Flu Vaccine Fiasco
His abdomen gaped from sternum to pubis. Fat pushed up against the bed rails.
The crater in his gut held a wedding cake’s worth of gauze: a sponge soaking up yellow fluid. Tubes, lines, drains, and leads — with monitors attached to half of them — buried our patient. Aside from gnarled toes and mottled ankles, only a few square inches of skin showed.
“There’s nothing surgery can’t make worse,” someone said, sotto voce. Most of us missed the point.
As a surgical resident, I remember the rush of adrenalin, the anticipation of opening an abdomen. Our goal was always the same: get in before the staff surgeon finished scrubbing.
But staff never rushed into a new case. They would ask questions, walk down for coffee, then ask almost the same questions again. They hunted for any possible reason to not operate. It drove me nuts.
Proof of Exudate
Surgeons fix things on the sickest patients (often at 3 a.m.), which no medicine can cure. They operate when certain nothing else will do. Ideally, surgery is not just the right treatment; it is the only treatment.
I watched my Chief Resident operate on my first case as a resident.
“Wahoo!” he yelled.
A trickle of pus had oozed out behind his knife. The pus proved he chose wisely. The pre-operative uncertainty — Does this patient really need an operation? — was gone. He whooped with relief.
Flu Vaccine Fiasco
Surgeons avoid surgery until certain there is nothing better. They do not cut because they can but because they must. Nothing else will do.
Bureaucrats do the opposite. They build bureaucracy because they can, not because they must. It is what they do.
Apparently, the Ministry of Health (MOH) sends out flu vaccine directly to pharmacies across Ontario. Individual pharmacists have vaccine shortly after the MOH release.
Every year, doctors complain, “Why do all the pharmacies have flu vaccine and we have none?”
Unlike pharmacies, medical clinics are blessed with public health bureaucracies to manage supplies. Public health follows a detailed process to determine how to divvy up the vaccine between all the doctors’ offices based on how much each doctor used last year.
This takes time. Public health dribbles out a wee batch of vaccine. Doctors use it in a few days. Then we wait for the next batch. Vaccine dribbles out until mid-December. Then a flood of vaccine arrives too late, a large part unused.
No doubt, public health employs brilliant, well-intentioned civil servants. Like surgical residents, they share enthusiasm to help patients. Bureaucrats may even feel the rush of adrenalin.
Similarity ends there. Surgical residents see the disasters they cause. Disasters might follow a staff surgeon for decades. Bureaucrats never face failure that way.
Complications temper surgical enthusiasm. Digging out dead tissue from layers of necrotic thigh fascia leaves your gown covered in pus to your armpits. Swooning from the stench, you promise to never let it happen to one of your patients.
Civil servants do not see the people they ruin. Bureaucrats never plunge arms inside necrosis caused by good intentions.
“The excitement fades but the stress remains forever,” an old surgeon said.
The rush of adrenalin forces mature surgeons to guarantee they have not missed a good reason to avoid surgery, before they touch a knife. Having found no better course, they do what they must. We need civil servants to do the same.
Photo credit NYTimes.