“Is it safe?” There are many scenarios where you might ask this question. Standing at base camp on Mount Everest and shielding your eyes from the sun, you turn to your Sherpa guide and ask, “Is it safe?” Or you sit down on the huge wooden rollercoaster at Six Flags Chicago and look up apprehensively at the teenager who has just fastened your safety harness, asking, “Is it safe?” You visit Africa and, while driving across the savannah in an open-top jeep, you spot a pride of lions and ask, “Is it safe?”

This question surfaces instinctively when we face situations where the possibility of danger is real and apparent. Climbing mountains, riding 100-year-old rollercoasters, and coming face-to-face with wild cats are activities fraught with danger: knowing that, we will have taken precautions. But we will also query the reliability of mitigation actions of those in charge, the ones we deem responsible, and ask them, “Is it safe?—generally assuming that the answer will be “Yes, of course it’s safe.”

But rarely do we walk into a hospital or a doctor’s office and ask that question. Of course, a hospital is safe. Of course, we are safe if we put our lives into the hands of a doctor, or entrust them to a system designed to guard our health and make us well. Of course.

Unfortunately, however, and with shocking frequency, the answer to this rarely-asked question is too often, “No.” No, this place is not safe. No, this place is filled with people, driven by systems, and fuelled by processes that make the environment inherently unsafe for many of those people who enter so trustingly: the patients.

Let me pause. “Yes, I see that hand in the back. Your question, sir?”

“What do you mean, hospitals aren’t safe? Do you mean hazards such as water on the floor and electrical cables hanging from the ceiling?”

No, I’m not talking about that kind of danger. Not the kind you’d find on manufacturing floors with whirling blades or on construction sites with bricks falling from the sky and giant machines racing about bent on squashing you. Nevertheless, I’m talking about danger just as real—although lurking largely unseen—with implications for safety every bit as real.

I am talking about real danger, but it is often a danger hidden behind systems and screened by our lowered expectations. You see, in a place like a construction site, if someone dies or sustains serious injury, people take notice. No one can see a worker at the bottom of a hole with a piece of rebar sticking in his side and just say, “Oh, that’s a shame, but, after all, these things happen.” Instead, people take action, first to rescue the man and then to ensure that this never happens again. In fact, if remedial action isn't taken, the site will likely be shut down and the construction company in for some serious trouble.

But what happens if something unsafe happens in a hospital? Something like failure to wash hands, spreading some dread bacteria from nurse to orderly to patient. And what if this dread bacteria turns a patient who is on the mend from surgery into a patient fighting for her life because of an infection? That kind of environment is unsafe. But this lack of safety often goes undetected in the midst of expected results. Environmental camouflage disguises the lack of safety.

Hospitals are places where sick people go, places where dying people often end up. One might wonder, “How are we to tell the difference between people running through the natural course of the end of their lives and those who are artificially hastened along their way through bad process, uninformed decisions, or negligence?”

On the day that I write this, a young man from Winnipeg is fighting for his life. He is in intensive care and on life support because of complications due to a wisdom tooth extraction. “People get complications,” you might remark, “so why is this a special case?” It is special because his complications are the result of someone on his medical care team making an error: the patient did not get a post-surgical prescription for antibiotics along with the prescription for pain killers that he did indeed receive. Because of that, he got an infection, one which went untreated because no one knew to look for it. The original error was compounded by subsequent actions—or lack of action—based on the assumption of a safe environment. The young man and his caregivers expected him to be safe in the hands of his medical team, but someone—perhaps many—let him down. At this time no investigative results have been made public, so not all the facts are apparent. The sources of error remain to be seen, but what we do know is that the patient who expected to be safe in the wake of a major but routine operation is now at risk of dying.

Of course, not all doctors make these kinds of mistakes. And not all hospitals foster environments which allow mistakes to happen and then compound themselves. Nor do all allow such disturbing issues to be glibly dismissed as one of those “things that just happen.” However, while I’d love to say this is an isolated case and events of this magnitude rarely happen, that is simply not true. In 2013 alone, one-half million people died in hospitals in North America from medical errors: half a MILLION! And that is only the people who died. There are countless others, perhaps millions, who have suffered permanent harm—physical, psychological, or both—from errors that happened in hospitals at the hands of people they trusted to provide them with medical care.

Hospitals should be safe places. Safe places for those who are sick to be admitted and get well. Safe places for people who are dying to receive quality palliative care. Safe places for the elderly to receive care for critical issues even while their bodies, overall, are failing them over time. Tragically, for far too many people, this is not the case.

What can we do? Well, to start, we need to demand transparency from our healthcare providers: from doctors and hospital administrators. We need to ensure that legislators are requiring full disclosure of errors and demanding good plans to ensure that system errors get fixed.

We also need to demand that doctors and other caregivers acknowledge what we already know: that they are not infallible and that they make mistakes. It is simply arrogant to believe and say anything other than this. Assuming responsibility for error and making apologies are critically necessary.

But we must not simply focus on those people who need more humility and institutions that are in need of improvement; we must also find ways to celebrate the places and people who are already doing it right. Let’s acknowledge the medical professionals who practice safety and transparency and model that to others, the administrators and policy makers who put patient safety high up on their priority lists when implementing change. Because, in the end, it is not legislation alone, nor just promises to change, that will make places safe. Widespread safety first requires that people and institutions actually change; then, that they model those changes to other institutions and medical personnel, including those in training.

I was recently at a patient safety meeting where Martin Hatlie, CEO of Project Patient Care, described a process one American hospital had put into place for dealing with errors in patient care:

1) Within 30 minutes of an error, it is reported.
2) Within 30 minutes of report of error, medical and hospital personnel are meeting with the patient and/or her family to admit an error has occurred.

The results will pleasantly surprise you. Not only did these simple steps (representing but one of many progressive initiatives implemented at this hospital) increase the level of trust that patients had in their caregivers, but it also decreased the number and size of lawsuits. Furthermore, it allowed this hospital to offer more to patients in compensation (financial or otherwise) than they had even asked for.

Why? Well, first, people are less likely to sue an agent who has been upfront about harm that has happened and who has admitted possible culpability. Second, subsequent steps in this hospital’s initiative had the hospital offer to make good to the patient and family if the hospital was determined to be at fault, which meant that lawsuits and lawyers were bypassed. This avoided the huge take previously going to lawyers who were helping to settle—no less than 65% of total costs. Wow! And all of this simply because, within an hour of an error, someone from the hospital was meeting with the family and saying, “Something happened, and although we do not yet know what the implications are or who is at fault, your father/mother/brother/sister/son/daughter has been harmed. We want you to know about it, and we want to involve you in the process of making it right.”

Every patient deserves to be safe. EVERY patient. Let’s start telling each other the truth in healthcare and see if we can’t do better in future than we are doing now—because half a million dead each year is far too many.

Dennis Maione is an author, speaker, and teacher from Winnipeg, Manitoba, Canada. He has been on a 20+ year journey through two bouts of colorectal cancer caused by due a Lynch syndrome mutation in his genes. He speaks and writes about many things, including his cancer journey, his insights into the medical system, and finding heroes and villains in the unlikeliest of places. He regularly blogs at http://www.dennismaione.com/blog.

His latest book, What I Learned from Cancer, is available in electronic form at his payhip.com site: http://bit.ly/wilfc-ebook. Physical copies of the book are available at the Prompters to Life web store, where shipping on copies of the softcover edition is always free (except to the International Space Station). To order a paper copy of the book, visit: http://prompterstolife.com/shoppers

When I was in high school, my father gave me his 1969 VW Beetle. Despite its age and the toll that time had taken, it was a great car. I especially loved it for its simplicity. In some cases it was too simple: the air-cooled engine that was supposed to supply heat to the rest of the car but never seemed to be sufficient for cold Saskatoon winters—I always had an ice-scraper at hand in the winter to clear a goggle-sized place on the windshield as I drove—and the Blaupunkt radio that only got one channel. But there were advantages to the simple nature of the car. While my friends were renting engine hoists to remove the big-block engines from their Chevys, the engine in my beetle was easily removed by loosening the four bolts that attached it to the transmission housing, lowering it to the ground with a floor jack (about 10 cm), and then having 4 friends pick up the back end of the car and lift it over the engine.

Throughout my relationship with my Beetle I rebuilt the engine twice, both times stripping it down to washers and bolts and then putting it back together, good as new, some of the parts cleaned up, some refurbished, and others discarded and replaced with brand new parts. Each time I put the engine together again, you’d never have guessed that a week earlier its parts had been strewn about my driveway in a disarray no one would have recognized as a car engine.

My body, however, is different. It wasn't designed to be taken apart, and there really are no parts that you can simply take out and replace—not “as good as new,” anyway. Each time I’ve been taken apart and laid out on an operating table with my bolts and washers all over the place, my surgeon cleaned me up, took out the broken bits, and then did his best to put me together again, as good as new. But each time, the process was more complex than with my Beetle. Each time, there were consequences to the action, and I was never again the same. Despite the skill of my surgeon, there were scars.

Scars: some were visible, like the permanent zipper on my abdomen, spoiling the potential for the perfect abs I’d always dreamed I’d develop some day. Other scars were deeper inside, scar tissue that invaded my body at its core. And, of course, there were psychological scars, which came from the trauma of the incident, the long shadow of death, and the realization that something had been taken from me which I’d never get back. Some of those emotional scars are still present, although not really evident until poked at by a mind trying to remember.

I recall sitting in a Starbucks as I put the finishing touches on my book, What I Learned from Cancer, sifting through medical records and remembering. I did a brief calculation about the spans of time in my cancer treatment and recovery, and I wrote this:

It had been 15 years, 3 months, and 14 days since cancer had been removed from my body. 5,584 days since my abdomen had been violated by the cut of a scalpel searching for the villain amidst the blood. And on that day, the sign reading, “5,584 days cancer-free,” came down and was replaced with one reading, “This body is out of order, again.”

And what was remarkable about the writing was that, 7 years after the incident it described, it drew tears. I sat at my table in the corner of Starbucks for half an hour, and I cried. I cried because that scar—the one I had not even known was there—hurt when I moved a certain way, and because, for a while, that pain would not subside.

The Japanese have an art form called kintsugi, a word which literally means “golden joinery,” and a technique which, for centuries, has been used to repair broken ceramics. Like the human body, pottery cannot be put together “as good as new” once it has been broken; the cracks will always remain. But in kintsugi, gold is mixed with the bonding material, creating a glue which not only repairs the piece back to its original function but also celebrates the repair. The cracks become the beauty in an otherwise ordinary piece.

Every nick, every cut, be it shallow or deep, invisible or substantial, each represents a change in me, a mark in my history. Each is a story, a part of the narrative of my life. With each scar I get to choose, whether to see it as something ugly which mars an otherwise pristine surface or to imagine it as revealing my true golden self beneath, a self born of trauma and turmoil and heartache. And while I am tempted to hide these scars, these imperfections, I refuse to do so. They are, for me, evidence of a life lived. Evidence that I was here and that I would not walk away without a fight.

I have had cancer twice and it has been ten years since the last incision began to turn to a scar. My body will never—can never—again be “as good as new.” Cancer and surgery have made sure of that. But I celebrate my repair. I can look at my scars and celebrate my recovery from crisis as well as all that the journey has made and will continue to make of me. I can show off my golden joinery and believe that somewhere in the breaking, I have become something even better than new.