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I’m sitting in the lounge of the Swift ferry looking out at the murky devilment that is the Irish Sea. Today is the day we started our move home. Just the same as we did when we arrived, I dropped my wife and children at the airport and then turned the car toward the ferry. When the ferry arrives, (to be honest given the way the sea is swelling and my guts are churning it’s probably more of an if than a when) I’ll spend a few days at the beach with them before commuting back and forth to Yorkshire for the remainder of my time here.
It’s not quite three years since I made this journey in reverse on a glassy sea, which shimmered like a millpond under a full moon. I was full of profound uncertainty, moving my family to relocate for an undetermined period of time to a place I’d never so much as spent a night in. The intervening period has seen joy, despair, triumph, and tragedy, sickness and health, much of which I’ve shared with you in these pages, more of which I never could. It would be customary in a piece like this to describe it as remarkable or regrettable time, to wax lyrical about friends made or smart at the harsh lessons learned, but it feels like some of each of those descriptions all melted into one. Which is just life, basically, no matter where you live it. Maybe that is the lesson. To paraphrase Jerry Seinfeld: no hugging, no learning, just life.
Can you imagine Bjorn and Kristianne and Sven sitting around going “we must do what the Irish do” (or at least say what they do, as Hickey remarked the document was one of the many strategies that went unimplemented here)
But surely there has to be more than that? This, after all, was my odyssey. America, then England. When you read those tales of my returning thirtysomething emigrant peers in The Irish Times, they all seem to have embarked on vast, quixotic projects, or as vast and quixotic a project as working as a systems analyst in a medium sized tool making firm in a provincial city in Australia or a physiotherapist in Edmonton could be I suppose. For me it hasn’t felt like that. Ultimately for a medic the road is a well-worn one. You are dumped off the rollercoaster pretty abruptly and armed with pluck, no little skill and the goodwill engendered on foreign shores by generations of your forebearers, doors are opened for you. Then after recovering from the PTSD of your training and a suitable period of decontamination from all the people you annoyed over the years you ‘bring something back’? Quite what I don’t know, but I feel there needs to be something. One pithy thing that will change how I view the wacky world of Irish healthcare. A way I can light my corner.
Before I went away when you’d go to a meeting and somebody would mention “how they do it in the NHS/Boston/Australia/Scotland/Canada”, a hushed and reverential silence would envelop the room. As if by dint of its otherness it was somehow better than poor old Paddy could provide or expect or even deserve in his own back yard. One thing I have gotten is the confidence to know that something has to be good for it to be good, not just foreign or exotic sounding. The NHS, in totality is brilliant, but I assure you there are efficiencies we have in Ireland that they would kill for. As a personal example in my current billet we have 14 gastroenterologists, 11 endoscopy admin staff, 60 nurses and 10 purpose-built endoscopy rooms stocked with the most modern equipment money can buy. We do 9,000 diagnostic endoscopies a year, by national metrics, inadequate for a city of this size. Where I trained in Dublin had four gastroenterologists, two endoscopy admin staff, 20-odd nurses, and three rooms stocked with the endoscopy equipment salvaged from when Noah thought it looked a bit grey overhead and went in search of a male and female colonoscope. We did the exact same amount of diagnostics in our little corner of Dublin. How? By starting work earlier and working smarter and harder. The hardly revolutionary concept of having people doing all day the things they’re most productive at being the heart of it. Yes, people were all paid a little better but given that their excess productivity comfortably exceeds any pay differential, maybe they deserve it.
At a brilliant talk given to the MacGill Summer School, Dr Fergal Hickey of the Irish Association for Emergency Medicine, referenced how Scandinavian countries had enviously copied one of our emergency medicine strategy documents. Can you imagine Bjorn and Kristianne and Sven sitting around going “we must do what the Irish do” (or at least say what they do, as Hickey remarked the document was one of the many strategies that went unimplemented here). The point remains though; enough of us are sufficiently smart and hard working to really get this right.
I can hear the cynics a mile off saying “give him six months” but if there’s one thing I’m taking back it’s a belief I’d never have felt four years ago: We CAN fix this system.