Posts Tagged ‘hospitals’

Over the last few years, I have spent more than my share of time visiting in hospitals. Visiting a patient in a private room has its advantages – I once marked several batches of essays in one – but can be lonely for the patient unless they have a constant stream of visitors. A semi-private room is better, depending on who the other patient is, but can turn into a nightmare, as happened once when the other patient was from a psychiatric ward and had to be strapped down because he was under the illusion that he was defending the west coast against a Chinese invasion. So, on the whole, a four-bed room is usually the best balance between privacy and company.

For instance, over the past three weeks, the four-bed room where I have been spending several hours every day has presented a variety of people coming and going, some pleasant, some eccentric, but all providing stimulation to one another with their differences.

One was a woman who in sixty years had been both a hairdresser and a prison guard. She was outspoken, and obviously restraining her language, but unfailingly polite to the nurses and everyone else. She quickly became friends with the person I was visiting, and the two of them soon started trading the contents of their meal trays like kids at recess, and watching out for each other.

At the start of my visits, another of the bed was occupied by a soft-spoken man who had recently retired from sales. His wife, a puppeteer, was another frequent visitor. He participated lightly in the conversation, and everyone knew he was a Christian fundamentalist, but it was only on his last night that he revealed his missionary instinct. In response to a few questions, he got out an oversized Bible and a stack of computer printouts and immediately started trying to convert the ex-hairdresser-prison guard. It was a mark of her restraint that she didn’t lose her temper with him, although she complained long and bitterly after he left.

The fundamentalist was followed by a man who kept the curtains drawn around his bed and said as little as possible. He, in turn, was followed by a male nurse who took some advantage of his conventional good looks, but also interceded with the ward nurses on behalf of other patients. After him came a folk singer from Prince Edward Island, hospitalized on the other side of the continent after he had come to sing at a family wedding and contracted laryngitis. He spoke little (unsurprisingly), but showed a strong streak of kindness when he did.

The other bed in the room was initially occupied by a young Vietnamese woman. She would talk, but she spent a lot of her time on her cell phone or watching videos on a portable player with her legs draped over her bed tray. Either her sister or her boyfriend would crawl into bed with her at night, a practice that disturbed the nurses, but seems to me a reasonable way to help lessen the strain of being in hospital.

When the Vietnamese woman left, her bed was taken by a homeless man who worked part time as a roofer. He had the most prehensile toes I had ever seen, and was absolutely filthy. Despite cracked ribs, he was always descending six floors to go for a smoke – and I suspect, to judge from his behavior, for his drug of choice as well. Talking to him, I got the impression that his brains and reality were not quite in sync. However, his brains worked well enough for him to realize that he had a good place to stay, and he only left when it was clear that the next step would be to have security escort him out.

None of these people were extraordinary. You could probably pick half a dozen strangers at random on the street and find an equally interesting assortment. But on the street, of course, you would never learn much about them. In a hospital room, where little happens between doctors’ visits and being wheeled away for tests, people have to pass the time somehow, and while some opt for a portable TV, sooner or later most people talk. And, because they have so little to do, anyone who does talk invariably ends up saying more about themselves than they would in other settings. Probably, it helps that the first questions anyone is asked is why they are in a hospital – a private detail that makes giving more private details easy.

I’m not sure if I or the patient I was visiting will ever see these people again. Both of us took several people’s contact information, but a promise to keep in touch made when you are sharing the experience of being in the hospital is easy to break afterwards. You can’t help suspecting that you knew the other people only in special circumstances, and that in their ordinary lives they might be strangers – and strangers who are not at all eager to see anyone from a time when they were helpless, bored, and far from their best. Still, for the time of a hospital stay, the people in a four-bed room provide a variety and interest that any other form of hospital accommodation cannot hope to match.

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Unexpectedly, I spent the past afternoon in the emergency ward of the local hospital. This was at least my twentieth time at emergency since 1995 (only once for me), but I’ve never managed to warm to such places. Spending time in emergency admitting is just a slow dread that leaves me feeling half-suffocated.

I suppose nobody welcomes a visit to a hospital, unless a birth is involved. If you are the one with an injury or illness, you remember it as a place where you were wrapped in your pain and discomfort like a second skin. If (as I usually am), you are there to lend moral support, then you slowly drain yourself while trying to provide comfort, all the time hoping that the patient gets some relief, and possibly hoping that, the trip is not fatal.

You might draw some support if you at the hospital in a group, but, even then, others can do only so much to help you. You are alone with your fears in a hospital in a way that you rarely are in any other place in modern industrial culture – all the more so because we are a death-denying culture, and a hospital doesn’t leave much room for denying.

But even if the emotions were not apt to be so intense at a hospital, the way they look and are run reduce your chances of relaxing or finding a moment’s respite.

Part of the trouble is that hospitals have the dinginess of any public places that are busy twenty-four hours a day. They are not dirty, but my impression is that no one has painted the walls or given the floors a hard scrub for years, if not decades. Like an all-night Denny’s, nobody cares for them. Hospitals feel like husks from which the soul leaked out long ago.

Another reason why hospitals depress me is that they are run impersonally. I do not mean that the nurses and doctors do not care about the patients; I know many who are dedicated and exhaust themselves regularly trying to provide the best care that they can.

But hospitals are busy, aggressively public places when you are concentrating on your personal crisis. You get the feeling that your crisis is unimportant, constantly about to be lost in hundreds of others. If it was not your crisis being dealt with, the resources it requires would immediately be taken up by someone else’s crisis. Nor is this feeling helped by the constant cutbacks, when you can easily feel that the real goal of the hospital is to spit you out of the system as quickly as possible, often before you are quite ready or your problem is solved..

Moreover, this feeling is only intensified when you hear the staff cracking jokes or bantering among themselves. I understand that they are only relieving their own tension, but, when you are sunk in your own crisis and trying not to curse the long waits, you can easily get annoyed by the apparent callousness.

But the really draining part of waiting for admittance into emergency is that the first casualty is always your privacy. With admitting clerks shouting questions at you, or nurses and doctors asking intimate questions while other supplicants sit a few centimeters away from you, your private concerns are suddenly on display. For that matter, you or yours may be literally on display, thanks to the backless gowns that are the norm. If you have not already shriveled up into your own private world thanks to your pain or concern, you may wish you could do so rather than having your concerns exposed in this way without anyone bothering to ask your permission first.

If you are there for moral support, you find yourself visiting the gift shop or going for an unhealthy snack you don’t really need, just so you are not on display for a while. But, if you are the would-be patient, you have little choice to stay, feeling like you are answering questions on the phone about your love life while riding a bus filled with eavesdroppers.

All this goes on for hours (six today, and we considered ourselves lucky). At the end, the patient is safely ensconced in a bed, and falls asleep from exhaustion, while – after a brief visit – their supporters stagger home and collapse on the living room couch before snatching a quick snack.

How the staff endures this environment day after day, I don’t know. I suppose the answer is that many don’t, because emergency ward staff have a high turnover. But how those who remain learn to ignore the place and what happens there is hard to fathom. But for those of us who visit, an emergency ward can often seem the last place that’s healthy to be sick in.

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Hospitals are not my favorite places at the best of times. They are such concentrations of pain, stress and raw emotion that I barely need twenty minutes before I start feeling emotionally overloaded in them. But, after last week, I have reason to like them even less.

Thanks to the overcrowding that has become the norm, Trish had to share a semi-private ward with a man having psychotic episodes. This circumstance is not (I say with understatement) recommended for someone who has just had major surgery.

At first, he seemed normal enough. Possibly, I thought on my visits, he was a little simple, not being able to distinguish his current hospital stay with past ones or give his doctors and nurses much information about himself, but I could hardly blame him for that. Even when he insisted on giving a half-incoherent, half-rambling reply to every comment made in the room, I dismissed his behavior as annoying but harmless.

Then, last Friday night, he went off like a bomb, trying to tear out his IV and catheter and other connections and struggling to get out of bed (which, fortunately, he was unable to manage). At first, he seemed to think he was in a war movie – and, before long, the movie became real. He seemed to believe that the Chinese had landed troops in British Columbia, and that he was on a boat that was shelling their positions. A little later, after nurses and security swarmed around him and tied him to his gurney, he seemed to believe that he was in a town called Dawson, where he had been taken prisoner and was being tortured for information.

Between swearing and shouting abuse, he made his plans out loud. He would pretend compliance, he said, so he could escape. He would even eat the food provided – although it was undoubtedly poisoned – but just enough to stay alive.

And Trish? In her room mate’s delusion, she was pretending to be his mother to trick him. She came in for a share of the swearing and abuse. She managed to get some sleep after the nurses brought her some ear plugs, but trying to sleep less than two meters from such events is not exactly restful.

Nor could she help thinking what might happen if her room mate got loose – he may have been too weak to walk far, but he still might get as far as her.

The next day, the hospital found a nurse to sit with the man, and Trish finally managed to get a few hours’ sleep. She also spent as much time as she could manage outside the room. Her room mate was mostly sedated, but he was still rude and angry when awake.

By the time Trish came home on Monday, she was more than a little tense. We weren’t sure she was healed enough to go home, but she wanted out of that room badly.

I don’t blame the nurses for what happened. They do the best job they can in trying circumstances, and, anyway, surgical nurses aren’t experienced in dealing with psychiatric patients. I’ve often thought that the medical system would be more equitable if doctors’ pay was halved and nurses’ pay was doubled. They do a job that I would flee screaming after half a shift.

But I do blame the organization and budget cuts to the medical system that such a patient was put in with another one who could only be traumatized by his behavior. The next time someone claims that the British Columbia health system is fine, I’m going to reply with this anecdote. It’s one that would be compelling as a Stephen King short story – but even King would have trouble convincing readers that such a real-life incident could happen in fiction.

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When you are trying to get something done in a large organization, frustration easily sets in. Before you know it, you can start fantasizing about shouting and name-calling and finding a throat that your fingers fit around – while in reality you slink off, feeling helpless and foolish. However, as I was reminded this past week trying to get action from the local health system on behalf of my hospitalized spouse, the secret is to use more indirect methods.

The first thing to remember is to never show that you are losing your temper. Show anger, and you’re giving the bureaucracy a reason not to listen to you at all. If you have to, retire to the washroom to snarl or cry, or go for some strenuous exercise after your efforts are done. But while you are talking to the members of the organization, keep calm. Smile. Say “Thank you,” even if the person you’re talking to has done nothing but obstruct you.

At the same time, never give up. In the typical bureaucracy, most people want nothing more than to go about their work quietly, and with a minimum of fuss. If you keep showing up, then after a while, they will be more likely to help you so that you go away and stop disturbing the quiet of their days. Calm, polite insistence should be your goal.

In addition, remember that you have to play by the bureaucracy’s unwritten rules – even if you are trying to get its official ones changed or rescinded (or maybe I should say especially when you are trying to get the official ones changed or rescinded). That means you need to have a simple, clear statement of what you want done, usually expressed in terms of a concrete action or two.

Even more importantly, the need to obey the unwritten rules means that your main strategy is to get allies in the system. Who can make your request a reality? Or – often more to the point – who can exert pressure on decision-makers to act in the way you want? Find out, and get those people on your side, advocating your cause within the organization. They know the structure far better than you have any hope of doing, often on an unconscious level of which they probably aren’t aware. Moreover, the more of your allies that surround the decision-maker, the harder the decision-maker will find resisting your request.

Finally, never forget your objectives. With these methods, you have a strong chance of realizing them. But if you’re expecting the decision-makers or the people who have been obstructing you to apologize or show any remorse for their lack of helplessness or failure to live up to the alleged ideals of their organization, you’re fantasizing. Settle for getting what you want, and keep polite even as you get it. While the primitive part of you might like to rub in the fact of your victory, resist the temptation, just in case the decision-maker balks at the last moment. Your purpose is not emotional satisfaction – it’s realizing your goals.

Getting a bureaucratic organization to get something done when you’re an outsider is like starting an avalanche. Anyone can set a boulder or two tumbling down the hill, and the result can even be spectacular. But finding the right pebbles to shift so that a large part of the landscape permanently moves (and doesn’t take you with it) is much harder. It requires patience, indirection, and an understanding of the landscape. But, in the end, the results can be farther-reaching than any expression of frustration or anger.

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Yesterday, I was sitting in the hallway of the emergency ward at Royal Columbian Hospital, waiting for a bed for a patient, when word came through that George Abbott, the BC Minister of Healthy, was expected through on a tour. “Trip him up and tell him you need a bed right now,” a technician whispered to me. That was about the only reaction to the news that I saw – and it wasn’t particularly busy, for once. But the episode strikes me as a good example of why voter apathy and cynicism are increasing.

First came Abbott and the member of the hospital board who was guiding him on the tour. For all I know, the board member is caring and dedicated, and has brought the hospital millions of dollars through his scrappy advocacy, but to my eye he and Abbott looked two of a kind. They both looked like middle-aged men used to authority. The only difference was that the board member was about fifteen years older.

Behind them came a woman with a hospital badge. From her stance and her dress, I suspect she was lower in the ranks than a board member. Behind her came three or four other men, non-descript except that they were younger and junior to Abbott. Possibly, one or two were bodyguards, but at least two had a clerical look. Bringing up the rear was a twentysomething man carrying a clipboard. He didn’t know what to do with himself and stood in a corner shuffling from one foot to the other, but, boy, he knew his job – nothing was going to make him let go of that clipboard.

The board member stopped the procession at the front desk. The nurses and the doctors nearby did not look up, and nobody introduced them. The board member explained what the list of patients on the white board meant, noting that those with an “A” beside their name had found a bed elsewhere in the hospital. This fact may have been meant to impress Abbott with the need for more funding, but, if so, it like failed. The minister only looked polite.

Then the board member invited the minister to see something in the back of the ward. Half the entourage hovered in place, while the other half straggled after the board member and the minister.

I don’t know what they went to look at, but in less than three minutes they were leaving, saying something about their schedule. All the while, the staff kept at their paperwork, or wandered off to see to patients. Clearly, they were unimpressed, and had no belief that the visit might make their lives easier. Nor did Abbott make any attempt to engage any of them.

Watching the parade and reflecting on the three hours I had been sitting beside a gurney, I had to wonder why anybody bothered with the whole episode. The health minister and his entourage could have seen nothing substantial in the time they spent in the ward, and must have learned less. Nor did they seem to want to. I would say they had done it for the publicity, except the only member of the press nearby was me, and I don’t cover politics. So what was the point?

The only conclusion I could reach – and, I think, the only one any witness could reach – was that the hospital tour was made because someone, whether the minister or some member of his entourage concerned with communications imagined that going through the motions would look good. How, or to whom, the person responsible probably couldn’t say, but the thing was done.

But I wonder if the tour did anything except to bring the routine of governing into contempt. After the tour had exited, you could feel the staff relax, but apart from a few raised eybrows and one shaken head, everyone had grown too cynical about such efforts to bother venturing any remark whatsoever. The tour was something inflicted on everyone, and, when it was over, people could get back to their routine.

[Update — A few weeks ago, Abbott was dismissing the claims of overcrowding made by a surgeon as “alarmist.” This pre-judgment, I suppose, goes a long way to explaining what I saw. I suspect that he wanted to say that he had personally investigated, but was determined not to let the facts get in the way of his position.]

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I spent yesterday afternoon pacing the corridors of a hospital, waiting on the results of an operation. That was the fifth or sixth time I’ve spent a few hours that way, nervous and trying to control my imagination, and it doesn’t get easier with repetition. Nor does familiarity make the hospital any more of a restful place.

Part of the problem, of course, is that very few places – if any – are comfortable when you’re in the lockdown mode of a crisis. Life gets ludicrously simple in a crisis, narrowing to two basic motivations: Doing what you can, and hanging on from moment to moment. Politics, your usual scruples or tolerance for other people’s vagueness – all get thrown out during crisis. You could start a nuclear war the next street over, and the fact would be largely irrelevant during the crisis. At the most, it would be just another damned thing piled on top of everything else.

However, I’m also convinced that hospitals are by nature uncomfortable places. For one thing, they’re full of hundreds of people, all rushing around on the trail of their own agendas and overflowing with their own anxieties. Other places have their crowds, of course, but in many places where we’re used to crowds, such as a mall or a university, the average person has less intensive feelings to add to the complexity. I imagine all these colliding priorities could be seen under the right conditions, like the streams of light in a time-lapse photo, or perhaps like particle collisions with some sub-atomic camera lens.

Even more importantly, I’m with Henry James in The Turn of the Screw: How a building is used creates its own psychological environment. There are places like the gatehouse that is all that remains of the BC Penitentiary that have seen too much human misery, deserved or not, to ever be places in which you can relax. And, conversely, there are places like Vancouver’s Sun Yat-Sen which are shaped so that any emotion except a tranquil contentment is difficult.

Not every place develops such a spirit, and just what details its spirit resides in is difficult to explain, although perhaps feng shui attempts to do so. But perhaps it’s a form of erosion, as the dominant emotions in a place wear at the corners and scuff the floor, as in a public building that never closes, which somehow retains a sense of restlessness.

But you can sense the creation of the spirit, if you look carefully. When a building is new, it generally lacks its own individuality. Then, one day, for reasons that are as hard to observe as the details, a critical mass is reached, and the building has its own spirit, not in a supernatural sense, but in the most mundane meaning of the word you can imagine.

In the case of a hospital, I suspect that the dozens of daily crises and dramas are what is gradually sculpting the hallways and rooms – these things plus a vast and personality-less indifference. For all the intimacy of health care (or perhaps because of it), we make medical procedures impersonal. Doctors and nurses practice a certain distance, both for their own sakes and to preserve the dignity of patients, and to this foundation, the need to organize adds a level of even more impersonal bureaucracy.

You can suffer and easily die at hospitals, not just because hospitals are places where people go to do those things, but because both are handled – despite the best efforts of the best medical practitioners – as a routine, and routines are simply not circumstances for emotion. Your friends and family might grieve you as you go, and maybe some of your nurses and fellow patients. But, not far in the background, the bureaucracy is willing to strip the sheets so that someone else can use the bed and to process your body so that, as quickly as possible, it is no longer the hospital’s concern.

In this sense, hospitals are far worse than other large public buildings like hotels. Hotels, too, are used to tidying up after death so their owns can get on with business, but, at least in hotels, staff might recoil from the reality of death and some visitors might avoid a room if they know that someone has recently died in it. But, at the hospital, few ever know that they are being ushered into the setting of a death and a tragedy, and the staff members, for their own sake, cannot let themselves remember very much.

All the same, a trace remains on the building. More than the complexity of conflicting emotions, more than the anxiety, the most basic of human drama slowly sculpts the hospital of the cleanest, most efficient hospital, sculpting an atmosphere of anxiety beyond any hope of exorcism. If you are a visitor, as I was yesterday, you flee the hospital, when you can, like the survivors flee a haunted house.

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