April 4, 2005
The ambulance arrived in ten minutes. The old man, his lungs destroyed by pneumatic spasms, was taken gingerly from his sick bed by two humane, good-humoured ambulance men.
They reassured him that all would be fine, even though it was clear he was very ill.
Within minutes he was in the accident and emergency unit, where nurses and doctors hooked him up to drips, ventilators and administered antibiotics gently into his tired forearms.
They assessed his chances honestly and humanely, taking great care not to cause too much distress to relatives or the patient himself. A few hours later, when his condition had stabilised, they whisked him up to a ward, where he has recovered well, if not completely.
What struck me most were the tiny details that go unnoticed, but can be as important as the medicine itself. A gentle rub of the shoulder, a little squeeze of a thin wrist, a kind, reassuring word, a broad smile when everything else is dark or encouragement when hopelessness reigns: these are the hidden tools of Irish nurses that can make the difference between the will to live or die.
Everywhere in the Irish medical system, real humanity is on display and it makes you think precisely what values we have as a society if these people are not paid sufficiently, while car or insurance salesmen make out like bandits.
What a pathetic little place it is when nurses have to live just above the breadline, while minor celebrities are paid multiples of the average wage?
This week, my experience with the public health system, where my father was treated kindly, efficiently and successfully, focuses the mind on the perverted system of rewards and status that governs modern Ireland.
This column has always supported the free market and the right of individuals to be allowed to do their thing, free from state interference.
However, it is time to question a society where the spoils are now far too unevenly spread. Is it right that a chief executive officer of a bank can be paid 100 times the average wage for carrying out a reasonably straightforward bureaucratic function?
Is it right that nurses have to rent houses miles away from the hospital they work in and commute for hours to get to work because they cannot afford to live locally? For example, my father was treated in St Michael’s in Dun Laoghaire and some of the nurses lived in Co Wicklow because they couldn’t afford to live locally.
The crux of this uneven sharing of the spoils stems from the advent of the winner-takes-all economy in Ireland. This is not capitalism, but a flashy, show-off, cowboy version of the old thing. The winner-takes-all economy is very evident in sport, where the rewards for the winner are enormous, while there are few prizes for second place.
So, for example, David Beckham makes a fortune, but a talented winger toiling away in the lower echelons of football might only just get by. The talent gap between both players is probably modest, but Beckham is the winner and he takes the spoils. For years, sport and entertainment displayed this type of reward system.
Now, however, many professions work in a winner-takes-all fashion. So the best lawyers get paid multiplies of the average lawyer. The best accountants do likewise.
Look at the Bar in Dublin. There are barristers who make fortunes and there are those who just scrape by. The best barristers are the ones who argue that the tribunals are bad for business, while there are many second-rate wigged ones who would give their right arms for a few months at Dublin Castle.
We can even see this behaviour in education, where grind schools poach better teachers and pay them considerably more than the local school equivalents.
The reason for this is the hyper-competitive economy we live in. The stakes in every game have been raised enormously. If the best barrister can increase the likelihood that you will win the case and either save or make a huge amount of cash as a result, then he is worth the money. Likewise, if the best teachers can give your child a comparative advantage and a place in college, then they are worth the price.
Similarly, if the best carpenter will make you furniture which you feel will distinguish you from your peers, he will be worth the price. It also exists in journalism, where the celebrity journalist, the one who is better known and more public, makes more per word than other hacks who might actually be much better writers.
The winner-takes-all economy also works in the status vacuum that exists in Ireland.
The best lawyers know that they are good and that they can put up their prices, not only because they are good, but because there is a status involved in hiring them.
How many times have you heard pompous wealthy men saying: ï¿½I have engaged Mr Bigwig Senior Counsel’ï¿½?
This is not only a statement of fact, but a multi-faceted indication of where the pompous man sees himself in society because only a certain type would either have the connections or the money to engage Mr Bigwig.
So the winner-takes-all economy, where rewards are skewed ludicrously to number one, embeds itself in society.
Being a mere worker or an average employee is simply not good enough.
The entire society becomes obsessed with being number one, having the newest, biggest, brightest, latest car, house or kitchen, because with the winner-takes-all rewards come winner-takes-all possessions.
If the society believes that it is totally defensible to have such a structure, those who get to the top are therefore to be admired. By extension, those who fall are to be shunned. We only want success, whatever that entails.
Ultimately, the gaps between the winners and the rest grow exponentially, as is happening in Ireland and has occurred in the US and Britain. And because all the prizes and accolades go to the winners in the private sphere, the public arena gets marginalised.
Once the public realm becomes marginalised, the process has its own momentum, which is very evident in the public health system.
So nurses and medics fall behind and lose status. Why be a nurse and care for the sick and the elderly when you could make twice as much as a marketing executive? Or why be a doctor when your lawyer mates take home multiples of your salary?
Gradually, the health service gets hollowed out. Relative wages and conditions deteriorate and it goes unnoticed.
So the very nurses who deliver our children and look after our aged parents become invisible, while the saccharine TV presenter gets on the front of the newspaper wrapped up in the faux-celebrity, look-at-me world of the winner-takes-all.
In Paris, in an effort to combat the declining income and status of the likes of nurses, the city’s mayor has decreed that 30 per cent of all housing be allocated to municipality workers, such as teachers, ambulance drivers and medics. It is hoped this will prevent Paris from being populated exclusively by bankers, lawyers, estate agents and property merchants.
For those who claim that adopting similar measures to raise the status of nurses is too extreme, let us just conclude on one fact: together with death and taxes, the only other practical certainty is that you will begin and end your days in an Irish hospital being tended to by nurses, kind angels shoddily described as mere workers.