Loula S. Rodopoulos
Torrential rains and winds thrash us as we alight from the bus and negotiate oncoming traffic. Cars – windscreen wipers on full speed, headlights full beam, begrudgingly slow down to allow us to cross to the hospital. There are no traffic lights or pedestrian crossings. As we reach the other side of the road and step on to walkway, the umbrellas snap in our hands. We wade through spreading puddles of mud, splashed by water from the footsteps of other commuters. I fear slipping so, head down and bags tucked under my left arm, I tread warily. By the time the warmth of the hospital heating hits us our clothes are dripping wet. It is 8.45 am. We left home from a nearby township at 7.40 am.
We resolutely stride down the corridor to the Oncology Unit situated in a major, University linked, public hospital, determined to secure our position in the inevitable queue. I drop the health insurance book and latest blood test results on the nurse’s counter. I then hurry down the corridor, around the corner and grab a hand scrawled numbered pink prescription ticket, left in a makeshift holder outside Office 1, to secure a place in the prescription queue.
A side entrance door, situated on the left of Office 1, rattles in the high wind as people strain to pull it open and enter. Hurrah – number two! It should be a smooth process. We’d be back home around midday I thought! I was the intermediary for the day, attending to hospital administrate matters on behalf of my brother in law Nicholas. Patients, without a friend or relative to act as an intermediary, often pay a foreign domestic to carry out these tasks.
This was not my first experience as an intermediary. In 2008 I’d written to the then Minister of Health in Greece suggesting improvements to the Oncology Unit conditions and procedures. Now, due to the necessity to assist Nicholas with his second round of chemotherapy and the quagmire of papers, signatures and stamps needed to ensure treatment I had promised him that I’d keep my mouth shut! The intention of my 2008 letter was not to censure either doctors or nurses who work in the Unit but to point out the deplorable physical, administrative and industrial conditions they work in. I commented that these conditions detracted from any semblance of dignified and therapeutic patient care. Unfortunately, notwithstanding my resolve, today’s experience confirms that nothing has changed.
We find seats and peel off our saturated hats, gloves and coats. My handbag is soaking and documents in a canvass carry bag are damp and smudged. I watch other patients, with family intermediaries, negotiate the swelling corridor and overhear rumblings about chemotherapy drug availability – but take little notice.
We sit and wait for the replacement of the health insurance book back on the nurse’s counter – the signal for me to line up at another counter in the main entrance of the hospital to obtain a “ticket of hospital admission.” Nicholas waits to be called for treatment. A doctor, presumably, checks the blood test results and approves treatment for the day dependant on these results. If the results are of concern for some reason the patient is approached in the corridor and told that more blood tests are required.
At last I have secured the “ticket of admission”; return to the Unit; leave a copy at the nurses counter and look for Nicholas. He tells me that he was called by a nurse and asked whether he’d brought one of the three-chemo drugs required with him. The hospital had run out of the third drug that finalises the treatment session at home. Nicknamed the “take home baby” patients cannot commence treatment unless all the drugs are available to complete the session. The “take home baby” is a bottle of chemo that is inserted into the patient’s infusion port and takes a day and a half to infuse. Nicholas is told to wait while the head nurse contacts the hospital pharmacy to see what, if anything, can be arranged. Nicholas is angry and berates the hospital for not informing him of the problem – “How was I to know? Smell it through my fingers?”
We wait impatiently. It is ten minutes to ten. The writing of prescriptions commences at ten. I decide to wait outside Office 1 just in case treatment goes ahead. I stand near the side entrance door. The wind has not abated. I ascertain from others waiting that Number 1 has already entered the office. I declare that I’m Number 2 and flash my pink ticket for all to see in case any difficulties arise and others try to push in. Otherwise we could wait until mid afternoon to enter the office! Others, who have been told that they need more blood tests, wait without tickets. From time to time a patient or their intermediary emerges from the office, directed to personally deliver vials of blood to Pathology!
To get attention I have learnt to be brash. I duck into Office 1 during one of these moments, ask if the young women doctors are ready for Number 2 and whether they’ll write prescriptions even if no treatment is offered. The medicines required deal with the side effects of chemotherapy. Answers to both questions are in the affirmative but I am told to wait outside. I stand in front of the office door frozen by the strengthening icy wind draft that flows through the corridor every time the side entrance door is prised open. I question why the door is not locked. Gaunt and sullen patients, waiting to see the oncologist in Office 2, are seated in the path of the windblasts, no doubt their immune systems cannot withstand the freezing onslaught – they watch with little amusement as others negotiate their entrance and exit from the recalcitrant door.
Suddenly some names echo through the adjoining corridor. The names turn out to be of those waiting for the “take home baby”. An outside pharmacy will supply the chemo drug. With other intermediaries I push through the corridor, following a young woman doctor who ushers us into a room, scarcely no larger than a broom cupboard, filled with medical flies. Apart from the computer in Office 1, she explains, this is the only other computer they can access to write up prescriptions. She tells us that we have to travel into the nearby city to obtain the chemo drug. She prepares the necessary paperwork to be signed and stamped by a senior doctor seeing patients in Office 2, then stamped by hospital authorities, at the main entrance, for health insurance purposes. More queues and waiting! Patients manoeuvring into the room constantly interrupt the doctor with their own enquiries. One patient hands the doctor two vials of blood. The doctor precariously balances the vials against a stack of files while she continues to write and check details on the computer.
Even though I visit Greece regularly and am bilingual I am anxious about venturing out into the torrential weather to find a pharmacy in an unfamiliar city. Sensing my concern, Nicholas asks another man, caring for his frail mother, if I could travel with him into the city. The man says he has to stay with his mother as she frequently needs his toileting assistance but his mate will take both our prescriptions. He explains that he had attended the hospital with his mother the previous day to find that the chemo drug was not available. He was told to find his own supplies and return today. He and his mate had searched the pharmacies in the district until they finally purchased a couple of doses and regret not having purchased more given the current shortage and inconvenience.
Another agitated wait ensues as the mate catches a taxi into the city. Time is moving on to midday and we have no certainty that treatment will commence today. We bite into toasted ham and cheese sandwiches and sip juices and water purchased from the cafeteria.
The mate finally returns swinging a bag of pharmaceuticals. We hand the bag to a nurse who tosses it through to the chemo preparation room yelling out our surname! Who knows what will happen next I thought! Perhaps they’ll give the drug to another patient by mistake! Again we wait. The corridor overflows with angry and confused, patients, relatives and intermediaries. A nurse shouts through the pandemonium demanding that we all sit down and stop talking – too much noise!
Too few seats! Patients, not required to take “the baby home” I presume are hooked up to their infusion drips in overflowing four bed wards, cluttered with chairs and surrounded by tall metal infusion stands. People stand around the patients using mobile phones, munching and drinking. There is no privacy or dignity – let alone infection control! Nicholas walks up and down the corridor peering into each ward looking for an empty bed or chair. He optimistically decides to appropriate a bed, warm still, from a previous patient, with the hope that his treatment will soon commence. Bedding appears not to be changed between patients. I walk through the corridors, my ears on the alert for his name being called. When I return to the ward a nurse is setting up the first infusion for Nicholas, constantly turning her back on him to chat to a woman in the room. Later she accuses him of opening the shunt to speed up the process – forgetting her own inattention!
The babble in the ward is intolerable. Too many relatives, too many exchanges about personal circumstances, too many inquisitive questions! Nicholas keeps his own counsel and encourages me to escape. I go off for another wander, sit and read for a while and return to find that he’s not in bed. Another patient tells me he’s gone to the ward toilet – in reality the public urinal! When he returns to his bed he tells me that the first infusion bottle is empty. He has endeavoured to alert a nurse by calling out to whoever is passing by in the corridor. I add to the cacophony and accost a nurse who tells me to wait! There are no buzzers!
The second infusion bottle connected, I remember to thumb through the slips of “next appointment” papers and blood test referrals in the tray at the nurse’s counter. I read a dozen or so names before finding ours! Nothing confidential of course! Intermediary tasks now finally completed I go off for another wander past the old man still struggling to spoon small scoops of yoghurt into his mouth; past masked, agitated family members, questioning when their ordeal will end. I witness a nurse spilling blood on the floor in another over crowded ward and wiping it up with a rag. Not for the first time I’m alarmed to find family members carrying or dragging an obviously terminally ill patient into the Unit – no wheelchairs! Others, new to the Unit, desperately seek information as to what to do, rebuffed by harassed nurses – who are constantly waylaid by distraught patients, relatives and intermediaries. I can’t understand why there is no triage system in place to provide information and to assist with directions.
Half an hour or so passes and I return to the ward, to find a volunteer joking with patients, wishing them a long life and handing out nibbles! Nicholas’s infusion tube is filled with blood. I alert a nurse who tells me not to be alarmed! Another turns her back on me when I ask what’s happening. Apparently the bottle is finished. Persons tending to other patients offer to close off the empty bottle!
After she attaches the “ take home baby” to the port, the nurse tells Nicholas that he should not have got out of the bed. Apparently he did so carrying the bottle, to tell a nurse that it was empty! This, she claims, caused the bleeding. Who knows?
Both now exhausted we don our coats, gloves and gloves. It is around 2.30 in the afternoon. The weather is still torrential and there’s no taxi outside the hospital entrance. At the hospital entrance security staff refuse to ring for a taxi. The public taxi telephone is broken so I take a step out into the rain beckoning Nicholas to follow me. He paces a distance behind me, in the direction of the taxi stand. We get into the taxi drenched and finally return home around 3.20 in heavy rain!
This torrent of angry words of desperation flowed the next morning illustrative of the trauma faced by all chemotherapy outpatients and their families at this hospital. Nicholas teases me about my 2008 letter to the then Minister of Health reminding me that it had made no impact. I just needed to accept that this was Greece not Australia!
Eighth chemotherapy session, Wednesday 22/02/2012.
On Thursday 23/02/2012 public hospital doctors held a 24-hour strike protesting Austerity Measures.
Loula S. Rodopoulos