A family's perception of a public hospital
Dianne Cullen
Lecturer in Education, Australian Catholic University, Melbourne VIC
PP: 243 - 246
Abstract
This article tells of one family's recent perceptions of a major public hospital. Their story is a personal one that revolves around the illness of a family member. Visiting their loved one every day meant they gained a heightened awareness of the day-to-day running of the hospital.
As the patient had to stay in hospital longer than originally anticipated the family members begin to observe details of contemporary hospital life not noticed on occasional visits. What they perceive leads them to question those often heard, and taken-for-granted, values of efficiency, accountability and competitiveness.
Article Text
What follows is a true story. It is not a story grounded in theoretical analysis but it is a story of one family's perception of a major public institution: a hospital situated in metropolitan Melbourne. Like so many public institutions throughout the country, this hospital has had to restructure itself several times over in an attempt to become more efficient, competitive and accountable. These three words are seen and heard regularly in the media but all too often little attention is paid to the inherent values which underpin them. However, when a family must engage with a public institution, words such as efficient, competitive and accountable begin to be questioned.
John was 84 years old when he entered hospital in January 1999 for a minor operation. He was a diabetic and suffered from a heart condition, a bad combination, for this meant poor circulation and as a consequence, for the second time John had to have a toe amputated. At the time, the doctor pointed out that because it was not major surgery, it would mean only a brief stay in hospital. Now John was not the easiest of patients. Indeed, he could be described as being a cantankerous old digger! Constantly he complained about such things as the toast served at breakfast being cold, the tea being lukewarm, the plastic knives being useless and the soup not being hot. Whilst initially dismissive of the complaints, John's family began to notice how difficult it was for the elderly to cope with meals served in a style reminiscent of airline food. Lacking the dexterity of fine motor skills meant it was not easy for the elderly to peel back the covering layer from the little plastic butter containers. The strength necessary to again peel back the lids on the water and orange juice containers often meant patients went without their drinks.
On weekends, the nurses were expected to reheat the patients' main meals in the microwave. This necessitated the nurse having to run constantly backwards and forwards down the corridor to the microwave thus leaving him/her with no spare time to assist the patients experiencing difficulties eating their meals. The nurse warned patients to be careful not to burn themselves when removing the cling wrap but it is awkward when you have a drip in both arms.
Moreover, patients with poor eyesight could not see the clear cling wrap covering the meal and as was the case with one of the patients in John's ward, he tried to eat his lunch through the plastic wrap. Not surprisingly, John's family, like many others, rostered their visiting so as they could assist with the meals.
Accompanying the food that came in plastic containers on plastic trays were the cups of tea and coffee served in dark, brown, plastic mugs. John whinged about these too, and admittedly they were not the most attractive colour. Later, the family learned that this colour is preferred by the catering companies as it is harder to see the tea and coffee stains on the inside of dark mugs. Little wonder John complained constantly about the food. But he did not understand today's system of contracting out catering services as it is more cost effective and therefore considered more efficient by the hospital administrators. In an effort to jolly him along, the family would remind John that he would soon be out of hospital.
But they were wrong. His wound had not healed properly and it became gangrenous. A couple of days later, the 84-year-old World War 11 veteran returned to the operating room to have his leg amputated below the knee. The second operation was successful but four days later John suffered a heart attack and experienced kidney problems. The combination of the skill of the doctors, modern medicine and technology meant he was able to pull through. But the family knew recovery would take much longer.
For John's family this meant an extension to the visitation regime, a development which brought with it an increase in familiarity with the hospital. They soon learnt that despite there being three elevators for the general public to use, only two were regularly in use. Due to the sign constantly placed in front of the third lift that read, 'not available due to maintenance', the family assumed money for maintenance at this major hospital was minimal.
Lack of resources for maintenance was not confined to the elevators. John was in hospital in the summer. During this period, Melbourne experienced a heat wave and John's bed was next to the windows. At first, the family thought he had the best position in the six-bed ward, but when the searing heat hit, they soon learnt otherwise. With the constant heat, the air conditioning in the ward proved inadequate, therefore, the temperature in the ward became most uncomfortable, a situation compounded by the fact that the venetian blinds on the window next to John's bed could not be closed. Upon complaining to the nurse in charge of the ward, the family learnt that the blind had been broken for some time but due to fiscal economies imposed upon the hospital only the most urgent maintenance could be undertaken. Repairing blinds so that they closed and served to help block out the heat was not considered urgent.
Likewise, the broken ice machine. John's daughter contacted the Director of Nursing and complained only to be told the ice machine could not be repaired at that time due to maintenance cutbacks. Fortunately, however, one of the nurses tipped off the daughter to the existence of an ice machine that did work and that was situated on the other side of the floor. For her, visitation now included the daily routine of raiding the ice machine and distributing ice water to all the patients in the ward. John and the other patients were too sick to engage in any discussion or argue about hospital accountability and patients' rights.
John's ward was on the eighth floor and like a number of other floors in the hospital, half of the wards were closed. Budget cutbacks and a lack of supply of nurses meant they could not be staffed. An existing shortage of staff was obvious from the work regime of the nurses. Compounding this problem was the hospital's reliance on contract and agency staff. One of the nurses caring for John explained to his family that having nurses unfamiliar with the basic work routines of the ward and the general layout of the hospital proved problematic. Agency staff often had to constantly seek assistance from the permanent nurses thus adding to the intensification of the latter's workload. That too much was expected of too few, did little to alleviate the poor morale among the staff.
Adding to this problem were the constant rumours of hospital closure, sell-offs, another restructure, broken equipment and inadequate maintenance. But morale is not something that can be costed, nor does it appear in the columns of accountants' ledgers. And getting the same work done with fewer people does appear to be efficient!
John began to steadily recover so it came as quite a blow when the family were informed that his wound had developed a staphylococcus infection. The doctor explained how staphylococcus can be found on people's hands, on equipment or furniture but that it is treatable by giving the patient strong antibiotics which in John's case would be administered intravenously. Knowing how rampant the staphylococcus germ is in hospitals, the family's sensitivity to cleanliness was heightened and their critical faculties became more astute. They noticed public toilet areas often ran out of toilet paper and paper used for hand towels sat in bins that overflowed. The spilt liquid in the elevators was carried into the wards on visitors' shoes. And then there were the visitors who in the heat did not bother wearing any shoes. Equipment such as wheelchairs, scales and walking frames lay round in corridors to be handled by whoever was passing. The family observed how busy staff often did not have time to wash their hands when running between patients. Issues of hygiene within the hospital began to be a matter of concern for John's family. All John knew, however, was that he had contracted the staphylococcus germ. Issues pertaining to what could be described as selective accountability, namely economic scrutiny being prioritised over any scrutiny of basic hygiene, did not interest him.
The antibiotics used to treat John's staphylococcus infection did not work. Again he had to return to theatre for another operation: this time to have his leg amputated above the knee. By now John had been in hospital for four weeks. He had lost interest in hospital meals, and each day the family would take food into the hospital in an attempt to coax him to eat. But it was a wasted effort. By week six John had stopped eating and was now being fed via a gastro-nasal tube. He no longer showed any interest in political events, news items nor his beloved football. After seven weeks in hospital, the family prepared themselves for the worst.
By now hospital visitation had become a harrowing experience. Constantly John complained about being uncomfortable and in distress he would demand, 'Shift me, turn me on my other side!' The family members did not like to move John for fear of aggravating his condition or dislodging an intravenous tube. But neither did they like to be too demanding of the nurses. After all, sometimes John wanted to be turned at intervals of three to five minutes. His wife and daughter had watched how two nurses would work together to turn a patient. On the count of three, they would turn John by pulling the blanket underneath him, and then they would pack pillows behind his back so as to give him support. John's wife and daughter began imitating the nurses and they felt quite proud of themselves the way they mastered turning John over on his side. On one occasion a nurse witnessed their efforts and suggested they apply for a job at the hospital. It was good to share a laugh and the daughter told the nurse, 'you taught us well.' But constantly turning John was hard on his elderly wife; after all she was 82 years old.
Because John had a bedsore on his back he was on an air bed. The motor which controlled the flow of air sat on the floor at the end of the bed. Due to the condition of this piece of equipment, the hose would sometimes come lose causing an interruption to the air flow which in turn would set off an alarm. When this first occurred the family were quite unnerved and immediately alerted the nurse on duty. Upon watching the staff fix the hose a couple of times, they no longer bothered to notify the nurse when the alarm went off. John's daughter mastered the problem herself. She would get down on her hands and knees and with all her strength reattach the hose as firmly as she could. On one visit she took in electrical tape in an attempt to make the connection more secure. For the family it was a relief to be able to fix the contraption themselves and not have to demand of the nurses once again. No doubt the hospital administrators would also be relieved the daughter did not charge a fee for service.
Although their hospital visits were now an exhausting experience equally draining were the long nights. The family would lie in bed worrying about who would fix the airbed when they were not there and who would turn John when he could not get comfortable.
John was treated as a private patient, a legacy of the Commonwealth government's changing funding arrangements for all World War 2 veterans who had served overseas. Knowing that all hospital expenses were met by the government was initially a source of comfort for the family, but as John's condition deteriorated, it became a matter of concern. After eight weeks in hospital it was obvious to all that John was going to die. The family was not keen to see his suffering prolonged and was now anxious for him to be moved to a palliative care hospice. The doctors were hesitant. Where the family had come to accept that death was a natural consequence of life, the doctors seemed to perceive death as a failure of medical treatment. Was it that they knew better, or was it that hospitals strapped for cash liked to hang on to patients with full private hospital cover? The family now became concerned that the doctors' judgement could be clouded by the need to meet budget bottom lines?
Exactly nine weeks after entering hospital, John died. Death is never easy and the family is aware that there are stages of grief through which each of us must pass. But it seems their grief is unnecessarily prolonged by the manner in which John died.
Constantly they ask themselves; how is it, that someone who fought for his country, who worked for the same employer for 38 years, who paid taxes all his working life, who remained married to the same woman for 58 years and who raised and educated four children, could be reduced to a mere statistic at the most vulnerable time of his life? And how often has John's story, and the perceptions experienced by his family, been repeated in hospitals around Australia?
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