hospitals

If It Ain’t Broke? CRH is Definitely Broke

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Local news headlines are reporting that the regional hospital on the western end of the island is having difficulties with the decades old ventilation system, forcing most of its services to be badly curtailed. As the only Type A hospital outside of the KSAC its services are integral to regional health stability. Not just the most critical patients but also the day to day management of stable patients depend on this hospital’s functions.

Which is perhaps why in an effort to avoid national panic, the Government (through the media) has downplayed the potentially longstanding and severe effects of the situation. Ventilation issues are the problem, they quip, and point to engineers assessing the situation, the plans in place to fix it. Never mind that every day brings the shut down or relocation of some critical department. Never mind that daily staff and patients are exposed to unknown airborne chemicals with unforeseeable effects to their physical health.

The problem as Dr. Christopher Tufton rightly pointed out is primarily one of neglect. For decades the ventilation at CRH has not been working and none of our successive governments has bothered to fix it. So when a simple problem of airborne irritants occurs there was no ventilation  system in place to redirect the fumes. And when they did turn the system on the problem only worsened. (This is a classic example of sick building syndrome).

Internationally speaking, workplace hazards are problems ripe for litigation. It is the responsibility of the employer to ensure that the employee is not placed at unnecessary risk in carrying out his or her duties (the so-called ‘due diligence‘). Where unavoidable this risk should be carefully calculated.

Human lives are at stake.

Healthcare workers are put at risk in so many other ways: needle-stick injuries, violent patients, contamination with blood or other bodily fluids, the constant exposure to illness. We mitigate these risks as best as we can, accepting them as part and parcel of our call to service. But the continued pressure to work in an environment with unidentified and potentially catastrophic risk is, I think, too much to ask. What the media (and therefore the public) have yet to fully realize is that human lives are at stake: patients, medical and non-medical staff, siblings, spouses, parents, children.

I don’t envy the Health Minister’s seat right now, backed into a corner with IMF restraints and the demands of an ailing health sector. And just as you said, Dr. Tufton, there is no quick fix. But the people working and convalescing in this contaminated institution cannot be left to languish while the situation is slowly rectified. Decisive action is needed if lives are to be saved. Come Dr. Tufton, do sumn before sumn do wi.

Type Sea Hospital 

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Noel Holmes Hospital sits almost on the edge of a cliff. Strong sea winds whip around tree branches, hairstyles, the odd piece of gravel. As you approach the edge the gust steals your voice, dulls your hearing. 

The hospital is a little thing, boutique in size if not style. There is nothing cute or trendy about it. Type C is the first hospital grade, a step up from the Type 5 health centre. There is a general ward, a maternity ward and a space for overnight observation. Staff is limited and patients are relatively few; cases are simple. The days are short, the workers friendly. Time passes in the island way. 

Historically, Fort Charlotte (where the building rests) defended Hanover from seafaring enemies. This bastion now turns inward, defends against a sinister more pervasive threat. Primary caregivers work hard to prevent the spread of illness, and control chronic disease. 
Our success or failure depends on the whim of patients and the dictates of a disinterested administration. Noel Holmes is a boat adrift, but does the tide drag it toward or away from the safer shore? 

The Unfortunate Business of Death

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Breaking bad news at one in the morning
Is not part of the prescribed medical school curricula
Real life has no point score for empathy
Patience
Directness
But conversations twist as they need
And break when they must into tears
Screams
Silence
Five minutes.
(Is an exam, not the ending of a life)

Seasons of Surgery

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Three months of my Surgery rotation are almost entirely behind me. Today I was on the ward jubilantly dancing to my own personal rendition of “Two and a Half Days Left” – if you haven’t heard it yet, don’t worry. It’s on my mixtape. Have a listen.

While a nurse wondered aloud whether I needed loading with Dilantin for my seizure-like activity, I blithely one-man-partied on.

This afternoon I had an epiphany: medicine is all about people.

But what about those five years of complicated biochemistry and endlessly detailed anatomy? Those reminders about evidence-based management and peer-reviewed research? All still relevant. But at the end of the day, what the delivery of health care is about is people.

Effective health care delivery means knowing what what people want.

We have to know what the patient expects from us. “to get better” is not a specific enough answer. It can mean keeping a limb or losing one. It can mean an IV line that never stops dripping, never mind that it’s only infusing normal saline. We have to know our patients.

Radiographers and radiologists are overworked. They know how we warp medical histories in our desperate attempt to get our patients’ done first, they know that sometimes we flat out lie. Yes, sometimes they send back really bad xrays and don’t bother to do the ultrasound for days because the porter only just now got sent for the patient, but getting angry has never solved any problems. They know we need their help, and we have to know when to pull back from all the pushing.

We have to know people.

Pharmacists are understaffed. They wield a lot of power behind their glass windows – second to laughter, medicines are the best medicine. They don’t have a lot of stock to work with either. Half the time, we’re out of this antibiotic or that painkiller. Now we have proton pump inhibitors, now we don’t. It’s like playing peek-a-boo only instead of a friendly face, what pops up is a stomach ulcer.

When we’re frustrated because the patient with a blood clot up the entire length of his leg hasn’t gotten his heparin because it wasn’t sent to the ward, it doesn’t do to yell. Yelling only makes pharmacists crawl behind their glass windows and give us a glass stare. I’m learning to bite back retorts and swallow anger because all it does is take me two steps back. Hopefully PPIs will be in stock by the time I get my stomach ulcer (which should be any day now).

We have to know people like porters. Have to know how to get them to work for you, instead of making them put you to work. Today, I got a patient down to the radiology department without having to accompany them personally for the first time. It was a red letter day, lemme tell you. It took me a dozen phone calls, endless cajoling and three months of saying hi and being friendly for it to happen. (In return, of course, I got a metric tonne of attitude, one “you owe me lunch, doc” and, AND, the results of my patient’s xray and ultrasound thankyouverymuch).

Working in a public hospital is about knowing how to tread around toes and egos, knowing how and who to bribe (always have candy) and knowing how to keep your head down and work hard. There’s a lot of humility and swallowing of pride and a little bit of knowing your limits. (there needs to be more knowing of limits).

It’s great to have someone you can learn from, even if that someone is sometimes yourself and your own mistakes because internship is one hell of a learning experience.

Why is a Raven like a Writing Desk?

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Because the emergency room is like a stage. And we poor players just strut and fret our hours.

I have been called “nurse” so often in the last three weeks that I have begun to ignore it. Most of my conversations end like this:
“No, sir, I don’t know if you can leave now.”;
“No, ma’am, I don’t know when the doctor will see you.”;
“Sorry, I can’t help you. Let me get you an actual nurse.”

Welcome to Cornwall Regional Hospital, where the patients are many and the beds are few. But don’t worry, the emergency cubicle is always ready and waiting. Oh, the anecdotes I could share.

For instance, once we were assisting the resident on duty to suture a three-year old’s facial laceration. Assistance at these procedures is mostly about restraining the screaming, kicking (biting) child while the resident tries to avoid putting his eye out with the needle. We assistants were actually being assisted by the toddler’s mother, grandmother and aunt and we were still having a hard time. On top of that the grandmother kept telling the little boy to behave because the nice nurse was fixing up his face for him. She said it like five or so times, and then the aunt started saying it too. Finally the resident tells them, “I’m a doctor, ok? Not a nurse.” at which point the grandmother goes “Oh, okay.” And five minutes later says, “The nice nurse soon finish, don’t worry.”

So there was definitely humour around the Sisyphean mountain of work. In between trying to site intravenous accesses (fondly termed “drip” by our patients), interpreting electrocardiograms and taking histories, we made friends and we made memories. I realized that I love the touch-and-go aspect of emergency medicine. I thought I would; I’ve never fancied holding on to patients indefinitely and inundating them with repeat blood test after repeat blood test, but it’s good to know. This feels more like ‘proper doctoring’ because we get the patient as they walk through the door – without the benefit of a preliminary diagnosis – and the detective work that ensues is like watching a piece of art take shape.

Okay, that might be a bit much. Suffice to say, that I find it all really, really exciting.

And all too brief. This week is the end of the rotation, and I feel like there’s so much more for me to learn. (There definitely is more for me to learn for my exams on Friday, actually). Like my three week stint on Gastroenterology, I just feel like staying in this department forever. I can learn to deal with sleepless nights and uncooperative patients. I just want more. I, I . . .

True story: this gif makes me want to cry every. single. time.

The Old Hospital

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The old hospital sat on top of the hill and sighed. It was thinking about its long life there, being a hospital, and whether or not it was about time for it to stop.

It sifted through its floors, feeling each of its beds and gurneys that held occupants closer to death than life. The hospital itself was closer to death than life. Its lights had started to flicker, trolley wheels were sticking, and its ceilings were starting to show more than a few cracks. It heaved a great rumbling sigh, and upset the aortic aneurysm repair that was going on on its second floor. The surgeon accidentally nicked the liver.

It opened its doors, stretching and yawning, and checked to make sure its elevators weren’t stuck. The air conditioning was still working in the intensive care unit, at least, and the labs still had enough reagents. But something just wasn’t right.

On the fifth floor a relative was complaining loudly that the doctors just didn’t care. Ah, that must be it. Its doctors and nurses for some reason lacked motivation. Maybe the old hospital just didn’t have It any more.

But it still had blood products and dialysis fluid and medical oxygen. So what if its curtains were dirty and the patients didn’t have enough bedsheets?

It gave another rumbling sigh, and the intern taking blood on the first floor stuck herself with the needle. The old hospital didn’t even blink; it knew the ARVs were in stock. Just like the sterile gauze and KY Jelly. Everything was in order on all of the shelves and cabinets, But maybe, just maybe, it was better to quit while it was ahead.

It started with the lights in the morgue, then the freezers, then the air conditioning, systematically switching off its electricity. It blinked and the oxygen tanks stopped delivering the gas; the suction machines turned off. Electrocautery machines stopped cauterizing and ventilators stopped ventilating. People started leaving, in whatever way they were capable of. And with a final lingering sigh, the old hospital shut its eyes, its windows and its doors and was no more.

kingston public hospital

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kph shall admit from the the wretched sea
that washes patients to its shores
here mothers cry for their young,
swallowed up by the sea
kph is nothing new
at kph, you do not speak of time
time is unlimited
time, undefined
kph shall call diagnoses
patients with:
polytrauma
stab wounds
gluteal abscess
diabetic foot
gsw
appendicitis
metastatic malignancy
kph is vexed about short staff, scant resources, broken CT machine,
loud patients, no beds, and where the hell is the 0.9% normal saline
kph is revolting against first world second world third world
division
standard of care should not have to be a decision
kph is nothing like the rest
kph will not be counted among air-conditioned private hospitals
will not be praised by the chief medical officer; doctors will not want to work here
kph is knives, bombs, guns, blood, fire
blazing for treatment
yes
kph is a lab
purple top, grey, top, blue top, red top test tubes
serial CBCs, U+E’s, LFTs
PT/PTT, Trop-I 
q6hrly vital signs
kph will not change things
kph need to be changed
vjh is the birth of a people
and kingston hospitals are
arising, awakening, understanding
kph treat, is treating, have treated
kph shall continue even after interns have stopped working
kph shall survive you, me
it shall linger in downtown kingston, on the corner, down the road in time forever
kph is health, only health will tell
kph is still not perfect
kph has no doctors, nurses
kph is just a part of the story
his-story her-story our-story
the story still untold
kph is now calling, yelling, begging, irritating
making you want to default from clinic
but you will not default from this clinic
kph is big
cannot be small
kph cannot be shamed, cannot be blamed
the story is still not told about kph
kph has copies of the bible, your dockets
lab reports, your x-rays, your consent forms, your nurses’ notes
the treatment plan, the diet guide
kph is no secret
kph shall be called boring, stupid, senseless
kph is watching you trying to make sense of kph
kph med students are messing up your veins
making you want to sign yourself out of kph
but you shall not sign yourself out of kph
kph shall frustrate you
because
its medical care is to be continued in the clinic
in the clinic in the clinic in the clinic

.

Based on Dis Poem by Mutabaruka, which is a very deeply moving spoken word piece that I happen to be dancing to at the aforementioned unnamed dance show this week. Yay. 

Almost doctors

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Our Introduction to Medical Practice course takes us to the hospital for two weeks so we can learn to take histories and do physical examinations. It sounded way cooler before I was actually doing any of it. Things I have learnt during my first week include:

I don’t like talking to people – really.
Every book I’ve read tells you to remember that you’re learning, and that the patient knows you’re learning so you shouldn’t feel like you’re wasting everyone’s time. Guess what? I still feel like I’m wasting everyone’s time. But I think, with practice, I’ll feel less unnecessary.

Hospitals are really big (and elevators are never on time)
Our hospital has ten floors. Ten floors. Are you kidding me? As a general rule, I only use elevators when I absolutely need to, simply because I hate them. But when you have to walk up seven floors using the stairs, you start to think that maybe a little vestibular wonkyness would be worth it if your thighs would just stop burning, oh god.

Consultants know everything (even the medical students in the year above you know everything)
Consultants work years to cultivate their mad skills of tripping up too-cocky residents and students. They all exude an aura of ‘my intellect is much too busy for you, but here have a crumb of knowledge from my vast and infinite repertoire. NOT.’ So often this week I’ve felt like everyone else in my class knew things that I didn’t. But then there’s always the times when you know things they don’t too.

Everyone is always busy
Consultants, residents, interns, nurses. Everyone has somewhere to be and something to do (usually several of each) except the patients. Which is kind of frustrating and kind of not. The buys people are who you need to learn from, but the patients are who you’ll be practicing your skills on. It’s kind of a trade-off… that doesn’t usually work out in your favour.

Surgery is no fun at all
Standing for an hour and a half with nothing to do except watch gloved hands clutching instruments and doing things that are far above your head because nobody bothers to explain any of it to you is not my idea of a good time. The most interesting thing in the room turned out to be the heart monitor, because I could actually see it clearly, and it was the only thing I could understand.

As long as there’s a seat available, take it
You spend so much time standing and walking that by lunch you kind of collapse onto the nearest (soft) flat surface and breathe an audible sigh of relief. Which brings me to another point: wear comfortable shoes. Use insoles if you have to. On my first day I was so excited that I hardly sat down. By the time I went home, I ended up having to soak my feet for an hour. Lesson learnt.

Pax.
–
Do you have any hospital stories to share, from either side of the medical field?