Sunday, July 01, 2012

Perfect In Their Cruelty

A friend of ours was recently diagnosed with breast cancer and made the hard decision to have a double mastectomy. My wife Jennifer was there as she regained consciousness after surgery. Predictably, she was in pain. The doctor had left instructions to start a morphine drip, the nurses stood ready to alleviate their patient's pain, yet no pain medication was administered for 45 minutes, a period during which our friend wept and moaned and suffered.

It seems someone has developed a system for Overlake Hospital in Bellevue, Washington, a presumedly state-of-the-art system, a system designed, as I understand it, to prevent the theft of controlled substances like morphine. Apparently, the hospital's pharmacist is the only one with the "key" to the morphine cabinet and that person, for reasons that were never explained, took 45 minutes to open it. The doctors wanted it opened, the nurses wanted it opened, the friends and family demanded it be opened, but the system was in charge. 

If there are any children in the room, cover their ears . . . That is one f**ked up system. Here is a woman in what is one of the worst physical and emotional moments of her life, and some bean counter's system, in a hospital, a place supposedly operating under the principles of "do no harm," viciously and cruelly put her through 45 minutes of entirely unnecessary agony. 

Systems: I have systems in my life, routines and processes that I've devised to make my life easier or more efficient or more effective. I always put my keys and wallet in the same place, for instance, so that I can find them. I have a system for brewing coffee in the morning, followed by another whole system that gets me set up for the day. I like my systems because they are an extension of me, of my personality, of my way of thinking, but what is most important about my systems is that when they stop serving me, I can tweak them, over-ride them, or just dump them altogether.

Systems like the ones at the hospital, systems imposed hierarchically, systems that cannot be over-ridden by doctors or nurses or patients in extreme pain are the worst kind of evil, because they force good people to take part in it. On a TV show, the hero doctor would have grabbed a tire iron from the trunk of his car and smashed his way into the morphine cabinet, damn the consequences, but this system is so incredibly cruel that it required someone not in any way involved in the human suffering to remotely activate that morphine dispenser. They've made it immune even to heros.

It's the kind of system that could have only been devised by a cost-control specialist or loss prevention manager or any one of the hundreds of other corporate operatives employed for the sole purpose of tending to the bottom line.  Of course, I don't know who it was who devised this system, but I'm confident in asserting that it wasn't my friend's doctors or nurses, the actual healthcare professionals responsible for her well-being. No, it was created by people whose only concern is not wasting even a drop morphine. It was created by people who don't trust doctors and nurses to, you know, make their own decisions about the practice of medicine.  It was created by people, in fact, who suspect that these professionals may be secretly plotting to steal or abuse this medicine because they are potentially nefarious, or lazy, or otherwise less perfect than their system.

This is a mentality that is pervasive within a certain segment of our society, this idea that amoral systems are, perhaps because of their amorality, superior to human beings. It's the kind of system corporate reformers are actively seeking to impose upon our public schools, with people who haven't been in a classroom since they themselves were in school, creating a standardized system of tests and curricula and schedules and assessments and procedures that are there to over-ride not only a professional teacher's best judgement, but everything research tells us about education. Children are in agony, education is suffering, but damn it, we aren't going to waste a moment of our teaching time, we will drill and kill them, and we won't have to rely on those nefarious, lazy, over-educated teachers who are less perfect than our amoral system.

I have no doubt that the people who devised Overlake Hospital's morphine system would have been mortified had they been forced to sit in the room with our friend as she unnecessarily suffered for 45 minutes on the worst day of her life. But that's how systems maintain their amorality: the human element is removed. The professionals, loved ones, and even patients are placed in service to the system, which has no interest in curing the patient, only in pinching another penny.

We live in a time in which those with their hands on the levers of power, those who sit atop corporate pyramids, don't have to witness the pain of patients or the suffering of children, where, in fact, news of this pain and suffering is just treated as further evidence of nefariousness and laziness. Rigid systems imposed upon the lesser humans, on the other hand, never complain. The best judgment of people, their knowledge, their experience, is immaterial within these systems. No one can even play hero as the system remains, as always, focused on the bottom-line. 

These systems are perfect in their cruelty.

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Anonymous said...

I am so sorry to hear about your friend's experience. A few years back, I was injured in a chemical spill at work, and suffered deep burns across my torso and arm. My clothing was literally taken from me on-site and packaged up to be disposed of as hazardous material. I will never forget the kindness one of the paramedics in the ambulance showed me on the way to the burn center - he rigged up a bag of sterile water to the interior ceiling so that he could irrigate my wounds and alleviate the pain during the drive. As anyone who has been burned will tell you, air hitting the open wound is agony. This kindness was nothing but a fond memory when I reached the hospital, where they refused to dress my wounds until someone arrived with clothing for me. I had refused pain meds because I was alone in a frightening situation and wanted to keep my wits about me. The hospital's system was satisfied: Patient offered pain drugs? Check. Patient has no clothing? Must wait to dress the wounds. I will never understand the logic that left me on the hospital table for nearly an hour in absolute agony, burn wounds open to every gust of air or random contaminant passing my way, but it certainly wasn't human compassion that made the call. And guess what? When my dear boyfriend (now husband) showed up with some clothing...the hospital technicians first bandaged my wounds, then put my clothing on. I'm sure it makes sense in someone's world.

C. Marie said...

I love the Teacher Tom blog -- as a preschool teacher, I have found a lot of inspiration here. I have also pumped my fist in solidarity to some of the comments about the corporate takeover of education. I do want to make one comment (with all respect) here, though -- the difficulty in accessing morphine in hospitals is often not put in place to save money. It is put in place to prevent abuse, illegal distribution and the destruction of lives that follows. There probably is some economic aspect to this, but, first and foremost, these systems have been created because some doctors and nurses, who are also humans, have been unable to exercise the judgment to withdraw the morphine only for the use of patients in pain (addiction does that to judgment). It is just horrible to hear that people are suffering. Indeed, these methods may well need improvement, but they are not entirely nefarious.

Rachel D. said...

Here's another example of a broken, cruel system. (As if you need more examples..) Lifeguard fired for saving a man's life, who just happened to be "out of bounds"

Teacher Tom said...

Oh, I understand C. Marie, but because there was no way for human beings to over-ride the system it caused a great evil to occur. There was clearly no one seeking to steal drugs in that hospital room, only one woman being left to suffer pain on what was already one of the worst days of her life. Amorality is never nefarious, but it is the coldest kind of evil.