The filthy business of health care
IN THE first volume of Capital, Marx defines the essence of capital as "command over unpaid labor." During the nine days and counting that my 84-year-old mother has spent recovering from major surgery at one of the hospitals at Baylor University Medical Center in Dallas, I have gained a deeper experiential insight into the dynamic nature of this definition.
Despite being affiliated with Baylor University and the wealthy Southern Baptist Convention and having sufficient funds to finance several ongoing construction projects as well as maintain elaborate outdoor water fountains and a lovely prayer garden, patient-nurse ratios are so high that my mother is fortunate if her nurse can make more than three visits during the 12-hour (!) shifts that nurses work here, and during those visits nurses have little time to do more than record vital signs and administer medications.
Other care providers here are stretched even more thinly. For example, a single primary care technician in the intensive care unit, where my mother spent two days, was responsible for bathing and feeding approximately 30 patients per shift. The workload of such technicians in the surgical recovery floors is similar.
As a result, despite having uncontrollable explosive diarrhea for three days that rendered her physically incapable of controlling her bowels for the less than 10 feet between the bed and the toilet, my mother was forced to lie in her own excrement for stretches of 30 minutes or more as she waited for the harried technician to come sponge her clean and change the bed linens.
On the occasions I was able to assist her in navigating that short distance, watery excrement gushed onto the bed and floor. Because I could not be sure that anyone would bring a mop to clean the floor before my exhausted mother wanted to return to her bed and I did not want her to track yet more fecal matter into the bed with her feet, I have found myself repeatedly wiping the floor with paper towels and sanitary soap from the sink. If I had access to bed linens, I would have changed the bed as well on such occasions.
Nor has diarrhea been the only hygienic threat to her recovery. Last night was fairly typical. At 2:30 in the morning, I was awakened to the sound of projectile vomiting. Had I not been there to empty the assorted trays and cups into which she threw up and clean her face and throat with wet washcloths, she would soon have been covered in the vile-smelling, bilious contents of her stomach.
As I struggled to contain the urge to retch that the odor evoked in me, I could not help wondering how many other people, bound by their concern for a loved one, were also struggling against their own exhaustion and contributing their uncompensated labor to a hospital that proclaims its dedication to the Christly mission of ministering to the sick.
A historical marker beside one of the hospitals boasts, "The Baylor Plan, created in 1929, was a pioneering hospital insurance program that later became Blue Cross." I suppose it should not be surprising that Baylor University Medical Center places a higher priority on naming buildings for its well-heeled benefactors than on hiring enough (no doubt poorly compensated) personnel to take care of its patients' basic physical needs.
Despite Medicare, her supplemental insurance and my hours of unpaid care, my mother will face medical bills when she is able to return home to continue her recovery. I will never again read Marx's characterization of capitalist exploitation and oppression as the "old shit" (alten Dreck, in German) as merely an inspired metaphor.
Thanks to Baylor University Medical Center, the Southern Baptist Convention and the U.S. health insurance system, that phrase has become for me a depressingly literal reminder of the urgency of overthrowing a social order in which meeting human needs is subordinated to the "filthy business" of bourgeois profit mongering.
Mark Clinton, Holyoke, Mass.
