In the literature on medical errors there is a concept called the “Swiss Cheese Effect.” This happens in real life, too. Accidents happen when all the little precautions we use to keep ourselves safe fail and we literally slip through the cracks.
Almost three weeks ago I was on my way down the stairs to drive to my osteopath for a treatment. My husband, Dave, had a dental procedure the day before and now that he was feeling quite a bit better he wanted to have the house to himself.
I had been having really bad headaches and neck spasms, precipitated I think by the war in Israel and Gaza. The horror of the war has me sick and heartbroken. This is compounded with my personal fears over the growing wave of anti-Semitic incidents, when shots are fired at the school around the corner and there are armed policemen outside my Synagogue. A McGill professor circulated a petition calling for “another night of broken glass” about a week before the 85th anniversary of Kristallnacht. Usually when people say they want to destroy you it is wise to believe them. This can lead to muscle tension.
Then there is my chronic ankle pain, a leftover from a bad and inadequately treated sprain 20 years ago. The other layer of holes in the Swiss cheese is the renovations in our home. Earlier this year we had a massive flood in our basement after the torrential rains climate change bestowed on us. The old carpet had to be removed. This was just replaced with tile almost the same color as the carpet on the stairs. Finally my landlady messaged me to tell me she was painting the bannister. So as I hurried down the stairs, not holding on, not bothering to turn on the light, my toe caught as I slipped on the bottom stair, my right foot twisted left, my left knee twisted right and I was crying in a heap at the bottom.
My cries brought Dave and Paule, my landlady who is a retired nurse, running down. They hauled me up to a sitting position from which I was able to call my osteo and tell him that I was in too much pain to see him.
A few days later, I’m sitting in the fracture clinic, waiting to be seen. My fractured toe is encased in a boot that my grandson admires. “Oh Bubbie,” he says, “you look like a Transformer!”
The sweet tattooed receptionist seems torn between acknowledging that he has been told that I am a VIP and his reluctance to put me ahead of everyone else. I assured him I was happy to wait my turn and sat myself down next to another woman wearing a boot same as mine. She told me about how the Emergency room had a physiotherapist doing triage for MSK patients, facilitating their care. Sitting there watching the ebb and flow of the clinic buzzing around me, I am impressed by the efficiency and what appears to be the genuine caring of the staff. The fracture clinic is happening at the same time as the foot clinic. There is a woman in the clinic, I am not clear whether she is a nurse or a physio, who almost every patient greets with great fondness and appreciation, thanking her for all she has done for them. I watch the director of the hospital’s family medicine teaching unit, who has a special interest in wound care, as he guides frail elderly patients, probably with diabetic foot ulcers, in and out of the clinic. He is kibitzing with them, teasing them fondly, although he has to tell too many of them that he cannot take them into his practice or find them a family doctor, as much as he would like to. My classmate, the hospital’s chief of ortho, comes over to say hello. He is looking worn and pale. “Are you OK?” I ask him.
“I am really jet-lagged,” he tells me. “I was in Israel, my mother was dying. I stayed for the Shiva, but then I got caught by the war. I needed to get back because I couldn’t leave my colleagues short handed for so long.” After I gave him my condolences he walked over to greet his next patient, who shuffled forward with his walker accompanied by his hijabi daughter in a dark embroidered abaya followed him in.
Meanwhile, fracture clinic was moving along. One of the nurses was staring at me. “Dr. Perle, is that you behind that mask?” I nodded, “It’s me Mel. Do you remember me?” I smiled and nodded but honestly I didn’t. Turns out she is someone that I knew from her childhood, her mother is a former patient and someone I worked with closely when I was younger. Suddenly I was whisked into an examining room and my ortho walked in two minutes later. Five minutes later I was on my way home much relieved with good information. Fair? Maybe not, but I guess membership still has privileges.
This is part of my hospital that I almost never get to witness, quite removed from my usual maternal-child haunts. But being there made me proud to work in this institution, where patients are cared for and don’t slip through the cracks. I hope the hospital stays safe too, and no danger slips through the cracks.