The Accident and Emergency department: a place for hope and healing? Or another sign of our broken system?
Earlier this week, I found myself in the accident and emergency department of our local hospital, supporting a dear family member in sudden pain. To say it was an eye-opener is an understatement.
From the time when she started to experience pain at home, until she arrived at the accident and emergency department, more than two hours had passed. Upon arrival, she was duly lifted from the stretcher onto the bed, wheeled into a corner, and left for a further 2 hours. The only contact we had with a medical professional was a cursory inputting of her details into the computer by one of the nurses on duty in the office. Groaning in pain, not a single person came to enquire after her well-being, or to offer any form of pain relief.
As I stood there, holding her hand, whilst we waited — endlessly — for a medical professional to attend to her, I silently observed the room around me. Stark white walls, beige curtains, and an assorted array of machines distributed around the room. Had my friend been able to have seen out of the window by her bed, she would have seen only the sign to the mortuary, and the organ donation unit. Was this a view and an environment that was supposed to calm fear and inspire healing?
The nurses, caught up in their administration and chained to their computers, were settled in a separate compartment. Not one person came up to her to see what they could do to help, despite her painful cries for help. When I went to make enquiries as to when we would be seen, we were told that there were others with more urgent cases and that she would just have to wait. The irony of having to tell my friend, used to private medical insurance in her home town in Latin America, that this was how the public system works here, were not lost on me. The nurse didn’t even know where Caracas was.
A few hours later, one of the janitors, the sole person of colour, and not one of the nurses, came to offer a bedsheet to keep my friend warm. We were grateful for her consideration. Was racism or xenophobia another factor in the treatment my friend received from the authorities? It’s possible, but I think the issue was larger than that. A lack of humanity in the face of a medical system focused on all the wrong things.
In my naivete, I had imagined that those working in emergency services are always working with speed and efficiency, fulfilling the Hippocratic oath of the responsibility of the medical profession to bring help and healing, yet it was hours before we saw a doctor. There was no sense of urgency — this the accident and emergency department of a large regional hospital in a developed country. It wasn’t for a lack of people. There was a constant coming and going of people, entering in and going out of the swing doors at the entrance to the department, an overdose of paramedics and ambulance drivers and associated visitors, nurses focused on administration, yet no one, it seemed, with a primary duty of care for an actual patient, still less a doctor who could at once diagnose and relieve the suffering.
I haven’t spent a lot of time in medical establishments, but it got me thinking about the systems we have in place for healing and well-being. At a time of great fear and suffering, don’t we owe it to people in that extreme state of vulnerability, to be designing hospital systems that place the human at the centre of the experience? Of all places, hospitals should, surely, be that place of care, compassion and efficiency?
I have huge respect for the medical profession and all those at the frontline of extreme need and human vulnerability and have encountered many people with a strong sense of vocation and selflessness in their desire to be part of healing and uplifting those in extreme suffering. So I can only assume it is the system itself that is to blame. Were the nurses so stretched to focus on administration that they were unable to care for the human needs of a patient? Were there so few doctors on that shift — an attempt to save money perhaps? — that countless people were lying listless on a trolley bed shunted to the side of the corridor? It seems I’m describing Victorian England, not a modern country with, supposedly, the most sophisticated health systems in the world.
Florence Nightingale, the godmother of the nursing profession, was a huge hero for me as a little girl, a social innovator who was not only famed as a statistician and her understanding of a data-driven relationship between hygiene and healthcare, but someone who also understood the need to take a holistic, systems-lead view of the entire architecture of health and well-being. Nightingale famously promoted the importance of music and writing in the healing of her patients and was known to draw up extensive plans of the architecture of how hospitals should be designed to best facilitate patient recovery. Indeed, in her Notes on Nursing, published in 1859, she explains how beautiful objects can have a physical effect on sickness, “Variety of form and brilliancy of colour in the object presented to patients are an actual means of recovery”. A far cry from the lifeless beige and white of most hospitals across the world today.
There is now a growing body of evidence of the role of the visual arts in healing, especially as it pertains to the visual and aesthetic experience of a hospital stay. But what we are also lacking is the very basic tools of empathy and understanding towards another person’s human suffering (something the arts can also address), and the role that that plays in the management and leadership of the very institutions designed to protect and heal. Should that empathetic understanding not be a central tenant of a doctor or nurse’s training? Should equal weight not be placed on the more holistic aspects of a patients experience than just the administering of drugs or analysis? Have we gone so far from the vision of the founder of modern nursing, to be so focused on precision medicine, the harvesting and processing of data, that we have forgotten the central tenets of the kindness and compassion of nursing and the medical profession’s role in healing through caring for another human being in their most vulnerable state?
Like so many other things in our world, I suspect the answer lies in the fact that medical care has become a commodity, an equation reduced to maximising profits, the solving of problems by yet another drug whose revenues line the pockets of profiteers, and not by a holistic understanding of a patient’s need or how to soothe them in what could also be the final moments of their life. The medical system is just yet another casualty of a world rapidly becoming devoid of its humanity in an insistence that technological progress trumps all other aspects of the human experience.
Thankfully my friend is now recovering at home from her ordeal. But what would it take to re-imagine hospitals as places of hope and healing, of taking a more expansive view of a human being, catering not just to our physical sense of wellness but also our mental and spiritual?
It’s time for a revolution in how we think about the systems and institutions that we have relied on for our health and wellbeing, and as consumers and citizens to demand of both governments and businesses to prioritise a larger sense of humanity in the decisions they make on what to invest in. We need to invest in a more human-centered approach to patient care, more intelligent hospital design and a more holistic understanding of the totality of what makes up a sense of our wellbeing. Let AI and technology play its part in the biological processes of healthcare and let’s ensure the money saved there is then reinvested into training people to be more empathetic and compassionate, hospitals to be designed with beauty and healing as their goal and priority, and quality leadership as a central tenet in the management of systems and processes.
Perhaps then, and only then, Florence Nightingale’s pioneering vision of the ‘higher order’ understanding of nursing and patient care of nearly two hundred years ago, would finally — finally! — be coming to reality.
Caroline Watson is the founder of The Centre for the Arts and Global Leadership, and a disruptive thinker, speaker and writer on issues of global governance and leadership.
