Care in the ‘Land of the Free’

It is not a secret that the wealthier receive the best medical care.  The poor receive the least in amount, type, speedy-ness, and quality.

I am a person who is in a low-cost health care program called ‘Healthy San Francisco.’  No doubt, this service is better than nothing and I am grateful.  I am very privileged to be in the US.  At the same time, I am afraid for my life and others’ lives (that are not rich).

Individual nurses and doctors at both South of Market Medical Clinic, where I was first received for my emergency care; and then at St. Francisco Medical Center where I would stay for six days for this particular ailment, was pleasant.  The individual nurses, on the whole, were mostly pleasant, engaging, and listened well and took care of me as best they could.  Particularly at St. Francis in the ICU (Intensive Care Unit) where I was first rushed to for my treatment, the care was top-notch and comforting, aiding in my recovering, I feel.

The problems I saw, were in the system.  I think there are several reasons for these ‘problems’ that I saw.  On two occasions, I could’ve died from ‘mistakes’ if things would’ve been just slightly different.  I feel that my stay at the hospital was made more stressful, and therefore NOT conducive to healing and empowerment and comfort, because of politics and the organization of treatment.   What the nurses, especially, must navigate in order to do effective work, is largely shut down.  The system is supposed to work in favor of all: the patient/client, the various nurses (RN; the aid; floor manager nurse; etc.) and the doctors and specialists.  What really makes the organization worse, are the intentions of the administrators and bureaucrats of  hospitals.  These administrators want the best hospital around so that money would come in and continue its flow through the halls and into the medical journals and cocktail parties.  Reputation comes from receiving high merits and having less trouble.  Most of the administrators never see patients on a regular basis, and rarely do they speak to the staff, unless there is crisis.  Crisis management is what ‘management’ has become.  It is no longer about everyone being on the same page, so to speak.  The client/patient and what is best, is the furthest thing from that arena.  Its link with capitalism is the tightest and closest, and therefore, cannot afford to pay too close of attention unless there is some financial benefit.  The care is left up to the nurses and doctors and specialists, but they are deeply affected by the organization of things.

In my six days of stay in the hospital, I went through 42 different nurses.  Three different nurses on staff= one day shift group of  three nurses (an RN, an aid, and the floor manager nurse), and a different set of three for the night shift.  Everyday they would diligently come in and write their names on the white board so I will remember their names.

At various points along the way, one nurse would refuse/ignore reading the chart that has my treatment, and would actively contradict what the last nurse told me.  Even as I insisted, they ignored and talked down to me as if I were a child.  In all fairness, I know that for most people, when they take care of others, they speak in a tone as if they are taking care of a child.  This would be the only reference many people have as far as ‘taking care’ and how to speak to people.    But to assume that patients don’t know what they are talking about is the biggest crime of most all of mainstream dominant western medicine anyway.

My mother was a medical student in Japan, in the postwar period.  Japan has had centuries of its own medicine system, combined with indigenous and Chinese and Korean medicines, Ryukyu and Ainu systems, and Dutch and Portuguese medicine.  The one thing my mother told me was that after World War II, the American doctors actively shamed the Japanese doctors in front of patients and their families.  It had to be done in a western way with ‘western medicine.’  Japanese doctors were used to using a vast array of medicines and treatments that did not rely on surgery, pills, and shots.  But she remembers that everything began to be turned into one of those three material things, giving the companies who owned those things (the fluids, the implements and technologies, etc) money.  My mother also said that one of the best things she remembers about Japanese medicine is that the doctors and nurses listened to the patients about their own ailments and feelings and thoughts and adjusted and discussed.  She said that the Western doctors just wanted to know where things were wrong in the body, then that would be the end.

This is certainly what I experience in US hospitals.  It is very violent, from my point of view.  The patient  (in this case, me) is an object of the doctor’s technology.  The doctors’ careers rest on their using technologies and medicines that they are brainwashed into loading into their career package, and their own package of techniques of being the identity: DOCTOR.

The doctors decided, according to one nurse, to take out my IV (intravenous) needle.  The next morning another nurse started putting another back in, even after I told her the doctor and nurse said I didn’t need one.  She didn’t even look at my face during the whole time.  The other nurse at night, said that she had a talking with that nurse and asked why she didn’t read the order that was written on my chart?  The nurse said ‘she didn’t bother.’   This is scary!!

Many things happened during my visit in the hospital.  What I come away with is that the foundations of our American society are based on being dependent.  People talk about being independent but it’s hogwash.  There is no power or even acknowledgement when it comes to leaving our health in the hands of ‘experts.’   We do need medical people and people who care.  But ‘care’ in the US, at least in the medical field but most likely in many places and sites, has become just something an individual does with their tone of voice and asking the same questions over and over and then we’re supposed to give them an answer, even though they already know the answer and will contradict you anyway.  Even if we tell the nurse or the doctor such and such, the nurse or doctor may do what they want anyway.

At one point, the fluids going into my body (in this case, heparin–which thins the blood) is supposed to be at certain levels and was not happening.  The nurses changed the machine and did things.  I asked one nurse what was going on and she told me not to worry about it.  Not to worry about it????????    Then a few nurses came in discussing with each other in front of me and were tinkering with the buttons and levers on the machine.  Obviously something was up.  Then the one nurse honestly told me that the wrong level of heparin was going in because the wrong bag was replaced with the other fluid.  She said that luckily the levels became too low and would not have harmed me as much as if it were tweaked the other direction by mistake.  Apparently the wrong buttons were switched on and off  (there were two different fluids going into my body and they were reversed).   I, apparently could’ve died if it was the other way.  How comforting.

The nurses were irritated.  With each other.   How can they care for me effectively?  With 42 nurses in a six-day period, they rely on paperwork for information, if not actual dialogue with each other.  They clearly did not trust each other’s words either because there seemed to be some nurses who don’t even read patient daily reports and instructions on the job!!!!   So there is fear and irritation.  Most of the time, when the nurses visit, they were in a hurry to get to all of the patients in their rounds.  Doing their jobs.  Healing is not their job.  Healing is seen as ‘giving medicine’ and doing the appropriate technologies.  The individual nurses understand the patients more and understand that other things are needed.  But they don’t have time.  They must fill a quota on their rounds and do huge amounts of paperwork and administrative work.  The managing floor nurses have the worse jobs.  At St. Francis, the reason there are so many nurses is that all the nurses rotate through all of the different nursing jobs so that there is no burn-out.  It is disconnected from patient care.  But they have to do this to keep their jobs.

Why, would the rotating of nurses be done this way?  Why not continuity?  I know for one fact, from being anthropologist of social change and violence, that a tactic of administration in dominant first-world nations now, is to not allow too much time for workers to fraternize and share information and to ORGANIZE.  So there would be no time to organize against grievances and injustices if the workers were kept working on crazy shifts that went against their own interests.  This IS A TACTIC.   Instead of acquiesing, I always feel that resistance must also become creative.

Western medicine is not about healing, or even preventing illness.  It is about feeding the drug companies and the technologies of western medicine.  When acupuncture was not taken seriously, it was off-limits.  As soon as the western establishment learned how to incorporate it into the system, that is when there was more so-called ‘open-ness’ to acupuncture, albeit slowly.   It is racist and capitalist.  It effects what we need to care for each other.

My feeling is that we are living in a degenerating USA and it will not get better in the short term.  Our economies continue to collapse and the richest of the richest will fly their health care people privately into their rooms or resorts via their private jets and they will be the cream of the crop with the latest in technologies.  They may even have a Peruvian, Ainu or Yaqui or Hopi shaman and a indigenous visionary healer from Kurdistan or Finland to heal them.  The rest of us must be disempowered enough to totally in the hands of the capitalist doctors……or begin combining old medicines with new, or leaving western medicine altogether, and other such ways.  Also, I know quite a few people who have undertaken paths to ‘know our own bodies’ to resist the disempowerment of the current western systems.

Memory can perhaps serve us, and also not just to co-opt and use, but to understand what has been lost.  Some of it can be recovered but we must know what can work in these times even though they may have worked in another cultural and historical context.  We have differences and similarities.  We need discussion.  We need negotiation, we must also pay attention to our own colonial personalities that wish to co-opt without understanding or respect to history, etc.  We must also not think of ourselves as biologically and culturally determined as well.  In taking care of ourselves, what does this mean?

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