Expectations: our experience at a foreign hospital

Yesterday we went to the hospital.  Yes, a public hospital in a foreign country . . . scary, right?  Not to worry – no one was sick or injured.  We needed vaccinations prior to our travels in Southeast Asia.  A strange quirk of the Canadian immunization schedule meant that our kids were not immunized against Hepatitis when they were young like most other developed countries (whoever said Canadian healthcare was rational?).  Plus, we all needed typhoid shots.  Since we didn’t know where our travels would take us, we planned on getting our requisite shots on the road.

Expectations: ours vs. theirs

The boys were well aware of the sharp, pokey procedure that awaited them.  They understand the benefits of vaccinations but more importantly they understand our expectations of them:  be polite and don’t make a fuss.

Over time it has become clear that our expectations have been internalized in our children.  We don’t have to bribe or coerce.  Good behaviour, even in the face of a scary procedure, is the standard.  We remind them, of course, but they expect it of themselves.  Like everyone, they don’t always live up to their own standards.  When they don’t, they feel shame – a useful emotion – and, hopefully, determination to do better next time.

Comparisons

Two years ago, as a volunteer at one of the kids’ schools, Lindsay helped during one of their vaccination days.  Twelve year olds lined up outside the library to get vaccinated against Hepatitis B, Meningococcus, and HPV.  Linds came home shaking her head. “You wouldn’t believe the drama!  There were kids freaking out everywhere!”  She was appalled that kids older than any of our boys behaved in such a way.

There are several possible reasons:  panic in the face of a perceived threat, conditioning of emotional outbursts leading to rewards in the past, conforming to the behavioural norms of their peers.  There are reasons, to be sure.  But no excuses.  As we have explained to the boys, everyone has problems – don’t make your problems other peoples‘ problem.  Be polite and don’t make a fuss.

For whatever reason, these grade sevens had low expectations of themselves.  If you expect to cry with a painful procedure, you probably will.  If you expect (even subconsciously) that making a scene will get you care and attention, you are likely to make a scene.  If your internal standard is to be like everyone else, you are likely to follow their example even if it’s a bad one.

Excited for needles

We place a high value on stoicism in our family.  Determination in the face of adversity.  Quiet endurance of discomfort.   As we maneuvered the logistics of obtaining our needed vaccinations, the conversation with the boys made a surprising change from pragmatism – something unpleasant that needed to get done – to anticipation.  Their eagerness was confusing to me at first.  Now I realize that they were looking forward to the challenge. They were testing their own high expectations of themselves.

In contrast, I had low expectations for our Cypriot healthcare experience.  We’d attempted to obtain our shots at a private clinic but they didn’t have typhoid vaccines and Hep B would be 70 Euros per kid.  They suggested going to the public hospital 30 minutes away.  Ugh.  Needing to get anything done at a hospital can be difficult and disorientating.  I should know – I have worked in hospitals for sixteen years.

Unrealistic expectations and burnout

In fact, expectations are one of the factors that drove me out of medicine.  Canadians are told their public system is wonderful.  Hospitals advertise “excellence”, “quality”, and “innovation”.  So it is understandable when a sick and suffering patient is frustrated and angry that they have to wait 4 or 5 hours to see an ER doctor and then are admitted to a bed in a busy, noisy, ER hallway when they are already feeling horrible.

Their expectations were too high but so were mine.  My own standards for care were often higher than what I could deliver.  Patients were frustrated and sometimes angry.  I am a doctor, so naturally they would look to me for answers.  All I could do was apologize.  It was not my fault, but sometimes it felt like I spent hours just apologizing for things I couldn’t control.  Doctors are held to incredibly high standards by patients, hospitals and regulatory bodies at the same time that their efforts are undermined by severely limited resources.  There is a limit to doing more with less and we hit it a long time ago.  Past it is just suffering.  For everyone.

Lower expectations, greater contentment

So we went to the hospital in Cyprus with low expectations.  We did not expect efficiency or friendliness or even availability of the vaccines we needed. I had gone the day before, but the clinic we needed was closed. I wandered over to the familiar bloody, coughing, puking waiting area of the ER and spoke to a staff member there. Surrounded by sick people staring at her while waiting their turn, she looked worn out – a look I am very familiar with. She told me to come back the next day – early – but she could not guarantee the vaccines. Fair enough. I smiled and thanked her.

We arrived at 8am and already there was a line-up at the main reception area. The lighting was dim and we absorbed strange looks and incomprehensible Greek comments as we ushered our four boys between the battered chrome railings of the queue. Fifteen minutes later we crammed our six bodies in a space meant for one in front of the counter. Other patients bumped into us as they jostled by.

Through a four inch hole in the glass, I explained that the kids needed vaccinations to a fifty-ish woman who looked like she’d worked there a long time (Linds and I decided that our vaccines could wait). Thick Greek accent. Minimal eye contact.

“You have the medical card?”

“No. We are tourists. No medical card, but we have money.”

“How many children?” I held up four fingers. “Four?!” She shook her head, sadly. “That will be a lot of money!”

“Can you tell me how much?”

“They have to see pediatrician to get the vaccinations.”

“OK . . .” They didn’t really need a doctor, but if that is the system here, I wasn’t going to argue.

Still shaking her head the woman wrote on a piece of paper with a thick blue marker, ‘4 x 15 Euros’ and held it up.

“That’s fine,” I said. She shrugged her shoulders as if to say, “It’s your money, pal!” and asked for our passports. Twenty minutes and sixty Euros later we were handed four charts and pointed in the direction of the pediatric out patient clinic.

The pediatric clinic

We walked into the pediatric clinic and were relieved to find a nurse who spoke English. Our relief didn’t last. “The doctor will be here at 10:30. You come back,” said the pediatric nurse as she was preparing some medicine for another child. It was 8:30am.

“Two hours?” She nodded.

Not the end of the world. We could kill some time. We turned around to leave, then I turned back.

“Sorry to bother you again, but I just want to make sure of something. None of the kids are sick. They just need vaccinations. You do that here, right?”

“Vaccinations? No – vaccination clinic is next door. Why did they send you here?” My turn to shrug. “You don’t need to register for vaccination clinic. Go talk to them and come back to tell me what they say.”

Door number two

Next door the sign said “Adult vaccination” and the door was closed. I pushed it open and went inside. No one. Another door, another room. A woman watching TV.

“Excuse me, do you work here?”

She did. I explained our situation, where we were going, the vaccinations we were hoping to get, that we had paid the registration fee but didn’t really need to see a doctor.

The woman looked concerned, then said, “Yes, we do the vaccinations here. You go get the children and bring them.”

When I returned with Linds and the boys, four other women had materialized and there was a heated Greek conversation underway. They shot us measured glances as the staccato interaction went on. We waited and smiled, trying to look like nice Canadians.

After a little while one of the women turned to me.

“OK, you are going to Sri Lanka and Thailand. We recommend typhoid and Hep B. Hep B is no charge. Typhoid is sixteen Euros for each. OK?”

“Thank you. That’s great. So, four Hep B for the boys and six typhoid, if that is possible?”

“Yes, of course! We do vaccinations! But now you come with me and we will get your money back for registration. We don’t need registration here.”

Unnecessary kindness

I left Linds and the kids in the vaccination clinic and followed the nurse. We chatted about healthcare in Cyprus, how she had always been a nurse in that clinic and didn’t want to work anywhere else, how the public system was relatively new and most of the doctors didn’t want it. We made four different stops from accounting to reception to administration, and back to reception before she finally accomplished her mission of getting our sixty Euros back.

We chuckled over the fact that healthcare is a frustrating bureaucracy anywhere you go, that a simple refund takes more time and energy than what the refund is worth. But she knew how much I appreciated her efforts. It would have been a very different experience if our expectations had been higher.

Mission accomplished

When we got back to the clinic, Linds was finishing up with her typhoid shot and the boys were lined up on a couch, beaming.

“We got our shots!”

“OK, who cried the most?” I chided.

“They were all great!” said Linds with pride as she pulled her sleeve down.

“Yeah, the typhoid one didn’t even hurt!” They relayed their stories in a play-by-play action-drama. They had organized themselves so that Owen went first. He set the bar high by watching as the needle went in and not making a sound (except he probably talked through the whole thing). Jake followed suit more quietly. Ben was surprised by the pain but repressed his reaction for the sake of Eli who was last. Not wanting to be the only one to cry, Eli took both needles without complaint.

Their high expectations of themselves had been met. They sat on the couch with big smiles as I got my turn.

“Wow, he didn’t even blink! Great job, Daddy!” Expectations go both ways.

We thanked the nurses profusely for helping us with the immunizations and the refund. I never get tired of seeing people’s reactions as four little boys simultaneously smile and say thank you. It means a lot and it was sincere.

High vs. low expectations

Contentment is built upon a foundation of expectation. When dealing with situations that are beyond our control like navigating an unfamiliar hospital, it is best to have low expectations. Picture a big broad slab – anything can be built there – open to a range of possible outcomes.

But when dealing with things that are within our control – our own behaviours and actions – high expectations promote growth. Picture a tower of steel beams rising into the sky. To build our tower higher, the next level must be built to exacting standards. Standards that must be internal. Expectations of ourselves.

We felt pride as we drove away from the hospital. As parents, we are like construction foremen for our kids who are the architects and builders of their own towers. It’s a neat trick to figure out when to have low, broad expectations and when to tighten them up. We don’t always get it right, but it sure is fun watching them grow.