Hell's just some people

‘Hell is other people,’ wrote Sartre.

My own feeling is that in reality it’s only certain other people that are hell. And some of them one can adapt to.

For instance, crying babies in planes used to drive me crazy until I had my own children, at which point my attitude went through a complete reversal. Now, when I hear a child crying I just feel sorry for the parents. I know how embarrassed, upset and impotent they feel, as they struggle with an impossible task, quietening an unhappy child. Or an angry one.

I was reminded of that today when I heard a baby wailing in a flat next door to us. It didn’t last all that long, but while it was going on it was clear that the parents were completely unable to calm him. He wanted something, he wanted it now, they weren’t able – or perhaps willing - to supply it, and he was making his displeasure fully known. Not to just to them but, as in our case, to the neighbours too.

He knows he wants something and he knows he’s not getting it.
That annoys him. But at least he has the potential to learn

Still, the noise didn’t irritate me. I’ve been there, held a wailing child, wandered around in the moonlight with him on my shoulders at 2:00 in the morning. I know what it’s like and can’t work up any annoyance, just some fellow feeling and a trace of ‘thank God that’s not me any more’.

In any case, it’s easier to forgive noise from babies because they are creatures of pure potential. Who knows what they may turn into. And, above all, they could well learn self-control.

It’s far sadder when the noise is being made at the other end of life, when there’s so little less to hope for. Visiting my mother in hospital, where she’s struggling against a battery of conditions that tend to afflict a 93-year old, is pretty depressing and not just because of her state. On one visit, when I arrived in the ward I could hear a woman down the corridor shouting quite as loudly as the baby next door today.

‘Help me! Someone help me! I need help! I need it now!’

I was there for nearly two hours and the shouting never stopped. People in the nearby beds must have found it insufferable. She was surrounded by nursing staff who were, clearly, helping her, but her problem wasn’t physical, it went far deeper, to an area within her well beyond their reach. Like the child, she knew she needed something, and knew that no one was providing it, but had lost the capacity to comprehend that they could do nothing so that continuing to clamour was ultimately pointless.

What made things worse was that before I even left the four-bed bay where my mother was sleeping, the woman diagonally opposite her also started to cry out.

‘I need help. Now. Urgently. I need to see a doctor. Straight away. Bring me a phone. I’m going to phone a doctor. I need a doctor. Come now and get me a doctor. I need a doctor now.’

The litany went on and on. At one point she spotted me.

‘You there. Yes, you. The man sitting in the corner. Bring me a phone. I’ll phone for an ambulance. They’ll get me into hospital.’

‘Err…’ I replied, ‘you’re in hospital.’

Not useful, I know, but I’m not much good in these situations. But simple pragmatism? It clearly wasn’t going to put her off.

‘I need a doctor. Bring me a phone. I’m going to phone a doctor. I need a doctor. I need a doctor now.’

Then she decided to adopt a new tactic.

‘I’m getting out of bed now. I’m going to look for a doctor.’

She made ineffectual moves towards leaving her bed.

‘Now, Sylvia,’ said a nurse, ‘you stay in bed. You might fall down and hurt yourself.’

‘I need a doctor,’ replied Sylvia.

‘A doctor will come and see you. But the doctors are busy just now. They’re in the Emergency Department.’

‘Well, I’ll get up and fall down. Then they’ll have to see me.’

She may have been not entirely conscious, but I have to say, her logic was impeccable.

The sad thing about these older women was that, unlike the child, there was little hope of their getting better. Of developing new self-control. Like the child, they wanted gratification immediately, and they’re unlikely to learn what the child may, that there’s much to be said for deferring gratification. If only, to avoid immediate disappointment.

That makes their protests harder to bear than a baby’s. Though they’re still not the least bearable of all. Those are the wailing cries of entitlement that come from people who are technically adult and who have neither the excuse of the child who hasn’t yet learned, or the older person who’s losing the lesson.

One of the saddest aspect of the world today is just how many of such people are in positions of power. Supported, apparently, by growing movements, in nation after nation: nationalists in Italy or Hungary, backing Brexit in Britain, voting for Erdogan in Turkey, supporting Trump in the US.

Now those adult babies really are insufferable.

He wants gratification. He wants it now.
And there’s no prospect of his learning better.

The dirty dozen

A great storm in a teacup last weekend. We were glued to our TVs and our newspapers. Well, perhaps not glued. Fascinated. Maybe that’s overstating it too. The stories caught our attention at least. And we talked about them. A lot. For an hour or two.

The subject: the ‘dirty dozen’ most underperforming hospitals in England.

The report that identified these citadels of shame came from Dr Foster Intelligence (DFI), a company that established its credentials a few months ago when it denounced Mid Staffs NHS Trust as an organisation that had chalked up 400 more deaths in three years than one would expect. Hospital leaders resigned. Auditors audited. Journalists journalised. All very exciting. Particularly as it’s my local hospital and a good friend works there.

So when DFI spoke out again last week, obviously they got an audience. And this member of the audience took a look at their website and at the methodology they’d used.

They had judged English hospitals on the basis of fifteen indicators. Most hospitals have 20 to 30 specialties, so the report didn’t even use one indicator per specialty. Four of their indicators concerned mortality – but only mortality after a specific type of case. Six of them concerned readmissions, i.e. when a patient has to return to hospital to fix problems that emerged after discharge – but again, the study looked only at certain types of readmission. And the other five indicators were all very specific – for example, the surgical technique used for gall bladder removals (and no other surgical technique at all).

A bit limited, you might feel. To give you an idea of how limited, if you were going to evaluate just one specialty, obstetrics – one of the biggest, since delivering babies is a major part of the work of hospitals in the West – you’d want to look at least at caesarean rates, episiotomy rates, perineal tears, forceps deliveries and post-partum haemorrhages. Five indicators. As a minimum. And you’d want to adjust them for risk – after all, if you’re treating high risk patients, you would expect a high rate of difficulties. Failing to take risk into account just penalises those hospitals with the guts to take on the toughest cases.

And then there’s the use of mortality as a measure. The study only considered mortality in hospital. That means that an institution which transfers its sickest patients to another hospital or sends terminal patients home (which may be a good thing to do, by the way – many dying patients prefer to end their lives in their own beds) will have an apparently lower mortality rate than others.

So a pretty flawed study. A flawed study which didn’t, by the way, class Mid Staffs among the dirty dozen. In fact, Mid Staffs did far more than avoid the bottom twelve – it actually came in at number nine out of 146. ‘Good work’, you might think, ‘the new management has really turned that hospital round.’ Except that the data on which the study was based came from the period ending 31 March 2009. And it was in March that the scandal about the hospital broke.

Oh, well. It made for some amusing reading and a lively conversation, on a grey winter Sunday. Before we moved on to a more intelligent topic.