WHEN A HOSPITAL DIES
Emotions run high as the 107-year-old Calgary General closes
God bless this hospital.
—Message left on the wall of an abandoned ward at Calgary General’s Bow Valley Centre
For more than a century, the “grand old lady,” as it was widely known, presided over the city like a doting grandmother. The Calgary General Hospital nursed the sick to health, welcomed babies into the world, cared for the frail and elderly, comforted the dying. Annual reports from the early years list pages of donations that sustained a frontier institution—everything from linen and jars of marmalade to eggs and live chickens. Over the years, it grew into a massive 960-bed complex with a national reputation for excellence. To Calgarians, it was still “the General” even after 1988, when it was officially renamed the Bow Valley Centre of the Calgary General Hospital. That close relationship between a city and an institution ended last week as the lights went out in what remained of the General’s acute-care wards, concluding a slow, painful and very public death.
As the tide of health-care restructuring rolls across Canada, the General’s demise is not only an emotional end to an era for Calgary, but also a glimpse into the health-care future of a nation. The fiscal conservatism of the 1990s has turned hospitals from political sacred cows into fatted calves on the altar of balanced budgets. The role and even the need for many venerable institutions has become uncertain as advances in technology reduced patients’ length of stay for many procedures—in some cases turning what a few years ago was a week in hospital into outpatient surgery. ‘There’s no question this is a different era for public health-care policy,” says University of Alberta health economist Richard Plain. “The delivery of health care has changed and we don’t need as many hospital beds as we once did.”
Amid all the closures and rationalizations, the Calgary General is unique in two respects. It is the biggest North American hospital ever to shut down and have its functions, equipment, staff and patients integrated into existing hospitals, and its closure leaves Calgary as the only large city in Canada without a downtown emergency department. There was really no choice, says Bud McCaig, chairman of the Calgary Regional Health Authority, which ordered the closure in 1994. Provincial funding for the city’s hospitals dropped from $730 million to $637 million between 1993-1994 and 1995-1996. The much newer 500-bed Peter Lougheed Centre, another part of the Calgary General system just nine kilometres away, was operating at only one-third capacity. “We saw it as an opportunity to build a better system at lower cost,” says McCaig.
But for many Calgarians, particularly the General’s staff members, the closure has been a wrenching experience. On C8, the 32-bed general medicine ward, nurse Jo-Anne Crossman is summoned to help turn a patient. Often the work isn’t glamorous, she says, but it forges personal bonds that come with working together in often stressful
conditions. ‘What bugs me,” she adds, “are the TV soaps that show nurses as pretty, pompous and always batting their eyes at the doctors. It is a tough job, physically and emotionally.” As she talks, nurses scurry from room to room, dispensing medication, bathing patients, preparing one for physiotherapy and teaching another how to deal with his newly diagnosed diabetes. “A hospital is a unique place,” says Crossman. ‘You have to work in one and know how strong the bonds and the feelings are to appreciate why it hurts to see it all taken away.”
During the final months of the shutdown process, Madean’s gained special access to the unfolding drama of politics and personalities, egos and money—all rolled into the debate over the future of health care. A diary of the closing of Bow Valley:
FEB. 13,7 A.M.: THE SURGERY CRISIS The critical-care planning group meets, as it does at this hour every second Thursday. Regional administrators are joined by doctors and nurses from the front-line ranks of patient care, drawn into a project they have come to accept with resignation. Their task: to ensure that the most sensitive parts of Calgary’s oldest hospital— the intensive-care and emergency units —are moved efficiently and safely to the Lougheed Centre. After that, the other services will quickly follow—to the suburban Lougheed, Foothills and Rockyview hospitals, which are receiving $95 million in new capital development funding—and the General will die.
‘To put a hospital together properly somewhere else, you have to take it apart properly,” observes Barry Kowalsky, an architect by training and head of the three-member core group managing the closure. Along with administrators Janice Hutmacher and Feisal Keshavjee, he is directing an intricate choreography involving more than 2,000 people. In charge of organizing the physical transfer, which would require the help of three moving companies, is Suzanne Boisvert, a former logistics officer with the Canadian armed forces who once closed down and moved a radar station in northern Quebec. “I figure if I can move trucks, radar and weapons, I can move beds and medical equipment,” says Boisvert.
The meeting runs smoothly until intensive-care head nurse Marg White raises concerns about a seven-day period when the new ICU unit will be operational at the Lougheed, but general surgery will not be available there. “We must have surgical backup in case of an emergency,” she insists. Hutmacher tells White that ICU patients needing emergency surgery would go by ambulance to another hospital, under a plan approved by a city-wide committee of surgeons. ‘That’s what we do now in some cases,” Hutmacher says. But White is not convinced. “We don’t transfer those kinds of patients,” she says. “We transfer the stable ones. I’m talking about a patient who’s crashing.”
This is Kowalsky’s worst nightmare. Privately, he admits to sleepless nights, worrying that something might go wrong. Dark circles around his eyes attest to his anxiety that a patient might suffer, perhaps die, if the closure of the hospital and transfer of patients does not unfold perfectly. “There is no room for error,” he says.
The emergency unit presents unique problems. The loss of emergency service in downtown Calgary is an emotional flash point not only for the public but for staff as well. The General’s emerg is being moved to the Lougheed to upgrade that hospital’s part-time “urgent care” ward into a full-scale, 24-hour emergency service. But unlike ICU, where a unit and its staff are being moved intact to create a new one where none previously existed, the General’s emergency personnel are being merged with urgent-care staff at the Lougheed. Dona Kelly, emergency head nurse, says staff members at both hospitals are unhappy. “People say this is being forced on them,” she reports. “It is very difficult to facilitate any team-building.”
FEB. 13,10:40 A.M.: THE MORALE CRISIS After the meeting, Kowalsky,
0 Keshavjee and Hutmacher move to the “war room,” a stuffy, windowö less retreat where they do most of their planning. The trio agrees the
1 surgery issue must be addressed. Then they are joined by the eight § other members of the overall planning support group. Reporting on t growing staff tension, human resources manager Wendy Griffin I says it is exacerbated by the threat of a provincewide strike by nurs! es, who are demanding a return of money lost in a salary rollback three P years ago. Sick leave is on the rise, some nurses are refusing over£ time—and then there are the personality problems. ‘We’ve got some nurses,” says Griffin, “saying they won’t move and work for a certain manager because she’s a bitch.”
The strike threat is designed to raise the health-care stakes in the campaign for a March 11 provincial election called two days earlier by Conservative Premier Ralph Klein. But it also poses a serious threat to months of planning for closing the General. Outside, a meagre crowd of about 100 gathers in front of the hospital for the opening of the Liberals’ Calgary campaign. Party leader Grant Mitchell says a Liberal government would keep the General open, but few are taking the opposition party seriously—polls show Klein’s Tories headed for a massive majority.
FEB. 19: THE MASH SOLUTION Tensions are high. So high, in fact, that despite a previous understanding Maclean ’s is denied access to a special meeting dealing with White’s concerns about the lack of surgery backup. Behind closed doors, minds change. “It was pretty dicey,” Keshavjee reports after the 90-minute meeting. “Mostly, it was a clash of egos, which is not uncommon when you get professionals together. But once we got beyond that, everyone agreed that surgery would have to be available when emergency and intensive care moves to the Lougheed.” The plan is for a MASHstyle unit, with surgeons on call for any emergency.
“It’s a solution we can live with,” says White.
FEB. 20: THE ONE-ISSUE CANDIDATE Retired radiologist Dr. Harold Swanson, who spent much of his career at the General, is running as a Liberal against Klein in his Calgary Elbow constituency. Swanson passionately opposes the hospital’s closure and believes the creation of powerful regional health authorities is a step towards U.S.-style medicine. Emerging from his mud-splattered Jeep after a morning of doorknocking, Swanson has the look of a man on a mission. The hospital’s demise, he argues, is driven by senior officials in the Calgary Regional Health Authority, many of whom came from management and medical ranks of the relatively new 744-bed Foothills Medical Centre, established in the late
1960s. “The Foothills was always jealous of the work done by and the reputation of the General,” Swanson maintains. “They didn’t want the competition.”
But Jeanette Pick, chief operating officer, acute care, for the regional health authority, flatly dismisses any suggestion that quality of care will suffer. In fact, she predicts the opposite—that consolidating specialized services, such as major trauma at the Foothills, will improve quality. “It’s better to do highly specialized services at one site,” says Pick. ‘When you increase the number of cases, the more you do and the better the staff becomes at doing it.”
FEB. 27: THE STRIKE THREAT The escalating threat of a nurses’ strike has all but overwhelmed the process as the planning support team gathers over a sandwich lunch in the war room. The consensus is that March 7 is the most likely date for a strike to begin because the nurses want to maximize pressure on the Klein government before the election. There is speculation that other unions would refuse to cross United Nurses of Alberta picket lines. “If we’re in a strike situation, all bets are off,” says Keshavjee, thinking of the carefully planned closure schedule.
The General is the biggest hospital ever to shut down in North America
Morale, meanwhile, is at a new low. Arriving late after consecutive 90-minute sessions with rehab staff, personnel co-ordinator Noreen Linton says: “Now I need rehab.” Asked to name the pressure points with staff, she answers: ‘Take your pick.” Nurses have been living with a five-per-cent wage cut, salary freeze and reduced staffing levels for three years. But beyond that, they and the support staff feel victimized by the closure, even though there will be few layoffs, if any. Kathy Bouwmeester, president of the nurses’ union local, agrees. “There is this sense that the medical programs that nurses worked hard to develop into something they can take pride in are being ripped apart,” she says. “A great hospital is dying.”
(A week later, one of the great uncertainties surrounding the closure would be resolved. With the looming election forcing the government’s hand, the nurses reach an eleventh-hour settlement giving them a 7.24-percent wage hike over three years.)
MARCH 4: THE LOSING CAUSE With the Klein government seemingly on its way to a landslide election win, the situation looks grim for the group calling itself the Keep the General Committee. It has been doing battle for 18 months. Now, in a desperate attempt to influence the election, it has called a news conference in a local community association hall standing in the shadow of
Calgary's Hospitals Open and Closed
the General. Not surprisingly, a poll of neighborhood residents has found more than 90 per cent strongly opposing the closure. But privately, Jim Webster, community association board member and founding member of the committee, is holding out little hope. “They’ve spent so much money upgrading the other hospitals, there is no going back,” he confides.
MARCH 6: THE $1,200 CHEQUE Eight people gather in a tiny, cluttered house across the street from the hospital for the weekly 7 a.m. meeting of the Keep the General Committee. With five days until the election, everything seems wrong. The plan is to hold a save-the-hospital rally that night outside the local Calgary Mountain View riding’s allcandidates forum. But the forum has been cancelled due to lack of in-
terest. Committee members decide to go ahead with their rally anyway, but they are not sure how to distribute 100,000 flyers they have had printed, calling on voters to support candidates who oppose the hospital’s closure. It will cost $1,500 to have them delivered to doorsteps, but the committee has only $500. Webster, a software development company administrator, comes to the rescue with a personal cheque for $1,200.
MARCH 11: THE FINAL STRAW Klein and the Conservatives cruise to a landslide victory. Adding insult to injury for those fighting the closure, the Tories easily win Calgary Mountain View. Across town, Swanson sharply reduces Klein’s margin in Calgary Elbow, but there is no moral victory in defeat. “This is a sad day for health care,” Swanson says in his sombre committee rooms as the outcome becomes obvious. There will be no stay of execution for the General.
The first major ward to move will be neuro-rehab, starting a
month-long chain reaction. One twentysomething patient, who declines to give her name, ambles unsteadily down the hall on crutches. She will be going home “for good” the day before the ward closes, she says, but she wonders about the move. Having spent time at both Bow Valley and Foothills, she says Bow Valley has “much better” physio equipment and facilities. “It’s too bad they’re closing it,” she says. “I know the nurses and staff are pretty upset.”
MARCH 13: ‘EVERYONE FEELS EDGY’
A mixture of anger, exasperation and sadness churns within Jo-Anne Crossman. Acting as charge nurse on C8, she directs traffic on the ward from the central desk. “You work with certain individuals for years, people you can count on, and all of a sudden it’s being ripped apart,” she says. “It’s emotionally upsetting and very stressful.” Unlike some units that will remain intact, C8 is being absorbed into two wards at the Lougheed, a situation that is creating anxiety among staff. With just a month to go before the move, the nurses have still not been given a firm date for the transition. “Everyone feels edgy,” says Crossman.
MARCH 15: THE FALTERING START The transfer of in-patients begins inauspiciously on a Saturday. Of the 14 patients in the neurological rehab unit, many suffering from brain injuries, eight are well enough to go home on day passes. Among the six remaining, apprehension grows when transportation fails to arrive as scheduled at 12:30 p.m. At 1 p.m., as they wait in wheelchairs, head nurse Doreen McLeod calls patient transportation and learns that, although she booked the move more than a week earlier and called daily to confirm, it was not entered on the schedule. With the patients clearly flustered and one threatening to call a cab, the manager of transportation is phoned at home and the bus finally arrives at 2:15 p.m. McLeod attributes the glitch to “a breakdown in communications.”
When the patients have left, she and three other nurses take one last look at the empty ward. After 17 years on neuro-rehab, McLeod is flooded with emotions as they hug tearfully. A few days later, McLeod still feels nostalgia for the General, but is pleased with how well she and her staff have been accepted at the Foothills. “They’ve made us feel very welcome,” she says.
“It’s gone smoothly.” Neuro-rehab patient Jane Dawson, 58, has been shifted from one hospital to another three times since being stricken with Guillaine-Barré syndrome, a paralyzing neurological disorder, while visiting family in Indonesia a year ago. She takes the transfer to the Foothills in stride. “I think the
move went very well because the nurses and staff worked hard to get everything organized,” says Dawson, who is slowly making progress and hopes to be sent home by summer.
MARCH 31: THE BIGGEST 10BS Two workers from Toshiba of Canada Ltd. perform the intricate, five-hour task of dismantling the CT scan for its move to the Lougheed. Perhaps nothing symbolizes a modern high-tech hospital more than this computerized, high-speed X-ray machine that provides detailed images of the body, particularly the brain. Busy nurses stop every few minutes to observe the operation. ‘This makes you realize it’s all over,” sighs one. Easily the largest of the machine’s five major pieces is the doughnut-shaped gantry, or supporting frame, filled with intricate computer circuits and weighing 1,600 kg. The same moving company that transported Bow Valley’s equally complex magnetic resonance imaging (MRI) system to the Lougheed in November brings in specialized cranes and hoists. The entire job, including testing and recalibrating the CT scan at the Lougheed, will take five days.
APRIL 8: THE WAKE FOR EMERG At exactly 6 p.m., barricades are placed across the ramp and a sign put in place declaring the General’s emergency department closed. Inside, more than 100 staff members cram into the emergency code room—where countless lives have been saved and lost over the years—for what has been billed as a private wake. Some weep openly as the hospital chaplain, Presbyterian minister Brown Milne, stands on a chair and delivers a eulogy. “In our Christian tradition, we talk of life after death, and there will be life after the death of this emergency,” he says. ‘This is the breaking up of a family, but you will be taking your high standards elsewhere and whatever institution gets you will be very, very lucky.”
After months of keeping her emotions in check, nurse Debbie King, a 15-year veteran of emerg, can no longer hold back. “It’s very, very sad,” she says amid tears. “You have no idea how much of yourself and your emotions you have invested in a job like this. That final moment brings all those feelings together.”
APRIL 10: THE HAPPY PATIENT Calgary legal assistant Mary Lou Whiffin, 60, the General’s last elective surgery patient, is preparing to be moved to the Lougheed with the two others left in her ward. She has nothing but praise for the staff and the care she re-
ceived after undergoing a hip replacement. “I was never concerned about the quality of care,” says Whiffin, holding a basket of flowers on her lap as she leaves in a wheelchair. “I don’t care if it’s a bit noisy and there are boxes around, as long as I can ring a bell and get the attention I need, and I do.”
APRIL 14: THE ACCIDENT Six days, almost to the hour, after Bow Valley’s emergency closed, a life-and-death drama unfolds during rush hour. Three teenagers are critically injured as their car collides with a city bus just minutes from the Bow Valley and the new emergency unit at the Lougheed. But emergency technicians decide to take the three to the city’s only major trauma centre at the Foothills hospital, 13 km away. Even with police blocking traffic, it takes 12 minutes for the first ambulance and 14 minutes for two others to reach the Foothills. One 17-year-old dies the next day from severe head injuries, his distraught family asking if his life would have been saved if the Bow Valley emergency had still been open. But regional health authority officials insist that, because of the severity of his injuries, the youth would have been taken to the renowned Foothills trauma unit in any case.
APRIL 18: THE AFTERMATH Capping a re markably smooth transition, the transfer of the final acute-care medical wards is accomplished four days ahead of schedule.
Last to leave are four patients from the general surgery ward, the same day the last operating room closes. The General is no more. All that remain until the hospital’s doors close at the end of June are a chronic-care mental-health ward— which will move to the Lougheed—and 12 out-patient clinics. The 8th & 8th Health Centre, a new downtown clinic offering 24-hour doctor care for non-life-threatening needs, has handled 1,500 patients in its first month. Only six had to be transferred to hospital by ambulance, and none died.
The Lougheed emergency has hit the ground running. On four of its first 10 days, the new unit saw more emergency cases than either the Foothills or Rockyview, reaching a peak of 211. The volume of work seems to have submerged the morale problems that once concerned Dona Kelly. “People have had to work together very quickly,” she says amid a swirl of activity as a middle-aged man is wheeled by on a stretcher for X-rays. “The staff is already very cohesive.” As for the move itself, Kelly wishes there had been more time for staff orientation once it was determined who was going where. ‘Two weeks just wasn’t enough. We could have used two months.”
In the new state-of-the-art intensive-care unit on the second floor, Marg White feels more relief than satisfaction that the transition is finally over. There were not enough surgical beds at the Lougheed during the transition, she says, creating a patient backlog in the new ICU. “No patients were hurt,” says White, “but it shows when you move a vibrant acute-care service, you need support at both ends.” As for Jim Webster, he has already been paid back all but $300 of the $1,200 he fronted for the Keep the General Committee, and expects the rest soon. But he remains upset about the way the General died. “There was no process,” he complains. “If the public had been involved before the decision was made, there could have been a lot less stress and heartache.” Perhaps. But after 107 years, the passing of Calgary’s “grand old lady” was bound to provoke strong emotions.