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Friday 23 March 2018

Why my diligent, caring surgeon is truly a saint

Nurses are considered 'angels' but a kind of inverse snobbery sees doctors treated unfairly, writes Emer O'Kelly

The Department of Health is a no-win situation for a minister serving a public demanding instant, luxurious in-hospital care no further than a mile from home, and immediate free medical care for every sniffle and scratch known to humanity.

It's a battle that can have no resolution: demand and expectation will always outstrip resources. Life is a battle and ultimately we lose it: we all die. The problem arises in the admittedly rare cases when the battle is unfairly lost, through error or inadequacy, or simply the unfairness of nature, creating irredeemable tragedy for those involved.

The current Minister for Health James Reilly, in Opposition laid the blame for every tragedy at the personal door of his predecessor Mary Harney. Now he's the recipient of the blame as the head of "the system".

In particular, Liam Doran of the Irish Nurses and Midwives Organisation has ceaselessly berated "the system" as though his members were outside it. He has successfully created a climate of public opinion where all nurses are considered angels of mercy with medical expertise to match that of any consultant, working slave labour hours for wages that would disgrace a Victorian miner. The nurses are now untouchable.

Such is not the case for the doctors, from GPs through to medical consultants and surgeons. Their representatives seem to feel a kind of embarrassment at defending their dedication and skill.

They are fair game; in fact, almost the only occasion in Mary Harney's career as Minister for Health that she met with unadulterated public approval was in her unsuccessful battle to subject medical consultants to seven-day rosters.

It seems to be a kind of inverse snobbery: nurses earn average wages (not slave wages, as is commonly believed, a staff nurse earns €44,000 per annum), and have fixed hours. They're what used to be called blue collar workers, part of the largest category of people in employment in the country.

Consultants earn the kind of money which makes the many years of study, apprenticeship and sacrifice finally seem worthwhile: many times the average industrial wage. It's also the reward, if we're frank, for their good fortune in having been born with the kind of brain (in the case of surgeons, hands) that excel in what we now know to be science, and what used to be considered black magic. Most of them work insane hours, contrary to the spitefully held belief that they do a lot of their work on a mobile phone from a golf course. As a result, they are to be envied and cut down to size.

So let's take just one surgical consultant, the man responsible for the current six-inch slit down my spine, and the array of pegs and wedges which have replaced some of my discs.

He has offered to give me a full breakdown of exactly what he and his team did on January 10 in the Mater Private Hospital. No thank you, dear Mr Ashley Poynton, henceforward known as SAP (Saint Ashley Poynton.)

I am already the proud owner of two tin hips, which work perfectly and also play symphonies when going through airport security.

And there have been many years of dedicated service from a wonderful physiotherapist, but despite several months (including an emergency three-day stay in hospital) of SAP trying to correct my inability to stand for longer than 90 seconds without collapsing, or walking for longer than five minutes without the same result, both accompanied by blinding, earth-shattering pain, he recommended a rather more invasive solution: spinal fusion. Waiting admission to the Mater at 6pm on Monday January 10, I got a tap on the shoulder. "Thought I'd find you here. Just to say your room's ready, and we'll talk in the morning". It was SAP; then he was gone. (We'd already talked several times, all without any sign of impatience or hurry on his part.)

I was told I was on "the early list". But I didn't see him until mid-morning. He had already been in theatre since 6.45am, and came to talk me through any questions I had. The next time I saw him was 7.20pm that evening. I was dopey and hooked up to various tubes, he was still in his theatre gown, barely out of surgery. He reassured me, told me everything had gone as planned, and he'd see me in the morning. He did. He was back at seven the next morning, asking what kind of night I'd had. My only worry at this stage, as it happened, was him: he'd looked exhausted the previous evening. SAP laughed, pointed to "your little box of morphine: keep using it". (I didn't need that much of it.)

I felt positively aggrieved that I didn't see him that evening. You can get spoiled. But next morning, there he was again: quite late. It was nearly eight when he appeared. I saw SAP every day I was in hospital, sometimes twice. One morning, he appeared just as I got back to the room after my statutory walk. He'd been tailing me along the corridor, he said cheerfully. I seemed to be doing well. The last time was Saturday morning. (Please note: the weekend which popular culture believes consultants hold to be sacrosanct to golf, sailing, or other leisure pursuits.) And it meant that I had a happy smile on my face, felt totally cared for, and knew I was "cured".

Nursing used to carry that purpose. Nowadays, nurses are qualified with third level degrees. They spend a lot of time sitting at desks dealing with clearly necessary paperwork, as I noticed when I started walking along the corridors. The helpful things that aren't actually duties, just kindnesses, are carried out by nursing aides: changing bed-linen, for instance.

Nurses no longer stick their heads around the door every hour or so with the comforting question, "Everything OK?"

You could ring the bell, I suppose: but if you've merely dropped your book, but you can't get out of bed, you put up with it. And 12 hours after orthopaedic surgery, with your mouth like the proverbial floor of the parrot's cage, and nobody has offered to bring you teeth-brushing equipment, you accept that it's routine to leave you until you can get out of bed ... unless you make a special request. And if you make a special request, you feel like a time-wasting heel. It's not the night-nurse's job to get you up and to settle and tidy the bed. Her job is pills and pulses, you gather.

But one night nurse refreshed and smoothed the bed, doubling my night's sleep. She said she was "old-style". And interestingly, her style seemed remarkably similar to the lofty eminence of consultant spinal surgeon Ashley Poynton who is not old-school at all: attention that wasn't strictly necessary, but made all the difference when I was feeling rather vulnerable and helpless.

And with the deepest respect to the members of the medical profession and their representative organisations who utter doomsday warnings (As did Dr Gerry Burke from the Limerick Regional Maternity Hospital last week about deaths because of the numbers of midwives taking early retirement to maximise already generous packages), it seems to me that it is how the job is done rather than the numbers doing it that can make all the difference.

Sunday Independent

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