5th January 2005
A successful outcome is now expected from every medical procedure. I have heard a person, well heeled and articulate, say that when he went to a doctor he was making a contract with that person to make him better, to cure him. He was rich he said, could go where he liked for treatment and expected the best that money could buy. The frailty of the human body or God Almighty's grace weren't mentioned, as I remember.
My friend Gerry was not like that. In his seventies, and a very lively person. His heart was giving trouble and he was told an operation was the only solution. His cardiologist, the cardiac surgeon and his numerous medical relations explained the risks but Gerry was determined. If it would improve his breathing he had to go for it, life was becoming very tedious after any exertion, he said.
I telephoned him the morning he was to go into hospital to wish him well. He was very excited, very hopeful and with full confidence that all would go well as indeed were we, his friends and relations, who were hoping and praying for him.
The operation went well, it was a success. Gerry was in intensive care. The problems were minor his wife said, when I telephoned her. I talked to his wife about the excellence of the centre at which the operation had taken place and was suitably reassuring all would go well.
I was phoned back later that night to say Gerry was dead. I went to his funeral a few days later. With truth, we all agreed, and a fine proportion of those assembled were medics, Gerry had just died. He was doing well and then suddenly his body in its late seventies just gave up. The operation was a success but the patient had died.
Gerry is the fourth friend of mine in his seventies who has died after or during elective surgery. I don't think I'm an angel of death but I think we more and more have lost sight of the fact that no matter how good the care received the body can just give up. One of the other friends who died was also having a heart operation. But the other two were plain ordinary hernias.
Medicine has improved dramatically in recent decades, new surgical procedures, new drugs, better anaesthesia, better post operative care. Everything is better but the human body is the same. Resilient and fragile at the same time.
To this day I can remember the person I first knew of die following an elective operation. At the time, the Good Old Days in Trinity, we had to read for an Arts degree as well as medicine and I had opted for Modern English. The lecturer was wonderful, his wife charming and they had a delightful little son. The little son had a big problem, however. We medical students had just been aware of it in embryology and anatomy. He had Fallot's tetralogy, a combination of serious congenital malformations of the heart. Cardiac surgery was in its infancy in Ireland and when he was about six the couple set off with their little son to the Mayo Clinic. Well, backwaterspeople we might have been but we knew they could do everything perfectly at the Mayo Clinic. So with great good cheer and none of the apprehension that the young are fortunate to be without, we waved them goodbye.
You can guess what happened. The little boy did not come back to Ireland. Not even the mighty Mayo Clinic was able to heal his little heart.
Three of my friends who died were in the private part of our medical system. Money can't buy you love, as the song says, and it can't necessarily buy you a successful medical outcome. Everyone, be they working in the public or private health care system, is trying, hoping all will go well. No one wants anything to go wrong. Everyone is working towards the best outcome. It is in our training and ethos to do so.
I write this gloomy treatise, because sometimes I feel there is still that illusion in patients' minds that if it is private it must be better. Sixty per cent of Irish people now have private health care and its advantages are advertised every day. But in the most serious of situations, for example major accidents, it is to public facilities that we all need to go.
This is why the Health Bill 2004 which is now upon us is so important. This Bill is to improve the management of the Health Services so that we all get what we need, which is what we should want.
Senator Mary Henry, MD
