Rural health care - or the mysterious tale of the spider bite

Last week I experienced what it's like to go to a GP in a rural town. A large red swelling had appeared on my right leg On New Year's Day. It was hot and had a hard centre. It was painful to walk and seemed to be growing larger by the hour. I tried a few remedies over the course of the day but when I awoke the next day to a bigger, redder, angrier swelling, I decided that I needed to see a doctor.

Firstly, I discovered that one must call in the morning to make an appointment for that day. It is not possible to book ahead. Therefore, making an appointment is like trying to win a competition on a radio station - you just have to keep hitting redial until you succeed in getting through. By the time we spoke to one of the receptionists, only late afternoon appointments were available. In the time taken to give my first name, the slot we thought we were booking for had been snapped up and I was in to see a different doctor at 3:45pm.

I arrived a few minutes early to complete paperwork. It was very hot, so I asked the receptionist where I could refill my water bottle.

She looked at me, puzzled.

"Where can I refill my water bottle?" I repeated.

"We don't do that here," came her mean reply.

"Wow. Really?" was the best that I could do.

I took a seat in the expansive waiting room. I took in the meagre pile of sticky magazines, children's toys spread all over the floor, the blaring television and the miserable looking people and imagined the difference a supply of cool water would make.

Before long a very large man came and sat right beside me. There were so many seats and available places to sit, but he sat right beside me and proceeded to sneeze and cough. I moved. I didn't want to leave the doctor sicker than when I went in!

I  was called in to see the doctor only ten minutes after my appointed time. He took me through and immediately took a past medical history. He didn't say hello and he didn't introduce himself. He asked a lot of questions about my past medical history that had nothing to do with my current problem. It was probably about ten minutes before he stopped typing on the computer, turned to face me and asked what my problem was today! I was appalled. (I know that all my work teaching doctors about empathy and communication probably makes me a tough audience, but really, this was sub-standard.)

I showed him my leg. The expression on his face changed (shock? distaste? fascination?) and he donned some gloves. He pressed and touched and then declared that I had been bitten by a spider. He asked me if I wanted some antibiotics to treat the secondary infection that had resulted and suggested that I take some antihistamines. I reminded him that I take antihistamines daily.

Seconds later I was out the door with a prescription for an antibiotic in my hand and a bill for $70.

By contrast, when I collected my prescription from the pharmacy, the pharmacist wanted to confirm that the tablets were for a skin infection. I showed her the bite. She nodded vigourously and said that she'd seen about five others just like this.

I've been sleeping with an icepack to take the heat out and the antibiotics have reduced the swelling and the red ring of poison. I now have a hard, dark, sore lump on my leg.

It's unlikely to be a Red Back Spider that bit me (I'd be really sick). The consensus is that it's probably a White Tail spider that feasted on me. Avoid this if you can!

Have you ever been bitten by a spider? What's the worst thing you've ever been bitten by? Did you bite it back?

Being a patient - for real this time.

This time last week I was recovering from general anaesthetic. Hence my absence from writing. Beforehand I was a little anxious and just didn't have the headspace to write.  Afterwards, I was recovering, sleeping and thinking and just needed space.

Thanks for bearing with me.  Thanks also for the love and support sent my way at this time.

While I'm very experienced in being a patient interacting with the health care system, I'm not usually sick. Everything feels completely different when you're confronting surgery. From the moment of walking in the front door of the hospital (if you're lucky enough to be able to walk in), doing paperwork and making payments, to following instructions and having observations taken, the power relationship shifts. Suddenly I went from being an independent woman who acts on my own behalf and decides whether or not to follow rules and obey instructions, to being completely passive and following all instructions without question or comment.

Luckily I had a solid and trusted person with me who helped me keep perspective and stop me from worrying myself into a puddle on the floor.

Waking from a general anaesthetic is surreal.  One minute you're listening to the friendly and soothing chat from the anaesthetist as whatever marvellous stuff he has given you starts to loosen your hold on consciousness; you're noticing a mask being placed over your face.  Next thing you're hearing your name, you're somewhere else and you're in pain.

Pain was attended to swiftly and with gentle concern. Even as I shook uncontrollably for what seemed like ages, I was aware of the care and attention I was receiving. When the shaking didn't stop, I started to become distressed and tears started to flow. It seemed like a biological reaction which I was observing from afar. Unpleasant. It took a long time to make it out of the first stage of recovery. I kept falling asleep and my oxygen saturation was low. An alarm kept sounding and I was being reminded to breathe. I would and the alarm would stop.

I was relieved to be moved to another area and see my friend arrive. God knows what we talked about. I can't really remember. I hope I wasn't rude and didn't reveal any secrets.  A different nurse took over. She  didn't introduce herself and I felt she was very matter of fact and not very empathetic. My friend said she was doing a fine job from his perspective and I should appreciate that. I did. I've spent so much time thinking about and teaching empathy to health care professionals that I really notice when it's not there.

We arrived home after 8pm and my friends changed shift. My friend who stayed the night had a quiet night of it. The next morning I thanked her for staying and apologised for there being no middle-of-the-night emergency. We both have an appreciation for drama and she said she was a little bit let down she hadn't been required to play the scene requiring her to drive me somewhere, in my car. The kicker is that it would have been her first driving practice in about 20 years.

We both understood that we were joking.

On Friday, I had a half day of simulated patient work. I was back in a hospital gown and lying on a trolley. While the case was very different from my own circumstances, I felt that my recent surgical experience was adding to my authenticity in the role. Several students checked to see whether I would be okay as they finished their exam station. (Now that's empathy!)

Monday, I was back in shapeless blue piece of material, hopefully (ironically?) referred to as a "gown" as I went to have an MRI on my knee. (This is the one I fell on back in August.) The procedure was straightforward and painless and required me to follow one simple instruction: lie perfectly still.  Suddenly, this was an impossible task. My right arm was at a funny angle. Could I move it? Only it? Surely if I just shifted it a little, it wouldn't move my right knee?  Would it? I can't breathe! Oh, yes I can, but am I moving too much when I breathe? Or maybe I'm not breathing enough? Is that why my left big toe is suddenly incredibly ITCHY? I've got pins and needles in my left hand! Just lie still! Just lie still! Only 17 more minutes to go. I hear the machine go quiet. The technician reads my mind and just as I think I can move, her voice instructs me through the headphones to "keep lying still...only five more minutes to go...you're doing really well!" Look how much my chest moves when I breathe! How deeply can I breathe without moving my whole body? Wow, suddenly I'm aware of my earlobes...

And so it went for the whole 20 minutes.

I was told I'd been very still and given a well done as I carried my basket of clothes back to a cubicle to extricate myself from what I hope will be the last gown I'll wear for real for a while.

Quitting sugar - FAQ

Yesterday's post about the impact of a year without sugar raised some questions amongst readers.  I'm happy to answer them all.

Lots of people wanted to know about the affect, apart from the lab results.  I've dropped a dress size.  I don't have cravings. My appetite is more stable. I eat less. My skin is clear.

I've really noticed the 3pm sugar run that people in the office have. There's a line to the biscuit tin, the chocolate box and the lolly jar. It's so great to be free from that kind of slavery.

The other question I received was about whether I eat fruit. The answer is: "rarely". I now eat fruit when I'm at an event and the only other food on offer is sugar laden cakes and biscuits. I will also choose the fruit carefully and pick high fibre or berries, ie avoid watermelon and dates and choose the pineapple, pear (skin on) or banana. I never have juice. Juicing the fruit turns it into almost pure fructose when the the fibre is removed. I also avoid dried fruit because the fructose becomes concentrated.

Some of you also wanted to know about my porridge. Breakfast was actually the meal that I had to change the most.  I used to be a yoghurt, fruit and muesli girl. That had to go. I discovered Vita Brits, just with milk. As my palate adjusted I discovered a natural sweetness in many foods that I would not have previously identified as being sweet. Porridge is my new favourite breakfast during the week. Oats are also recommended for lowering cholesterol. I buy rolled spelt and mix it with rolled oats, cook it on the stove top with some added chia seeds and then serve with milk and a sprinkle of seeds and cinnamon. You can sprinkle the chia seeds on top instead of cooking them in if you prefer. This is a long way from brown sugar and maple syrup that I used to love.

If the supermarket has other rolled grains available I buy them and mix them in too.  I cook two thirds of a cup of grains with twice the amount of water and find the stirring at the stove with my myrtle spurtle a quiet moment of morning meditation. This keeps me going until lunchtime. Ground cinnamon is an easy ingredient to sprinkle over if you need a little sweetening. With time, I've discovered that there is a natural sweetness in the oats and it's not needed. I haven't gone down the Scottish path of adding salt.

Anything else you'd like to know? Just ask me.  Thanks for your interest.

Quitting sugar - it paid off!

It's been almost a year since I quit sugar.  I did it at the suggestion of my doctor when my blood results showed an elevation in liver enzymes and cholesterol going in the wrong direction.  That day, I read Sarah Wilson's I Quit Sugar and I started immediately.  I viewed food with sugar as not being food.

So today, I want to tell you a good news story.  I received my latest blood results today and I can tell you that I've never been so excited.

Those liver enzyme markers were back to normal.  All the cholesterol and fat markers are back where they should be. Everything is looking great!

Here's the interesting thing - all I have done is cut out sugar (fructose).  I eat a balanced diet but you should know: I eat cheese; I use butter; I eat red meat, sometimes with the fat on. I eat the skin on chicken. I do not eat fructose. I also eat multi grain porridge (oats, spelt, barley etc) sprinkled with chia seeds.

This is what all the books say will happen.  The science around fructose is that the body processes it into fat through the liver and causes issues with cholesterol, appetite regulation and so on.

I was a bit nervous as I waited for my doctor to explain the results.  I really hoped that the early struggle and now my mindset had paid off with positive health results.  It did!

What's your view on sugar? When my doctor asked me that a year ago my answer was, "I love it!"

My favourite things - this week

1. You may remember meeting Rose Wintergreen right here on divacultura.  Rose crowd-funded her album and I was very happy, willing and privileged to be able to contribute.  My favourite moment of week was reading about the release of her single, Feet in the Sand. You can read more and listen over on her blog.  What do you think?  I LOVE it!  If you like it too, pass it on!

2. This morning I set aside time to write a first draft of a book chapter that I'm collaborating with several other people on.  I'd had a few false starts in actually putting words down, but the ideas had been whirling around in my head for a while. I knew it was just a case of having a block of time and no distractions.  I put Bach's cello suites played by Yo-Yo Ma on the stereo and pretty soon I had exceeded the word requirement. I know that it's a first draft and now the task of editing and blending with my collaborators has to occur, but it is always thrilling to see ideas come to life on the screen/page. There's the additional excitement of discovering new insights as fresh connections are made.

3. I managed to get tickets for Sunday's AFL final match between my team, Richmond, and Carlton. Technically my friend got the tickets and they came with the news that we would need to hire a sherpa, take oxygen and leave now to get to our seats at the Melbourne Cricket Ground in time to watch the match.  I don't care!  I'm so excited.  Richmond hasn't played in the finals since 2001 and I've never been to a finals match at the MCG.  I figure you just have to do it!  As a consequence of actually going to the footy, I have had to put a hold on my lack of love for the colour yellow.  Richmond's colours are yellow and black and I just can't go without sporting my team colours.  I managed to snag the last ball of yarn in the perfect shade of yellow and figure I can knit a yellow and black beanie in time for Sunday's match.

4. My physio's declaration that it is possible for my knee to fully recover was definitely a good moment..  This made me very happy after struggling to zip my boots this morning.  (The angles were all wrong.)  Apparently my PCL (posterior cruciate ligament) has been stretched so far that it hasn't sprung back.  It's like an elastic band that has stretched too far.  Despite this, my physio is confident that with exercise and treatment it will regain its elasticity.  (My physio contributed another favourite moment when we were discussing the soreness in my left arm which had probably resulted from the fall that injured my knee.  The muscle I've hurt is called the "supraspinatus".  I heard her tell me I'd hurt my "super bananas". I felt lucky.  Imagine if it was my ordinary bananas!)

5.Waiting on platform 9 at Flinders Street Station today, I watched people on platform 10 running for the train.  Human beings move in some mysterious way:. the squat woman, struggling with several bags, her body engaged in multi-directional undulation; the neat Asian man wearing a backpack shuffling, Cliff Young style - not very fast but certainly tidy;  the confidence of the long-legged lunge of a besuited, bespectacled, bebearded man;  the weirdly stiff-legged gait of the man in too-skinny jeans; the small pointless steps of the woman in stilettos running for her life to catch that train; the hopeful striving of the wannabe medalist, slowing and slumping as hope fades that he can make it before the doors shut.

What was your favourite thing this week?

Wild imaginings.

My imagination has been out to play lately.  I think that the physical constraints I'm under as I recover from my knee injury are resulting in my mind saying "yippee!".

As I've been nursing my injury and waiting to discover how serious it is and what my recovery will be like, I've had all kinds of thoughts.  As I struggled with pain and lack of mobility, I started to see myself as instantly decrepit.  Before my very eyes, my shoulders hunched, my ankles thickened and I lost inches from my height.  All colour disappeared from my wardrobe.  And from my hair.  All heels disappeared from my shoes.  Hair appeared on my chin.  Nooooooo! I railed against this.  No instant ageing for me!

My thoughts were interrupted by a phone call.  It was from a blocked number.  I answered anyway.

"Hello."

"Oh hello darling.  How are you?" a fruity male voice said.

I thought this was an unlikely greeting from the bank.  If my phone doesn't tell me who is calling I have no idea who it is.

I scrolled through my mental list of blokes who would ring me and call me darling.

"Um....hi?"

"It's John!"

"Ohhhhhhh.  Hellooooo."


During my appointment with the physiotherapist the other day, we were accompanied by incessant hammering on the floor above the treatment room.  The Novotel Hotel is up there.  We wondered what could be going on.  Here's my list:

1. It's a carpentry convention and there are regular and rigorous demonstrations of hammering - perhaps a new hammer is on show.

2. It's the honeymoon suite in the hotel and they are reattaching the bedhead.

3. There's actually nothing up there and now they are building a hotel.

4.  It's not hammering at all, but an Irish dancing, clogging or tap dancing gathering and they are practising.

5. It's a training session for the International Synchronised Hammering Championship.

6. It's a physiotherapy clinic for people with wooden legs.

7.  It's an avant garde percussion group rehearsing their original composition, "Hammered".

8. It's an avant garde performance art piece and our reactions to the incessant banging are being filmed as part of a projection festival to be shown in Iceland.

9.  Santa's Workshop has gone global.

10.  There's a cockroach infestation and the only eradication method available is manual!

The road to recovery

The knee injury is healing slowly.  There's only pain if I try to bend too far, twist or roll over in bed.  Putting a shoe on my right foot is becoming less of a production too.  It will be one week since I fell over and I'm at about 85% capacity.

Every night as I watch the television news I look at the footballers and the injuries they sustain and wonder how on earth they can go back on and play with torn and broken bits.  Firstly I do know that I do not have the same level of fitness as an elite athlete so my recovery will take longer, but even considering that, bodies work in generally the same way.

My issue with walking properly is not really pain, but a lack of ability to fully bend and extend my leg.  As the physio said yesterday, it's like a rusty hinge which has to be worked and worked and worked until the rust is gone and the hinge moves freely.  As a result of my altered gait, I now have a sore lower back and hip on the other side.  It's actually more painful than the knee.

Physiotherapists are miracle workers.  I always approach them with trepidation.  I know that they are probably going to cause me pain but that I will be much improved the next day.  It must be a hard job to do where you know that you will be causing someone pain but that it needs to happen if they are to feel better.

I've recently discovered the television program "Embarrassing Bodies".  After previously writing it off as voyeurism I stumbled upon it a couple of weeks ago and found it to be informative and interesting.  Last night one of the segments featured a baby girl born with talipes (club foot).  The baby was being treated with plasters and boots to straighten the foot.  In between plasters, which were applied weekly, a physiotherapist worked on her tiny foot.  The physiotherapist looked gentle and kind and seemed to be handling the baby's foot carefully.  The baby was screaming and the mother was crying.  The physio continued her work and then reassured the mother that she wasn't hurting the baby and explained exactly what she was doing.  It turned out that the baby was hungry, but it was intense watching this scene and I wondered at the focus and commitment to healing that a physiotherapist needs to have in order to help their patient.

Yesterday's visit was my first encounter with this particular physiotherapist.  From my point of view, the first visit is all about trust and rapport.  Am I confident that they'll work with me?  Do I trust that they won't hurt me?  Are they listening to me?  I'm happy to say that the answer to all of these questions was "yes".

The rusty hinge is squeaking away and the initial treatment made a world of difference.  I'm heading back tomorrow and expect that I'll be nearly right as long as I keep up my exercises and take  my own share of responsibility.   Perhaps this is the key to athletes' recovery - physiotherapists and doctors on tap from the moment of injury.  I hope it's that and not "performance enhancing" drugs.

My performance in the Global Corporate Challenge has taken a severe hit too. My daily average steps has now slipped below 9000 steps per day and I'm annoyed that I can't be active.  It's been interesting to notice the steady increase in daily activity as the days since injury.  I was barely reaching 1000 steps per day over the weekend and yesterday almost made 6000.  Can't wait to crack 10000 again.  No performance enhancing drugs for me!

How are you going?

Spectacular trip and I'm off to hospital

Regular interaction with the health system is a feature of my working life, but usually I'm a simulated patient, rather than a real one.  Today I experienced the emergency department of one of Melbourne's main hospitals from the perspective of a real patient.

Following my usual routine, I had enjoyed the walk from Flinders Street station to the office South Melbourne.  There's something refreshing about a brisk walk in the cold air.  I arrived at the office just after 9am and entered the foyer.  I took one step, felt my left ankle slip, I corrected and over-balanced the other way, landing on my right knee as I went for a spectacular slide on the ground.  I lay on my face for a moment (elegant!), gathered myself together and sat up.  Several people walked past and then a woman stopped to help me up and ask if I was okay.  It was then a few steps into the office.  I sat in reception, burst into tears and announced that I had just had a fall.  

An icepack was brought immediately and a team of people sprang into action.  I had been able to walk, but bending the knee was causing a nasty twinge at the back/side.  I peeled back my leggings and discovered a nasty bruise and some swelling.  We quickly decided that I should head to an emergency department for xrays and assessment.

I arrived with a work colleague at 10:10am and could immediately see that it was busy.  My colleague joined the queue for me while I sat and waited for the three people ahead of her to be seen by the triage nurse.  She was lovely but had an unusual definition of pace and urgency.  I was thankful that I had someone with me and that I wasn't really, really sick or injured.  Several people in the queue looked terrible and there was no one to go to for help except the slow moving triage nurse.  

After about 30 minutes I made the front of the queue.  I gave my name, date of birth, address and gave a description of what had happened and a rating for the pain.  I was directed to take a seat and wait to be called by the administration clerk.  After a further fifteen minutes, I was seated in front of the administration clerk and asked exactly the same questions again as well as details of my Medicare card and employer.  These two people were sitting a metre from each other and using computers, so it seems incredible that my information hadn't been passed on.  Several times when I was trying to respond to questions, the administration clerk turned to talk to other people or answer the phone.  

Soon a very friendly physiotherapist came to see me.  She did a quick examination and then took me for an xray which was done quickly and I was back on a bed.  It was good news: nothing broken or torn, but some local bruising, likely deep bone bruising and soreness.  I discovered that one part of my knee is very sore to touch normally.  I nearly jumped out of my skin when she pressed somewhere that I hadn't realised was sore.  When she checked the other knee in the same spot I had the same reaction.  Apparently I just have sensitive knees.

Two hours and ten minutes later I was in a taxi on my way home, wearing a sexy compression bandage with a list of instructions for regular application of an ice pack.  

When I came back to the waiting area, there were more people and people who had been there before me were still waiting.  None of them looked happy or comfortable.  All the seats are upright and there wasn't even any way that I could sit with my leg elevated while I was waiting.  

I put my brother down as next of kin and called him to tell him what was going on.  He's a veterinarian and immediately performed a lameness exam over the phone and promptly ordered a full body cast while laughing maniacally.  I started to reconsider my decision to have him as next of kin.  After I had been seen and was waiting for the paperwork to take with me I called him again.  He obviously still thought the whole thing was hilarious and asked me what  he should say if he got a call that said I was unconscious and they needed to know whether or not to amputate.  My response was "wake me up and ask me!"

My final instructions to him were that he wasn't to plug me in or unplug me.  Nothing like a sympathetic little brother to lighten the mood.

A weekend of lying in bed reading or lying on the couch watching TV with hourly trips to the freezer to retrieve the icepack stretches before me.  And I don't have to feel guilty!  I'm pleased that I haven't sustained a serious injury  and can't imagine how much pain I'd be in if I had!

Oh that's right, I quit sugar.

It's been a while since I quit sugar.  The days of withdrawal are long ago and now sugar laden substances don't even seem like food to me.  This is the best place to be.

Last week I had a facial.  I used to go once a month and then my financial circumstances changed and I couldn't afford them as often.  Now I can, but I'm time poor.  All of that means I hadn't seen my regular beautician since March.

She commented on how settled and clear my skin is looking.  The usual problems I have with congestion (I've never recovered from living in northern humid lands) were much reduced.  My skin wasn't as reactive and sensitive as it had been.  She asked me what I had changed.

I couldn't think of anything.  I shrugged.  She continued to exclaim about how amazing it was.  Then she asked me if I was still off sugar.

"Oh yes," I replied.

"Well that must be it," she replied.

"Oh yes, I suppose that's right.  It's so long ago and so much part of my life now, that I forget that I've given up sugar."

She continued with the usual reactions about how hard it must be and it sounds like a good thing to do, but that she would never be able to do it.

I rested back on the pillow and relaxed.

This was a great moment of recognition and a reminder that the hard work and struggles of withdrawing from an addictive substance were worth the pain.

The other thing I've noticed is how much my palate has changed.  I should disclose that I recently shared a macaroon with a friend.  I didn't enjoy it and felt sick afterwards.  Won't be going back any time soon.  In the meantime, I now eat my porridge with milk and a sprinkle of chia seeds or a seed and nut mix.  I make my porridge from a mixture of rolled oats and spelt and find they are naturally sweet.  If you had told me this back in the days of brown sugar sprinkled on (or maple syrup on special occasions) I would have had you committed.

I told colleagues that porridge is naturally sweet and I had to run away.

This is a lifestyle change that was relatively straightforward to implement and is paying dividends in lots of ways.  Now I'm off to feed my television and knitting addiction!

What choices have you made lately to improve your health?  What's the hardest thing you've ever given up?  How did you make it stick?

Hanging out at hospital

Lately I've been hanging out in hospitals, walking past hospitals and thinking about hospitals.  I'm fine, by the way.  I've been working as a simulated patient, managing a mental health simulation project and often grabbing a coffee and sandwich in the cafeteria.

Walking through the ground floor of the busy Alfred Hospital in Melbourne I'm struck by being amongst the walking wounded.  There are people on crutches, arms are in slings, people have tubes in their nostrils, they trail drip stands.  Walking outside, there is usually an array of people assembled out on the footpath smoking.  Today I saw a woman sitting at the tram stop wearing a pink dressing gown.  She had a tube going into her nose and she had to move the tube out of the way so she could put her cigarette in her mouth!  With the weather becoming cooler as we approach winter, I was surprised to see a man standing in bare feet, wearing nothing but a hospital gown out on the footpath getting his fix.

The other thing that is noticeable is the incredibly detailed conversations people have on their mobile phones in lifts and hallways.  Today I travelled six floors with a woman who was describing her potential liver failure and the fact that the doctor is recommending extreme changes to her diet to avoid the need for diabetes medication and that all of this needs to happen before surgery could be considered.  Her tone suggested that she could have been booking a carpet cleaner or organising her car for a service.  I looked at her again - she did seem to be a funny colour.

Having spent the day working with paramedics (being a simulated patient and giving feedback on their communication) I then visited the Medicare office to lodge my claim for some recent medical expenses.  The place was packed!  I had to squeeze into a space between two people who looked like they had been there for a while.  After five minutes the voice of the automated queue lulled us into calm - "A123 go to counter 4".  I had A 138 so it would be a while.  Twenty minutes to be exact.  There were ten counter bays and there were staff at three of them to begin with.  After a while, closed signs went up at two of the bays and the voice of the automated queue fell silent for ten minutes.  Then two people came back and things started moving again.

An older man expressed a lack of patience for waiting.  Two people with exotic accents asked when is a quiet time to come back and how long would they have to wait.  Someone was told it would be four weeks before they would receive their Medicare card.  A good looking man wearing a jumper with the logo for King Kong the musical came in - one of the dancers claiming for a work related injury?  Largely people sat in silence and played with their phones.

A138 was called to counter number 4 and within 90 seconds my claim had been lodged and I was being advised that the money would be in my bank account tomorrow.  Surely there's a way that could be lodged online?

This week is a week of health care education: today was the paramedics, tomorrow is mental health, Thursday I'll be trained in the role I'll be playing i upcoming medical exams and on Friday I'll be at the College of Surgeons working with healthcare educators who are learning about working with simulation as a teaching tool.

In the meantime, if you want to watch people and contemplate the frailty of human existence, the hospital cafeteria or hospital footpath are rich with examples.

How's your week looking?

Ouch! When the "care" is missing from healthcare

This year I've been focussing on communication and empathy in health care.  Working with undergraduate students in a range of health care professions, I was heartened and optimistic about their views towards patients/clients and thrilled that they seemed to want to work with patients and their families in an empathetic way.  It was hard to reconcile their attitudes with the studies done by Monash University that show empathy declines during the course of study and falls off a cliff in the first year of work in most health professions.

This week, I've been face to face with the health system in New South Wales and I am completely disheartened and appalled.

My Dad required emergency treatment for a potentially life threatening condition.  He lives in rural NSW near a large regional city and another smaller country town.  He was admitted to hospital in the large regional city, but required a surgical procedure which could only be done at the nearest "tertiary hospital" which is the John Hunter Hospital in Newcastle.  After four days he was transported by air ambulance to Newcastle.  He was treated yesterday and seems to be on the road to recovery.

He's also on the road to nowhere.

We needed to get him back home after his treatment, about four hours or so away by road.  All family members who live nearby are unable to drive and the rest of us live in different states at opposite ends of the country.  We would need assistance to get him home, but were being told by the Doctor he could not travel by bus or train and then by a very cranky nurse that the Doctor didn't know what she was talking about and that of course he'd be fine to travel on the train.  Who should I listen to - the cardiologist or the nurse?

I swung into action, calling my contacts in ambulance and health to find out how to solve this problem.  All the advice I was receiving was that he should be transported home in the non-emergency patient transport provided by the ambulance service.  As a paid up member of the ambulance there would be no cost to him and there would be no cost to the hospital, but a Doctor needed to authorise the booking.

Hospitals are impenetrable.  They are lumbering institutions that require insider knowledge to get what you need and find who you need.  I took a deep breath and called the one number listed on the website.  I was put through to information.  Information put me through to a lovely Doctor who was in the intensive care unit and had not met Dad and knew nothing about his case.  Dad wasn't in the ICU.  I explained the situation to the Doctor and he agreed that suitable transport should be arranged.

No one called me back, so I called again and was put through to the Registered Nurse on Dad's ward. This nurse had the tone and attitude of someone who has forgotten what their job is all about.  She spoke to me like a naughty child, talked over the top of me, was impatient when I asked her to listen to me and dismissive of my concerns for my father.  She said she would talk to the social worker and hung up the phone while I was in the middle of explaining the family situation, including the fact that Dad had no clothes with him, only his pyjamas.

After 20 minutes, I called again.  I asked her why she had hung up on me.  Her response was that she told me she was going to speak to the social worker and she already knew what I was going to say.  Again, her tone was horrible.  I told her that I wanted to have a conversation with someone about my father's situation to get a better resolution than putting him on the train to a town he doesn't live in.  She then argued the point with me about where my father's home is, interrupting me again to confirm with my father where he lives.  As if I don't know where my father resides! I asked her to change her tone and speak to me with some respect and empathy for the situation and she told me that wasn't possible.  Apparently I had offended her when I said she was wrong about where Dad lives.  I asked to speak to someone who was interested in helping us, she said that wasn't possible either.

She then proceeded to shrilly tell me that I shouldn't be concerned.  He'd had his procedure and lots of people have the same procedure and he's fine! What's the big deal?  She said - in the most condescending tone possible - that Dad was sick when he came in and that's why he needed an ambulance.  The hospital had made him better, so he wasn't sick anymore and now he just had to go home.

Here was a blinding lack of empathy for me to confront.  I heard myself echoing something I said in the empathy workshops I facilitated during the year:  "This might be routine for you, but this is the most serious health concern my father has ever had.  It's the first time we've dealt with something like this and it is not routine for us.  I'm a long way away and trying to be supportive and organise everything on the phone from Melbourne, I need your help!"

She then advised me that normally the family would collect a patient.  Just what I needed - judgement.  I'd had no impact at all.  She had become institutionalised and part of a system that obviously sees the people who are meant to be served as an annoying inconvenience.

I asked to speak to the social worker.  "That's not possible," came the reply.

"Why not?"

"She's gone home for the day."

"What's the social worker's name?"

"I can't tell you."

"Why not?"

"I don't know her name."

"How many social workers are there?"

"One."

"And you don't know her name."

"No."

"Not even her first name?"

"No."

If this nurse had been empathetic to our situation she would have just told me that the social worker had gone home for the day and that she wasn't sure of her name but would leave a message for her to call me in the morning.  It didn't need to be that hard.

Even when I explicitly said I wasn't looking for a fight, she expressed frustration that she had become the meat in the sandwich.

"Why? What's the sandwich? Aren't we all working for the same thing?"

"What do you mean?"

"To look after my Dad and make sure he travels home safely."

She had no answer.  She was clearly viewing us as a battle to be fought and won.

It appears that the clinical care has been great.  Hopefully the procedure will make a big difference to Dad's health and well being.  Clinical care is not the whole picture though and I'm surprised at just how lacking the broader care has been.  In regional Australia, in this hospital, it must be common for people to be admitted to a hospital far from home and need to get back to where they came from after they've been treated.  I hate to think of all the other people facing the same dilemmas.  To be a patient subject to the a nurse who is a bully is a significant power imbalance - all at the time when you're trying to recover from surgery.  How can you advocate for yourself in this situation?

I've been researching about the hospital.  Like most big organisations these days they have a statement of rights and responsibilities for patients, including values.  Sadly, there is a big gap between the big statements of values and the lived reality for one patient and his family.

I really hope the awareness of the need for an empathetic approach to care will make a difference in the future.

Now, I'm off to research the complaints process.

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You might like to read this earlier post about empathy.

I'm all heart - and it's beating!

On Friday I was hooked up to an ECG machine and being attended to by several paramedics.  It was an interesting day and there was nothing at all wrong with my heart.

I was playing a role and providing feedback about communication* to postgraduate paramedic students. The character I was playing was complaining of tightness in the chest, but didn't know the paramedics had been called.  It took a lot of convincing before I would let the paramedics attend to me.  Apparently this does happen.

This resistance was the hardest part of the role.  If I really had something wrong with my heart, you wouldn't need to convince me to do something about it.

During the first scenario with the first student, I had this sudden worry as he was taking my blood pressure and pulse - I hope he doesn't find anything wrong!  I may have been playing the role of someone else, but it was MY pulse, blood pressure and heart he was assessing!

I waited, a little nervously, for the results.

The last time I had my blood pressure taken it was a little on the high side and my doctor sent me for some investigations to rule out things like kidney problems before seeing if adjustments to lifestyle**could bring it down.  My blood pressure was very good.  (The bottom number was 70, last time it was 85.)  I was amazed and pleased.  Within the scenario when my blood pressure was being taken, I was highly agitated and very stressed, but this didn't show up in my blood pressure.  Yet another of the mysteries of acting.

Being hooked up to an ECG machine is a little freaky.  It's a fairly intimidating piece of equipment.  Suddenly you can see your heart rhythms and hear your heartbeat.  I was curious to know what all the different sensors were measuring, but didn't have the opportunity to find out.  The main thing is that my heart is great!  I thought my mini health checks were a great perk for this job.

Coming at the end of a week where I've been running workshops on empathy for undergraduate paramedic students (and other health care disciplines) it was really interesting to be in these encounters.  I've learned so much about paramedics.  As I approach another week of empathy workshops, having the context of my (fictional) encounters on Friday will surely enrich my facilitation.

DID YOU KNOW the machine which measures blood pressure is called a sphygmomanometer.  Try saying that five times, fast!

*The main communication issues came down to really simple things and are useful for everyone in all settings:
1. Use the name of the person you're talking to.  Many people ask for a name and then fail to use it.  Using a person's name creates intimacy and connection within the conversation, whatever its purpose or situation.
2. Don't use jargon.  It is alienating.  Listen for the words the other person uses and reflect their language.
3. Think about where you are positioned in relation to the person you're talking to. You can change the dynamics of the conversation by changing your "level" eg standing, sitting, stepping back.
4. Focus on the needs of the other person.  If someone is resisting doing what you need them to do, find out what matters to them and think about how doing what you need will actually help them meet their own needs.

** The main lifestyle factor that's different is actually my work.  I'm self employed now and while there are stresses, I feel that I'm living in a way that is more true to who I am.  I think this is the single biggest thing that has helped with my blood pressure.  (No medication required.)

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There's still time to win a 2-for-1 pass to see The Sapphires.  Entries close today, Sunday 19 August.  There are still a few left!  Details on how to enter are here.

Political healing

The nightly news is full of proclamations of commitment to healing.  A couple of days ago, it was a very different story.  Healing was the last thing on anyone's mind as the knives were sharpened and wielded publicly as the ALP brawled over who should (or should not) lead the party and therefore the country.

It's good to hear it being considered.  Healing in the aftermath of conflict is something often overlooked.  When I am asked to mediate a dispute, the focus is on resolving the conflict and little attention is paid to what happens next.  Resolving the conflict is certainly important, but it's not the end of the story.  Especially in the context of workplace conflict.

When hostility is openly directed towards others, the instinct is often to fight back.  If this dynamic is left alone for too long it is that much harder to have a healthy relationship once the conflict is resolved.  It's even more difficult when the hostility has been hidden, rather than in the open and questions of bullying arise.

Most people probably don't expect too much of politicians.  I think this is a shame.  Public service through the holding of public office should be a noble thing to be respected and rewarded.  But when the media is telling nothing but a story of jealousy, disloyalty, thwarted ambition, midnight coups and stealth campaigns to undermine leaders, it's hard to cast our leaders in a positive light. These plots are what Shakespeare wrote about in his enduring stories.

The stories of conflict are compelling.  They are hard to turn away from, holding a grim fascination.  I will admit to being drawn in despite feeling shame at the behaviour of those I worked so hard to get elected in 2007.  As the conflict is over (for now?) the story is less compelling.  Watching people make friends again and talk off a script about healing has no drama.  I work with people to resolve conflict, so normally I find this stuff really interesting.  I wonder why?

If the healing had been concentrated on in a serious way perhaps the so-called midnight coup that saw Kevin Rudd ousted as Prime Minister may have been avoided.  We all know that it went ahead.  If the healing had been concentrated on in a serious way after that unprecedented action, perhaps the we wouldn't have a hung parliament now.  If the healing had been concentrated on in a serious way...and so it goes.

At other times I become more ruthless and think the biggest mistake in any coup is leaving a warm body, with a beating heart which can be resurrected later.  By then that heart won't only be beating, it will be filled with vengeful thoughts, if not hatred.

The ends were left loose, unexplained.  There was pain and ego.  The vanquished Kevin Rudd was always going to fight to get his crown back.  Even when it was clear he couldn't win, he went ahead anyway, completing the ritual of political death.

Perhaps the act of bringing the leadership speculation to a head using the formal mechanisms within the ALP has also been part of the healing process.  It may have been the necessary thing to close that chapter and get on with the next.

Healing can be painful.  Think of what it takes to heal an injury - I tore my gastrocnemius (the big muscle in the calf) a few years ago.  The injury was swift and the pain over in a second.  The healing took weeks of intense focus and painful visits to the physiotherapists.  And I still need to be aware that I have a weakness in that leg and be careful.

Same with healing after conflict.  I wonder if they're equipped?