Essay – Do no harm
September 27/2020
Hospitals are at times very interesting and amusing places. You begin to realize after a while that the general banter is very much like what one sees in fictional TV shows. This in itself tends to provide more than enough entertainment for an evening in crisis.
In this particular instance, I found myself in the ward due to a sudden reaction from a new medication that saw my heart rate skyrocket to a whopping 150 bpm in resting state. I called an ambulance, genuinely terrified that I may in fact be close to having a heart attack.
When I arrived at the hospital, I was placed in a private room in the “rapid assessment” zone, at the very back end of the hallway. I was promptly forgotten about.
After about four hours of waiting, lying there on the gurney and slowly willing my heart rate to drop, they moved me out into the hall, supposedly because it would get me seen faster. But I know that really they’re just clearing the room for the next round of patients, some perhaps in a more serious crisis than I. I’ll gladly take the hallway, for whatever small and hollow promise of speed it may come with.
As I lay in the private room, counting the minutes on the clock, counting my heartbeat in time with it, I hear the sounds of laughter, applause and cheering coming from the nurses station.
A party. They’re actually having a party.
Staring up blankly at the metal grates of the lights above me, I am reminded of one of the quintessencial episodes of the TV show “ER”, where Lucy Knight and John Carter get knifed in the exam room by a schizophrenic patient, while everyone on the ward is grooving out over the cake they were going to cut with that very knife.
About ten minutes after the party had dispersed, I heard someone rapidly approach the nursing station, and say to her colleague in a tempered panic,
“Did that cake have peanuts!?”
Her colleague replies with a nervous laugh
“Ummm… I dunno. Why?”
Another nurse joins them and replies,
“Yeah probably, why?”
The level of panic increases to palpable.
“Because of Jim! He has anaphylaxis reactions. Oh my god-“
As quickly as she had come, she disappeared again, conceivably to rush an epi pen off to wherever Jim had taken his rounds.
“My god;”
I laughed aloud, outside of my own fear and pain for the first time in hours,
“They’ve killed one of their own.”
The real world does seem more and more like our fiction, serving as a mirror for our more unpleasant truths. The irony and drama of the moment was as perfect as it was horrific. What hope could anyone with a life threatening condition possibly have in an ER when the staff are liable to cause injury by negligence to their own staff.
The medical system itself is so broken, and seems more specifically broken into so many different parts that it cannot maintain any kind of cohesion between its own various branches.
The general practitioner has no direction in how to treat their patients without guidance from a diagnostic specialist, while the diagnostic specialist has no prerogative to act without a referral from the general practitioner. The ER doctors then end up in the middle, picking up the residual overflow from those who in the span of waiting for the system to come through, end up having successive and worsening crashes. And unless you’re critical enough to be admitted to the medicine wards, the ER doctors will always refer you back to your general practitioner.
This process creates an unending feedback loop, where someone with a chronic condition could spend years going back and forth to try and find the answers and access the proper treatment that they need. All the while, the government health insurance scheme is paying out on the scans, the tests, the hospital visits, double billing itself in circles while providing almost nothing in the way of actual treatment.
The fact is, that the definition of “life threatening” does not include the majority of those chronic illnesses that wear a person down over time, that wear down the system over time. They’re looking for horses, not zebras. A car crash, a fall, a heart attack, or some other more serious and acute wound or condition.
And yet, throughout the red tape, hiding in the cracks that we fall through, there are so many compassionate and generous people that got into the medical profession to be of genuine help. But they are so rare, so overworked that eventually, many of them simply give up from the exhaustion, leaving the profession entirely and subsequently leaving hundreds more people to fall through those cracks. The ones who stay become burned out, and stop seeing their patients as people. There isn’t any room for emotion or morality in the system; they are just doing their job, trying to get through the sea of bodies without being drowned by it.
Those in the system who have always treated me the most kindly are often those who have the least amount of power to change it. They are the nurses on staff who take the time to check in when they have it, to see if you’re scared, or need more fluids, or if you’re hungry and need a bad sandwich from the reserves. They are the orderlies that ferry you from ward to ward when you need a scan done and aren’t allowed to walk yourself, sharing a joke or a story to make you smile along the way. They are the housekeepers who stop in between cleaning and restocking to keep loading you up with blankets because they can see that you’re cold.
The medical system is suffering from the same kind of discontinuity which most of society does; treat the symptoms, not the disease. Even when we can look at it clearly and objectively, somehow the more details we discover, the less apparent a solution seems to be, or the less effective the system as a whole is in enacting that solution.
I know there isn’t an easy answer. I don’t expect one. I expect to have to work hard, for everyone to have to work hard, and to maintain those more difficult responsibilities that are required to make the system work. When we have a chance to make things better, it’s up to each and every individual to do what they can to make it better, to dispel the apathy, the misery and the hopelessness which says that we should lay down and give up simply because the world is sick.
So do what you can do, whenever you can do it, for your community, for your little corner of the world, and the world gets better for every little bit that we do. Take the time to stop and help a stranger. Share a smile when there’s a happy moment. And most of all, choose to believe that things will get better for each of those small actions that we take.