Dusty grapes

It was sometime in 2007 and we were enjoying a lull between admissions. Times like that are rare, and in those few, precious minutes, we brainstormed about creating a hospital medicine course for nurse practitioners and physician advisors (NP/PAs). First, we would roll it out at Mayo Clinic's headquarters in Rochester, Minn., then spread to all three Mayo sites if we were successful. It seemed so easy. It wasn't.

Naiveté was our best ally. If we had known how much work it would be, perhaps we would never have headed down the road of lifelong learning. The first barrier was finding a time that did not interfere with other courses for NP/PAs. And anytime between late October and March in Rochester carried the risk of blizzards. After much too much discussion, we settled on May.

Now all we needed was a place. Not an easy task when you are not sure if 50 or 500 people will sign up. We learned that you must book your space a year in advance, then book the subsequent year before the course has even run once. Not an easy sell to our ace administrator at the time, Natalie, who was more practical than us by a factor of at least 5.

Next came the chasm that must be crossed: a deep canyon, a gaping gorge...in fact, a gap. To those unfamiliar with the dreaded gap analysis, it is an essential part of getting credits for continuing medical education hours. Essentially, you find a question that needs to be answered, then find the answer, then make sure it's covered in the lectures. It's easy when you know how to do it, but we did not.

Finally, we had it all done. The course was run, and it seemed like a huge success. The seats were full, the food was good, and the speakers were reasonably coherent. We even had a band one night for the reception, and one of us led a conga line. Everyone came up to us and told us how much they enjoyed it and that they would be back with all their friends. We were happy as pigs in lipstick. Then we saw the course evaluations.

We grouped the complaints. They were a small percentage of attendees, but we took them to heart. There were issues with the speakers, the facility, and the food. The lectures were too basic or too complex. The speakers talked too fast or too slow. Their noses were runny. They were trying too hard to be funny, or they were boring. We took these complaints seriously, except for the coryzal comments. It takes a dedicated speaker to honor his commitments when he feels like reheated cabbage.

The facility complaints were legitimate and predictable. For an NP/PA crowd, primarily XX chromosome, there was a vast restroom shortage. Also, it was too cold, too hot, too noisy, and had bad wi-fi. We took these things in stride.

As for the food, it was lacking protein and there wasn't enough fruit, but overall it was appreciated. One comment puzzled us: “Dusty Grapes.” What did that mean? Were the grapes actually dusty? We shook our heads. This was beyond our control.

The next year was better. We were refining our speakers. There were still outliers, but our average rating was above the key 4.2 out of 5 score and several speakers were in the 4.8-and-higher range. The bathrooms were still bad, but we had blocked off a mens' room for non-male usage. The food was great. Yet lurking there in the comments: “Dusty Grapes.” Really?

The following year the scores were even higher, the bathroom lines shorter, and the food better. But there it was again. “Dusty Grapes.” What did it mean? We spoke to the caterers; they assured us the grapes were dust-free. We hated this dusty-grapes mystery person.

We planned our expansion and added a course in Scottsdale, incorporating more critical care topics. It sold out. The evaluations were pretty predictable by now. Mostly great, a few good, and a few unhappy. And in Scottsdale, there was no comment on dusty grapes.

However, the second time we held the course in Arizona, “Dusty Grapes” was back like a bad meal. We indulged ourselves in plotting the commenter's untimely demise. We returned the course to Rochester, and the crowds increased and the scores improved. But every time, there it was in the evaluations: “Dusty Grapes.” We abhorred this person.

This past May, we were ready. First, we made sure there were NO GRAPES served. Then we crossed our fingers. We stood by the line for handing in evaluations, our eyes boring into each attendee. Who was responsible?

It was then that an older PA walked up to us. He told us he had been coming to our course since it started, and even had been to the second course in Arizona. He loved it and had spread the word among his colleagues. This guy was great. But then he told us his one complaint. He wasn't sure where to put his name on his CME form, so he just wrote it in every time in the comment section. I looked at his nametag: Dustin Grapes from Mineola, Minn. He held out his hand for a shake, and said we should just call him Dusty.

The events in this column are fictional.