… steps out into the early morning. Mist covers the river as he begins to run, turning east toward the sea. Along one bank for thirty minutes, across at a road bridge, back on the other side. Pounding along in his new trainers. He feels that flicker of satisfaction that always accompanies something new and well designed. The shoes mould to the shape of his foot, with just the right curve beneath the arch. The soles are firm yet spring readily on impact. Each time he buys a new pair of running shoes, the technology gets better.
He checks his watch. (Timex, digital, accurate, lightweight, snug on the wrist: another improvement.) 6:03 and another day lining up. You’re never quite sure until you get in, of course. That’s what drew him to emergency in the first place: the absolute certainty of uncertainty. On the alert at the frontline, handling whatever comes through the door. And now there is another uncertainty. Bloody Barry. And the deadening panoply of idiocy that has been dropped upon them from above.
Management. It’s as if all those zombies you thought you’d left behind in the fourth form have been given new life and walk the earth. The dullards of 4C, destined to spend their lives as salesmen or clerks, or, if they were lucky, a vague attempt at a commerce degree, part-time, arriving on campus after a day spent in some dire office, still wearing collar, tie and pressed trousers, when every other student wore jeans and a T-shirt. But now it’s their turn, the office drones. Somehow they have morphed into management. Awarding one another bigger and bigger salaries. Men like Barry.
Barry knows a lot about selling apples, but not a lot about medicine. Yet Barry talks blithely about ‘efficiencies’. In the plural. Barry inhabits a refitted office overlooking the river with smart leather chairs and a desk clear of clutter, while he, Paul, a mere functionary on the factory floor, labours in a broom cupboard near the emergency room, its shelves piled high with papers and files. Tidiness had never been particularly valued in 4A. What mattered then was getting good marks in chemistry and maths, what mattered was As in physics and biology, and dux or proxime accessit and a scholarship, then surviving the first year scrambling for admission to med school, and the years that followed of long hours, high on exhaustion and adrenaline as you walked home to some defiantly grotty flat on Cumberland Street. What mattered was doing a fine job, making a calm and considered assessment under pressure: ‘Don’t do something,’ as one of the supervising consultants had said to him when he was starting out, ‘just stand there!’ Make the assessment, determine a course of action, set in train a decisive and orderly procedure. Confront day by day the multiplicity of disasters to which frail human flesh is hostage. Do his best for his patients according to his ability and judgement. Do no harm. Heal.
A tidy desk and efficiencies are the priorities of another school of thought entirely.
Mist furls and swans and scaup leave long arrows on the serene surface of the river. He pads along beside it, liking the sound of the tarmac beneath his excellent shoes, liking the in and out of the cool green air, the steady ti-tup ti-tup of his heart. He likes having a house here, close to the river. It had been an economic choice to begin with, beautiful but in need of renovation and on the unfashionable eastern side of the city rather than the more expensive west. It was the best he could afford at the time, given the inordinate cost of sending his children to schools where they received the same education others received free. The kinds of schools that had chapels.
He had protested: What was wrong with the local high school where they would learn to mix with everyone, the way he had in Hokitika? As Diane must have learned, presumably, in its Taihape equivalent? But Diane had insisted, and off their children went to the kinds of schools where it was proposed that the senior students might benefit from a field trip to Pompeii.
‘Pompeii?’ he’d said. ‘What’s wrong with a trip to the cheese factory?’ Or to Wellington to see the leaders of democracy yawning on the parliamentary benches? Or the trip to the car factory, observing people standing by a conveyor belt, making the same adjustment, over and over, to a Holden chassis? The trip that had persuaded him to stop mucking about, pass exams and work his way up and out.
‘Pompeii? And Greece? Who the hell needs to go there at sixteen? It’s the bus trip everyone remembers: the kid who throws up, the chance to sit next to the girl you’ve been eyeing up for months. That’s what field trips are for.’
They went, of course. Everyone else was going, it would be a once-in-a-lifetime opportunity, and Diane had hissed that he was being ridiculous, as if he were depriving his offspring of essential nourishment. They went and returned clutching Benetton bags from Milan. So much for the Acropolis. So much for the Doric order.
Now he’s glad he lives near the river where, each morning, he can run beneath the trees down to the road bridge and back. He pads along, to that simple, easy, duple beat. Ahead lies a day of argument with Barry and the other graduates of 4C. It’s a disaster. An emergency department without enough beds while they witter on about competition between the city’s hospitals, as if they were rival companies scrapping for business. Forget Hippocrates. Forget ‘do no harm’. This was medicine as profit-making enterprise, sick bodies as marketable assets: roll ’em in, fix ’em up, get ’em out, like some cut-rate garage attending to a succession of broken-down Toyotas.
It took so much time and energy to voice dissent. One of his colleagues had done the maths: quite simply, the department needed more nurses, more staff. In Australia, they reckoned on one full-time equivalent per 1000 patients per annum.
Paul categorically refuses to use Barry-speak: consumers, clients, units. They’re patients, damn it. It’s a good word, an old word, for people who are waiting as they mostly do, with the touching submission of the ill and damaged, for him or someone like him to do his best to make them well. It is their trust that most appals him yet makes him come in, day after day, to do his job. These are not consumers, fecklessly occupying their free beds, gobbling up some finite resource. They are patients. He makes a point of using the word when talking to Barry and his mates as they chatter in their alien management tongue.
In this hospital, the figure is more like one FTE per 1529 patients-not-clients per annum.
In Australia, they reckon on 27.75 doctors to safely operate an emergency department equivalent to the one where he works in this city.
This department operates with eighteen doctors, often house surgeons, eager and bright but inexperienced, with a registrar, exhausted after long hours on the job, without proper supervision, at risk of making wrong calls.
People could die, unnoticed by distracted, overworked individuals doing their best to cope, not reading crucial notes, missing some detail in the rush of handover, in the muddle consequent on Barry’s ‘efficiencies’, which require the closure of certain wards overnight, the way you shut down a factory line. Patients with head injuries end up in urology, or the medical day unit, or parked for hours in the traffic jam in the hallways, with, always lurking, the constant risk of infection.
And still the Barrys in management and ministry talk in their big cool offices about financial performance. And all of them, the staff, have been locked into their vision, signing absurd job descriptions, while the patients wait on the trolleys with their bleeding heads, their worried relatives.
But ah yes! Savings must be made, $12 million, a figure arrived at by management without consultation with Paul or his colleagues, for they have been relegated to the fourth tier of management in this efficient structure, beneath three tiers of Barrys to whom they must report: the service manager, the general manager, layer upon layer, as in a car factory.
Paul breathes, the green air entering his lungs, cool and clear. On the river the scaup dive and pop up at unexpected angles. He runs beneath the elms along the far bank, crosses the little footbridge and heads for home. Back along the river and onto Savage Street, into the cool shadow of the driveway and up the steps to his own front door. Half an hour to shower, dress, get to work.
And he doesn’t mean to, but as he goes inside, he slams the door. It swings to, heavily: so heavily that one of the little pink glass panels set in the doorframe cracks across from side to …