I have just received an email from Stephanie Dowrick, the Australian author and psychotherapist who has written some of my favourite books including The Universal Heart and Forgiveness And Other Acts of Love. There is a line in her note that resonated with me: " the greatest gift that any of us will give this Christmas is kindness - and all that flows from it: tolerance, good humour, hope, gentleness. Have it, give it and receive it in abundance."
If you are about to immerse yourself in the the last two shopping days before Christmas think of that. Especially when the crowds get to you or someone else takes the parking space you want or cuts you off on the motorway.
You see, I'm not a curmudgeon all the time - though I am about to tell you about an experience I had this week that tested my capacity for kindness.
On Wednesday I went to my Doctor (General Practitioner, not PhD). I rarely visit medical services, being male and all that. My symptom was a persistent headache. My brain had been pounding for five days, to the extent I could not concentrate on my work. As part of the diagnostic procedure the doc interviewed me about the where and how longs etc and went through the trees of elimination that you would expect. Then she measure my blood pressure and gravely asked: "Would you like me to call an ambulance to take you to the hospital or is there someone who can drive you?"
I thought she was kidding. A little post modern medical black humour to put me at ease. But she wasn't. My BP was off the scale over 240. When I realised it wasn't a joke I think my BP went up even higher. How could I go to hospital? Didn't she realise I had things to do? All I wanted was some stronger analgesics and the comforting words 'It's nothing to worry about'.
The Doc suggested the headache might be the result of a brain-bleed (a stroke). There was the possibility it might also be a tumour, she said. She gave me a pill designed to rapidly reduce the pressure.
As I had left my cell phone at home I had to use the medical centre's phone to ring around and organise for my son to be collected from golf by his aunt and to call clients to cancel meetings in the afternoon. I fet anxious about being plunged into this unknown and the pending loss of control.
A member of the staff drove me to the North Shore Hospital. I felt a certain dread as that is where my father died a few months ago (not from the condition that took him there, but from an infection contracted there).
As I was a walk-in with no obvious symptom other than a note from my GP. I was treated with that sort of mild disdain you might expect a regular hypochondriac to receive by a bored male nurse. I got the feeling he had chosen his occupation for the glamour and had been disappointed that casualties aren't routinely choppered in, covered in blood, to be met by the fast talking doctors like Hawkeye or commanding heartthrobs like George Clooney from ER.
On reading my doctor's notes and asking me questions about my headache (in the disbelieving way my mother used to ask me about how severe my tummy pain was when she suspected I was malingering to avoid a maths test at intermediate school when I was 12) the nurse finally relented and took my my blood pressure. I noted the equipment was a little more raggedy than my doctor's. Used more I guess. The pill to rapidly bring the figure down may have worked but I suspect the stress I was feeling had taken it to a new high. I was asked to walk through the electronically locked doors, down the corridor to 'the red chairs' and wait. The sign hanging above the ominous red chairs said 'acute ward'. I certainly didn't feel acute, aside from my annoyance at missing my meeting. It all seemed a bit much. They should have sent me to the exaggerated ward.
I was now in the system. Bemused in the belly of the beast.
I waited, there is no reception area as such. Before long I caught the eye of a cute, dark-haired nurse with green rubber clogs that I noticed were de rigeur
amongst the younger female nursing staff. "Are you waiting to be seen?" I suppose I could have been a visitor, given that I was not awash in arterial blood (yet), so the question wasn't as silly as it at first seemed. I gave her the folder containing the note from my doctor, explaining my symptoms and the admission paperwork from the bored reception nurse.
"Wait a here a minute and I will find you a bed…" she said after looking at my file.
A bed? But I wasn't in the slightest bit tired. And I had meetings to attend.
She came back, ushered me to a cubicle with a framed picture made from a piece of badly drawn kiddy jungle fabric - the sort you might expect on a child's duvet. The curtain was the same, though, mercifully not matching. I was to be housed in a pediatric cubicle.
"Take your clothes off and put this on…" She handed me a hospital gown with "Hospital Property" printed in a bright mutli-coloured repeating pattern. As it was hardly the sort of thing one would steal (like a fluffy towelling luxury robe from an hotel) I could only assume that I had become hospital property, ratcheted a notch further into 'the system'. "Is this all quite necessary?" I asked. "It allows the doctors to examine you,…get onto the bed when you're done and someone will be with you soon…" I wondered what they felt the need to examine? I had a headache, after all.
As my afternoon was shot anyway I went with the flow.
I experienced my first half hour of waiting. Propped up on a gurney in a ridiculous garment that the helpless are expected to wear (I suspect to reinforce their helplessness).
A chap finally appeared with a trolley, laden with medical stuff. "I'm Bill, …I just need to get this tube into your arm and take a little blood". At first I wasn't sure whether Bill was a doctor, a surgeon or an orderly. He wore a set of scrubs that seemed generic. "Are you a doctor?" I asked "Nurse" he replied with the gruff manner of someone who has been the butt of one too many nurse/gender jokes to take any shit from a bloke wearing a little lace up at the back number.
Bill proceeded to apply a strap to my arm, explain that once the needle was in he would also insert a shunt device in case they had to insert medicine intravenously for speed. Whether that information was intended to instill confidence or drain it I couldn't be certain.
As he worked the slight pinprick promised did not eventuate. A very uncomfortable few moments followed as he wrestled with the fiddly device. My dark, oxygenated blood streamed over his hand, directly from the vein.
"Shouldn't you be wearing gloves…?"
"I haven't had any cuts recently, I'm not worried about it…"
The fact that I now had an open wound on my hand and had no idea where he had been in the past half hour attending to what or who seemed to escape him. And this in the very same hospital my father had died of infection caught at the hospital. My confidence began to drip on the floor like the large blob of blood from my hand (the one that was not cleaned away in the hours that followed).
Now that I had a tube in my hand and a tag on my wrist, courtesy of Nurse Bill (who reassuringly told me it would probably fall off in half an hour) I was one hundred percent, certified hospital property, ratcheted another notch, locked down.
In the hour that followed I recieved no further attention (other than the kindly old trolley lady who wondered if I would like a cup of tea. I would very much have liked a cup of tea. Was I permitted a cup of tea? She could see no sign to advise to the contrary. Nothing to indicate 'nil by mouth'…unfortunately there was no sign of a member of the nursing staff to advise the trolley lady, so she shuffled off leaving me with the only reading material I had…my wristband. Name, date of birth, age (43 years and 11 months apparently), barcode (nice touch) and address (wrong address, neither my GP, nor the hospital had asked whether my details are current and correct…).
Another half hour. No signs of life.
As I was in a curtained cubicle, I could hear the conversations around me, the comings and goings. In the cubicle to my left was a young Indian man who had been admitted slightly before me at 10am. His family was anxiously waiting with him while he waited for a diagnosis for his abdominal pain. It was like listening to a radio play. The tension and drama, punctuated by a family member surreptitiously glancing through the gap in my curtain as they passed. Occasionally a nurse would stop by to assess my neighbours pain. More morphine?
Then it was my turn. "I just need to check your blood pressure…"
"The doctor will see you soon."
It was then that I recalibrated my understanding of the word 'soon'.
Another hour past before a young chap showed up. Open neck shirt, smart pair of trousers? Jehovah's witness,…here? The stethescope and array of pagers gave the game away. He introduces himself in a slightly apologetic manner. Reminds me of the lead character in 'Scrubs'. I go through the symptoms again, focusing on my headache, which continues to pound. He prefers to concentrate on the blood pressure. His pager goes. He apologises "My boss…I'll be back soon…"
Ah…, righto…, 'soon'.
Three quarters of an hour later he returns in a 'where was I?…' flourish. He tests me for symptoms of a stroke or neurological 'event'- hand shaking, push pull strength, ability to grimace and raise eyebrows… palpates my abdomen (well, if I've gone to all the trouble of wearing a hospital gown…). He examines the blood vessels in the back of my eye for hemorrhage…nothing. For which I am glad. He tells me he will get me some accupril to lower my BP. Once it is down I can go home and they will treat me as an out-patient to find any underlying causes of the hypertension.
Cool, get that pill and let me out of here…
I wait another hour before a nurse shows up with 10mgs of Accupril (quinapril) - I'm familiar with it…got boxes of the stuff at home (haven't been so great at compliance…it's a guy thing…mea culpa
Hey, at least she showed. There has been a shift change, so I have a new nurse, a temp from the Geneva agency. She's not sure what the doc has decided, the notes are incomplete.
More waiting. The guy next door has been taken for CRT scan and come back. I'm pleased to learn he will be fine. Just a small kidney stone, it'll probably pass by itself. "More morphine…?"
Meanwhile a kid with a gastric upset has come in. She's permitted to run wild up an down the corridor, pausing to disgorge the contents of her stomach outside my cubicle. Nice.
A patient down the corridor is calling out pathetically for help, repeatedly ringing the 'call' button (which rings above my bed) and banging the wall. It's a little like bedlam.
When the nurse comes back its about 10 at night. My patience has worn thin. I tell her that I need some information about the plan or I'll be dressing and going home.
She tells me she'll find the doctor. Before she leaves I ask why nobody is assiting the person down the corridor. "That's not my part of the ward…" Nice…
I wait another half hour.
I get up and dress. An admin person arrives to tell me that I have a call but I can't take it because another patient is using the phone. Nice…
I ask her to get a nurse to come take the pipe out of my hand. She tells me she'll get a nurse.
I wait. They can see me waiting, fully clothed now, from the nurses station. I push the call button. Nobody comes.
I guess they don't do room service at North Shore Hospital?
I left. It's nearly 11pm. It has been a very weird experience. There are no taxis, I walked to my car at the medical centre a couple of kilometres away and drive home. On the way I stop at the supermarket for something to eat and some strong Ibuprofin. In my bathroom I pull out the shunt and am surprised by the spray of blood. Impressive. Pressure and elevation and I'm amazed at how quickly my body responds to seal the hole. It reminds me of the health cartoons they showed us at primary school - the white blood cell army…
All in all a surreal experience. I am sure that the staff were doing their best. Though I wonder if they were annoyed when I decided that it was a waste of time and became an individual again (rather than Hospital property).
My observation is that I could have received the same amount of care in the space of one hour had staff completed each task promptly, rather than doing things piece meal.
I was reminded of the American insurance company that sends assesors to the scene of motor accidents with the authority to settle claims on the spot and organise panelbeaters and mechanical services. The service saves/makes the company millions and customer satisfaction is stratospheric, compared to industry benchmarks.
I didn't feel that staff had any autonomy-from nurses who wouldn't cross a line to attend to a distressed patient to a doctor who left twice during a consult when his chain was yanked by a superior. Standards of hygiene were disgusting. I stepped in the remnants of the kids vomit when I went to the toilet. My blood was not cleaned off the floor. Failure to wear gloves when in direct contact with blood. Wrong patient information/identification (which makes me wonder what other clerical errors, leading to clinical errors occur?). All systemic problems.
I remain untreated. Still have headache. I am self medicating from my Accupril supply and have notified my GP of the circumstances by email (though the medical centre receptionist told me there is no email address I could use to communicate with the doc - hey, it might interfere with the number of visits/profits - though I understand that some people might abuse access and endanger their health, bog down the doc).
Stephanie Dowrick's message came just at the right time: tolerance, good humour, hope, gentleness.
If nothing else it will keep my blood pressure in check.