The Privilege of Public Service

It has been almost a year since I quit my job as director of communications with the Ministry of Health. It was a watershed moment, walking away from a job that for many years I had confused with my life. It was said that the job was 24/7 and I took that message seriously. You see, health care doesn't stop on the weekends - and more often than not I was chained (by my own choice) from the minute I awoke to late at night to the hundreds of emails and phone calls I'd receive every day describing a myriad of issues, mistakes and tragic patient stories. Pharmaceutical negotiations, labour issues, the black hole of senior's care, SARS and H1N1, excessive wait times, medical errors, and families who in their grief or guilt about the loss of a loved one would lash out at the system when there was no one left to blame - a complex system in which every occurrence seemed to be painted in black and white. A ministry that consumes about half of all government spending, where the needs are endless and the voices of the interest groups and naysayers drown out the vast majority of encounters where the system actually works. I recently listened to two of my former Ministers almost in unison declare on a cable program what a "grind" the health portfolio was - and I listened with particular sympathy. And yet, I was privileged in so many ways to be a part of that world and with the gift of hindsight understand with a new clarity how fortunate I was to have people, right up to the end, place their trust in me - and as a patient myself, have a new appreciation for the system I was a part of for so many years. I worked with some incredible, dynamic and passionate people, Ministers and their staff, executives, health authority leaders - no more so than in my own communications shop - where I was spoiled by a group of creative, funny and caring individuals who still remain in touch - and continue to exemplify public service in the best possible ways. However, I also spent a great deal of time and energy on the inside, railing against the system and challenging policy decisions that in retrospect were better left alone. More significantly, I used it as an excuse to ignore what was going on with my own health - which might explain how in the six years that elapsed between doctor visits, my kidneys went from functioning to almost dead. People say I was passionate about my job and that was true - but that can also be a kinder way of saying strident - and I know there were many moments where I crossed the line. Still being part of it - particularly in moments like the SARS crisis - when an entire system mobilized against an unknown enemy against a backdrop of incredible fear and uncertainty - is a privilege I will never forget. In part, this is why I am so conflicted over my own patient journey and why I believe in my heart pouring resources into people like me is not the answer - not because my life doesn't have value but because I know as with any chronic disease the best opportunity for healing - or at a minimum, a better outcome - comes at the beginning, not the end of the road.