March 13, 2005

Listen to Me

They finally delivered her from the Recovery Room to one of the wards after the surgery. By the time I got in to see her she was still woozy from the anaesthesia but reasonable coherent and thoroughly pissed off. Some of that was just anger at having cancer, but most of it was entirely justified. In every instance where she has had surgery (save one) she has been unable to convince the doctors to give her anti-nausea meds along with the stuff they use to knock you out with. On the one occasion when someone listened and gave them, she came out of surgery with little pain and no problems. On this occasion of the mastectomy, like most before, no one had listened.

You should understand that my mate is no shrinking violet. She is a health care professional who knows the system well, and an assertive woman who presents her needs with some force and credibility. Still, no one listens to her. When she says that she has a violent reaction to almost all narcotic pain killers, they make a note in the chart that says "Patient is uncooperative and refuses all medications." That is to cover their collective ass. When she says that virtually all general anaesthetics make her horribly nauseous, they look at her as if she is an idiot, and take no appropriate precautions to preclude that result. As a consequence, she tolerates the surgery very well, but her adverse reaction to either the anaesthesia or the pain meds is almost invariably a problem, and she ends up miserable with unnecessary pain, and often requires an additional day of hospitalization, as was the case on this occasion.

Don't get me wrong, these are dedicated doctors, nurses, and technicians, who are for the most part caring human beings as well. None of what happens to you in the hospital is malicious or hostile. It may sometimes appear so, but this is a mis-perception. The staff does not start out being arrogant, detached, and isolated, some of them just end up that way because of the toxic environment they must work in. No hospital have I seen that was free of the Acquired Inefficiency Virus (AIV). Just as in the history of HIV, when it first started showing up in the gay male population that frequented San Francisco's bath houses, the origins and method of transmission of AIV are shrouded in myth, mystery, and misinformation.

Prerequisite to an understanding of the etiology of AIV is the realization that the hospital is just another bureaucracy. After several years of existence, concerns about its self-preservation and preoccupation with the comfort of the staff have begun to dominate management decisions. After five years of life span, a hospital, like all members of the phylum bureaucratica, species institutional, has forgotten its original purpose (in this case to serve a patient population with acute health care needs) and has begun to regard patients as annoying but necessary objects that are required to justify staff salary increases and additional plant resources. To put it succinctly: census is important; patients are now seen as a bother.

Should you ever be held captive in a hospital, you will soon discover that nobody really listens to patients there.

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