Its Everybody’s Fault I am Sick
There are times when I wish I was an a**hole. Nursing staff don’t bother a**hole SHO’s. If a patient gives them a hard time complaining and whining and demanding, they just deal with it. If you are a nice doctor though, it suddenly becomes your problem and you have to deal with it. The politics of ward-based medicine boils down to finding a balance between being Dr Nice and Dr Stuck-Up. There are pearls of wisdom that are passed on by generation of doctors to help strike that balance: make nurses coffee (only once), buy them sweets (only once), and help them out do something you asked them to do (once or more). If you don’t do that, you sign your own death sentence. They will go out of their way to make your professional life a living hell.
“Will you have a word with this woman in the side room please, doc!” Said one of the nurses on my ward.
“I’m too busy. Ask the house officer to talk to her [Maybe give her a cuddle too]”. I spent at least 2 hours a day in the last 2 days talking to this woman. That is 4 hours I could have been helping really sick people.
“The house officer phoned-in sick and this woman is threatening to pull out her heparin infusion”
“I will talk to her when I have a minute then”
It was 9:00 AM and that day I practically walked in what you folks would call a disaster, someone in their death bed, about to go with the angel, going into the light or whatever it is that is used to describe a dying person these days. We just call it everyday-rubbish. The on call house officer was bleeped in urgently to see this poor old woman who was breathless and looking blue. As soon as I showed up she sighed:
“This patient is hyperventilating and centrally and peripherally cyanosed”
This just means she is breathless and looking blue. We like to say it in big words. It helps us feel smart and closer to solving the problem. She continued:
“I did her ABGs and these are the results. I am not sure what to do now. I am just the house officer”.
I look at the results she handed to me and put on my confident SHO voice:
“She is going into type II respiratory failure”. (AGAIN just meaning breathless and blue). “I can take it from here. Thanks.”
The next few hours I spent trying to sort out this lady (and one other with pretty much the same story) who were both making up their mind weather to die on me or not. All the while, contemplating weather I am out of my depth yet and if it is time to call in the SpR (music + grand entrance) who will be less than impressed if I missed something.
Sick patients started coming from everywhere that day and I was almost in tears trying to sort them all out. I was again asked about a million time to go and talk to Mrs Its-everbodys’-fault-I-am-sick. At 3:00 PM, I finally had 10 minutes to eat, pee and talk to this woman and I worked out the best way of doing it. I will walk past her room, tell her what she knows I am going to say in 30 seconds, listen to her whining for a minute and a half, smile and leave the room. Then I will use the toilet just next door before I grab a sandwich from the shop downstairs and come back to eat it while writing down blood results from the computer. Perfect!
“Mrs […….]. This is an acute medical ward and I have 27 patients half of them are going to die here at some point this year. I have been asked to come and speak to you 5 times today in the middle of medical emergencies. You can pull the heparin needle out of your hand if you want. Its your choice but with your current INR, there is a more-than-likely chance you are going to have a stroke in the next 24 hours. And No, I can not give you the 10mg of warfarin you have been asking for for the last two days because there is a good chance you will get a stroke in the next 72 hours if I do that. Your body is not responding well to the drugs and we are working you up a standard protocol. We will get you out of here as soon as it is medically safe. This is not prison, however, and if you want to walk out right now its entirely up to you but you are putting your own health at risk”
What happened next totally messed up the plan for my 10 minutes break. She looked at me down her nose and said: “Who said that I was going to pull my needle out. That is a lie. I demand to know who said that and you will tell me because i am putting a complaint letter”
O’shit! I have been conned into coming to talk to this crazy woman by wicked nurses. Now she is going to write a complaint letter and she is going to put my name at the top of it, I will get bollucked by the consultant and lawyers and then the GMC is going to get involved and my licence is going to be revoked and I wont be able to practice medicine ever again.
“That is what I have been told. Mrs […….]. Was there anything else that you wanted to discus?”
Obviously there was nothing else she wanted to know but I had to spend the next 10 minutes telling her she has to stay in hospital. She was discharged the next day and sure enough, a month later, the complaint letter came.
PS: This post is dedicated to the Wicked Commentator for publishing a book and sending me one of the first 100 copies. (free copies still going - I think they are free!)
January 18th, 2007 at 10:28 pm
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January 19th, 2007 at 4:11 am
I know the power of nurses. I get along with them mostly and find they are always watching out for me and taking care of me behind my back (I guess I am lucky).
But the OBGYN ones are the ones who will give you hell no matter what.
I miss internal medicine, lots of detective work, so stimulating.
January 20th, 2007 at 11:46 am
I enjoyed reading this..loool…
January 20th, 2007 at 1:40 pm
once i was on call in the pediatrics ward, and i recalled that i yelled at a nurse cus she didnt give a child that was boilling (fever in other words) the anti pyretic medication.. and i never thought that this action wont let me sleep for the rest of the night! .. that nurse (the one i yelled at) told ALL the nurses, working that night, to (attack me) & keep bugging me for wut-so-ever *silly* reason they have just to keep me up and torture me for what i did! i swear i cudnt sleep at all that night.. and after that i learned how to treat nurses!
January 20th, 2007 at 3:42 pm
I forget to congratulate you…. for this nice simple design
Congratulation
January 20th, 2007 at 8:31 pm
Ashah, Low tdreen 3loom testwi fel hospital. I envy the general public for not knowing what actually happens in hospitals for if they did, their feelings of security when inside a hospital will soon dissapear..
I am glad you like the website new looks. :)
HLH, I tend generaly not to have problems with nurses. In fact, I think i am way too nice with nurses and they abuse that.
silence. kel yoom ta3ali :P
uaeadorable, that actually happened to me once. They do take their revenge collectively dont they.
January 20th, 2007 at 9:17 pm
that’s funny. btw.. aren’t you guys prohibited from telling stories about your patients? privacy act of 2222222 :p
i hate it when the politics in an organization prevent it from fulfilling its job..
January 21st, 2007 at 7:21 am
I know about the abusing part.
So, now, I learnt to introduce my self in a snobbish manner, ask questions, draw boundries, once they get used to that horrible person (usually a week or two), I just become me and they are relieved.
I had to do this twice, but in general, I have delt with nurses who are nice and appreciate nice people (like me I hope).
Good luck
January 21st, 2007 at 1:35 pm
As this is my 1st participation in your decent, well-prepared and intelligence WEB, which is fill full of wisdom stories/personal experiences, I would like to great your parents of having such a kid ;) as part of their family members. (alla yi7meek)
Moreover, I bet, you experience such as those patients everyday, but the smart doc “like you :D” who only knows the right way to deal with…. all the best … keep going and god bless you.
One last thing,,,, can I ….? Yea I can :D
I personally prefer the old web design, cz its much more comfortable for reading. This one is too bright, although it is simple. (maybe you can change the background colour)
January 22nd, 2007 at 8:03 am
>>wallah ALLAH iwafigk inshallah Dr. Sultan!!!!
it’s all about ethics and one’s fear from ALLAH that will keep hospitals and the rest of the world running smoothly!!!!
When my grandma -now ALLAH yir7amha- got admitted into the hospital, I made sure any nurse and doctor that came to examin her, got the full story and I made sure that that we know what mumble doctors say to their peer specialists that visited her….why did I give them a hell time? because I discovered that they thought she’s too old and all that is happening to her is because she’s too old! *CAN YOU BELIEVE THIS, PEOPLE?!* ….I knew her too well that, imagine, when the doctor came to talk to her she wouldn’t talk….they thought something happened to her….but I knew that she didn’t talk because she hated being examined by a male doctor…I told the doctor that…..he didn’t believe me……..until the doctor left the room and she spoke to us infront of the nurses…..I had to drag the nurse to the doctor so that he believe that and stop the order of a new medicine that he was asking for from the pharmacy!!!! Every minute of that “sad-nervous-wrecking” experience I thanked god for not being a doctor because of that fine line that they don’t see that affect their decision….although I knew my grandma toooooo well I hope that ALLAH forgives me for anything wrong I did..ever since I fell in love with my grandma I feared that day :’( ….I miss her!
January 22nd, 2007 at 11:01 pm
saed, not if ur not disclosing any personal information. Which I am not. In fact, I make sure I change the names and identifiable information and share only the anecdotal bit of the story.
Thanks Dandona. :)
CuteUAE, I can only imagine how anxious you must have been to see your gramma’s health deteriorating. We definitly do need people to talk to us and tell us when we make mistakes and assume things. Sometimes we dont like it and sometimes it feels like people are telling us what we should be doing. But it has to be done and we need to know most of the time. It only gets frustrating when every member of the family wants to speak to the doctor. And then the next hour or two, there is an other memebr of the family who wants to speak to teh doctor. And again, and again, and again. This really compromises the care we are able to give the patients in the next bed, or next door. I know it does sound like an excuse but unfortunatily that is how the practicalities of things work out.
January 22nd, 2007 at 11:33 pm
I totally sympathize with CuteUAE.
Unfortunatly the communication between doctors and patients in our part of the world is bad. Some tend to take the paternalistic approach where they take decisions, inform the patient/family and go ahead and if God forbid anybody had questions, the immediate response would be “who is the doctor, me or you”.
I know there are really good doctors who are ethical and are in touch with their human side. I guess some just get consumed with the disease rather than the person.
I am glad you were there for your grandmother, I am sure she was comforted by the presence who knew hwo she felt and was there to take care of her. Things are improving, patients rights are addressed, it’s a matter of time.
I agree with e3ashig, sometimes the families expectations could be hectic. I guess if that was addressed early on, before any conflict arises, the outcome might be better. An example would be to ask the family present at times who should you (Dr.) be talking to about any updates or questions and explain why you are asking and state your time contraints and throw in confidentiality. I’ve tried that when I was in AlAin and it worked there.
January 24th, 2007 at 7:47 am
Ok I like totally think ur cool. I passed across ur website in the past but I never took the time to actually finish reading the post and commenting on it. This time I really loved your post and I was anxious to read it till the last letter. Mission accomplished I did. You remind me of Mcdreamy in a way (Grey’s Anatomy) I’m sure u watch it. Dude, as I already said this is a lovely post filled with wonderful stories. I wish you all the best of luck in ur career and may God Bless You.
January 24th, 2007 at 11:38 am
Dear e3ashig and HL&H!
Thank you for your response, I totally agree with you e3ashig that it is very annoying when several members of the family ask for info from the doctors, it is very exhausting to repeat over and over and it makes the doctor annoyed by wondering if the family is questionning his ability, and this is why they made me the spokesperson especially that I knew her too well el7imdilah and capable of talking english when it came to non-Arab doctors, and because of that I felt that I had a huge responsibility….more like the doctor’s responsibility of making the sickness experience less painful….
e3ashig I have to thank you more…especially to that entry that you wrote about how doctors are trained to inform the family about the patient’s death and the 3 types of people that deal with this news…….the doctor asked me into his office, when it happened….[I saw it happen…it’s just that he had to give me the scientific reasons to why he thinks it had happened despite her “recovery” 15 minutes before she left us :’( ]…at that moment Sultan, wallah I remembered what you wrote and I looked into the doctor’s eyes to make him know that I know…it’s ALLAH’s will….yet I looked at him with a “you better give me the right excuse to what lead to this peaceful ending” look…….then I had to come out stronger than my family to brief him what he said……
ALLAH yir7amha wu yir7am kil mawta elmuslimeeen! Ta3adadat al’asbab walmawt wa7id!
ALLAH iwafigkum doctors in everything you do….may you enjoy your time….everytime you go into a career-low-point remember the time you first wished to be a doctor…..I am sure you wished to be so for a human reason…if you did it for the fame of the “Dr.” title………think again! maybe ALLAH helped you to go that path to learn something humane!!!
ALLAH iwafig eljameeeeeeeeeeeeee3!!!
(isma7li Dr.Sultan…6awalna 3alekum!)
January 24th, 2007 at 5:59 pm
OOOOOOMG SAD EYES!! UR SOO RIGHT! HE IS MCDREAMY!!! an emarati version hahaha
February 27th, 2008 at 1:15 pm
of avenged sevenfold sevenfold avenged the