to sudden emotional outbursts and demands for functional overhauls without rhyme or reason. There was no telling what her hot button would be from one day to the next. I once spent weeks working with her to come up with a design for MedQIC 2.0 lanyards that we were giving away at a trade show. I assured her that I’d select a material that was strong enough “to hang a Medicare consumer with.”
But perhaps the most disturbing trait of our fearless leader was her horrific cackle when she got excited. It sounded like the mating call of a chicken on angel dust. It knocked the wax out of my ears.
Fortunately, our 12-person journey to nowhere was small potatoes compared to the debacle in Iraq, and our “nut job leader” (Max’s term again) had no artillery at her disposal.
While my attitude waxed and waned like everyone else’s, I served bravely and loyally for most of the year I was on the team. In addition to performing marketing and communications, my original role, I managed the vendor who did our Web design and even took on the role of our company’s project leader for a few months. Team turnover was nearly 100% by the middle of the year, so ultimately, several of us had to wear many hats.
However, by August, I had become persona non grata because of my reluctance to aggressively market MedQIC 2.0. The system wasn’t nearly ready; trying to market it, let alone launch it, had become a suicide mission. In an attempt to find an ally or at least a sympathetic ear, I sat down with my new supervisor, a young Indian M.D., to have a heart-to-heart talk about the precarious state of MedQIC, and why it might be a good idea for us to hold back on marketing it for a few months. Tanuj had remained cool, calm, and collected through his first weeks at the helm, so I thought he might understand my concerns, or at least offer some sage advice. “It’s very risky for us to promote something that isn’t there, especially given the history of MedQIC,” I said to him. “We aren’t even sure which features and functions we’ll include in the initial version. Right now, we’d just be selling vapor.”
Tanuj nodded for a few seconds, appearing to be in deep thought. Then he asked me if I had seen the movie “Harold and Kumar go to White Castle.” His question was bewildering, and while I love going to the movies, especially art and independent films, I told Tanuj that I hadn’t managed to experience that piece of cinematic brilliance.
“That movie is about absolutely nothing and yet it made a shitload of money at the box office,” he told me. “And that is your task at hand — to make MedQIC appear to be the best quality improvement Web site ever, even if we have nothing to show right now.” Not only did his comment make me feel even more helpless and alone, from there on out, I could never disassociate Tanuj from shitty little hamburgers and pot smoking. He had just become another fuck in the cluster.
While the craziness of the MedQIC project was frustrating, it wasn’t shocking. After nearly 30 years in the working world, I’d seen plenty of SNAFUs. In fact, it is amazing to me that anything ever gets done. Sometimes I just look around at all that man hath accomplished — the roads, buildings, dams, nuclear power plants, heart transplants, etc. — and I am blown away. Who in this world has their shit together enough to make all this happen?
And speaking of keeping one’s shit together, I tolerated the wackiness of the MedQIC project, mainly because it had helped me escape and recover from an impulsive decision four years earlier to drop everything and move from Washington, D.C., to Des Moines, Iowa, to be with a financially strapped divorcee-to-be with two kids who I met on the Internet.
I had just published “The Further Adventures of Eczema Boy,” a humorous essay on my bad skin, as a health section cover story for The Washington Post; quit my job as a communications director at a hospice-care/long-term facility; and was feeling quite lonely and horny. I give partial credit for the move to the romantic lure of the tornado sirens I heard in the background when I began talking to Melanie on the phone in late spring. After traveling back and forth to Des Moines over the summer, I moved there permanently during the fall.
Things started out OK. Melanie and I had a lot of sex, and after feeling guilty for ignoring the kids, took them out to Chuck E. Cheese for pizza and mayhem. If you’ve never been to the place, its wall-to-wall food, rides, and games. All the lights, sounds, and smells are like crack-cocaine for the kids. So we adults had our hedonism, and the children had theirs. This M.O. for our “family” sort of worked. But eventually, the situation turned out to be a real FUBAR. Given all the turbulence for Melanie — the divorce, custody issues, financial challenges, and emotionally confused children — it was a FUBAR waiting to happen.
Adding to the challenge, my first December in Des Moines was climatically brutal, even by Iowa standards. In fact, it was one of the coldest and snowiest winters on record there. During the winter of 2000-2001, there was at least three inches of snow on the ground in Des Moines for 91 days straight. Melanie’s house was poorly insulated and inadequately heated (the pipes occasionally froze) — so I was constantly freezing my ass off — and by the time I did find a way to warm up, I needed to head back outside to shovel out the mini van to pick up her kids or meet a potential freelance client.
One particularly blizzard-like Saturday night in late December, we stopped at a Walmart somewhere between Lincoln, Nebraska, and Des Moines to do some shopping. It was a 250-mile round trip we made every weekend to shuttle kids back and forth to her ex. I stood in the middle of boys’ clothing and nearly broke into tears, wondering to myself, “How the fuck did I get here? I left one of the most vibrant, cultured, and sophisticated communities in the world to be unemployed in Iowa in the dead of winter with a divorcee with two kids?”
I expected Jack Nicholson in the trademark blue Walmart vest to appear from around the corner wielding a fireman’s ax. We’d lock eyes. He’d grin widely and say, “We’re not just slashing prices. We’re slashing customers!”
Melanie and I split up two months later, and I, having run out of money because of my less than meteoric success in freelancing, took a job as a writer for the Iowa Foundation for Medical Care (IFMC), Iowa’s Medicare quality improvement organization. Though I had my sights set on getting the hell out of Iowa, 9-11 happened, the economy and job market went down the crapper, so I languished in corn country for the next two years writing about flu shots, mammograms, and strokes. Then in late 2003, I heard about a position on IFMC’s MedQIC team in Baltimore and jumped on it without hesitation. While I was well aware that MedQIC had issues, I was absolutely delighted for the opportunity to move back to the East Coast.
While conditions were deteriorating for me at MedQIC, my friend Keryl had cut out a newspaper ad for a science writing position at the Foundation Fighting Blindness (FFB), a nonprofit funding retinal degenerative disease research located right down the street from my then office. She knew I was on the hunt for a new job and thought this might be interesting for me.
I knew nothing about the retina or the degenerative diseases that affect it, but the idea of writing about science and research was compelling. So I applied for the job, and after a rather lengthy interview process, was offered the position just five days after being fired from MedQIC.
Getting fired from MedQIC was anticlimactic. In fact, it was a relief for me and everyone involved. I got called into Tanuj’s office, where he and a department director were waiting. A human resources manager from Des Moines was on speaker phone, as well. They all had been fed up with me, because a month earlier, I had initiated the company’s highly bureaucratic problem resolution process to fight the job-performance warnings they had issued me. I claimed that I was being scape-goated, which was true to some extent. But admittedly, I had also become the project’s leading pain-in-the-ass out of my frustration with our lack of direction and progress. But at this point, I was done fighting. I had a look of “whatever” as I signed a couple of termination forms, and I didn’t let the door hit me in the ass on the way out.
I left the office in a downpour, and as I walked away, the events of the past four years ran through my head: meeting Melanie, moving to Iowa, winter, unemployment, leaving Melanie, leaving Iowa, and finally, leaving MedQIC. It was the end of an era punctuated by several bone-headed moves on my part. I had gone into this period without much of a plan, and I was about to move ahead without much of one either.
But I felt a new lightness as I headed to my car in the rain. I didn’t hurry. The deluge felt refreshing and renewing. I carried a small box of belongings from my office, but I wasn’t concerned about them getting wet. It contained only meaningless paperwork and a few of the strongest lanyards a person could ever need.