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Salvaging the sick

Sunday, May 19, 2013

Only a doctor of medicine can comment on medical reasons for releasing patients from hospital, but anyone can assess practical reasons. Dr Anand Chatoorgoon’s advice that patients requiring haemodialysis “should be sent home and not kept here at the SFGH at expense cost... while waiting” nails cost as a deciding factor.



Those who cannot afford one or two haemodialyses per month, he says, “can return to SFGH” for “a slot to haemodialyse them and send them home.” He explains the psyche of the critically ill patient with “other life-threatening conditions, such as severe heart disease, or severe diabetes, or severe hypertension” who “want to stay at the SFGH where they can be treated in the event that any complication sets in.”


Sheer wisdom on their part, surely, since Dr Chatoorgoon says nothing to imply that they are well enough to go home, too far gone to benefit from being in hospital (he calls them critical, not terminal), or not ill enough to be in hospital. Anyone desperately ill (with the possibility of a heart attack or stroke thrown in) heads for hospital. That’s practical. As for nipping back and forth to SFGH from a remote village over lamentable roads, only a patient that had lost all touch with reality would embrace that idea. 


Family members who want their critically ill relatives to stay near to modern drugs and equipment in the hospital are presented as unreasonable, even quite selfish. The critically ill are taking up bed space that others need, others who are more salvageable.



The layman understands that if a thing is no longer salvageable it is better dumped than left to take up space. Even if there is a technical medical meaning for salvageable, space-saving lies at the core of this argument: send them home because of chronic bed shortage and overcrowding. 


I know of people, one or two dear to me, who have lingered overnight on a chair in SFGH—one with severe chest pains—because of inadequate bed space. Hurt and infuriated as I was, it never occurred to me that the blame lay at the door of critically ill patients who fail to recognise death as a “graduation.”



In my naivete, I thought that the Government of an oil-rich country owed its citizens adequate medical facilities. To be fair to Health Minister Dr Fuad Khan (who lauds Dr Chatoorgoon’s “practical” approach), he shifts the blame for overcrowding from the critically ill patients themselves. Instead, he directs it at the doctors who fail to discharge them, thus causing new patients to “sit on corridor chairs and trolleys or go to private institutions.” 


Again, when my friend languished in the corridor, I had not thought to blame doctors for struggling on with the critically ill instead of sending them home.



 What is actually being said? The core argument is that critically ill patients are to be sent home not for medical reasons but because they are not worth the cost they incur or the space they occupy. The responsibility for adequate medical care is diverted from authorities whose business is to provide a satisfactory facility, and is instead directed at grievously ill patients, their anguished families and those doctors who are striving to relieve their suffering as far as is possible.


And, if this actual meaning behind the morally bankrupt arguments is not distasteful enough, it is served up in sanctimonious slime: “death is a gradation, a promotion, says my Lord....”  As if using words suggestive of advancement and uplift would conceal the laying down of responsibility for the critically ill; as if invoking the Lord would legitimise a vacuum in care and compassion.


Dr Chatoorgoon, if you are not a believer, avoid hypocrisy in invoking the Lord; if you are, stop short of blasphemy. Just write the minister for beds, equipment, a new wing or two, not the eviction of the desperately ill for whose care you swore a sacred oath.


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