It has been a week of bed pressure in Tatamagouche. Like bed sores, bed pressures are caused by friction, but the friction is inter-personal. The Tatamagouche hospital is managed at a distance under the authority of the Northern Zone of the Nova Scotia health authority, which, in turn gets direction from the provincial department of health. The department of health has directed the health authority to restrict hospital beds during Covid and the Health authority has passed this directive to the Northern Zone who has passed this on to Tatamagouche
At this point, some definition of terms is in order. A hospital bed, in health care usage, is not a mattress and box spring, nor is it even a room with a door, buzzer, and medical outlets. Rather a ‘bed’ is a verbal construction that means the entirety of resources that is required to look after one patient for one day, including, but not limited to, food, cleaning, heating, nursing care, physician care, drugs, and security. That total package is referred to as a ‘bed’. During Covid the department wants resources at the ready for a potential surge and has directed hospitals to use only 85% of their beds. This means that larger Centers that do surgery and have stroke and cardiac units are squeezed and want to redeploy beds. What this means in actuality is that a patient who is ‘filling’ a bed at a regional center is not seen as a person lying in a bed but rather a ‘resource sink’ preventing the hospital from doing the work that it sees as important. This leads to the unfortunate situation where the frail elderly who are unable to be cared for at home and are waiting in hospital for a permanent solution are seen not as a privilege to have because of their generally fewer medical needs and more pragmatic view of what medicine can accomplish, but rather are seen instead as ‘bed blockers’ best sent to wherever there are ‘open beds’ even if far from home and family.
This reality has created a new health care sub specialty, the bed manager, who’s job is to be the air traffic controller of ‘beds’ (again, these are resources, not furniture, space, or even patients). Our Northern Zone bed manager has been trying to ‘bed traffic control’ some ‘bed blockers’ to Tatamagouche because of the present ‘bed crisis’. For a number of reasons, both particular and principled, the doctors in Tatamagouche are not pleased with this
This weekend my mom and dad were visiting for mom’s 90th birthday, the first visit DC (during Covid) that we had had with them. As often happens, the conversation ranged widely with 3 generations having different thoughts and attitudes on a number of topics. Heroes came up, does a society need heroes, and how do we deal with people who have behaved both heroically and dismally. How do we define society. This led to a discussion on the intersection of individual rights and responsibilities, especially during the pandemic and the racial reckoning that the world is facing. We agreed that some societies emphasis individual rights and others group responsibilities. One could argue that in times of health and wealth a country devoted to the individual looks very attractive, in times of sickness and struggle a society devoted to the collective looks good. For example one could see the US as focussed on the individual and South Korea focussed on the collective, with Canada between. As of the time of this writing the US has 10.3 cases of Covid/thousand citizens, Canada 2.8, and South Korea 0.3. This would seem to be almost directly related to the degree with which I am willing to put aside my individual rights to take up responsibility to my society.
This led to the question, ‘what is a society?’ I recognize we seem to have gotten a long way from ‘beds’, but I found the answer enlightening to the issue at hand. A society is a group that is committed to each other. It really doesn’t exist except in the minds of those who are aware of it. A star exists whether I know its there or not, but a nation-state, a group, a town, an organization only exist because it is acknowledged to exist. Take Yugoslavia as an example, or Crimea. Do they ‘exist’. For that matter Tatamagouche. Our little town exists in the hearts and minds of its residents as ‘home’ and in the thoughts of many vacationers as ‘fun’ and ‘pretty’. It is somehow an amalgam in our thoughts of geography, history, hurts, longing, friends, rivalries, disappointment, and support. Without those thoughts and commitments, it ceases to exist.
Now, I was not born here, but I consider this home. I would take my responsibilities for the well being of Tatamagouche seriously as it is my main geographic society. That sense of responsibility is not limitless for me, but I think that I can name a few people who would put aside all individual rights for this town. I have other ‘societies’ that I feel responsible to. My family, the hospital, my patients. In past years the hockey team I coached, maybe even 4H. It is interesting to me to think of some of these. My patients are probably a society only in my own mind, and yet I would feel that I am responsible to them. All of these ‘societies’ could rightfully make demands of me that I would seriously consider, and likely do.
This leads to the bed pressure. I realized this weekend that the real root of the issue is that I don’t believe in the health authority or the Northern Zone as being a society that I am willing to accept responsibility for it’s good. The Northern Zone does not ‘exist’ in my heart or mind in the way my town, my hospital, my patients, or even 4H does. I also realized that I am not alone in this as a health care provider. This disconnect between an organization demanding that providers meet seemingly ever-increasing responsibilities, and providers who are living and working with that organization not even ‘existing’ in their circle of society is leading to greater and greater health care dysfunction. Because of this, administration demands responsibility and providers demand rights. There seems no way forward. Future blogs will look on how to break down the demand-distrust-despair-disunity that plagues health care today
