By Coby Omvlee, actress, playwright, puppeteer and visual artist in Theatre Fusentast, Trondheim, Norway
In 2011, my husband and I had a car accident. We ended up going off the road and, in the accident, the safety belt cut through my small intestine. This happened largely because my intestine is less flexible due to the radiation therapy I received when I was 15. Surgery got me a temporary ileostomy and the promise of a stoma-removing operation within three months. Soon after the ileostomy, eating and getting nutrition became problematic as the stoma was placed very high, so high that the food I ate ended up in the stoma-bag almost immediately.
Though I received additional nutrition through a venflon, my condition worsened. Officially, I had one responsible doctor; in reality, 15 doctors shared my case, some of them with little knowledge about my condition. One day, one of them decided I needed a Central Venous Catheter. Happiness: No more venflons!
Four days later, before I had the chance to regain my strength, they removed the catheter and moved me to a rehabilitation center to wait for my surgery.
Why? They said my bed was needed.
At the rehab center, the doctor came just once a week. The week I arrived he was fully booked. I had a letter from the hospital, so I assumed he would make time to see me. I was so wrong.
Surprisingly, at the center, they couldn’t feed me intravenously. I tried to eat and wrote down everything that went in and came out. Unfortunately, no one paid attention. Then the doctor went on leave for two weeks without a replacement. Since my husband is a doctor, they told him to “keep an eye on her.”
My condition continued to decline, and I was soon bed-ridden. Then the laboratory called my husband and told him that my blood samples showed a danger of heart failure. Without emergency treatment, my life expectancy was just two days.
My husband arrived and was the first person to read my detailed notes. He saw that every day, more fluid went out than I took in. I was dehydrated and malnourished. He called an ambulance to get me to the hospital.
During this time, several questions entered my mind:
- Why did the rehabilitation center admit me, knowing they couldn’t feed me intravenously?
- The hospital knew I was dependent on the tube. Was there no communication?
- Was I really transferred due to a shortage of beds? How was I selected to leave the hospital?
When I was stabilized, the hospital wanted me out again. This time, they sent me to a nursing home. At least at the nursing home I could have a catheter and get the nutrients I needed.
Setbacks 2 & 3
I worked out every day to get in shape for my surgery and I was well prepared when I got back to the hospital for my surgery. And the hospital? It seems as if they’d forgotten my medical history. They assigned an inexperienced surgeon for my surgery and again, something went wrong. My stitches loosened, the contents of my bowel flowed into my abdomen, and I was rushed back in for another surgery. I ended up in intensive care with a fever and an open abdomen with two new stomas.
No one took responsibility for the errors. My husband insisted on having a single responsible doctor who also had to be the best surgeon available. The hospital complied. This time, no one tried to move me out. I became a Stayer.
Recovery & Rejuvenation
Through the next eight months, I had the same dedicated doctor who did my fourth and final surgery. That operation went well, and I recovered. This time, the choice of when to leave the hospital was mine.
Once back at home, I wanted to find out what happened and why. I decided to tell my story through a theater performance: STAYER. In creating this performance, I did a lot of reading, attended patient safety conferences, interviewed health experts, and worked and wrote with colleagues.
We learned a lot! Patients aren’t just moved for a lack of beds. Hospitals generate revenue through patient turnover. Turnover is good for their bottom line. Patients like me just “laying around” cost them money. This is not the way patients should be treated and has to change.
Healthcare in Norway is generally of high quality, paid over the tax bill and basically treats rich and poor the same; and health care personnel do as well was they can. In 2002, Public Services suddenly got a reform, called New Public Management (NPM). NPM aims to allow the public sector to mimic a private company, but that does not work well in our system. If you try to pretend that a well-functioning public health system can be transformed into a Toyota-like factory, in addition to using the DRG system wrongly, then you get into difficulties, which unfortunately, causes huge problems to patients and health personnel alike.
Extremely well-paid managers without medical experience are now in charge and they distrust their medical staff. They’ve implemented a control-regime in which everything is checked and measured. Extreme levels of report writing are demanded. Forty percent of nurses’ working hours are spent documenting what they do rather than caring for patients. NPM demands loyalty to managers, not to patients. Frustrated staff who go public, face retaliation or lose their jobs.
Professor Emeritus Eli Berg from the University of Oslo traveled Norway for years studying the effects of NPM. Has the reform succeeded? Was money saved?
Bergs conclusion: No. Bureaucracy has grown. Norwegian hospitals today hire more managers and bureaucrats than medical staff.
There is hope. We also learned about how Scotland and New Zealand successfully abandoned the NPM model and now run patient–centered hospitals, though for less profit. Likewise, Denmark and its Trust-Reform is based on leadership’s trust of the medical staff, recognizing the patient-staff relationship as crucial to positive outcomes. We can borrow from these models to create a system that works for Norway.
Preparing and creating the documentary theatre performance, Stayer, took three years and the collaboration between eight theatre artists, one theatre and one theatre house. The effort helped me deal with my physical and emotional health. Through STAYER, I have become the voice of many. The two versions of Stayer are being performed both in Norway and abroad.
Teater Fusentasts website: www.fusentast.no
Trailer performance : https://vimeo.com/265394063
Coby Omvlee (the Netherlands,1949) is an actress, playwright, puppeteer and visual artist in Theatre Fusentast, Trondheim, Norway. She is married to a Dutch medical doctor/puppeteer, and together, they are raising a Norwegian teenage foster-daughter. Coby is currently performing in different theatre-plays, creating art and living a good life.