What causes misanthropy

 

I heard a podcast recently about stroke care: the sad fact that over the couple of decades between her husband dying from a stroke and her son having one stroke care has barely changed. She talks of how doctors assumed in both cases that disability was permanent, and rapid decline to death inevitable, and that this was their prognosis.

She was a journalist, and spoke to various stroke experts, and the more expert they were, the less certainty they had over any one prognosis. Her husband had begun to recover his ability to write when he died; her son had regained the ability to walk, but she had to fight for his treatment. Emergency thrombolytic treatment has been invented that reduces the damage caused by a stroke but is to be given within 4 hours of the stroke.

He had a stroke while sleeping and when his wife woke up in the middle of the night was told an ambulance would take 4 hours to arrive. A kind neighbour drove him to A&E and they arrived 4.5 hours after he had gone to sleep.

They initially refused him the thrombolytic treatment, even though the 4 hour limit is a guideline: biology rarely has absolute cut-offs, and also despite the fact that it was most likely the stroke had occurred within the 4 hour limit.

He was given physiotherapy, which is vital for stroke patients; they need constant exercise for their immobile limbs to prevent them painfully atrophying and help them rebuild the nerve connections for control. But the hospital could only manage 2 sessions a week, which hardly counts as constant. 2 a day would be effective: one stroke expert she interviewed called his 'homeopathic physiotherapy'.

I find such stories annoying much of the time: one anecdote proves nothing about the wider world. This one chimed with me because it is exactly how my mother died. She had a catastrophic stroke during surgery (we will never know, now, whether this was a mistake or a tragic accident) and spent a couple of weeks on a stroke ward receiving care and physiotherapy. She smiled, she talked, she beat the staff at Scrabble and was, broadly, her normal self, despite being completely paralysed on her left side: her arm would not move, her left mouth barely moved.

Then the hospital said it needed the bed and kicked her out to a care home. Without physiotherapy her immobile arm seized up and she was given massive doses of opiates to kill the pain. These also sedate people, and she spent the rest of her miserable life either forced asleep or in even greater pain than she had endured during her better years, before finally dying of a lung infection, probably caused by breathing in food when someone in the care home was trying to get through the long list of people needing to be fed.

These concrete anecdotes demonstrate how lack of funding directly kills people. It's not just an abstract concept that means nothing. Ambulance services that cause many emergencies to wait; junior doctors who don't fully understand the treatment protocols because they've been given massive responsibility, insufficient training and are stretched too thin; physiotherapy cut to nothing because it doesn't sound important; stroke wards with capacity for one third of the stroke patients in the area (and because this kills off so many early, this could be more like one fifth of an appropriate level); these all kill people.

When our doctors provide us with a bad prognosis, it might be their experience, but it might also be a self-fulfilling prophecy. It's not the case that disease is simply terrible and bad outcomes inevitable.  This is sometimes true, but often we have caused the outcome to be bad through our voting choices. I would give all my wealth for my mother to have been saved for another few years of conversation. Most people feel the same way about those they love. And yet we resent tax increases of a few pennies; we prefer to have a bit more money to spend on cheap tat than keep people alive.

Every week there's another story about a brave campaigning family trying to get very expensive treatment for a disease. Hospital bosses are typically portrayed as the enemy, evilly refusing treatment that this family knows might help.

That money might save dozens if the boss spends it on faster ambulances, or a handful of people if on physiotherapy. Hospital bosses are papering over massive holes in care, barely managing to make it look serviceable. You might argue that this is counter-productive; that if they funded some carefully and had none left for the more expensive diseases at all this would show how poorly-funded they are. You might argue that some hospitals are run inefficiently: that some bosses are better than others and inefficiency could be spent on care. This is probably true, but this will be 1 or 2%, or maybe 5% of the total. 

The real enemy is us. We are the ones giving bosses 50% of what they need. We vote for politicians who say they will fix things by reorganisation and new targets, and maybe a 1% increase in funding for some areas when inflation is 6%. We voted for politicians who burdened hospitals with massive, real, PFI costs just so that they could pull off an accounting trick.

We need to stop ascribing to disease what is a result of our social systems. When doctors give a prognosis for a stroke, that's more because of human decisions than biological necessity. 

When I think of why my mother died, it wasn't an inevitable consequence of disease. It might have been a careless anaesthetist. It wasn't a mean hospital boss; it wasn't the consultant who discharged her from the ward. It was you. It was the people I walk past on the street. It was the not-so-great British public who voted for a Conservative government that cut government services. She died because of humanity's short-sighted selfishness, trying desperately to grasp onto a few pieces of silver at the expense of our humanity.