Monday, April 26, 2010

A public hospital experience

Don't expect civility from bureaucrats

Last week I had reason to visit the emergency department of a metropolitan hospital. My family doctor had become alarmed at the quantity of over-the counter pain killers I’d consumed – an orgy of paracetamol brought about by the agonising fallout from a routine a bit of dentistry – and strongly advised me to visit ER, to have my blood toxicity levels checked. It was not an adventure to which I looked forward, and as I traveled toward the hospital I braced myself for what would undoubtedly be a wait of many hours, there surely being more important emergency cases than my own. It was perhaps na├»ve of me to think the hospital would greet me sympathetically, but the hostility I encountered left me, for one of the few times in my life, speechless.

Upon arrival at the hospital, I presented myself to the woman at the front desk, who smilingly took my details and told me to take a seat and wait for the call from the admissions nurse. Only a few minutes passed before she called my name and I approached her booth. Housed behind protective glass (for reasons which would become obvious), she was a short woman in her late 40s, with a teardrop-shaped body that I conservatively figure would weigh in at about 140 kilos. This would not be worth mentioning but for what happened next (her hair do – a ginger coif swept behind the ears with the extreme slick favoured by teddy boys and butch lesbian stereotypes – is perhaps not worth mentioning at all...probably). Without taking her eyes from the computer screen in front of her, she asked me what I was there for, and I told her, to wit:

“My doctor suggested I come here for blood and liver toxicity tests, on account of the large amount of pain killers I’ve taken over the last five days.”

I smiled for the benefit of her right ear and pointed to my tooth. “Bad bit of dentistry,” I said.

At this she thrust her right hand towards the gap in the protective glass and, in a voice entirely free of humanity, said: “Show me the letter.”

“I don’t have a letter,” I replied. “I spoke to my doctor on the phone and she suggested to me that I come here.”

Her eyes still on the computer screen, she took a deep breath of tedium, her beanbag bosoms awaking for a moment and stirring like two huge Gullivers before her sigh of expulsion nestled them back into the doubtlessly sweaty hell in which they sleep. I got the distinct impression that, somehow, I’d done something I oughtn’t.

“How many have you taken?” she asked, in the kind of bored, sing-song tone one might employ when asking the family dog which part of the carpet it has poo-pooed upon this time. I decided it best to be honest, as the only loser of a lie would be me.

“Probably between 20 and 30 in the last 24 hours,” I replied. “It’s the only way I’ve been able to...”

At this point I stopped talking, because her face had turned toward me for the first time this afternoon. Upon it was a look that I see most commonly these days on American teen TV shows, when the nerd in the clique says something common and the the silver-spoon bitch turns with her head bowed, her mouth agape and her dead eyes peering up through her fringe as if to say: “Like...duh!” Only there was no humour in this face at all – it was designed to convey pure contempt, and that is precisely what it did.

“You’re joking,” she said, disgusted, though she knew I wasn’t joking at all, being that I was in the emergency ward of a public hospital. “No,” I replied. “Like I said, it was the only way I could kill the pain.”

For a few long moments she was silent, her voiceless eye contact prolonging the humiliation I was meant to be suffering.

“Did you bother to read the label?” she finally asked, her eyes fluttering closed until the very last syllable, after the fashion of the grotesquely superior (what I would have given for a gorilla suit into which I might have swiftly changed before she opened her eyes again).

“Like I said, I was in pain, which I guess makes people do silly things sometimes.”

And I would have continued with this line of argument, describing the desire for pain relief as not unlike hunger, which can cause some people to eat like filthy @#$%ing swamp hogs until their silhouettes are indiscernible from those of the Teletubbies. For it occurred to me that, if you took our surroundings out of the equation – if the buildings and uniforms and name tags evaporated until there were just two people and nothing more – what we had here was a woman the size of a small 4WD vehicle, who couldn’t walk (I was to later observe) without swaying like a sumo from one point of the compass to the opposite other, berating someone for unwise consumption.

But we were in a hospital, she was in a uniform, and there are signs on the walls of all emergency departments declaring that abusive behaviour will not be tolerated – signs that, at time like this, can be interpreted to suit passive aggressives in uniform. And I needed help. If ever there was a situation where one had to suck up the contemptible rudeness of another, it was here, at the emergency department of a public hospital. That we were in such a place, and she employed by it, made her next comment the most reprehensible of all.

“You do realise, don’t you” she fumed, that look still on her face, “that you could quite possibly die?”

Now, the fact that I was in the emergency ward of a hospital should have been proof enough that I was concerned about my condition. I would have thought one of the core duties of the staff of any triage unit would be to alleviate, to the best of one’s ability, any anxiety that a patient may be feeling. Well, somebody didn’t tell Makka Pakka, who seemed to think it was her job to fill me with self loathing and alarm.

She did a bit of typing, during which she repeatedly shook her head in demonstrative disgust, then said: “Sit down over there and wait till you’re called.”

I waited in emergency for four hours before my name was finally called. It would have been a long four hours if I’d had the mental space to dwell upon this hideous gobbledock’s prophesy regarding my imminent death, but I was more furious than anything, and time tends to fly by swiftly when you’re butchering someone in your mind, weighing up methods of dispatch and disposal (I spent a good deal of the time trying to calculate how many weather balloons I’d need to ferry her off into the stratosphere and out to sea, provided I cut the pieces small enough).

Once inside the hospital proper, the doctors and nurses were bloody wonderful, not a one of them failing to appreciate how I’d come to be there. One doctor I spoke to went so far as to blame my whole adventure on the over-cautious nature of pharmaceutical classifications, and the society that deems the most effective pain killers off limits to people in pain, lest they might enjoy themselves. “It’s madness,” the doctor said, and I agree.

Emergency departments are unhappy places, full of people whose pain and panic tends to make them impatient, and the reason for those signs that warn about abuse is that health providers deserve better than to be shot as the messengers of a notoriously ill-equipped and understaffed system. But this has to be a two-way street - the people who visit emergency wards are frightened and hurt, and any health provider who makes them feel worse is a bad one. I cannot imagine the sort of spray that Nurse Charles Laughton has in her arsenal for the addicts, the alcoholics, the chronically depressed and anxious, who should never, ever be discouraged from visiting hospitals. Her argument is doubtless that they’;re wasting public resources, but we all pay for those resources, and I can promise her that, in ten years time, when her obese arse will doubtless be strapped to a bed haemorrhaging money from the public system, I won’t be bedside abusing her for what she’s done to herself.

I’m willing to accept that my experience with this particular nurse was an isolated incident, but then, all experiences are isolated incidents - we deal with them one at a time. Which is why I’ve written this today, and why I’ll be printing it out and making another quick trip to emergency tonight, just to silently slip something under the glass.

I’m sorry for the offense, lady, but, frankly, you deserve every spit of it. Whatever you do to kill the pain is more than alright by me.


One Victorian State high school enforces standards

NOT many people would figure that as school girls' skirts rise, education standards fall. Last week Ms Wade made headline news when it was revealed her state high school regularly checks the length of its girls' skirts.

Yes, that's right, headline news. This "back to basics" stuff sure did cause a fuss. This was a revolt against the slackness of the post-'60s decades and so was news.

And I was relieved to hear it. Until I checked what else the school is doing to warrant such gasps of shock. In fact, Bentleigh shows that our social pendulum may still have a long way to go before it's swung back to anywhere near where it was.

The school won praise for also insisting students line up in an orderly fashion before class and sign good behaviour contracts in the senior years. What's more, they risk failing subjects if they wag school too often. Talk about revolutionary. Or, as Ms Wade put it more demurely: "We are raising expectations".

I so don't have a problem with any of this. It's all the little things - the skirt lengths, the nose rings, the coloured beanies, the hooded jackets - that give a school an identity, or, rather, an oh-dear reputation.

Sometimes such fashion statements can be refreshing - or surly - assertions of individuality outside school. But in a school they can be signs the school is failing to teach the kids that individuality often has to be balanced with a sense of community if we're all going to get on with each other and thrive.

Such sloppiness also signals that the school doesn't dare to impose any expectations on children, who signal back that they owe the school no duty.

Same story with lining up, which is a basic acknowledgment that life can't be a me-first free-for-all if we want a civil, well-run school or any other form of society. Cracking down on wagging and bad behaviour is also basic stuff in socialising children, teaching them that some kinds of discipline are actually going to make their lives better, not worse.

I most certainly am not hankering for a shut-up-or-smack kind of teaching, but the fact that Ms Wade's very modest changes have made such news makes you realise many other schools must have given up insisting on anything at all.

No wonder there's been such a drift away from state schools to private schools, which for some years have insisted on the kind of things that in a state school seem so brave.

But I'm still worried, and not just because Bentleigh's new rules are not so much back to basics as plain basic, yet are seen as so new. Why do Bentleigh's students now need to sign "contracts" to behave well, when it should be a school's unchallenged right to insist they must?

Why are students under this "tough" policy allowed as many as seven unexcused absences a semester before they fail a subject? Why does the school make a boast of having just two assemblies a term at which the national anthem is played?

When all this is hailed as "tough rules", I'm reminded again how soft the rest must be.


The Leftist Premier of Victoria is just a blowhard

JOHN Brumby was quite a different bloke as leader of the Opposition compared to his recent years as Premier, as you'd expect. Back then he tended to deal in absolutes - and wasn't too hesitant about recycling a few urban myths.

He was vehement in his support for a thorough clean-up of what he saw as systematic corruption throughout the state under Jeff Kennett, with a particular interest, since waned, in the tendering process for Crown casino.

But he also wanted a robust, rigorously independent inquiry into police corruption, and many agreed. If only we had attacked it back then, so much that is now the black legend of these last few years might never have taken place. As later Liberal Opposition leader, now Mayor of Melbourne, Robert Doyle, observed: "Who would know that it would lead to 27 killings?"

Brumby could also be sidelined by fiction, even gossip. He once tackled Kennett in State Parliament claiming the government had a list of journalists who could be ethically "corrupted" to support Kennett's huge and contentious privatisation agenda. Kennett denied such a list existed and asked Brumby for a copy of it. In the excited session that followed, Brumby called Kennett a liar.

Brumby later admitted he did not have the list, but he was reported as being "fairly sure" of its existence, because he'd heard it being talked about on 3AW.

Brumby also named in Parliament 20 Victorians he said were "cronies" of the Kennett government. One of them, Ron Walker, said he was considering legal action.

But most extraordinary was the claim that two top businessmen, who Brumby named to the Herald Sun, would be in jail by the time he was elected Premier. "I mean, some of them will be in jail. Seriously, some of them will be in jail. I won't be working with them in jail!" Brumby said. As it turns out, he doesn't have to go to jail to do business with either of them. Neither was locked up, nor charged with anything.

I called one of those two wealthy businessmen yesterday, and was surprised that he had never been made aware what had been said of him (the Herald Sun chose not to publish the names at the time). "I was never, ever a crony of Jeff Kennett's," said the well known Victorian adding that he never had a poor relationship with Brumby.

"It's the first I've heard of it," he said, laughing, but annoyed. "I am most surprised to hear it. There would be no logical reason why he would say that. A comment like that is defamatory. He didn't know me."


Camera-shy Rudd is exposed by Libs

WITH the Liberal machine convinced they will have to be on an election footing any time from August, the opposition leadership group has taken the irrevocable decision to make Kevin Rudd's character an issue. There will now be two lines of attack: competence and cowardice.

This high-risk strategy reflects the fact that the Coalition has precious little time to deconstruct the Prime Minister's persuasive public persona, the "dentist between appointments" as Barry Humphries so nicely put it. Labor will claim that this new assault is playing the man and not the ball. But this argument will not be sustainable. The opposition leadership group, which has been discussing this new tack for the past few weeks, wants to concentrate on the flaws in Rudd's political persona, not on the man himself.

As one senior Liberal told this column, "We have always believed that there is hollowness at the centre of Rudd." The difference now is the Coalition believes this impression is crystallising in the public mind. Three indicators that reinforced the opposition's confidence voters are finally waking up to the Prime Minister have tumbled out in the past week.

They involve what the opposition argues is Rudd's "gutlessness" in sending out his juniors to cop the blame for failures that, when they previously looked like successes, he was more than happy to be associated with.

One senior frontbencher involved in the leadership group's tactical discussions put the argument this way. "This is based on increasing fundamental incompetence: the pink batts roll-out, pink batts small business false promises on the steps of parliament, Green Loans fraud, the inquiries into the Building the Education Revolution rorts. It just rolls on . . . This is all about the difference between the grand moral gesture and the reality of governance, which in the case of the pink batts program has led to 120 home fires, 1500 electrified roofs, 240,000 dangerous or dodgy roofs and the four fatal tragedies."

That's the competence front. Then, says the Liberal frontbencher there's the associated issue of cowardice: "The failure to front the cameras to deal with the abandonment of the pink batts program after having personally promised to restart [it] in a classic grand gesture in front of the cameras.

"The breaking of the election promise on building childcare centres [announced on the day the Melbourne Storm story broke by junior Minister for Early Childhood Education Kate Ellis who now says only 38 centres will be built compared to the 260 trumpeted during the 2007 campaign] . . . The schools and the Green Loans announcement are all examples of a fundamental lack of leadership and courage. In short, character does matter and Rudd's incompetence and cowardice are now front and centre. The opposition believes that there was a turning point when Rudd ran away from, in particular, the pink batts program announcement and that both Canberra insiders and the public felt there was a failure of leadership that puts him in a new light. "These are deep issues of character and after having been a wonderful presenter, the fact that `there is no there there' to quote Gertrude Stein is becoming evident to the public in the view of the opposition. Against that background, Tony Abbott's authenticity, love him or hate him, shows up well," the frontbencher says.

In fairness to Rudd, that last proposition will also be well and truly tested as the Coalition develops its new line of attack.

In terms of competence the next hurdle for Rudd could be his "activity based funding model" developed as part of his buyout of the state Labor premiers at last week's Council of Australian Governments meeting. Rob Messenger thinks he'll fall at that hurdle.

Messenger is the LNP member who blew the whistle on Jayant Patel, the former Bundaberg surgeon who is now facing charges in the Brisbane Supreme Court. Patel has pleaded not guilty to unlawfully killing three patients and causing grievous bodily harm to a fourth. The charges relate to his time as director of surgery at the Bundaberg Base Hospital between 2003 and 2005. Bundaberg Hospital is in Messenger's electorate and he has taken a keen interest in Rudd's health reforms. While Patel deserves the presumption of innocence until his trial is done, Messenger nevertheless fervently believes that Rudd's COAG agreement on health will only lead to more such cases.

And there are royal commission findings that back what he has to say. "One of Rudd's key structural changes to health is [the] activity based funding model," says Messenger. "The phrase and name is immediately appealing to the layperson . . . [It's] a grouping of words carefully put together by spin doctors and designed to swing the worm in your favour during a televised health debate. As soon as Rudd spouts, `we are going to reform health nationally with activity based funding" you know that the voters are pressing the worm button in [Rudd's] direction," Messenger says.

"But the voters of Burnett and Bundaberg have had a different experience with [the] activity based funding model."

Messenger says that the Davies Royal Commission, which examined the Patel case, found that health bureaucrats put budget bottom lines before people's lives. Two quotes from the royal commission illustrate Messenger's point: "Budgets became heavily linked to activity and activity indicators without fundamentally ensuring there was no erosion of quality." The "evidence showed budgetary concerns and activity targets figured prominently in management strategies generally, as it did at other Queensland public hospitals; in particular, in relation to the employment of the two Senior Medical Officers. The emphasis was on reducing elective surgery waiting lists, not patient safety."

Messsenger says that because Patel was carrying out so many operations, some of which are at the centre of the Brisbane Supreme Court case, the local area hospital board treated him as "the goose that laid the golden egg" in terms of continued funding levels.

"Rudd's activity-based funding model was one of the reasons why Queensland's health system crashed and burned," charges Messenger. "He needs to be challenged and held to account for this failure," he says.

It's the model, of course that Rudd developed as former Queensland premier Wayne Goss's chief cabinet officer. Now that we have it nationally, the opposition will no doubt want to know if it will be Rudd who'll front the television cameras if it produces another Patel.


1 comment:

Paul said...

We were having a discussion on Nightshift the other night while waiting for a cliche named "OD" to be admitted to us. We rattled off what we expected...female, 40 something, multiple presentations, aggressive personality disorder etc etc,...I then commented on the refusal of all our overdose patients to actually conform to our beloved prejudice. Up she came, 40ish, asleep, victim of shocking events in her life, worker, stuggling with real pain...We all laughed at our own collective blindness and got to work to help this poor lady.