Once
into the ICU area I ran another gauntlet – the receptionist. Over weeks, most would let me in on suspicion
that I was not masquerading as someone else.
That was a comfort. Yet, one took
delight in putting me through the hoops.
I suspect he was a retiree from one of our disciplined forces. He had a determined look that suggested any
expectation of sympathy was fruitless.
This was his domain and no anxiety-riven family member was getting past
him without clearance from the shift nurse, no matter how many times I
confirmed my relationship to a comatose patient.
Every so often, the word from the unit was to
stay outside until doctors did their rounds or nurses attended to Carolie’s
ablutions. I would sit for hours,
witnessing all manner of things done to her, but the occasional intervention
was strangely out of bounds. There
was no obvious logic to these random exclusions, especially since they knew I
was her next of kin and likely prime carer.
I particularly failed to grasp why
morning rounds were sometimes an exclusion zone. For me, these mini seminars were a moment of
clarity as the ranking ICU registrar or consulting specialist oversaw a
coordinated update on each patient’s situation and prognosis, in the company of
shift nurses, interns, residents and registrars.
In a teaching hospital, morning rounds
provide trainee staff opportunities to demonstrate and build on their
learning. When not excluded completely,
I found the dynamics and substance of these daily seminars instructive. Although the artificial walls of bed screens
would often exclude me, I could hover at the central station and overhear
proceedings.
Senior
registrars or consultants would turn up intermittently with students or an
intern. Inured to any effect these exercises
might have on family, various scenarios and prognostications played out between
mentor and trainee as if they were in a soundproof booth. These were exclusive exercises for
self-absorbed initiates. Carolie was an abstraction, an ‘interesting case’. I heard every word and nothing brought
comfort.
I wondered at the complete lack
of concern that the patient or family might be hearing these dire
prognostications and losing hope. In
fact, he was asking his student to hypothesize on the basis of ‘knowns and unknowns'. Her actual circumstances were beside the
point.
In recent years
medical communities in some countries have focused on health design,
environment, and patient-centered care; in recognition that subjective and
amorphous qualities, including attitude, state of mind, and personal
empowerment, can have an enormous impact on a patient's treatment and
recovery. I saw some evidence of this
evolving regime in the practices of ICU nurses and a few medical staff, but Australia
has a long way to travel if equal emphasis is to be given to inner and outer healing.
The relative willingness of key players to
enlighten, listen and respond to real concerns and fears was instructive as an
indicator of progress. The
majority of nurses and an advanced trainee specialist in intensive care
provided glimpses of how an integrated model might work with doctors and nurses
working together closely at its hub.
Rather than operate on the periphery - a ‘high-wire exponent’ called on
only as required - the trainee was hands-on from the outset. His explanations of Carolie’s treatments were
regular, informative, detailed and constructive, avoiding the pre-determined
prognostications of others we encountered.
He dealt solely with actual specificities, rather than generalized
declarations, and kept me abreast of updates generated from CT scans,
angiograms, X-rays, pathology tests and any associated revisions to the
treatment regime. It was refreshing,
comforting and most of all, empowering, to have quality feedback and a
manifestly genuine interest in our plight.
I was more relaxed when he was on shift and missed his input terribly
when he moved on.
From our overall
experience, Australia has a way to travel to be at the leading edge of
integrated care. Courses abound and there is an emphasis on skills development,
but the labyrinth only showed glimmers of interest in holistic healing approaches.
Rather, the medical establishment seemed
inclined to pull up the drawbridge and repel boarders.
A medical culture steeped
in highly structured, rigid work practices, with truncated dialogue between
in-house cohorts, patients, family, carers and other stakeholders, will be slow
to change. Yet, a better paradigm might
be on the horizon. Following is the mission statement of the “life house” under
construction for cancer care:
The facility will integrate
clinical care, research, education and integrative therapies, creating
opportunities for innovative discoveries, compassionate holistic care and
better outcomes for patients, their families and carers.
This could be a healing space if the promise is
more than just a glossy ‘promo’. Positive
indicators from our own journey left me with hope that certain redundant practices
might evolve in time.
Thoughts of how to manage life-threatening
illness come into stark relief when patients in danger surround you. The spatial disharmony of the ICUs – the
‘fractured mosaic’ referred to earlier - was hardly ideal.
I kept imagining the characteristics of an effective
healing space, where teams of allied professionals and complementary therapists
worked together in an integrated way, technically and spatially, with patients
at the centre. It would curtail the
endless traipsing off to other areas for various procedures, physical disruptions
that must inevitably disturb, and occasionally threaten, recovery
processes. Removal from and return to
the controlled environment of the ICU was a constant for Carolie throughout her
stay.
The traditional hospital design
of intersecting linear corridors on multiple floors is counter-intuitive to service
integration and management. The old
layered box construct, typical of 19th and 20th century administrative systems,
is not conducive to an enlightened approach to hospital management, as described
above. Architecture informed by an integrated philosophy of healing would see a
different paradigm emerge. The labyrinth would get a makeover, spatially and
culturally.
To be continued....
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