The Essence of Safety
9 August 2021
The kick-off… the first blog for the Centre of Safety in Healthcare. Without a doubt something we will look upon with endearment in ten years. We were so young, enthusiastic and honestly, who did we think we were to assume we could make a difference in healthcare? But let’s keep that worry for later, first things first: where are we now? When I told my surgical colleagues that I was going to make a career change into safety sciences at the Delft University of Technology, I got blank stares in return. But then what are you going to do? Something technical? Implying even more rules? Trying to explain my future job in the approximately 15-millisecond attention span of a surgeon proved a challenge that actually made me wonder; What exactly is it, what I am going to do? What is safety? I spent weeks trying to answer that same question in an academic pile of papers during the application procedure, but I had still not grasped the core. And then I remembered a situation from my work as a medical doctor, that entailed exactly what I had in mind.
It was a quite shocking situation, so don’t hesitate to jump to the next section if this is not for you. I was working at the ICU and was asked to assist a young colleague in a case of a patient who had just returned from the operating room. A vulnerable elderly woman, with multiple comorbidities and now an acutely life-threatening disease. After careful consideration at the emergency department, the choice was made to give it a chance with surgery. At first, all went well, above expectation. Until she started to severely bleed again in the ICU. What happens after this, is a familiar sight in healthcare: numerous people surrounding the bed, getting materials, calling, stethoscope to the chest, running nurses… experienced and professional chaos. My job (as a senior physician) was to pick up the main thread and to make the decision on what to do. And this was not a pleasant decision to make. I summarised the situation and possible options aloud, consulted with her surgeon, and sadly we had to conclude that that was it. We were going to stop treatment. The life of this woman could not be saved. Having said so aloud, it became quiet. The only one who was making a sound was the woman herself, who was still somewhat awake lying in her bed. A vulnerable woman with a scared look in her eyes, with hands reaching and searching, while life was visible draining from her. At that moment a nurse, who just a minute ago was squeezing a bag of blood, pulled up a chair, put it next to the bed, took the hand of the woman, sat next to her and said “We are with you, you are not alone”. Another nurse dimmed the lights and closed the curtains. We gave her something for the pain. And I asked my colleagues nearby who were unaware of the situation and who were talking loudly, to move their conversation elsewhere.
What had happened? Well, what happened was that this nurse did exactly the right thing at the right moment. Without hesitation. That her colleagues saw this and helped to make the final moments of this woman humane. That I addressed my colleagues on their behaviour, and that they understood and respected this comment. That there was peace and respect for this woman's final moment, despite the numerous times we had seen people dying before. For me, that is the essence of safety in healthcare.
