Thursday, October 05, 2006

Microstructure of Relationships--Part Deux

Following my last post, I was invited back to the hospital for a CT scan. The doctor I saw previously had suggested that this would provide a clearer picture of the major blood vessels entering the heart and should clear up any ambiguity surrounding echocardiogram results.

This takes me back into the microstructuring of daily life. Before I went to Onati, in the Basque Country, for a Workshop on "Legal Certainty Beyond the State? Autonomous Structures in Globalised Exchange Processes", the hospital wrote giving me an appointment for the scan during my week away. I called and they were able to work out a new appointment the day before I was due to leave. Unfortunately, that was not to be as the scanner operative couldn't be in that day. And I received another letter rescheduling me for the week I was away, even though I had, with them, blocked out this week. A further phone call rearranged the visit to their scanner for last Tuesday.

On Tuesday I was not to eat or drink anything for 4 hours before the scan. No coffee... When I arrived at the radiology department, I was told to sit and wait among various people with broken bones and tubercular coughs. Some were being given strange, lemony-looking liquids to drink, at least a pint of the stuff. I think it was a "contrast material" (dye) to show up the internal organs. After half an hour, someone called for "Mr Floooood". I had a professor at the LSE who called me the same.

The nurse gave me a basket and a robe and told me to change. She rapidly disappeared,
so I was unsure how much of my clothing I was to take off. I remained decent by keeping my underpants and socks on. I struggled to tie the robe's little bits of material at the back. My remaining clothes went in the basket: it was like being in a strange supermarket.

There were several of us hanging around, similarly robed. The nurse would pop in and out of doors. I could see I was next when another nurse came out and told someone else that she would be next. I got hold of "my nurse" and asked if I was next. She thought so. Fortunately, when the CT scanner came free, she took me in.

Now the fun started. Before me was a machine looking like a giant doughnut with a bed piercing the hole. I was told to climb on the bed and a series of explanations started. I was to be given an IV through which a dye would flow to provide contrast for the scan. I might feel a metallic taste in my mouth and a hot flush in my groin that would feel as though I'd "peed in my pants". The radiologist started to insert the needle in the back of my right hand. Yes, it hurt. After a few minutes she sighed. She couldn't find a vein. She was sorry but she would have start again on my left hand.

It hurt again and I couldn't look. My veins were too mobile and she couldn't get the needle in. At one point she thought she had it. She injected some water and if she had been successful I would feel no pain. I felt pain. She sighed again. "I'm sorry I can't do this. I'll have to get a colleague."

After ten minutes I had two tufts of cotton wool decorating the backs of my hands. Her colleague apologised and began to tackle the crook of my right arm. It hurt again: I think it was a big needle. He managed it and the dye was inserted. I thought I'd peed my pants! No metallic taste though.

The doughnut was started up as the bed was pushed through its centre. The doughnut talked to me--hold your breath, now breathe, hold your breath, now breath. I was good. I did as I was told. Three minutes later it was over. Maybe fifteen minutes in all...and 12 of them was sticking the needle into me.

I was told to get dressed, then nothing. I asked about the results. "Your doctor will have them." It's been a week and I heard nothing about the results.

I called the hospital today. On the third call I found the right person to talk to. Homerton's website isn't very informative on people or numbers to call them on, at least not in cardiology. I did find a secretary who looked up my file.

"I've just written to you," she said. "You're to have some tests."
"I've had them; I want to know what happens next."
"Come back next year."
"What about my results?"
"Your doctor's got them."
"Right, but which doctor?"
"The results have been sent to your GP."
"All the results of all the tests?"
"They've got your scan."
"And the EKG and blood pressure monitor results?"
"I can't tell you that because of patient confidentiality."
(But you've just told me about the CT scan, I thought.)
"Well, no one has informed me of what is to happen next."
"See your GP and you'll come back next year."

This has put me in mind of a lecture I gave recently to first year law students. I mentioned that the regulation of lawyers would be taken away from lawyers themselves and be assigned to an external body. The impetus for this had been the rise of consumerism and the enormous numbers of complaints made against lawyers, many of which were never resolved. The main complaint against lawyers is the lack of communication. They just don't tell their clients what is happening. Clients don't like this.

Hospitals aren't like law firms. But their procedures have an alienating feel about them. It is as though we are the software that fills their hardware. However, once installed, we can be forgotten. It would be so simple to have an automated response system that produces a letter following a visit to inform the patient what would happen next with a number to call in case of trouble. Considering the flurry of activity that occurred to set up the appointment, the absence of any movement afterwards was striking. In my case, if I hadn't taken the initiative, would anything have happened?

Who knows?
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