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How the dices pour

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Orwell wrote about all the important human experiences possible, including youth, poverty, begging, jail, politics of course and various aspects of society, recounting both his stealing and his police work, up to executions, war, etc. One of his most poignant testimony is in the hospital, with an Orwellian title that summarizes it all: How the poor die. Having myself spent quite some time lately in this environment, I found it entertaining throughout the long hours I was contemplating at the walls in front of my bed and at the various people occasionally crossing through, to compare my own experience with what Orwell immortalized at the beginning of the last century. This text is available as such or with illustrations, some of them being unceremonious and possibly troubling, so click with care.

The first difference, and it is a welcomed one, is that the fitting title of Orwell that captured the condition of the 20th-century society, would be outrageous nowadays. Although I have been convinced by Audrey Vernon that we, common people, are still poor, and that I have also crossed death's path during my stay, my experience is much more mundane and unimpressive. I have, however, spent considerably more time so I have had time to acquire more experience, observe recurring patterns and start to grow the familiarity of one's natural living environment. Although I will mainly focus on personal anecdotes, I will try to identify what remains true and what has evolved. Orwell being such an insightful and deep observer, there is surprisingly much which remains true.

My treatment was in a Spanish hospital (La Paz), while he was in a French one (Hôpital Cochin), and just as he did (more so in his other bibliographic segments), I will retain the original spoken expressions (hovering over will offer an English translation). The most obvious observation that remains true to this day, and which is certainly familiar to anybody who had to deal with the medical environment, is the de-humanization of the patient, who becomes a sort of product or raw material which is being probed, molded, investigated, queried, experimented upon and sent back and forth between various services as if in a factory chain. In Orwell's perspective that contemplated death as a possible if not typical exit, this took a much more pronounced character and one can see that, nowadays, there are many efforts made to provide a humane interaction between those who are in pajamas or gowns and those who are in hospital uniform. Still, it remains true that

it is a sound instinct that warns people to keep out of hospitals if possible

My father died in a hospital, and although it was in my arms, it will remain forever a stain in my soul that it couldn't happen in his home, as he requested. The medical staff judged that it was enough little time left to save them the bother and possibly expenses. My father did not want to be hospitalized for what would be his last visit there, which we did not know by then but that he had guessed. In this case, in 2006, it would have been better to keep out of the hospital, which the family's obedience in an illusory medical power overruled. A stain in my soul.

I will both make general—and therefore only partially correct—statements, as well as provide concrete, personal—and therefore anecdotical and possibly not meaningful—ones. A first general statement, which is probably true in hospital as well as everywhere else and that is not a pleasant one to make, is that flaws of all types are typically most marked in the staff of lower qualifications, be it in terms of one's respective competencies (a surgeon is better at surgery than a stretcher-bearer is at moving people) or social skills (the cleaning lady would have less tolerance and friendliness than the nurse). The celador, who is in charge of transportation, and might be at the bottom of this scale, could be found to be incredibly dull at a job which could be decently done with minimum efforts. They would typically fail to distinguish a case of acute pain with moving garbage and kick both equally with all possible obstacles on the way. In my case, the urinary catheter would hurt terribly right after its installation, due to some obstruction in the ureter which had been removed by the tube the hard way. Still, I would be jolted around carelessly and my complaints rebutted with ya, ya with, once, a perdon as the tube got almost caught by a protuberance which had harnessed it, the traumatic image of which had caused me to plead with cuidado! cuidado. The pain on such days would be such that I would hold my crutch over the blanket to minimize any movement, and a celador once gave a sharp pull to the blanket to center it again, which caused my hand to echo it to the tube, causing a spike of pain which made me shout. The celador rebuffed me with ni te he tocado!. Another case of rather poorly done job comes from some of the cleaning staff, who would make the most symbolic display of cleaning, waving a cloth on the few available spots available to that purpose. For instance, if a table would support even the most easily disposed-of stuff, instead of moving it around (like putting a towel on the nearby pile of towels) to clean the whole table, they would just move the cloth around the obstacle. On a busy table, this procedure would result in the slightest contact with any detergent, similar to a painter putting a finishing touch. This had me speculate that such a superficial display was either to evidence that some cleaning had been done (look, this is even still wet over here) or that maybe, obstacles moving around from day to day, this would eventually result in an overall cleaning. I have never seen, however, such a respect for objects that the other free hand could easily pick up the time to give a good sweep. The most annoying unprofessional behavior from the next stage of qualification, the so-called ATC, just below the nurses, is their complete lack of concern for the rest of patients. I learned to never sleep before their last turn of taking temperatures, which could be anytime between 22:00 and 23:00. At a time where someone sick could be reasonably expected to rest, they would slam open the door, switch-on all lights and trumpet in high voices with the clear intent to wake up everybody in a matter of seconds temperaturas. This is the sort of things they do in prison, particularly for those punished of solitary confinement. It would seem so easy, so natural, to gently wake-up people with a murmur and the light of the corridor. On one day where I had a terrible migraine and had a hard time to bring myself to sleep, this treatment left me shaking for the rest of the night with an unbearable headache. Incompetencies in nurses would be of various types:

In Orwell case, he recounts how the patient would be exhibited to a company of colleagues and students and his case discussed in his physical presence but devoid of any concern for his humanity and dignity. Nowadays, certainly as a result of a positive evolution in this matter, some care is taken by the medical staff to devote some personal time to the patient, if only in a vacuous protocol of superficial preoccupations: que tal esta?, como se encuentre hoy? Most of the time it is apparent that there is close to zero interest in such exchanges, that conversations are kept to a minimum, that the doctor is already on his way tiptoing backward towards the door with a drift proportionally increased as the patient's response shows signs of elaborations. The typical exit door consists of pero eso es normal, eso no nos preoccupa demasiado or a ver como eso va a evoluar, in reply to any concern or interpretation by the sick of his affliction. Obviously, doctors have little time to enter into discussions, but for one thing, this shows again how the illness more than the ill is what matters. For another thing, it seems instructive to gather various people's description or sentiment of how they perceive what science otherwise describes in colder and more technical terms. Medicine is far from an exact science and much is probably to be learned from the variations as they manifest or as they are perceived. Finally, it is not always obvious that time is so precious. Often visits are from couples, triplets and occasionally from an entire horde of people, and certainly it would be better to focus more attention from a single doctor than a perfunctory visit of a group of three. Also, in one case where a high-end surgeon was waiting for something to be brought to attend to me, she spent this time looking at the random TV program which the neighbor had put on, instead of talking or listening to me. So while it is clear that some effort is made to bring some human interactions between the two sides, it seems more part of a protocol and duty than a natural inclination to bother for one's fellow being. Also, while I have no evidence that patients were systematically in greater needs of care, either physical or psychological, after rather than before the surgery, I observed from the sample of my own experience enlarged by that of 15 neighbors, that more attention was given after the operation than before, both with respect to medical procedures, which might make sense, but also in terms of personal interactions. Visits are more frequent, more lengthy and exchanges more elaborate and caring. This could be a mixture of the already mentioned personal familiarity with the greater interest in how one's job did turn out over the condition of someone who came up with their own problems. Also,

As an example, the food would come with a little menu printed indicating the callory content and the type of diet. If it would be your birthday, the menu would come with a Feliz Cumpleano felicitation.