The Decomposition of Healthcare – Part 3

“The food you eat can be either the safest and most powerful form of medicine or the slowest form of poison.” – Ann Wigmore

Shortly after having published Part 2 of this series I did receive a very apologetic note from Island Health suggesting I contact the Patient Care Quality Office.  I did respond highlighting one of the reasons I became involved with the Patient Care Network was at the suggestion of the Care Office.  However, in a twisted way, this re-enforces my belief that administration gets a better budget to handle PR than health care receives to manage bedside care.

One of the first things you should quickly adjust to when an in-patient is the hospital “minute”.  I had nine days of staring at a ceiling with an IV running and hearing “I’ll be back in a minute”.  Often that “minute” turned into an hour and sometimes just disappeared all together.  By the time I reached my “permanent” hospital bed there was little nursing care I required with the exception of medication and assistance for those functional things associated with polio so usually the hospital minute had little impact on me.  When it was important I had the capability to make my case, other patients didn’t.  I also understand how that “minute” comes about due to inadequate staffing, an administrative activity.

I don’t check into a hospital for a five star hotel experience or an epicurean adventure but I do have an expectation of care and nutrition.  In nine days I was given six basins of water and a wash cloth.  On five occasions I was given a disposable (again disposable cardboard equipment) kidney basin with a couple of plastic cups with water along with a towel.  I had my son bring up my toiletries so I was able to brush my teeth and cover my burgeoning body odour with Old Spice deodorant.  Direct care was aimed at those needing it the most with the limited staffing admin allows.

On the priority list I was very low and should have been.  I was a medical patient taking up a surgical bed.  The level of healthcare I required meant staying in bed and letting the antibiotics do there work.  With that said I did have some expectations around the nature of rehabbing, 1. being knowledgeable and 2. being nutrition.  My first suspicion about knowledge level was a young care aid who asked me what polio was.  After explaining it her response was that she thought it was one of “those diseases you hear about in Islamic countries”.  I’m sorry but in my mind that’s not only ill-informed but it borders on racism.

As far as nutrition, while I don’t expect five star quality food I do have some expectations on nutritional value.   That is a slice of “Moroccan meatloaf” (and yes it exists I Googled it when I got home), next to that is a beef “ragout” with steamed to death carrots and some slice peach.  This was one of the better presented meals but I’m pretty sure there is very little real nutritional value there.

I think you might have trouble finding a nutritionist that would defend the nutritional value of carrots steamed just short being pureed.  Personally a handful of raw carrots would have worked even better.  That Moroccan meatloaf was as heavy as a brick and could be dropped from quite a distance while not breaking.  This is not nutrition, it’s production line budgeting.

I was left with a lot of thinking time which was good for me.  It provided time (no WiFi) to declutter my mental filing cabinet and take my metacognition out for a good walk.  What made that so useful was it provided me with a window to evaluate something a counsellor friend of mine had pointed out recently.  Coming to grips with my wheelchair dependence.

I had spend my life living with the results of my polio and that involved walking on crutches.  That was always normal to me.  My shoulders began wearing out in the mid 80’s and I slowly began using my old basketball chair for use around work.  My doctor at the time would often tell me that shoulders were never developed as weight bearing joints which was something they didn’t take into account in the 50’s and 60’s.  My dependence on my wheelchair raised my disability to a whole new level which I ignored.

Lying in that bed thinking and re-evaluating my beliefs just started pulling all of this anger out of me.  I had spend the last twenty years (I consider 1996 as the next step into the world of disability) denying this anger while driving other people away.  My obsession with personal independence and self responsibility was actually driving other people away.  People I had assumed understood these things.  I had spend a career guiding others to the acceptance of their disability and yet ignored every bit of that advice when it came to myself.

By Sunday October 2 I knew I had to start planning for my own discharge.  I could be just as effective for myself in the comfort of my own home but I do admit some apprehension.  The current healthcare system in BC hasn’t reached that point where they are prepared for patients like myself.  I was to discover this when I started having to meet with social workers, occupational therapists and a physio regarding my discharge.  Although they all expressed concern for how I would manage on my own at home, not one of them gave me any indication that they understood the nature of a functional assessment based on criteria thinking rather than norm.

I had had enough time to think.  I could no longer lay there evaluating my circumstances, the ones I had ignored for twenty years, while being surrounded by everything I see wrong with our current healthcare.   You can throw all the money you want at it but when millions are being used to pay severance packages I’m not convinced money is the problem…too much administration and a system that no longer knows what they are there for are the problem.  Healthcare, not health administration, is where budgets should be going.  I fully agree with Minister Philpott when she talks about, not more money, “transformational change“.

On that same Sunday I made my first transfer in a week from the bed to my wheelchair.  I knew it was time to get out of this place so someone who really needed it could have the bed space.  I spend the next three days getting ready for discharge.  More on the difficulties of discharge in my next missive…

Just one mans’ opinion