Seeing and hearing.

If you are reading this, then go to Jem's blog, here:

http://www.jemshaw.blogspot.com/

Find Saturday 17th November, 2007, "Health and Safety Costs Lives"

and

READ IT NOW.


My heart goes out to Jem's son, someone half way around the world away whom I've never met. At the same time, I do know him. He could be the nice lad I saw at clinic last Friday afternoon or my friendly next door neighbour whose little son and daughter run around in the backyard squealing with delight when it rains or the young man who does my accounting and jokes with me about the rising cost of Bic biros.

And I know Jem's frustration and anger. In 2003, I lost a dear friend to uterine cancer. She was living with her husband in the UK. She started bleeding and was told by her GP, after already waiting some time for it to stop, that she should wait some more time for it to stop and then come back for a pap smear. It didn't stop and so eventually the next plan was an ultrasound. The waiting time for an "urgent" scan was about six weeks for an outpatient. By this stage, she was sick and in pain, so they packed up and headed home. A few months later it was too late.

I have also seen my own patients die on cardiac surgery waiting lists, on interventional radiology waiting lists and waiting for specialist clinic consultations and it makes me want to throw things, or worse. The cold rationing of resources and the fiscal waste the politicians and administrators lumber us with never ends.

However, my rage and outrage at the bureaucrats is outweighed by my own guilt. Some of it is vicarious to be sure; a collective shame. Some of it is personal and immovable.

Collectively, as physicians, I ask, why can we not see properly? Why can we not hear properly? Years of training, science galore, every whiz bang tool imaginable and we are still blind and deaf to our patients' needs. It should be so easy to listen and to look and to "be there" and yet we don't and we are not. What makes us so distant that we lose our own humanity?

The following are pieces of my own experience.

In 1991, as a second year resident, I spent some weeks working in a remote mining town on the edge of Sturt's Stony Desert. It was New Years Eve, so about 41 C and at about eleven pm I was called to see a young indigenous man who had got drunk, punched a wall and broken his right hand. He was loud and threatening and offensive. I was hot and tired and fed up. I splinted his hand and wrist and told him to come back in the morning so I could x-ray his hand and see if anything further was needed. At about 2.30 am I was called again, this time to see a 16 year old girl who had been raped and dragged by her hair out to a railway camp on the outskirts of town. She had got away and had walked bare foot back to town. A policeman came and told me that they had apprehended the perpetrator because the girl had described a brand new splint on the man's right hand. If I had been more tolerant, more culturally aware and had organised the young man with the broken hand a meal and a hospital bed for the night, that girl would have been alright.

Then, in about 1998, I was a registrar in Far North Queensland. It was monsoon season, hot and humid. I started a weekend shift on Friday morning and finally got to bed at about 1 am on Monday morning. The night resident rang me at 2am about a young man with pneumonia. He wasn't doing well and so I ordered some changes to his treatment and went back to sleep. The resident rang again. It's now about half past four. We didn't speak for long. She just said, get here, now. It was only a five minute drive. When I got to his bed side he was in extremis. I intubated him and got him to ICU where he died a day or so later. I should have gone in to see him at 2 am when an earlier intubation would, most likely, have made a difference.

These are just the things that come to mind at the moment. There are other things and I'm sure there are some things I'm not even aware have gone wrong. You might say that these things were due to systemic problems such as inexperience, isolation, under-staffing or fatigue. In fact, the real cause was not seeing, not hearing and not being able to care enough. You have to learn to live with the guilt of such things. There's absolutely no room here for intellectual rationalisation, some sort of quasi-existential self pity.

There are times when, because of the deficiencies of medicine, I've thought seriously about leaving the profession altogether or at least leaving the public hospital system but where does that leave the people whom I might help, despite my limitations? For the moment, I try to accept the uncertainties and hope to improve things through teaching and by trying very hard to see and to hear and to "be there".

(A bottomless pit of loathing for health bureaucrats, pharmaceutical company representatives and politicians also helps).