Continues...
The
different cohorts you encounter shape the cultural landscape of the labyrinth. Top of the food chain are various
specialists, whether surgeons, anaesthetists, consultants or senior
registrars. My interactions with this
class were spasmodic and cursory.
Obviously, they are all short of time.
The senior neurosurgeons engaged
me on occasion, usually when there was a substantial development to report or
procedure to implement. They kept discussions to a minimum. A junior registrar was the designated
‘gofer’, sent to fetch permissions, update the situation and convey bad
tidings. He was prone to the declarative gestures common amongst his
tribe.
One ‘clanger’ was a rather casual
observation that a previous assessment that Carolie would likely resume a
normal life was now qualified and that she would never be the same again. This came without clinical context or any
‘parenthetical amplification’ to assuage the nasty effect it had on me. He was a regular visitor to the ICU as
neurosurgeons are central players in this area. I later suggested his choice of
words were insensitive at times. He
replied arrogantly that this was his way and that it was best to lay out the
‘facts’. It was a tad depressing to
think he inculcated such communication strategies as part of his training.
I wondered whether a focus on emotional
intelligence might better prepare medical specialists to deal with people
meaningfully. Nurses did their best to mitigate the worst effects of the
medical hierarchy’s studied disengagement.
I perceived
a lack of either empathy for or genuine interest in the fate of individual
patients emanating from the senior medical cohort. Doubtless this is woven into their DNA via training
and operational culture. Obviously, there
are too many damaged souls and they maintain a detached professionalism to be
most effective. I would argue that a
more personalized approach is preferred, whilst retaining professional
objectivity.
Across the public sector it
is a truism that the more senior staff become, the less contact they have with
actual ‘people’. Those who determine
policy and the quality of service delivery become increasingly detached from
the supposed beneficiaries of these same policies and services. Clearly, the senior medical cohort do have
contact with patients and family, especially when they are directly involved in their
treatment. From my personal experience, a surgeon who treated me in
recent years visited me every night after my procedure and spent ‘quality’ time
with me. I wondered whether he ever saw
his family.
During
our stay a member of the senior cohort wandered into the ICU occasionally to
engage the shift registrars. They were
obviously clever and skilled and wore their status like a cloak of
unapproachable authority. I was reminded
of a kind of aristocratic mannerism
I have experienced in England – personable, chatty, but a body language resonant
with detached superiority and an implied declaration – ‘do it my way or the
highway’.
It must be difficult for the
senior cohort to avoid falling into absolutism in managing junior cohorts,
especially if they have trained under authoritarian regimes. Someone has to be
in charge and make decisions. Yet,
collegiate processes are healthy, and respect for leadership should derive from
performance, knowledge and skill. ‘Best
practice’ must surely be a touchstone in a teaching hospital, and doubtless guides
the work of the labyrinth, despite its evident spatial, operational and
cultural limitations.
One
of the senior ICU registrars made efforts in my direction. He would put on his ‘concerned’ face and sit
with me. Whenever he finished his
expositions, I would steel myself for Carolie’s imminent demise. On occasion I was so upset by his words I
sought further clarification from nurse managers. They would explain that he was outlining
broad parameters that would not necessarily apply to Carolie. He would wander off, pleased with his
handiwork. He reminded me of a central
character in the Discworld novels of
Terry Pratchett. A central character - ‘Death’
- never enjoys his work – he has a hangdog approach to the harvesting of ready
souls.
None of the registrar’s dire prognostications took place. I recall him arguing the toss with an ICU
consultant as to who should remove Carolie’s brain drain. He was adamant it did not fall within his
responsibilities and should be the domain of neurosurgeons. One of the experienced ICU nurses later
removed it in a blink.
Social
workers are a discernible ‘tribe’. When
you arrive in an ICU or high dependency ward, they are quick to make their
presence felt. I was ushered into a deep
and meaningful meeting with an earnest soul, and regaled with a shopping list
of potential support opportunities; a veritable smorgasbord of help. The parking pass was one of them.
Another was a list of local accommodation
with reduced tariffs for family visiting the hospital. There were others on offer but it was little
more than a check-list exercise. I
quickly discovered the pass was a cruel illusion. The accommodation prices turned out to be
wrong as Sydney hotels were cashing in on the Gay Mardi Gras by hiking all
their tariffs. To access a petrol
subsidy required a process bordering on the absurd. It would have cost more than the pitiful
reimbursement.
All of the social workers
met on our path were engaging, likeable people operating in a bureaucratic maze
of ticked boxes, regulations and illusory support. They coordinate in-house meetings designed to
provide information feedback, and facilitate form filling by in-house actors,
and they know a thing or two about off-campus parking. All seemed run off their feet, dashing from
one meeting to the next, providing gratuitous advice, getting the check-lists
and meeting minutes sorted.
To be continued...
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