On Convoys and Caring

We talk a lot about a health care system because that's what it is. It's a system. Like any other, it is based on efficiencies and statistics and bottom line dollars. We analyze bed capacity and staffing and projections of possible admissions, equipment needs, budgets, vaccination rates, and skill sets. Like any system, it has hierarchies and values, and choices must be made every day about which values have priority.

So it is not surprising that some people feel lost, unheard, and invalidated in this system. It is a real problem. More than anything, I am concerned that many people are losing their trust in this system altogether, especially their trust in health care providers, as legitimate questions about a rapidly changing pandemic come about as quickly as the tidal waves of information and misinformation that try to answer them.

When we have a question about the wiring in our houses, we go to an electrician. When we have a question about migration patterns of dolphins in the Gulf of Mexico, we ask a marine biologist. But for some reason, when it comes to our own bodies, more and more we are turning to the people on the internet, many whose credentials are inflated or entirely misrepresented, and then turning around to call the ones who have spent their entire lives studying the human body and epidemiology untrustworthy. What is going on here? Are some people just idiots? Or could there be some problem with us in healthcare?

Now, I am hardly some veteran, experienced nurse over here by any means, but I have done some thinking and tried really listening to a lot of people with different perspectives than mine, and while I still think many are totally quackers, I have come to the conclusion that not everything is their fault. I think part of the blame is with us. It is my opinion that much of the pandemic fallout shows us that our healthcare system could use some tweaking.

I hear many people who feel like their concerns about vaccines and side effects often go unanswered as we rush them through the system like a production line in a factory. The drive to vaccinate has always been about numbers, statistics, and a race against time, and to some degree rightly so. But we all know that one of the biggest problems in this pandemic has been that people are not feeling heard or seen. Some people feel talked down to or ignored by their health care providers in the rush to protect the public and stop the spread, or just because we don't have time or energy to explain the same thing one more time. Some people feel like they are even treated like the enemy because of their health beliefs. Some honest questions are met with derision or a brush of the hand instead of an attempt to give thoughtful answers. This has to be, in part at least, our own fault. The metaphorical call bells are going off somewhere else in the ward and so we triage, we prioritize, and sometimes we just don't have time to explain why we are doing what we are doing, Mr. Jones, so please just sit down and take your dang medicine because we don't have time for your shenanigans.

Right now a trucking convoy for freedom, with a lot of my friends hollering their support, is a symptom to this problem of not feeling seen or heard. The pressure has been building for a long time. It is hard to listen to and see the answers from someone when you don't feel listened to or seen by them first. It speaks to a demographic who hasn't had their concerns acknowledged for two years. In my church we teach that 

"No power or influence can or ought to be maintained...only by persuasion, by long-suffering, by gentleness and meekness, and by love unfeigned; by kindness, and pure knowledge, which shall greatly enlarge the soul without hypocrisy, and without guile—reproving betimes with sharpness...and then showing forth afterwards an increase of love toward him whom thou hast reproved, lest he esteem thee to be his enemy." 

As I see many who now esteem scientists, government officials, and even healthcare providers as their enemies, I wonder if we need to re-evaluate how we do things.

Any system like ours naturally thrives on administration and bureaucracy. We all know this. Rules and policies and rollouts and shareholders are what steer Alberta Health Services, not the benevolent nurse who holds hands and validates feelings. This does not mean administrators do not have their place. We need administrators and science informed policies and quality control and someone to balance a budget. But it isn't enough. It is not a balanced system if we don't carve out and protect a space for caring and compassion and listening and nurturing and a whole lot of patience. And I think this is what is missing today.

In any system there is a Yin and Yang of feminine and masculine qualities to make things run smoothly, but more often than not, the masculine qualities of efficiency and quantifiable production will beat out the feminine qualities of the compassionate, caring nurse every time. Because newsflash! We are living in a patriarchal system. We value masculinized characteristics over feminized ones. It's the very air we breathe, and healthcare is a pretty good case study for it. The administrative qualities will rise to the top and the nurturing qualities of caring will remain unpromoted at the bottom.

After the physician strolls in and gives the diagnosis and writes the prescription, he will have to move onto the next one, because this is an assembly line model with a waiting room out there full of other patients, and with specific billing procedures to follow. Most policies are formulated with the business model in mind. Almost all physicians I know are furious with recent changes in our province that make it even more like an assembly line, with artificial quotas and red tape that put unnecessary restraints on a physician's ability to take time and care. Meanwhile, on the other side of the team, nurses are facing the cutting block in virtually every budget meeting, and it is a constant fight to even keep our place in the system at all! Some suggest that humans in healthcare could be replaced with an App. Obviously, this is an imbalanced system. This is not news to anyone who works in health care, and we generally work out that balance between efficiency and caring in our practice as best we can.

Every nurse I know starts out caring deeply about people. They are naturally drawn to a profession that values listening, taking care of people, talking with them, alleviating suffering, and teaching. But more often than not, the system doesn't allow much time for that. When you are short staffed on the floor and the bells are ringing, the expectation is that you get the job done, even if it means treating people like pieces of meat in a factory as if everyone just needs a pill and a wipe and then you can send them out the door as fast as you can because the hospital is in overcapacity again. A nurse can quickly become jaded in such a system. There is a good reason you might get greeted by a tired, crusty, burnt out nurse who doesn't have time for your questions. It isn't that she or he doesn't care. They probably cared too much. But when you are treated like a cog in a factory, it will get to you eventually, and it isn't necessarily our fault.

Mind you, there are so many heroic caregivers that go above and beyond every day to take time to see the people instead of the numbers. But it is largely unsustainable in our current model. Anyone who cares deeply about people in this system all the time will burn himself or herself out. So you learn to ration your feelings and your caring, because compassion is not an inexhaustible resource. The time taken to explain treatments and answer questions and provide education about medications including vaccines to a blustering Mr. Jones is about maintaining an attitude of caring, sometimes superhuman acts of caring, and more often than not, this is the part that gives out well before the physical exhaustion sets in. 

This side of health care, good nursing care, cannot be valued properly when the entire system is based on a masculinized business model where the bottom line is efficiency and people's health become the commodity. The pandemic has put even more pressure on us, and the gaps are glaring at us even more than they were before.

There is so much about our health care system to love. Socialized health care for all is something I am fiercely enthusiastic about. But I know not everything we are doing is working great right now. For one thing, voting for policies and governments that continue to gut the healthcare and education system in the name of freedom and a dollar will not work for me anymore. For another thing, I despair to see more and more people I know turning to the wild west of the internet for their scientific and health information, wading through garbage because they don't know the difference between politics and peer review. But I can't blame them. There is a reason they don't feel comfortable to turn to their own health care providers for clarification. How would they even get an appointment? To me that is the most alarming thing.

As I watched this past week's freedom convoy, battling between feelings of charity and disillusionment, I began to wonder what freedom and caring even means anymore. What it means to me. What is freedom without caring? Without truth? Without responsibility? As caregivers drown in the impossible task of single handedly educating a nation, of listening to people mired in conspiracy fears and trying desperately to earn back the trust of a demographic that has become more and more disillusioned, and all this while we face the unrelenting workload of saving lives in a short staffed and burnt out fifth wave, it becomes obvious there will be no convoy on their way to Ottawa demanding support for nurses and healthcare providers anytime soon.