In praise of inefficiency

Charlotte Squires is now delighted to be back at work as a medical registrar in the Scottish borders, having completed treatment for advanced Hodgkin’s Lymphoma. She intends to specialise in Geriatric medicine and tweets at @charsquires

I love being a doctor and hospitals have long been something of a comfort zone; predictable, with protocols, and plans, and SOPs. To me, they often feel more controlled than the unpredictable world outside. When I am working, I know my role and its expectations, who to phone in any given situation, and how the system fits together.

This feeling vanished entirely following an unexpected diagnosis of advanced Hodgkin’s lymphoma, whilst working as a medical registrar in New Zealand.  I returned to the UK for treatment, leaving behind a job, a home and a country, but still found myself spending long hours in hospital – only this time as a patient, with a name bracelet instead of an ID badge and a chemotherapy schedule instead of a rota. I’d pitch up to the day unit for my eight-hour sessions, shackled to a drip stand and dependent on the system I had once been part of, feeling horribly vulnerable and very out of place. I wanted to be done and out the door as soon as possible - inside the building, I was a pitiable cancer patient, surrounded by the reality of what was happening; outside, I was still me, though newly bald and very shaken.

Often, just as when I was working, there were delays and inefficiencies. The drugs weren’t available at the right time, or there weren’t enough staff, or chairs, or pumps - all recurrent and familiar issues. My long day would be longer still and I’d silently get increasingly irate as I watched the clock, desperate to leave.  I’d think about how for me, with my hopefully curable disease, waiting was one thing, but how unfair it was to make people with a poorer prognosis waste their limited time in a plastic chair, in a windowless room, when they could be at home, doing as they pleased. I’d start angrily working out ways to address this, as I’d done for efficiency issues when I was working, conjuring up ideas for quality improvement projects and spreadsheets, only to realise that now I was a patient, not a doctor, and therefore unable to complete them. My role had changed. My role was merely, now, to wait.

One day I found myself in a chair next to a frail, older lady I knew to be a regular. She was always greeted warmly by staff and always seemed cheerful. She asked me if I’d been waiting long. ‘Two hours’, I replied. ‘It starts to get a little annoying’.

‘You’re young and probably want to go home’ she said. ‘But I love coming here chatting to everyone. I quite like it when I get to stay longer, it’s lonely when you can’t get out like you used to’. We talked some more, and she told me about her lovely husband who had died, the busy daughter in another city, the difficulty walking, the long and lonely days in an empty house she could not often leave. To my surprise, another patient, also older, joined in the conversation and explained how he felt the company perked him up as much as the regular blood transfusions did. I found myself falling quiet, no longer angry, wondering if I had misjudged the situation entirely.

The NHS does many things for many people and I’m proud to work for it. Until that moment, I hadn’t realized that almost by accident, it provides the contact with society that some of our older members desperately need, and for that I will gladly wait an extra hour. John Donne wrote that no man is an island, but nowadays I’m not sure this is as true as it once was, as families live apart and our sense of community seems more nebulous. Going through cancer treatment is hard but would have been harder still without the family and friends who have carried me through and who continually support me. This exchange reminded me that having social support and capital is a not a universal privilege, something I had been aware of before, but perhaps did not fully comprehend, and that I suspect is more widespread amongst our older patients than many of us realise. This moment was a stark reminder that loneliness is both endemic, and ignored. We know that some of our most isolated people rely on the district nurse, or the postman, or the delivery man, for some much-needed social contact. It seems that they also rely on our hospitals. It had never occurred to me that just as I found comfort and security in my workplace, that patients sometimes find this too. Whether we should be proud, or appalled by this, is unclear. For those of us who are islands, the NHS can be a passing ship offering much needed social contact.

Sometimes, a little inefficiency is a better thing than it first appears.