I spent one summer doing the round trip between Croom hospital and St John’s in Limerick, and on another occasion used to swop floors between the paediatric and surgical wards in the regional hospital, Limerick. Another time when I tried to take the train to Cavan hospital, I found that it doesn’t actually go up that far and so grew familiar with Podge and Rodge’s home town on regular car trips to Cavan through Ballyjamesduff.
I know it’s not a competition or anything, I’m just saying that in relation to Irish hospitals and hospital care I’ve a fair bit of experience.
Both my parents are now dead. But whilst they lived, my mother suffered from chronic rheumatoid arthritis and my dad from emphysema. My mother had battled ill health all her life, but my dad only took it up in his later years: when he was given a prognosis of around two years to live, he took it as something of a personal challenge and was proud to say that he had survived for an “extra” three years more than he’d been allotted. We had become so used to his regular lapses and recoveries that I had taken to calling him Lazarus. That’s the kind of bluff and bravado you use when you’re dealing with this kind of stress.
Still, it is strange that even when you know to expect the worst and live in a state of constant tension over a terminal illness, you’re never prepared for that current bout of ill health that will be the last one.
Let me tell you about the way my dad died. I was called at work and told that an ambulance had taken my father into the hospital. I left the children in their creche and followed by car with my partner. When we arrived at the accident and emergency unit where he had been admitted, it was quickly clear that none of the nursing staff were expecting a recovery.
My partner went to collect my mother and I was left with dad, in a small nursing bay in the middle of the A&E unit. The bay held six beds. Dad was in the middle bed on one side.
At first, it was clear that although he could not speak, he was still conscious and able to hear me. When I spoke to him, he made the kind of facial expression to suggest; “here we go again” and later to acknowledge; “it’s not going to get better”. The monitor by his bed indicated that his oxygen levels were falling. When I arrived, they were somewhere in the mid-80s. Gradually the level lowered and at some point, he became unable to communicate. One nurse explained that it wouldn’t take long, if I just waited till the level reached around 50, he’d be gone by then. I heard another nurse ask a doctor if they should move my dad to another ward or bed, but the doctor answered that it wasn’t really worth it.
And throughout this time, the other five beds in the bay were in constant use. Although I tried really hard to focus on the last few moments I had with my dad, the absurdity of the death was hard to ignore. I remember looking across at the woman with a broken arm in the bed opposite dad and wondering how she must feel watching the two of us. A nurse pulled the cubicle curtain around us, which I remember thinking was very thin.
Like I said, I have a lot of hospital stories, but this is the one I always think of when the talk turns to health reform. It’s the one that has been on my mind since the Roscommon hospital A&E closure hit the news. The other vignette that comes to my mind is the scene from the film Postcards from the Edge, where Meryl Streep screams to Denis Quaid (I paraphrase): “It’s not what you did, it’s the fact that you lied about what you did.” Denis disagrees vehemently and argues that it really isn’t the lying. She’s obviously upset because he was screwing around.
And if you look at another relationship — the one between the Public and the Government — you’ll find exactly the same scene being played. It’s not, we’re told, that the Public feels that they’re being fecked about by the Government, it’s the fact that the Government has lied. Well, as I’m listening to the story unfold, that’s the way it seems to me. All the political analysis is over the impact of “the lie” and the consequences of “broken promises”. Did Enda Kenny make a terrible mistake? Has the Government begun to loose its credibility?
So which should we be most concerned about — the lie or the change in health service provision?
Looking at the lie and how it affects the relationship between the public and the government: it’s very clear that we’re coming into this relationship with a lot of hurt. Our last relationship didn’t end well and so it’s not surprising that issues about confidence and trust should manifest so quickly, especially when we know that promises were made that have not been kept. If this relationship is to have any future, The Government has to learn to behave responsibly. We’ve heard all the promises before. What we really need now is some honesty and clear communication.
Looking at the change in health service provision is a bit more complicated. Whether or not we decide that we’re being fecked about depends very much on knowing all the details, of all of the story. I suspect that the number of people who have an opinion on Roscommon A&E service provision far outweighs the number who have read the HIQA reports. I have read the HIQA reports on Roscommon hospital. For the most part they reflect a systems failure, where lack of adequate staff prevented the systematic delivery of optimum healthcare routines. The report routinely recognises attempts to overcome these shortcomings, but equally routinely recognises that the required action has only been partially completed. Many patients commend the efforts of staff. The hospital is not a bad hospital and hospital staff are not negligent. Overall, however, the HIQA reports suggest that the system of care does not work as well as it should.
It reminds me very much of the services I experienced the day that my dad died. The hospital was not a bad hospital and the staff were not negligent. But still my dad deserved better. The woman in the bed opposite him deserved better. The nurses deserved to work in a better system and the doctor who was so pushed for time and resources that he concluded that it wasn’t worth moving a patient into a quiet room for a couple of hours before he died, also deserved to work in a better system. The fact of the matter is that healthcare is emotive and political campaigns often make more promises than they can keep. But let’s not get distracted. The electoral promises of two TDs should not be the basis for important decisions about healthcare services and we don’t need to obfuscate an already tough decision with political point scoring. What we really need now is some honesty and clear communication.
* Maura Adshead is Head of the Department of Politics and Public Administration, University of Limerick.