I am still in the private sector, still learning about the realities and vagaries of this system. In my last column I said I thought this area was not for me. But perhaps I judged too soon.
It’s not all cruciate ligaments and liposuction. Some of the operations carried out here are world class. Some of the medical staff are enormously talented. Some give back, regularly.
It is not the individuals but the private system as a whole – relentless in its drive for profit, blind to the concept of social responsibility and dismissive of the ethics underpinning the Hippocratic oath – that is unable to give back.
The admission forms in the private hospital sometimes say “self pay”. More often than not, these are elderly patients without medical insurance. Their conditions are so grave, unsightly or painful, they cannot afford to wait on the public list. But they cannot afford to pay for their private procedure either.
Post-surgery, they no longer have the financial cushion that should be part and parcel of retirement
A woman in her 70s, whose single hip replacement cost in excess of €11,000, is initially delighted to be able to get around again. But soon, as retirement plans fade, a harsh reality dawns.
These patients leave the private hospital and enter a world of worry. Yes, they have homes, cars, State and sometimes private pensions. But, post-surgery, they no longer have the financial cushion that should be part and parcel of retirement, for waged and unwaged. These elderly people feel powerless, voiceless and frightened.
These are the stories you hear as a nurse.
Of families clubbing together to pay for an operation so a loved one can avoid waiting for years.
Of master’s degrees and PhDs discontinued.
Of mothers and fathers forgoing trips to see a son or daughter getting married in Australia.
Of sacrifices being made because of a system so blind and inefficient that it no longer cares to learn to adapt. Unless it is forced to, at the behest of a powerful vested interest (a Minister or influential public servant).
Turning a blind eye
When powerful people demand changes to the system, it usually happens, but usually has no lasting impact on waiting lists.
When patients, patients’ organisations or nurses demand change, or when they highlight inequality, the system turns a blind eye.
But nurses know the human reality. Which is as close to the truth, and the whole truth, as is necessary to obtain. I don’t need to know the wages bill for radiography or the indemnity insurance bill. As a caring professional, I need to know if my patients are going to be able to live a decent life after they leave.
Not everyone has a family. I watch older, retired people waiting for visits that don't materialise
Or maybe I am being naive? Should I, like the HSE, limit my care to the point at which the patient exits the building? I have heard it referred to as “the horizon policy” – once they’re over the horizon they are someone else’s problem: the local GP’s problem, the public health nurse’s problem and, ultimately, the family’s problem.
And not everyone has a family. I watch older, retired people waiting for visits that don’t materialise. Sometimes it is because families live too far from the city. I see the lockers without cards or chocolates. For some patients, the chaplain is the only one to come calling.
Families break down all the time, as do marriages and relationships. Hospitals aren’t able to capture that reality.
Patients need visitors
What do I want? I want everyone to have visitors, and I believe it is the duty of hospitals – private and public – to assist in that endeavour. Visits cheer people up. Patients recover faster.
I want our elderly citizens to be able to get a new hip, or have cataracts removed, without having to beg, steal or borrow. I want retired people, and pensioners who don’t have medical cover, to be recognised as a special category. If they have to take out credit union or bank loans for late-in-life operations, I think there should be a Government intervention.
I want to be able to look around the workplace and be proud
I want my parents, and my partner’s parents, and their entire generation, to be able to relax a little every time they get sick. Their fear of being admitted to hospital sometimes means they won’t visit the GP, which means routine illnesses can become much more dangerous.
Pride
I want to be able to look around the workplace and be proud. Not just of my work, or of my colleagues, but of the ethos underpinning the hospital.
Yes, you’re right. I’m dreaming. I wake up and I look around, at people in their 60s, 70s and 80s who have had to make themselves cash-poor in order to be able to walk properly or see properly again.
At families who have given up dreams, big and small. At people who have been forgotten, by relatives, by the system, by the hospital. At the lack of love, the lack of humanity.
I count my blessings. I try to live in the solution. But sometimes I drive home thinking what a selfish little island we have created. And then I think, maybe, just maybe, I am doing something to challenge that.
The author’s identity is known to The Irish Times.