THIS is a tale of three hospitals, including wonderful but underfunded Wonthaggi. It’s a story about the kindness of strangers, and a brief reflection on the roles of faith and science in society. I’m not normally given to pondering institutional faith, because I have my own moral compass and my own sources of spiritual sustenance. But there is nothing like a glimpse of the shadow of the valley of death to focus the mind on the numinous and the ephemeral. And there is nothing like experiencing three very different hospitals to make one wonder about the roles of faith, science and ideology in institutional cultures in general.
Several years ago, after an unusual and crippling bout of nausea, I was taken to the emergency department of a small hospital in Melbourne; let me call it Hospital A. Both the admitting doctor and the surgeon diagnosed appendicitis. Astonishingly, they offered no supporting evidence for their opinions – they did no tests at all, which is strange given that the medical profession is always presenting itself as a purveyor of “evidence-based medicine”, which it contrasts with “untested” vitamin-based and other “alternative” therapies. The accumulated clinical experience of my surgeon and his colleagues does constitute a body of evidence, but the scientific method requires that numerous, independent and precise replications of an experiment are needed before a result can be considered a fact. In particular, the existence of a single verified counter-example is enough to disprove a purported fact. How many counter-examples must already have existed to prove that appendicitis is not the only cause of nausea? I believe I can now add one more: I suffered the same nausea once again, sans appendix.
Of course, ruptured appendices can be fatal, so perhaps my doctors can be forgiven for their “caution” – although the haste with which they operated belies the word “caution”. But the surgeon went on to say that he did not think it necessary to give me antibiotics after surgery. I agreed that it is a good idea to pull back on over-prescribing antibiotics for every cough and sneeze, but surely not, I asked, in a hospital after an operation? His imperious, belittling reply stunned me, but I was feeling too poorly to pick myself up off the metaphorical floor and protest. Suffice to say that I did succumb to a mystery infection, after which the surgeon went into overdrive. He or his staff ordered dozens of blood tests, X-rays and CT scans, pumping me full of antibiotics and unnecessary radiation. The nursing staff did not help. With one or two very welcome exceptions, they acted as if I weren’t there, other than as a mechanism to be prodded and measured every six hours for two weeks.
I suppose that part of the reason for this kind of institutional hubris is the brilliant success of much modern medicine. But my treatment at Hospital A led me to wonder if a less obvious cause of this kind of negative culture lies in the particular difficulties inherent in making medicine a science. It is not an easy fit. Medicine wants to see itself as scientific and “evidence based”, which is as it should be. Yet science is supposed to be detached, “objective”, whereas medicine should involve the whole person – body, mind and heart. Clearly, the scientific philosophy behind medical science should not necessarily be the same as that underlying physics.
The uneasy fit goes even deeper than this, though. In the “exact” sciences – physics and chemistry – you can do experiments and deduce amazingly accurate, quantitative laws of cause and effect. But the human body is so incredibly complex that often this kind of “simple” science isn’t possible. For instance, discovering the causal link between germs, viruses and disease was a huge scientific breakthrough that continues to deliver spectacular life-saving results; discovering the cause of cancer or the secret to longevity, on the other hand, is not such an easy matter. Nor is discovering which interventions and diagnostic tools are more dangerous than helpful. There are simply too many factors at play in our awesomely complex bodies.
Historically, medical science turned to an extreme form of reductionism in the face of this overwhelming complexity. How many of us had our tonsils or appendices whipped out as a matter of course – and how many of us knew that our doctors actually had no idea of the function of these organs in the body? This kind of reductionism – focusing on one symptom and forgetting the whole body – has long tainted the medical profession, although practitioners are increasingly aware of the problem. Nevertheless, medical science needs a robust critique if we are to build positive medical cultures. But I can’t help wondering if another source of Hospital A’s particular negative institutional culture is its corporate nature. Its generic, impersonal “Values Statement” is simply a one-size-fits-all corporate document, in which patients are “clients” and nothing at all is mentioned about care and healing. Nothing would tell the casual reader that this is the mission statement of a hospital rather than a banking or industrial business.
On the other hand, the “core values” of Hospital B – another small Melbourne hospital – include Compassion: “Feeling with others in their discomfort or suffering, striving to understand the other’s experience and a willingness to reach out in solidarity.” When I was recently transferred to Hospital B from Wonthaggi’s excellent emergency department – where doctors had diagnosed (via proper tests!) that scar tissue from the earlier appendix operation and infection had impacted on my bowel, leading to a potentially fatal blockage – I did indeed experience this kind of compassion from the staff. Which was just as well for me: perhaps there is nothing that speaks to our common humanity, stripped of false dignity or scorn or pity, like a disorder of the bowel. Reduced overnight from the prime of life to utter helplessness, I was totally dependent upon the skill and kindness of strangers at Hospital B. Strangers with whom I felt a timeless connection, hour by hour, day by day, with one human being caring for another as if it were the most important thing in the world.
I would like to think that Hospital A is the exception (although I know from others’ stories that it is not), and that Hospital B’s culture simply showcases the best of humanity, as implied in the Australian Charter of Healthcare Rights. I’m sure there are humanitarian secular hospitals – and my brief experience in the emergency department suggests that Wonthaggi is one such example – but it is interesting that Hospital B is run by a Catholic organisation dedicated to carrying on Christ’s healing mission.
I am not normally a fan of the Catholic institution – think of the paedophilia cover-ups and the opposition to marriage equality. But Hospital B made me wonder if our secular institutions, including scientific ones, have made enough room for the numinous and the human. Hospital B wore its Catholicism lightly. Its chapel was a welcoming space for contemplation, with its altar dedicated to celebrating spring; a Message Stick celebrated Aboriginal spirituality, and a poster highlighted the fact that “do unto others as you would have them do unto you” is common to all faiths. Which also suggests that it is a common human response that need not be enshrined in any particular faith or dogma. Its expression can be as simple as the smile that you give a stranger in the street, or waiting to let others pass at a busy intersection – the kind of friendly interactions I experience every day in Wonthaggi.
There is a real community feeling in Wonthaggi, and I found this reflected in the caring, skilled staff at the third of my hospitals. Although it is a public hospital owned by Bass Coast Health, Wonthaggi Hospital’s values statement is similar to Hospital B’s: Well-being, Equity, Compassion, Accountability, Respect, and Excellence (the acronym is We Care.) Unfortunately, I was only there for a night, because our hospital does not maintain a full-time surgeon who would have been able to oversee my case, so I had to be transferred to Melbourne.
If only we could attract more funding, and entice good surgeons to live in our beautiful area! It seems – from a recent article in the Sentinel Times, and last year’s Bass Coast Post interview with BCH CEO Jan Childs – things will soon look up for Wonthaggi, and this is wonderful news. But I do hope that the institutional culture of a bigger, better hospital will continue to reflect and serve our community and our humanity.
My time in hospital reminded me how good it would be if all of us – especially those with the power to influence the cultures of institutions and professions – regularly pause to check on how we are doing ethically, and to choose to build a positive culture rather than a negative one.
Easier said than done, I know, given our busy lives. But life is short, and in hospital it is very easy to remember what really matters.