That Ugly Place, the Hospital

My considerations about staying at the hospital when caring for someone, which happened to me four times in the past years, in three different hospitals in Southern England.

It is a mish-mash of thoughts on how to get through a hospital stay a bit more easily: please feel free to call bullshit on them, especially if you are a doctor or anyone that actually *knows* something about it.

An unfamiliar place. Despite being exclusively devoted to extend people's lifespan, a modern hospital is one of the most unwelcoming places you will ever visit. Ugly blocky buildings surrounded by full-to-the-brim parking lots. Often shabby. Dull. Unwelcoming. Sprawling and hard to navigate, littered with confusing signs pointing all over the place.

Still here culminate centuries of human knowledge, first clumsily gathered by trial and error, now developing at marvellous speed thanks to the scientific method. I cannot stop seeing hospital as temples devoted to the noblest of endeavours: making us defy death. And boy, it works. Just check how newborns' death rate dropped in the past 70 years in Europe.

There is something else at work, I believe. Hospitals could be all marble and fountains and gardens but they remain a place where we suffer pain and discomfort. Our mind is wired to build strong aversive feelings towards contexts in which we experience pain, no matter how nice they look. Which brings me to suggestion #1: make yourself at home. Bring pictures to hang around, your favourite pillowcase and throw, books to fill a shelf, your favourite brand of tea to sip from your favourite mug. Seeing your own things will trick your mind, reinforce the sense of familiarity, making you feel more at ease. A tablet packed with films will make time pass, but you need to *own* the place first. Take a look around, walk the ward a few times. Find where the coffee machine is, and where the good coffee is instead.

The spaghetti conveyor belt. Why can't hospitals be nice? Because they are built for efficiency. The aim is to extend our lifespan as much as possible using limited resources, the most precious of which is the time of highly trained and educated medical staff. I will not stress enough how high is the quality of medical training. We all watch in awe at the godlike skills of trained SAS troopers, how good they are at putting bullets into people to reduce drastically their lifespan. The average surgeon is as trained as an elite force member - for quite the opposite reason.

Being the doctors' time so important, our time as patients is not valued much. So we wait. And wait. Then it's time for our scan. Then our scan is canceled until tomorrow, sorry. We feel like parcels on a conveyor belt, except it's a bundle of conveyor belts because each of us is a different case with different diagnosis and treatment needs. And the bundle keeps changing because of emergencies. What happened to your scan? This mighty machine that *looks inside your body from the outside while you experience negligible discomfort* (how can anyone give this wonder for granted?) and the highly trained personnel operating it are suddenly needed to look inside the belly of a 4-year old child who's been hit by a van. So you wait, quietly. Since even a perfectly organised hospital looks disorganised to a patient, here's #2: plan for boredom. It is normal and understandable that we focus on our own problems, after all we are scared, worried, maybe in pain. But while we wait for someone to remember we exist there's a lot going on around us: not only people are taken care of, but staff is trained, routine screens happen and tons of data are collected. A functioning health service will take these data and turn them into better practices, all for the same reason (yes, it's extending our lifespan, you guessed right). Also, no matter how long you are put on hold, #3: they haven't forgot about you. Rest assured. This can be really hard to accept if you are in pain and waiting for a painkiller. You may need to take action and pester a few nurses but don't be confrontational - it won't make a difference.

Hospitals make us feel stupid, mainly because we do not understand what is going on. For reasons of efficiency, there are shifts - almost like in a factory. Efficient, but not nice. A doctor & a nurse all for yourself, that you can learn to know and trust, would be way better for us but this would lead to less people being treated. Instead we have this constant flow of new faces, showing up after the new shift begins: who is this nurse? I liked the old one best! Why do they keep me asking the same questions? They seem to know everything about me already.

I find this particularly hard: I can't remember names, I never know who to ask for things, I cannot make sense of lanyard and uniform colors. What we need is #4: establish an information flow. Answer patiently to all the questions. The new shift will have looked at your records before asking you anything, still they may repeat questions. Before any treatment they'll check your identity, even if your name is written all over the place. They are not idiots, it's a simple but effective strategy to avoid fuck-ups, like giving your allergic neighbour the antibiotic that would kill him.

The flow goes in two directions: ask. #5: once you got hold of them, don't let the doctors go until you are happy. Doctors will show up apparently at random intervals to check on you. Ask who they are ("are you my doctor?" is a perfectly good question). Make the most of it, because you will not have their full attention until the next time they show up. Ask until you are happy with your understanding of the answers. Don't be afraid to appear stupid. Don't pretend you understand (I _never_ tell doctors I am a biologist, so they don't make assumptions on what I do and do not know). Repeat the answer loud, in your own words and check that the doctor knows you understand. Be assertive, not confrontational. If you realise you are asking the wrong person, ask who the right person for your question is. Take notes - seriously, write a list of questions, answers and any contradictory information on a scrap of paper. Differently from years ago, the medical staff know how important bedside manners are.

Badass doctors. In my experience, exceptions are surgeons and anaesthesiologist in the imminence of surgery. They can be all but talkative. Think Liam Neesom in Taken with a few changes: "But what I do have are a very particular set of skills, skills I have acquired over a very long career. [...] I will look for you, I will find you, and I will FIX you". These people are focused on repairing your insides and on switching off bits of your brain and body without accidentally killing you. You don't need them to be nice while they are at it. When my first daughter was born my wife asked for an epidural. The anaesthesiologist did it in a 15 minutes window. He came, he told me to help my wife sit still, he pissed me off with how curt he was. Then it dawned on me that he was not there to be polite, but to take my wife's pain away without damaging her spine, and help my daughter to be born. He was in the zone. I remember telling my wife (in italian) "relax, this guy looks like an asshole but he is completely in control. You'll be fine". The following day he shows up all smiles, relaxed, checking if everything is ok - and I do not recognize him at first, such is the change in his attitude. And we interact like sociable human beings. #5: seeing the bigger picture can spare you a big deal of annoyance and disappointment.

So it is all nice & good things. Of course not, there are (a few) incompetent people (even if redundancy helps), resources may be allocated poorly and we have to keep management accountable for that. But the bottom line is that as of now a modern hospital running on the principles of evidence-based medicine is the best solution humanity has come up with to solve the problem of extending people's lifespans. 

Thanks for reading all this - I hope it helps!