HEART BEAT:Time to cut the cloth according to our new measure, writes MAURICE NELIGAN
IT IS SURPRISING how many people claim to have few regrets in life. I have loads of regrets. These range from the trivial, investments on slow horses or palsied football teams or underperforming golfers and the regret consequent on injudicious partying, all of which are usually accompanied by firm commitment not to fall again.
There are more serious doubts. Was my judgment well founded? Was the operation appropriate? Was there anything else I could have done? Such uncertainties are part of surgical life and mostly are addressed and faced frankly. Postmortem examinations and mortality conferences form part of the process to assess medical misgivings. They do not usually go the whole way and leave you with the inner person whose truthful pacification is necessary to allow you sleep at night.
Such doubts are an integral part of competent medical practice. The acceptance that you don’t know all the answers and the ability to seek appropriate assistance are also essential. Knowing that you have done your best to acceptable standards and consulted colleagues in times of doubt and difficulty, allows you move on and learn from the inevitable bad experiences of medical life.
I have more general regrets. I wrote recently about the siting of the new children’s hospital. I am sorry now that I had not done so earlier. Not that I think for one moment that an earlier intervention by me would have made any difference. The minds were closed very early in the process, and the HSE and Minister knew what was best for the sick children of Ireland. The fact that the procedure was neither transparent nor rational was irrelevant. I very much fear that political considerations, both medical and national played an inappropriate part in what those responsible hoped would be the final decision, possibly a “vanity” decision, and the desire to leave a monument among the wreckage created in the health service.
“My name is Ozymandias, king of kings
Look upon my works, ye Mighty and despair!”(Ozymandias, Shelley)
Despair is right. Future generations of sick children won’t care whose name is on the plinth. They will ask, “How was this allowed to happen?”
Since the article was written I have received very many messages of support for the hypothesis that the hospital should be located on a larger site with better access. There were various suggestions as to where that might be and how it might be financed. This latter point is very important in these straitened times. Much of the money for this project, wherever it is sited, is postulated to come from the private and voluntary sectors. The present proposal is rather opaque in identifying precisely from where this money is to come.
It would have been prudent if the proposed plan for the development and its access had been made available for public scrutiny before planning permission had been sought. That might have allayed the fears that many have about the project. It might on the other hand have demonstrated the inadequacy of the proposal.
Letters to the editor recently have shown that my doubts are not universal and that some are happy with the proposals and anxious to proceed quam celerrime. This is a view that must be respected. I feel nonetheless that a decision made during an era of unfounded national hubris should be re-examined in these days of stark fiscal reality.
Prof Denis Gill, late of Temple St Children’s Hospital, wrote of my objection “at this too late hour”. I believe it is not too late. Planning has not yet been obtained and no structural work is in progress. My only interest lies in where all the children of Ireland can be treated in best circumstances. We are not just talking about the children of Dublin but all Irish children heading for the capital on the radial network that brings them to the M50 and the main train stations. An inner city location manifestly does not serve them best.
Another letter derides my suggestion that we wait until the sun shines again. I would point out to the writer, that in the same issue of The Irish Timesin which his letter was published, August 3rd, a proposed cut of 1,000 temporary HSE staff in just one HSE area (West) was reported. This would lead to further bed closures and curtailment of services. Similar cuts are forecast for other areas. Do we let all this happen to Irish patients while we build one iconic hospital on possibly the wrong site?
Maybe we should stand back, wake up and cut our cloth according to our belatedly recognised, slimmer fit.
