MOANS AND GROANS

Picking bones and throwing stones at the Irish health service has caused Maurice Gueret to fall asleep on his worry dolls

We hear a lot these days about calcium. The food, dairy and supplement industries all love it, though they rarely call it a metal, which is what it is. It’s good for your bones, growing monstrously big children and shiny, happy teeth. There is no doubt that calcium is an essential mineral. We wouldn’t be standing up without it. But there is a body of opinion that believes the benefits can be exaggerated, and that perhaps we need to consider again how much calcium is enough. We hear a lot less these days about hypercalcaemia that’s having too much calcium. As trainee doctors, we were all given the helpful mnemonic ‘bones, stones, groans and moans’ to remember the classic symptoms of having too much calcium. They are painful bones, kidney stones, tummy ache causing groans, and mental illness with associated groans. But we were also told that about half of all cases present silently without symptoms. Taking too much calcium or vitamin D can bring on hypercalcaemia, but the commonest cause is an over-activity of small neck glands called the parathyroids. If you are having a blood test to look at the general biochemistry of your blood, a calcium level is usually done. And it’s certainly worth checking in unusual cases involving bones, stones, groans and moans. I’m not one of the world’s great papists, but it’s hard not to take notice of Pope Francis. He’s the most interesting church leader of my lifetime, and the headlines he makes I find well worth reading. He must have a good book or two in him. In February, the Vatican daily newspaper carried a piece about what Pope Francis said to international members of a religious congregation visiting Rome. He told them that the anxiety he experienced as bishop of Buenos Aires vanished when he was elected to the papacy. He credited some of this to the Italian laissez faire attitude to life, and part of it to the fact that he doesn’t take tranquillisers. It’s a little-highlighted medical fact that if you take sleeping medication for longer than a month, they can cause the very insomnia you are trying to prevent. But there was one big secret to his calmer state. Frank is getting a good six hours deep sleep a night, which is no bad thing for an 80-year-old. He told his visitors to Rome that he writes down all of his worries and places them under a statue of a carpenter in his bedroom. The woodworker in question is a sleeping St Joseph. It reminded me of a children’s picture book I used to read at bedtime a decade ago. The Worry Dolls told of an old tradition in Guatemala where children tell their worries to little hand-made dolls before going to bed. The woollen figures then lie under their pillow at night and, as the little ones sleep, the dolls do all their worrying for them. I gather they have even been used by psychiatrists in South America, and the best ones are made and sold by nuns. My readers have solved the conundrum of what to do with missed outpatient appointments. Hospitals around the country tell me that they regularly text patients asking them to ring and confirm their availability to attend. Patients around the country tell me that they get these texts, but when they try and ring the number they are asked to phone, the line is invariably engaged. I have lost count of the number of readers who suggest that hospitals simply devise a system that patients can text back their reply instead of having to ring an engaged phone number for hours on end. We can’t blame An Post either. The son of one reader got a test appointment. The letter was franked for the day of the appointment and delivered the day after it. When the hospital was informed, the secretary’s reaction was “Oh no, not again!” It didn’t end there. The following day, a letter was sent to the patient, and a copy sent to the GP, admonishing him for a no-show! There are two sides to all these HSE missed-appointment stories. Irish politicians were once highly qualified in jumping their supporters up hospital queues. Families with political connections, party members or hotlines to a local TD could cut months, sometimes years, off waiting times. I have seen patients who were stuck in casualty departments ring the local TD for a bed! It’s funny how a society so intolerant of interference in the judicial process can treat clinical interference as the norm. I noticed in my hospital days that doctors who were known supporters of particular parties would receive ‘bounce letters’ from TDs and ministers, even when the doctor’s speciality had nothing to do with the patient in question. I’d like to see the practice of political interference under the microscope, and ended for all time. Every time a patient jumps, another falls more ill. The way to get moved up a list or get your case seen urgently today is to go on Prime Time. It’s appalling, in the 21st Century, that families have to show graphic depictions and pictures of their ailments on national television in order for a minister to sit up and take notice. There needs to be a way that patients can highlight injustices in the healthcare system and keep their right to privacy, too. Health is big enough and important enough to have its own independent Ombudsman, and not one who also deals with complaints about every other field of public service. Failing that, perhaps we need an up-to-date model of a major Surgeon-General who knows the system, and whose job would be to listen to the many problems, advocate for patients alone, and prescribe mandatory solutions.