To fix the problem, the CAP team decided to put a Cisco 6509 router between the core network and PACS, eliminating spanning tree protocol and its seven-hop limitation. (The 6509 also has switching capabilities, so the team decided to kill three switches inside PACS and use the 6509 for that too.)

Soon after 9 p.m., a 747 with a Cisco 6509 on board left Mineta International Airport in San Jose bound for Boston’s Logan International Airport.

The local CAP team spent the night rebuilding the PACS network, a feat Halamka talks about with a fair bit of awe: The first time around, PACS took six months to build.

After working through the night, the team was momentarily disheartened Friday morning to see that, despite PACS being routed, the network was still saturated. But they rebooted Libby030 and another core switch, which brought out the smiles.

"We rebooted and things looked pretty," Halamka says.

Friday Back to Paper

By 8 a.m., the network started to flap again.

At 10 a.m., Halamka and COO Epstein decided to shut down the network and run the hospital on paper. The decision turned out to be liberating.

"We needed to stop bothering the devil out of the IT team," says Epstein.

Shutting down the network also freed Sands and the hospital’s clinicians. Some had already given up on the computers but felt guilty about it. But "once the declaration came that we were shutting down the network, we felt absolved of our guilt," Sands recalls.

The first job in adapting to paper is to find it: prescription forms, lab request forms. They had been tucked away and forgotten. And many of the newer interns had never used them before. On Friday, they were taught how to write prescriptions. When Sands had to write one, it was his first in 10 years at CareGroup. "When I do this on computer, it checks for allergy complications and makes sure I prescribe the correct dosage and refill period. It prints out educational materials for the patient. I remember being scared. Forcing myself to write slowly and legibly."

At noon, Epstein came in to lend a hand...and walked into 1978. Epstein worked the copier, then sorted a three-inch stack of microbiology reports and handed them to runners who took them to patients’ rooms where they were left for doctors. (There were about 450 patients at the hospital.)

In time, the chaos gave way to a loosely defined routine, which was slower than normal and far more harried. The pre-IT generation, Sands says, adapted quickly. For the IT generation, himself included, it was an unnerving transition. He was reminded of a short story by the Victorian author E.M. Forster, "The Machine Stops," about a world that depends upon an Ÿber-computer to sustain human life. Eventually, those who designed the computer die and no one is left who knows how it works.