• Prequel – The Self Defeating Heart
• An Overloaded System – Port of Spain General Hospital (Casualty)
• An Overloaded System – Port of Spain General Hospital (Observation)
• An Overloaded System: From Observation to Internal Medicine in another Location
• Reprieve: St. James Medical Complex, Internal Medicine
• Dancing Beyond The Medical System
• Afterword And Observations (Coming Soon)

Day 3

Waking up after my a decent night’s rest – thanks to that Venezuelan nurse and her sacrifice of the fan – I felt good. The lights were on and had probably just been turned on. The nurse was making rounds. I’d heard the tell-tale sound of the velcro of a blood pressure cuff. I sat on the edge of the bed and waited – she only had 3 more patients to get to me.

She was also distributing medications in those small paper cups that serve no other purpose.

She got to me and my blood pressure was down. I’d ‘scored’ much better than the previous days, and my blood pressure had dipped lower the day before but today was right about where a 20 year old’s blood pressure should be. It was 127/80.

I wasn’t feeling 20 years old. In the moment, I couldn’t pin down an age I felt. I didn’t even care about age. If you ask me when I’m not expecting it, I have to subtract the present year from my birth year if I want to be accurate otherwise I just guess. Birthdays made no sense to me. Counting revolutions I’ve been on the planet seemed pretty small considering the planet revolves before and after us.

The doctors seemed to have gotten my medications and their amounts figured out. That’s good. My body was responding. I did not like the subcutaneous injectables in my stomach, the ones where one rated the nurse giving them. Those that did them right but ‘wrong’ caused a burning. The ones that did it right didn’t. I graded them on it. The Venezuelan and the original ‘Hyatt representative’ had nailed it perfectly. The others hadn’t. Some nurses have the touch. Some don’t.

Once the nurse went back to the head of the ward, all of 20 feet away, I brushed my teeth to test myself out standing and since I did well, went back to the shower- careful to have my shoes at the door so I didn’t go skiing down the ramp again on wet feet. It was a good shower, though the IV access in my hand was really beginning to be a nuisance despite the plastic bag I had put over it.

The tape still gets damp, the dampness causes the tape to loosen, and then when you’re half awake you hit it on something and are rudely reminded of where you were and that you had a plastic catheter in your hand, attached by loosened tape.

I needed mine re-taped, so I got that done. The nurse decided to add more tape over the old tape rather than remove the old tape, clean the area with alcohol and add the new tape. I said nothing. It was probably that she wasn’t a good ‘stick’ if she lost the IV access, and re-doing it that way might have compromised the catheter so she didn’t think it worth the risk.

The result looked like a bad boxer’s wrap in my opinion, but I was left alone with my thoughts and opinions in silence. For some things it was better to be silent.

I thought about the medical system. I had named the periods alone under the fluorescent lights as my ‘Fluorescent Musing’ periods.

I was adjusting to prison hospital life. I found that idea troublesome. The only people who should be used to hospitals are the people who work in them. Maybe it was the rest catching up with me. Maybe it was because my body was demanding my own bed. Maybe I just wanted natural light.

I had a sense that I didn’t belong where I was anymore.

Food was dropped off. There was a styrofoam cup that looked like tea with some more tortured and saltless mass in a smaller cup with the standard 3 slices of bread.

The Revelation

The doctors came by on rounds where they walked around rectangular buildings through rectangular doors seeing patients in rectangular beds with nursing notes and doctor’s orders on rectangular sheets of paper. ‘Rounds’. It was more sticky than ‘Rectangles’, I suppose.

I sipped the tea. It wasn’t tea. It was a form of watery oatmeal. I apparently made a face that appeared ‘unpleasantly surprised’.

The head doctor asked me if there was something wrong with it, and I explained to her that I was expecting their version of tea (which seemed a mix of tea and chocolate, perhaps as a slight toward both British and Americans). Instead I had gotten ‘chunky fluid’ which, as chunky fluids go, wasn’t bad. It was really the best meal I’d had so far. The kitchen should do that more often rather than torturing innocent vegetables that just wanted the pain to stop, and so would confess to being any meal of the day.

Some people aspire to be cooks, some really want a job with the CIA to waterboard people, and most are shades in between.

They didn’t really appreciate my humor, which is fair. I didn’t appreciate their lack of it. Yet I did get a smile from one of the junior doctors. The day goes faster with a laugh and a smile, I’ve found.

They conferred about me at the foot of the bed. I recognized the doctors, one was from Casualty, the others had been through before. The conversation had turned to the antibiotics and why I was on them. I hopped in and explained that they had done that in Casualty because my initial blood tests showed a ‘shift’ since the two junior doctors didn’t know why. The senior Doctor discontinued them, stating that when there was heart muscle death the tests always showed a shift and that I was asymptomatic for an infection.

I told her I liked her. She asked me what came next, to which I said, “Discharge!”. She laughed and said no, an angiogram. She was right, but I felt I could do the angio as an outpatient rather than staring at fluorescent lights and keeping a bed that they obviously needed from floating away. That’s when she told me – and she’s the first person to tell me since I got into the hospital – that they legally had to keep me for 5 days because of the heart attack. 5 Days. I was on day 3.

Well, maybe they’d get the angiogram scheduled during then. There was a clear need to get people out of beds quickly in a hospital, and it was in the interest of the hospital to free as many beds as possible as quickly as possible so that they could accommodate more patients. It’s the calculus of medical administration – the flow out should match or exceed the flow in, or you end up with more patients than beds.

Instead, I was told I would be transferred to St. James Medical sometime that day and that it would be an upgrade. I replied that I’d be hearing that for days. We smiled but really weren’t smiling. We were both trapped in the system.

They left, leaving me with my thoughts. I was already considering leaving ‘AMA’ – Against Medical Advice.

I balanced this with the facts – that the week prior I had not made the best judgements and decisions for myself, so I decided to stick with their legalities and protocols for the 5 days.

The whole heart attack still didn’t feel real to me even though I intellectually understood it, and the medications likely had me feeling better than my body was, tricking my body into behaving itself while I recovered. I wasn’t convinced I was taking it as seriously as I should. They’re used to patients doing dumb things, and I’m not used to doing dumb things.

I knew I could walk out at any time. What’s more, they knew I knew. They were advising. I thought through my recent medical history, I went over every bad decision I made that got me where I was, and I decided the 5 days would give me enough time to satisfy my requirements.

Fluorescent Musings

Paul-Michel Foucalt (they drop the ‘Paul’ in his name mostly) came to mind with his biopower theories – about how nations use public health to control populations. It seemed a sort of conspiracy theory when I had read those works decades ago, but there was merit to what he wrote about – the trouble I had was intent and I could never reconcile it with Hanlon’s Razor: “Never attribute to malice that which can be adequately explained by stupidity.”

Every medical professional I encountered had been competent and empathic to varying degrees while being nonplussed by the system, which means that they were used to it and any fight to improve it seemed impossible. This makes people jaded about the system. They did what they could within. The problems seemed with administration.

The doctors and nurses I had dealt with were not stupid, and they did not harbor malice. In fact, it seemed quite the opposite. They were trapped in the system as much as I was, though for me the stakes seemed higher if only because it is my life and health. That simple thing of sacrificing a fan reminded me of why good people in healthcare are in healthcare in the first place.

The doctors had also appreciated that I was already looking to be discharged. They had also done their part to try to get me into the High Dependency Ward which seemed like it had no beds at all. In the interim, I was becoming more stable while less stable patients kept coming in. It’s about flow rates, the calculus of real estate in a hospital, with doctors constantly re-evaluating during rounds. Those evaluations would be evaluated by Department Heads, or whatever called them, and patients would move through the hospital peristalsis – how things move through your gut. In bad situations, it can become hospital paralysis. Think constipation. Even with my decision to stay, I had knocked on the sphincter to release me.

I acknowledged that some of my biases were shining through. I did not like this place, and let’s be honest: You’re not supposed to like hospitals. You’re not supposed to stay in them. You’re supposed to stay in them just long enough.

For some reason, “Pedagogy of the Oppressed” (Paulo Freire) came to mind. A system can make everyone victims, a point forgotten by many. In an era where everyone cloaks themselves in victim-hood, few recognize the other victims of other things.

Is a doctor or nurse who wants better for the patients not trapped within the same system? What about the administrators? The security guards that had to bar people and witness things they themselves might not understand?

The doctors are not as quick with empathy as the nurses, traditionally understood as a balance between rationality and empathy, but that understanding also had roots in a society where the two professions were largely gender based. They are less so now. Add in the fact that the nursing field had made some drastic leaps and bounds over the last century. A good Nurse Practitioner was generally better than a Medical Intern.

It seemed the difference was about the amount of time spent with the patient. Doctors spend less, nurses more. I’ve worked and been worked on by both genders and both fields over the course of my lifetime. This seems to fit.

The whole gender thing seems to be about people who are obsessed with people’s genitalia. When put into that context, it’s a little disturbing that people still think like that.

All of these are interesting puzzles to consider when trapped in an uncomfortable bed.

Nosocomial

Then you notice that the bed guards haven’t been cleaned in a while for whatever reason, with whatever bacteria that may have hitchhiked aboard. I recalled how many people on their way to the bathroom had touched the guard rails of my gurney in casualty. Unwashed hands. In casualty. I cringed.

Nosocomial infections are infections you get in a hospital. Where there are sick people, you have a potential breeding ground for all manner of bacteria. In the 1990s, this had become a real enough issue where they were finding antibiotic-resistant bacteria at nursing stations, where medications were prepared and where syringes were often sprayed in the air with antibiotics as the dosages were adjusted. Cleaning those nursing stations became a priority back then.

On this bed, tape from long ago still attached to the bed guards, lingering medical detritus from however long ago. The fact that the tape was still there was an indicator that the guards hadn’t been cleaned. Sure, they wiped down the beds themselves, but the guard rails seemed to be immune to that cleansing. The person who mopped the floors as regularly around, leaving behind the scent of chlorine in their wake.

Yet the bed rails were immune – probably the most touched thing in a hospital by sick people.

Medical systems of any sort are built on small things. Minute things. The small things done right build up into larger things done right like any other system, and over the decades I have worked on many types of systems, from medical to engineering to financial.

Overworked staff miss small things more often than staff that is not overworked. The delays in transfers because of bed availability creates a storm of Parkinson’s Law: “Work expands to fill the time available for its completion.” In medicine, like most things, time is important – and the inefficiency of the bed availability was a puzzle for me. Trinidad and Tobago is a small country. Depending on who you ask, there are 1.2 to 1.5 million people in Trinidad and Tobago. It seemed like the medical system shouldn’t be flooded outside of things like Covid-19. The system itself seemed sick.

I was biding my time, with doctors and nurses apparently legally obligated to keep me for 5 days, but they had no near ideal place to put me.

Surely better minds than mine had thought about this more with the benefit of not being stuck in a hospital bed. I didn’t have an answer, unsurprisingly. It’s not my field. Yet it didn’t need to be my field to see that the rumors were true, and that the experience I had with people I knew who had been in local hospital was unchanged.

Time traveling

I remembered late Uncle John, who at the time was in his 90s, had asked me to look for someone in San Fernando General Hospital to check on them for him. His knees wouldn’t permit him to wander the halls as he might have liked to, and I went and found the person. This was in the early 2000s. He said he’d heard the gentleman might have HIV, and was concerned for him.

I went in, and was directed to one of the wards upstairs. I went up and asked the nursing station, which created a lively conversation between the nurses that lasted too long for my liking. They pointed toward a hallway and I called his name. His bed was parked along a wall.

We chatted. I told him who had sent me and why. He reached for my hand, and so I held his hand a bit. He was emaciated. I didn’t see purple splotches but didn’t ask. I wasn’t there to interrogate him, I was there to let him no Uncle John had thought of him and couldn’t make it himself. I was an emissary. He asked me about the outside world, about how Uncle John was doing. He talked about hunting, something he and Uncle John had shared. There was no place to sit, so I stood there a long while chatting with him, all the while holding his hand. He dozed off.

I left, looking for somewhere to wash my hands. The bathroom didn’t have soap. I asked the nurses about soap, they simply said there was none. I went downstairs, wondering how a hospital could not have soap, and bought a bar from one of the vendors downstairs, went to the bathroom and washed my hands thoroughly. I left that bar there in the hope others might find it useful.

All of this came to me. I should get out of the hospital before some stray bacteria hitchhiked aboard me.

Transit!

Suddenly, a wheelchair appeared with transfer papers to St. James Medical – I was about to become someone else’s problem. I was wheeled down, through Casualty and through a side door out to an ambulance bay to an ambulance where I sat in the chair and another patient was in a gurney. A doctor showed up with paperwork, and off we went to St. James Medical, lights and siren.

Lights and siren – called code 3 where and when I had been involved in such things – took us through the tight roads. I used my feet to hold myself in place – there was no seat belt for the chair. Feeling the ebb and flow of the engine, I looked to verify what I believed – this was a manual transmission. Oh, yes, very exciting on the crowded roads. I watched as the driver navigated the road sometimes seemingly precariously close to other vehicles.

At St. James Medical, we were waved through by members of the local constabulary, and the other patient was wheeled in while I walked. So I walked to what would be my new place for a while, St. James Medical on the Internal Medicine Ward.

It looked brighter. It had natural light. I walked over to the medical customs and excise with my paperwork, and they pointed me to a bed at the end. The end table was full of someone else’s stuff though the bed was empty, so I chose the bed across and walked back, informing the nurses. They were nice, helpful, and were letting me walk around so I took advantage of that. I cleared it with the charge nurse and stood outside the quiet ward a bit, soaking in sunlight and wind until my nose was cleared of the memory of Port of Spain General.

I inquired about the facilities which the nurses gave me direction to. A wrong turn would land me in the female ward, so I made sure I made the right turn and saw them. I didn’t need to use them, but I’ve found it’s always best to know where such things are.

I then went to my bed and sprawled out. There were multiple fans on the walls, so patients shared the oscillations every two beds, and the high ceiling and open windows allowed air in. Granted, Western Main Road was nearby and it wasn’t fresh, but it was outside air. In the moment, after the closed air of the Port of Spain Casualty and Observation Ward, this was wonderful. It wasn’t freedom, but it was closer to.

The first night, though, would have it’s own adventures.

• Prequel – The Self Defeating Heart
• An Overloaded System – Port of Spain General Hospital (Casualty)
• An Overloaded System – Port of Spain General Hospital (Observation)
• An Overloaded System: From Observation to Internal Medicine in another Location
• Reprieve: St. James Medical Complex, Internal Medicine
• Dancing Beyond The Medical System
• Afterword And Observations (Coming Soon)