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    Comment: Behind the emergency ward curtain


    Monika Ullman

    A plea for a better, more compassionate health care system.

     

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    JANUARY 21, 2am, in an overflow cubicle of the Emergency Ward, Royal Jubilee Hospital. Trapped on my gurney behind the curtain for three days and nights, I was sliding into despair. It was hard to fathom how I flipped from a healthy senior recuperating well from hip replacement surgery to a frail, very ill woman suffering from some intestinal bug that was never diagnosed. They thought I had pneumonia and possibly a blood clot as well. But the respirologist disagreed; he thought I had food particles lodged in my lungs due to throwing up and fainting at the same time, right in front of the admissions desk. I highly recommend this as way of getting instant admittance.

    Once inside, nobody had time to think much about a diagnosis; it was enough that I had an infection. They proceeded to pump me full of powerful antibiotics. And nobody could get near me without wearing the full hazmat outfit: a big plastic garment, gloves, and masks. A warning sign was pinned to my curtain. I was clearly a danger to the general public though I wasn’t even coughing. They continued to ignore my intestinal bug, which kept me from eating. I was getting weaker every day.

    Worse, I wasn’t getting any information on my condition; everybody was much too harried to stop and chat. Even if they had been able to agree on what exactly was wrong with me.

    I was lucky they did not “forget” me in a hallway for five days, which happened to a veteran my age at Victoria General during the same week. I was only left for an hour, while still throwing up and waiting for a special X-Ray device that blows up like a balloon while they move you into position. The orderly, who was in charge of pushing my gurney through the hallways, kept muttering, “not well done, not well done,” before leaving me to my fate.

    All this is churning through my exhausted mind while I pray to the god I don’t really believe in to please, do something. Get me out of here. Let me sleep. Let someone figure out what I actually have. Let me talk to a friendly doctor, please.

    But this cannot be done. There are GPs on staff, but you have to really put on the pressure to get him/her to your gurney. They are super busy, just like everyone else here. Who is in charge? Well, that is a good question. Apparently, the system is in charge. But a system is not a human being, and it is very poor at communicating or empathizing.

    Those skills are frills; just getting the workload done is the priority. Since the introduction of a digitized health care system, everyone finds themselves serving this system instead of their patients. In addition, everyone lives in their own silo. Nobody is responsible for the patient; instead, they are responsible for a body part that corresponds to their speciality. It’s the factory system of medicine, and everyone knows it is deeply flawed. We don’t have to do it this way, but change is hard. And even more important, there is a lack of vision. What is the future of this well-intentioned enterprise going to look like? And why are we so terrified of making any fundamental changes?

    I had ample time to ponder such questions during the previous year when I battled to see a surgeon who would consent to give me a new hip, and that is an improvement over the two years it used to take. I had no GP during this time, and I still don’t. GP’s are becoming rara avis, leaving the profession in droves. Thousands of seniors in this province cannot find one. They are stressed, as are the doctors. One of my doctors at a walk-in clinic literally had a fit and threatened to quit on the spot while I was just trying to get a referral to a surgeon. My bone specialist was sad because his American-trained son could not practice in BC “because the numbers don’t add up.”

    This situation is entirely the fault of the provincial government that doesn’t pay general practitioners what they are worth. If you’re not a specialist in BC, you’re barely making a living. In addition, foreign-trained doctors find that they are not wanted here; that they basically have to redo their entire training. We can protect our standards and still admit doctors from other countries; however, the political will is sorely lacking. Instead, we train doctors for other countries, such as Saudi Arabia. Not well done.

    It’s not surprising then that Canada’s health care system is ranked at a dismal #30 by the World Health Organization. It isn’t even as good as the UK’s, which comes in at #18, or Malta (!), ranked at #5. Germany is ranked at #25, Switzerland is #20 and the number- one position is given to France. Why can’t we learn something from them? The USA is #37, which should cure us, once and for all, of thinking they know how to do things better. I suspect that our aversion to making the changes that need to be made is linked to our underlying fear that we might, somehow, end up with the US system.

    But wait. Wait. I am not saying that overhauling the system we have is going to solve all our problems. More often, the Law of Unintended Consequences kicks in and things are no better or even worse than before. See the Province of Ontario’s plan to “integrate” everyone under a new, bigger umbrella system called Health Ontario. They claim it will make everyone more “efficient.” That’s a weasel word for cuts, as everyone knows. Being efficient is good, but not at the cost of actually treating patients like human beings.

    We are overdue for a public conversation about where our beloved health care system is heading.

    I believe that, no matter what kind of system we have, we might remind ourselves that patient care is more than a practical problem to be solved with drugs, tests and digital systems. There is another, largely forgotten dimension: let’s call it healing. It includes prevention, mental health care, and has more to do with attitudes than efficiencies. It used to be the job of priests and shamans. Or relatives. But priests are not what everyone wants, and relatives are often living somewhere else. Psychologists are also becoming rare, just like GPs.

    So it really is up to the hospital staff to minister to the emotional, or dare I say spiritual side of people in their care. We are not simply a collection of symptoms and body parts. We all have need of human connection, especially when we’re ill and vulnerable. When you experience empathy and caring, you feel stronger and better, no matter how ill you might be.

    I can only speak for myself, and I am sorry to say that during my three days of hell behind the curtain, I found exactly two people who, in spite of having too much to do and too little time to do it, chose empathy and kindness over expediency.

    One was a middle-aged nurse named “Nishi” who stroked my tangled hair and murmured, “there there, you’ve had a bad time, haven’t you? Don’t worry, I will look out for you.” And the other was one of the GPs, who appeared after I pressured the nurses with questions about what was going on with me. I told him that I was about to have a breakdown and would escape into the parking lot in my bare feet because I couldn’t face another sleepless night on the gurney. That I still had no clear idea of what I actually had. He apologized, explained my case in great detail and ordered Ativan to get me through the third night. He wasn’t in charge of the transfers to the wards, and he wasn’t pretending that three nights on a gurney was an acceptable situation. I will never forget the kindness these two professionals showed me. It was thanks to them that I didn’t have a complete breakdown.

    I think Tommy Douglas, the father of our health care, understood this. Like the great African-American intellectual, Cornel West, Douglas pushed hard for social justice in all aspects of Canadian life and might have made West’s definition his own: “Social Justice is what LOVE looks like in public,” wrote West. Douglas meant much the same thing, when he said: “We are all in this world together, and the only test of our character that matters is how we look after the least fortunate among us. How we look after each other, not how we look after ourselves. That’s all that really matters, I think.” We strive towards that ideal, but we’re always in danger of forgetting it in favour of managerial Holy Cows like “efficiency” and acquiring ever-more-sophisticated machines at great cost.

    The administrators of this stressed system should acknowledge that there are serious problems throughout. Instead of apologizing endlessly and insisting that leaving patients in hallways is an anomaly, let’s talk about what needs to change. Publicly. And since change is hard and takes time, you could stress that while we sort out the practical problems, empathy, caring and love are priorities. Your stressed staff and the patients need to know that the BC health care system and the Royal Jubilee Hospital care for the whole human being, not just their body parts. They need to know that somebody up there is listening, and acting on their behalf. That we can and will do better. That the system can and will be fixed. That you care.

    Monika Ullmann is the author of The Life and Art of David Marshall (2008) and Rebel Muse, a Memoir of Life with Peter Paul Ochs (2017).

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