Q J Med 2002; 95: 641-642
© 2002 Association of Physicians
Coda |
Hot water
We spent our family holiday this summer in a Greek beach resort, where doctors seemed to spring out from behind every bush. Including myself, there were at least seven in the hotel, all British: three GPs, a GU physician, an orthopaedic surgeon, a cardiologist and a palliative care specialist. Between us, we could have covered most medical eventualities, and it would have been entertaining to imagine a scenario that might have called for each of our particular skills in turn. Be that as it may, it meant that my services as a generalist were only called upon for the less alarming kinds of incident. I removed a speck of paint from the eye of a compatriot whose gratitude was hugely disproportionate. I attended a small girl with a scalp laceration sustained from a close encounter with a swing. And I advised a number of people who had gone down with gastroenteritis. In fact, an increasing number of guests seemed to be getting gastroenteritis as the fortnight went on. I got it myself for a day. So did two other members of my family.
It was only a few days before the end of the holiday that I considered there might be a connection between these illnesses and something else that I had noticed: there was no hot water in the toilets of the hotel restaurant. As it happens, I had spoken twice to the reception staff about the lack of hot water quite early in the holiday. They had made appropriate noises of concern, and they reassured me that it would be rectified—but nothing changed. Once I started to worry about the possible link with so many stomach upsets, I considered asking to see the manager in person to express my concern. I even thought of suggesting to the manger that he should close down the restaurant toilets and ask people to use the ones in their rooms instead, where the water was piping hot. However, I kept putting it off, and in the end I just filled in the hotel feedback form when we left, pointing out the possible reason that so many people had gone down with diarrhoea and vomiting. I have no idea if the manager acted on this.
Since returning, I have wondered why I did so little to protest. I have also wondered why several of my professional colleagues—some of whom said they had also noticed the lack of hot water—did not complain more forcefully either. The restaurant was a buffet, which meant that everyone used the same serving implements. Faecal-oral transmission must have been happening all the time. I have been trying to work out what led all of us to say nothing about such an obvious health risk.
The most important factor, beyond a doubt, is that we were all having a jolly good time and everything else seemed to be going very smoothly. The seaside setting, surrounded by mountains and overlooking the Ionian Sea, was idyllic. The staff were outstandingly attentive, and they treated all our children like dignitaries rather than detritus (one of the main reasons, apart from the weather, for taking holidays in Mediterranean countries). If there had been many other problems, I am sure that I or one of my colleagues would have managed to harness our dissatisfaction into the fabrication of some wrath on the subject of hot water, but the raw material for outrage was simply not there. And like most Britons, probably none of us wanted to upset anybody by making a fuss.
Personally, I was influenced by other things too. I knew from previous visits to Greece that the plumbing there often leaves much to be desired, and I decided that you can't hope to change something that's generally accepted. I reminded myself that there was no actual proof of a link between the illness and the lack of hot water. True, I suffered some mild anxiety when I recalled John Snow and the Broad Street pump, or remembered studies of hand washing in hospitals and its relation to nosocomial infection. However, I then managed to reassure myself that I had no definite statistical evidence in this instance of raised morbidity above what one might expect among tourists in a hot climate. I also took note of the fact that none of the other doctors had seemed very bothered. If the truth be told, it was fairly easy to put the problem to the back of my mind.
Everything else was going very smoothly ... none of us wanted to upset anybody by making a fuss ... you can't change something that's generally accepted ... no actual proof of a link ... no definite scientific evidence of a raised incidence of morbidity ... it probably would all have happened anyway ... none of the other doctors seemed very bothered ... it was easier to forget about the problem. Does any of this sound familiar? Of course it does. It is the miserable and unconvincing chorus of self-exculpation that attends every single health service scandal that ever occurs. What I and my colleagues had enacted on our holidays, with characteristic professional insouciance and automatism, was classic medical bystander behaviour. We had played our traditional parts in a simulation of the prologue to systemic disaster, the sort of disaster that befalls people like us in our workplaces time and again, year after year.
It did not feel like that at the time. It felt, of course, like normality. Better than normality, positively hunky-dory. But that precisely is the problem. Apathy is a retrospective diagnosis. Had there been a serious epidemic of gastroenteritis ending in hospitalizations and a catastrophic end to people's summer break, I am sure that we would have reframed the experience very differently. What seemed at first like an idyllic holiday would have been recollected as a nightmare, and our inaction would have become a cause of deep guilt and shame. Next time, I have promised myself, I will make a fuss.
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