“Are you anxious?”
“A little bit.”
“What medications do you take?”
The neatly packed transparent plastic bag is a gift for the nurse.
My mother is having a procedure and I have taken time off. She is elderly, hard of hearing and a non-native English speaker – just one of these would qualify for an extra pair of hands and ears, but with all three, I am not taking any chances.
Being a doctor is a privilege in so many ways. My first realisation that I am on the patient side of the equation is when I drive past staff parking to find a spot. The two minutes I am used to become 20.
The admissions clerk is faintly unimpressed that my mother omitted to bring one of her many types of health-related cards. I feel for both clerk and patient and problem-solve by messaging my dad.
The room is nice and quiet. I gauge whether the couch is enough to sleep on. Maybe – if I lie still on my right side on with legs at 90 degrees.
The nurse has left the beleaguered NHS and has a brogue that I can only just decipher; I am impressed that my mum understood his first two questions.
“Are you in transit from an international destination?”
The big words are lost in enunciation.
“How about pressure sores?”
She looks at him quizzically; he tries to explain. It’s painful: the questioning, not the sores. Most patients are not aware of developing pressure sores. The ones who suffer from them are typically emaciated.
“No,” I reply before explaining in Hindi how pressure sores develop. She shudders.
“Do you use a gait aid?”
I translate and let her answer, the more to empower her for the future.
“Are you cognitively impaired?”
I consider the irony of this question and the singular unreliability of a response. Cognitively impaired patients would deny this or not know how to answer and the well ones might be offended.
There is no easy Hindi translation; before I say more, the nurse helpfully adds, “like dementia”.
Her expression clouds.
“Do you have dietary restrictions?”
“He is asking what you don’t eat.”
“Beef and pork.”
“Are you on a fluid restriction?”
“I just don’t eat beef and pork.”
The questions keep coming. My mum nods and smiles, confident that if something really matters, I will step in.
By now, I am wondering how other patients faithfully answer these questions filled with jargon and some even unintentionally discomfiting. How many anxious people simply nod along, trusting the staff know what they are doing?
I wouldn’t rely on a cognitively impaired patient to provide the details that would help me provide better care – being vigilant about the risk of delirium and falls, for instance. It is the uncommon patient who knows the date of their last blood test, every dose of every medication and the precise indication for every procedure.
As the nurse continues, all I can think is: who writes these questions and who vets them? How can we know that this is time well spent on patient care? Is there a box saying that the patient did not (seem to) understand? Or one saying that an interpreter was required but not provided? (Large public hospitals typically provide access; private hospitals bypass the very expectation.)
Her doctor is calm and confident, but his reassurance is marred by the next entrant, dressed in a black cassock and purple Roman collar.
The priest’s eyes flick between my mother and me. He has probably been called to administer last rites and looks confused.
“Are you Joan, or is she Joan?”
“Neither of us looks like a Joan,” I smile, prompting him to flee.
I am guffawing when I hear my mum concerned.
“Why did the doctor send a priest?”
“It wasn’t for you.”
“Are you sure?”
It’s a scene dying for a comedy scriptwriter.
To do something nice, I call the kitchen and order jelly, one of two things she is allowed.
“She can’t have it,” the chef rules. “Jelly contains gelatin and your mum is allergic to beef and pork.”
“She is not allergic; she is Hindu!” I protest. “And she eats jelly.”
But my protests fall on closed ears.
“The allergy label has to go first.”
I hang up, bursting with laughter but also sympathetic to the strain it places on patients and relatives to settle inane issues among important ones.
Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, a least for a spell, to identify ourselves as citizens of that other place.
Susan Sontag’s words, written in 1978 during her cancer diagnosis, remain as meaningful then as now, in an era of unprecedented gains in medical technology and treatment but not necessarily in the way we communicate with patients.
My mother’s experience has given me renewed empathy for patients and their caregivers. While we are busy documenting their needs, we are not actually meeting their needs. From visible symptoms to unspoken suffering, from cultural preferences to deeply personal choices – there is a lot healthcare providers need to know but only if our head is not buried in the paperwork. True patient-centred care takes more than a checklist.
It takes the nurse on the next shift time to understand the issue, re-enter the computer system and delete the allergy. A triumphant chef delivers the jelly. I feel bad knowing that the nurse had more fruitful tasks at hand.
Australia performs very well in the world in important healthcare metrics.
We must not rest on our laurels – and continue to strive for patient-centred care, which includes stopping doing things because “they have always been done that way”.
Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is Every Word Matters: Writing to Engage the Public
