[Originally posted to my personal blog, reposted here with edits.]
Introduction
You could call it heroic responsibility, maybe,” Harry Potter said. “Not like the usual sort. It means that whatever happens, no matter what, it’s always your fault. Even if you tell Professor McGonagall, she’s not responsible for what happens, you are. Following the school rules isn’t an excuse, someone else being in charge isn’t an excuse, even trying your best isn’t an excuse. There just aren’t any excuses, you’ve got to get the job done no matter what.” Harry’s face tightened. “That’s why I say you’re not thinking responsibly, Hermione. Thinking that your job is done when you tell Professor McGonagall—that isn’t heroine thinking. Like Hannah being beat up is okay then, because it isn’t your fault anymore. Being a heroine means your job isn’t finished until you’ve done whatever it takes to protect the other girls, permanently.” In Harry’s voice was a touch of the steel he had acquired since the day Fawkes had been on his shoulder. “You can’t think as if just following the rules means you’ve done your duty. –HPMOR, chapter 75.
Something Impossible
Bold attempts aren't enough, roads can't be paved with intentions...You probably don’t even got what it takes,But you better try anyway, for everyone's sakeAnd you won’t find the answer until you escape from theLabyrinth of your conventions.Its time to just shut up, and do the impossible.Can’t walk away...Gotta break off those shackles, and shake off those chainsGotta make something impossible happen today...
The Well-Functioning Gear
I feel like maybe the hospital is an emergent system that has the property of patient-healing, but I’d be surprised if any one part of it does.Suppose I see an unusual result on my patient. I don’t know what it means, so I mention it to a specialist. The specialist, who doesn’t know anything about the patient beyond what I’ve told him, says to order a technetium scan. He has no idea what a technetium scan is or how it is performed, except that it’s the proper thing to do in this situation. A nurse is called to bring the patient to the scanner, but has no idea why. The scanning technician, who has only a vague idea why the scan is being done, does the scan and spits out a number, which ends up with me. I bring it to the specialist, who gives me a diagnosis and tells me to ask another specialist what the right medicine for that is. I ask the other specialist – who has only the sketchiest idea of the events leading up to the diagnosis – about the correct medicine, and she gives me a name and tells me to ask the pharmacist how to dose it. The pharmacist – who has only the vague outline of an idea who the patient is, what test he got, or what the diagnosis is – doses the medication. Then a nurse, who has no idea about any of this, gives the medication to the patient. Somehow, the system works and the patient improves.Part of being an intern is adjusting to all of this, losing some of your delusions of heroism, getting used to the fact that you’re not going to be Dr. House, that you are at best going to be a very well-functioning gear in a vast machine that does often tedious but always valuable work. –Scott Alexander
Recursive Heroic Responsibility
Heroic responsibility for average humans under average conditions
I can predict at least one thing that people will say in the comments, because I've heard it hundreds of times–that Swimmer963 is a clear example of someone who should leave nursing, take the meta-level responsibility, and do something higher impact for the usual. Because she's smart. Because she's rational. Whatever.
Fine. This post isn't about me. Whether I like it or not, the concept of heroic responsibility is now a part of my value system, and I probably am going to leave nursing.
But what about the other nurses on my unit, the ones who are competent and motivated and curious and really care? Would familiarity with the concept of heroic responsibility help or hinder them in their work? Honestly, I predict that they would feel alienated, that they would assume I held a low opinion of them (which I don't, and I really don't want them to think that I do), and that they would flinch away and go back to the things that they were doing anyway, the role where they were comfortable–or that, if they did accept it, it would cause them to burn out. So as a consequentialist, I'm not going to tell them.
And yeah, that bothers me. Because I'm not a special snowflake. Because I want to live in a world where rationality helps everyone. Because I feel like the reason they would react that was isn't because of anything about them as people, or because heroic responsibility is a bad thing, but because I'm not able to communicate to them what I mean. Maybe stupid reasons. Still bothers me.
You might be wrestling with a hard trade-off between wanting to do as much good as possible and wanting to fit in well with a respected peer group. Those are both good things to want, and it's not obvious to me that you can maximize both of them at the same time.
I have some thoughts on your concepts of "special snowflake" and "advice that doesn't generalize." I agree that you are not a special snowflake in the sense of being noticeably smarter, more virtuous, more disciplined, whatever than the other nurses on your shift. I'll concede that you and them have -basically- the same character traits, personalities, and so on. But my guess is that the cluster of memes hanging out in your prefrontal cortex is more attuned to strategy than their meme-clusters -- you have a noticeably different set of beliefs and analytical tools. Because strategic meme-clusters are very rare compared to how useful they are, having those meme-clusters makes you "special" in a meaningful way even if in all other respects you are almost identical to your peers. The 1% more-of-the-time that you spend strategizing about how best to accomplish goals can double or triple your effectiveness at many types of tasks, so your small difference in outlook leads to a large difference in what kinds of activities you want to devote your life to. That's OK.
Similarly, I agree with you that it would be bad if all the nurses in your ward quit to enter politics -- someone has to staff the bloody ward, or no amount of political re-jiggering will help. The algorithm that I try to follow when I'm frustrated that the advice I'm giving myself doesn't seem to generalize is to first check and see if -enough- people are doing Y, and then switch from X to Y if and only if fewer-than-enough people are doing Y. As a trivial example, if forty of my friends and I are playing soccer, we will probably all have more fun if one of us agrees to serve as a referee. I can't offer the generally applicable advice "You should stop kicking the ball around and start refereeing." That would be stupid advice; we'd have forty referees and no ball game. But I can say "Hm, what is the optimal number of referees? Probably 2 or 3 people out of the 40 of us. How many people are currently refereeing? Hm, zero. If I switch from playing to refereeing, we will all have more fun. Let me check and see if everyone is making the same leap at the same time and scrambling to put on a striped shirt. No? OK, cool, I'll referee for a while." That last long quote is fully generalizable advice -- I wish literally everyone would follow it, because then we'd wind up with close to an optimal number of referees.