The Case of the Big Set-Up

COLD OPEN

TRACY (V.O.)The very first question I got about my study was a fair one, right down the middle.

I had a filing cabinet of answers ready to go, and not one of them was to that.

— music sting —

ANNOUNCERWelcome to Adverse Events. Transcribed stories from the case files of Dr. Tracy Grant, who writes the protocol, and Connie Chase, who makes it all happen.

ANNOUNCERThe story you are about to hear is fiction. Any resemblance to your last study is purely coincidental and entirely predictable.

ANNOUNCERThe Case of the Big Set-Up.

SCENE ONE — A HALL WITH A PROJECTOR

a slide carousel advancing · a hall of people settling · a chair scraping somewhere at the back

TRACY (V.O.)The ANCHOR trial. Sixty family caregivers, twelve weeks, a support group with a trained facilitator and a skills curriculum we spent a year building.

And it worked. Strain went down and it stayed down. I had been selected to give a presentation about it at the very next conference. Now, understand, you get to stand at the front of a hall and say a thing like that out loud about twice in a career. I stood up there and proclaimed it to a sea of eager faces.

a chair, at the back · a voice from back there, indistinct

TRACY (V.O.)Then a woman from a nearby county program raised her hand in the back.

She has run a caregiver group out of a county office for six years. Thursday nights, on a budget that would embarrass you. What she has never had is a curriculum, or a facilitator trained for a year to deliver one, and she had driven a long way to hear somebody stand up and say those things worked.

Now she's heard it. Excited, she had just one question before she went home and started looking for the money.

Because a facilitator is most of what this costs. If it's the curriculum that actually moved the needle, she raises that money and waits another year for it. But if it's the room, she has had the answer for six years and nobody ever told her.

murmur in the crowd agreeing with the question

I said that was a great question and I would get back to her.

— music bridge, four bars, then under —

SCENE TWO — THE WALL

a corkboard, hollow, and a pin going into it · another · chairs dragged in from somewhere else

TRACY (V.O.)To tell you how I lost that question I have to take you back eight months before anybody was enrolled, to a Tuesday afternoon and a wall.

You have not lived until you have planned a trial on a corkboard. One card for every visit, straight across, and string from each card down to the measure that gets collected there. Stand back far enough and it looks like the wall in a picture where somebody is about to rob a bank.

CONNIEWhose corkboard is this?

TRACYIt's the department's.

CONNIESure got a lot of holes in it.

TRACYThat's from the pins.

CONNIEYeah I know it's from the pins, it just sure has a lot of holes in it is all.

TRACYHard to use a corkboard without putting holes in it.

a card going up

TRACYWeekly strain score. Four items, over the phone, every week, all twelve weeks.

CONNIEFour items I can do. Four items on a Tuesday night with a person who has been up since five, that's fine.

TRACYAnd the full battery. Depression, sleep, coping, social support, self-efficacy.

CONNIEHow long is the battery.

TRACYForty minutes.

a beat

CONNIEForty minutes, in person, how many times?

TRACYI had it monthly.

CONNIETracy. These are people who cannot leave the house without arranging for somebody to sit with their mother.

TRACY (V.O.)She was right. She is always right about this and she is right in a way I can never argue with, because I read about caregiver burden and she calls them on Tuesdays.

a pin coming out · a card moved

TRACYBaseline and twelve.

CONNIEBaseline and twelve.

a marker

TRACY (V.O.)I wrote one word at the bottom of the week four card, so we would remember why the long one wasn't being asked every month.

Burden.

And then we stood back and looked at that wall. And I'll say this much: we were pleased. Sixty people. Seven hundred and twenty phone calls and a hundred and twenty visits. Nobody looks at a wall like that and thinks what won't this be able to tell me.

— music bridge, two bars —

SCENE THREE — THE OFFICE

a box down off a shelf · a lamp chain pulled · nothing else in the building running

TRACY (V.O.)So. Was it the curriculum, or was it the room. Two suspects, and no way on earth to put either one in a lineup.

To answer that you have to catch the thing that moved in between.

Say it's the room. Then the room does its work by making a woman less alone, and if that is what happened, her loneliness should come down first and her strain should come down after it. That is all an explanation ever is. One thing moves, then the other one moves, in that order.

So you need both of them measured, over and over, the whole way through. Enough times, close enough together, that you can lay the two of them side by side and see which one moved first.

I had that for the strain. Every Tuesday, twelve times, sixty women, without fail.

For everything else, I had two.

a folder · pages

Social support. Baseline and twelve.

another folder

Loneliness. Baseline and twelve.

Coping. Self-efficacy. Baseline and twelve, baseline and twelve, every one of them a straight line between two dots, because two dots is all a straight line can be.

Her loneliness went down. Her strain went down. Both of them, somewhere inside those twelve weeks.

Two of them in the same room, same hour, and not one witness in that building who could tell me which moved first.

the folder closed

I went at it for six hours, the way you work a case with no body. You go back over what you've got until it talks or you quit. I pulled the weekly cards and read every one, looking for anything in four items about strain that might stand in for a fifth item about loneliness. There isn't one. I looked at attendance, on the theory that showing up more often meant the room mattered more, and attendance was ninety-six percent, because these are people who keep their appointments.

a handset lifted · a number dialed · ring, and ring, and a pickup

CONNIESomebody had better be dead.

TRACYConnie. It's Tracy. I am aware of what time it is.

Before anything else, I want to be clear that nothing is on fire, nobody has been hurt, and this has nothing to do with the freezer disaster. I raise that only to rule it out.

I should also say that you are the most reliable person I have ever worked with. In this building. That I have worked with directly.

CONNIETracy. What can I do for you.

TRACYThe weekly calls. What did you actually ask them.

CONNIEIt is a quarter past eleven.

TRACYPlease.

CONNIEFour questions. The same four, every Tuesday, twelve Tuesdays. How hard was this week. How worn out are you. How much of it is on you. Are you managing.

CONNIESixty people, one at a time, and I could say it in my sleep. One might say I'm doing that right now.

TRACYAnd the long one. How many times.

CONNIEThe forty-minute one? Twice. Once before they started, once at the end. That's what we said in the spring.

TRACYThat's what we said in the spring.

a beat

CONNIEIs something wrong with the study?

TRACYNo. No, the study is fine.

CONNIESay goodnight, Tracy.

TRACYGoodnight, Trace— er, Connie.

the handset down

TRACY (V.O.)Four questions about strain. Twelve times each. And one long walk through a person's whole life, at the start and at the finish, and never once in between.

a handset lifted · a number dialed

Around one I called downstairs to see whether the closeout boxes had gone to the archive yet, which tells you the quality of thinking I had arrived at.

ring · click

RECORDED VOICEYou have reached Records Retention. Study records are held for seven years from the date of closure. Adding anything to a closed study requires forms 10-A and 199B signed in triplicate and a medallion signature, with a wait time of 5 months. That may sound like a joke but we don't have a sense of humor, or so we've been told.

the handset down

TRACY (V.O.)I put the phone down and went back to the box.

— music bridge, two bars —

SCENE FOUR — TWO DOTS

a pin out of cork · a card off the wall

TRACY (V.O.)The wall was still up. Nobody takes them down while a study is running, because a corkboard is a promise you made in public.

I found the card. Week four. And down at the bottom, in my handwriting, one word.

Burden.

the card turned over

Here is the thing I want on the record, and it is the whole case.

Reading that card tonight, knowing what it cost me, I would write it again.

Because the alternative was forty minutes, two more times, from sixty people whose mothers cannot be left alone in a house. Some of them would have quit. The ones who quit would have been the ones having the worst year, which means the trial that proved this thing works would have proved it on the people who had it easiest, and it would have proved nothing at all.

the card set down

Connie was right that afternoon. Being right that afternoon is why I stood in front of forty people tonight and said I'll get back to you.

Nobody was careless. That's what makes it a case and not an accident.

— music bridge, two bars —

SCENE FIVE — THE CURVE

a box of weekly cards · a rubber band off · pages laid out, and more pages

TRACY (V.O.)And then, because it was two in the morning and I had nothing better to lose, I did the thing I had not thought to do, which was to look at what I did have.

Twelve weeks. Sixty people. Every week, on the phone, four questions.

pages, steadily

Participant thirty-one. Week one, she is where she started. Week two, the needle moves a little bit. Week three, a little more.

Week four, she is most of the way to where she is going to end up.

And weeks five through twelve, she stays there.

the sorting stops

Fifty-two of them do that. Not identically, nobody does anything identically, but the same shape. It lands by week three, or four, or five, and then it holds.

I cannot tell that woman from the county what part of this works.

Here is what I can tell her instead, and I have been turning it over ever since, because I think it is worth more than the thing she asked me for.

Whatever it is that works, it does all of its work inside the first month. Weeks one through four, every bit of it, and then it holds for eight more.

She came to that hall to find out whether she had to buy the half of my program she has never had.

She doesn't have to buy anything yet. She can walk into her own room on Thursday, with the group she already runs, and by the end of the month she will know whether she has something.

She asked me for my answer. What I've got for her is better than my answer. She can stop waiting on me and go find her own.

— music bridge, two bars —

SCENE SIX — THE BOARD

early traffic through a window · a chair pushed back

TRACY (V.O.)The study was closed, so I took the wall down.

a pin, out · a card off · another

Card by card, twelve weeks, straight across. The string went back in the cabinet with the other things we are saving.

the last card · a long pause

What's left is a board full of holes.

a hand across it

I could not tell you which of them were the expensive ones. They are all exactly the same size.

Seven hundred and twenty phone calls, a hundred and twenty visits, and not one of those numbers ever made me certain of anything. Certainty isn't something you get by weight. You get it on a Tuesday, eight months early, picking which two things you will be able to lay side by side.

a pin, and one card going back up

I put one card back. Week four. My handwriting along the bottom.

The visit where I decided not to ask, and the week the answer turned up anyway.

a drawer · a sheet of paper squared up on a desk

Then I started a letter to a woman in a county office.

Her group meets Thursday.

— music —

ANNOUNCERThis has been The Case of the Big Set-Up.

SIGN-OFF

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ANNOUNCERDr. —— appeared as the Voice of Records Retention.

ANNOUNCERWith thanks to Burns and Allen, whose radio and TV show ran from 1929 to 1958.

ANNOUNCERAdverse Events is brought to you by Software for Research. For those who love discovery more than data entry.

ANNOUNCERAnd even though the grants office rules this an unallowable expense whenever they hear us say it: this is Adverse Events.

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