When It's You...
Ministerial Meandering
When it’s you
Sheila and I have just finished watching a programme on Netflix called ‘Critical - Between Life and Death’. It is a documentary following the course of several victims of trauma in the UK, who are dealt with by the recently formed London Trauma Network, which comprises four major London teaching hospitals that are designated as Level One Trauma Centers.
The cases we followed were all victims of blunt trauma - road crashes, assaults with a piece of piping, and so on. For Sheila this was an eye-opener, as she has not been exposed to major trauma very often as an ophthalmic surgeon.
One of the things that came over very clearly was the value of the National Health Service - even though it seems to be going down the toilet at present. It gave access to anyone and everyone to the best available treatment in the country, at absolutely no personal cost. No member of staff was looking in the victims’ wallets for a Blue Cross card, or asking if they had private insurance as they were wheeled into the OR. The post-operative care and follow-up was just as good.
The patients were also interviewed when possible, and several things struck me. First, that they were surprised that they had been injured - and their families also were constantly asking, “Why?” Second, those injured realized just how lucky they had been to survive their injuries, and this gave some of them cause to think harder about their ultimate destiny, and their faith - or lack of it. One man of Somali origin paused the anaesthetist as he went to place the mask over his face, and asked for a moment to pray silently. Then he gave the signal for the mask to descend.
The system worked, and the viewer went away with faith that the NHS is a Good Thing.
I won’t even start on the comparison with the medical system here as, despite BC nominally having 2 Major Trauma Centers (VGH and Royal Columbian), the level of care is generally below that which we were able to give in rural Africa, and the chance of being taken to one or other of these centers is largely a lottery. One of the greatest dangers of being taken to another hospital is that the staff may well not recognize the severity of injury that they are dealing with, and so we see many ‘…died later in hospital’ reports in the newspapers.
My experience of major trauma is very different, having spent decades in the military, served in 9 war zones, and spent 12 years in South Africa.
Two things make it very different; the first is that the majority of injuries I saw and dealt with were penetrating - caused by bombs, bullets, mines, knives, machetes, etc. We had our fair share of the blunt injuries too, but over 60% were penetrating.
In addition to the injuries of interpersonal violence and arguments with the hazards of driving, Africa provided us with a cornucopia of interesting meetings with our wildlife. Bites of various descriptions - snake, shark, hippo, crocodile, spider, bat - and even human. And the regular frequent dog bites - but the large feral dog population made the risk and incidence of rabies significant. Bats also carry rabies.
The second difference was that my trauma patients took their injuries with an equanimity unseen in the so-called ‘first world’. They almost expected that they would be injured at some point in their lives; there was no anguished crying of “How could this happen to me?” The families had the same frame of mind. There was an acceptance that hurts are part of living in this world, and wailing that it is unfair gets you nowhere, and certainly hinders recovery. Even young children who suffered horrible burns or traumatic amputations would seemingly consent to what the world or their ‘fate’ had doled out to them without complaint. There would be tears, of course, but then they would face up to their condition - whatever it was they had to come to terms with - and smile again.
We have a lot to learn from that attitude.
Philip+