The next thing was a tremor. My family have a ‘familial tremor’. It too was worked up. No explanation and generally reassurance. The two together caused me uncertainty about being a surgeon. The work was steady for 4 years. Rather than lighter than medical school, internship and residency was more demanding. I’d later find out that my familial tremor was simply made more prominent by lack of sleep and excessive coffee but that took years to discover. The doctors at the time said that it would take a year or two to observe to see if it was progressive.
At the same time I was disturbed to see that my new friends, young surgeons, last year’s senior resident’s couldn’t get OR time. There was this incredible surgeon who was working a few years and he still only had one morning of operating time. Surgeons are at their best young and this fellow was faced with wasting his best surgical years fighting bureaucrats for the right to operate because they were intent on stealing the health care funding meant for medicine and surgery and spending it on themselves to make more wasteful political bureaucratic positions. Cronyism and corruption have always been the bugbears in the Canadian Health Care system with it’s horrendous abuse of the front line workers for the sake of the fat cat desk jockeys calling the shots from a far.
A young girl died for want of surgery in my internship year. She could have been cured and would have lived if she’d had the surgery when she needed it. I saw the surgeon whose patient she had been devastated. Most of the surgeons seemed to spend all their time arguing for OR Time. Greatest doctors I knew and they were begging these swaggering politicos. I’d already had my encounters with administration. I worried about having more and what I would do f I had to depend on these self serving popinjays.
This one night I had a man dying from cardiomyopathy. He couldn’t go to ICU because if he went on a respirator he’d never get off. But I could give him the heart medication that would keep him alive. Only this medication was restricted to ICU use because it required constant monitoring which the nurses did in ICU. Just like I’d stay on watch as a solo blue water sailor years to come, then I set up the drip and pulled up a chair and settled in to watch the patient all night. What was sleep anyway?
That’s when the hospital administrator exploded on the scene. He began shouting at me in front of the patient that I couldn’t do this.
“If I pull out that line the patient won’t live through the night.”
“”I don’t care. It’s against hospital protocol.” If I had a dollar for every time I’ve been told that what I’m doing is again some outdated committee decided protocol for some patient I’d be a rich man.
“If you want to pull out that needle. You can but I’m not going to do it.” I responded think how horrid this little man was traumatizing patient like this.
“He needs a nurse monitor. ‘. This is where they always throw their weight around, insisting that a nurse is needed then refusing to pay a nurse to come in even if it’s life saving. The nurses are as furious as the doctors by these shell game excuses. When there’s a need for money for the bureaucrat parties, raises, more bueaucrats and more office furniture and office interior designers , there’s never a problem.
“I’m monitoring the patient.” I said.
“All night?”
“Yes I’m sitting there all night.”
“It still can’t be done. You must observe protocols.” He couldn’t let it go.
So he called the head of medicine at night for this non emergency. Typical.
I loved the head.. One of the greats of medicine,
“What you’re doing is right Bill. It’s kind of you to forfeit your sleep. I see he wouldn’t have lasted the night. He’s doing well. I’ve had to deal with this administrator before. I’m sorry as.a junior doctor you’re exposed to what real medicine is all about. I hate it but now I’ve got to convince this fellow our job here is to save lives not follow his protocols. I’ll take it from here.”
The administrator had been yelling at me. He now was whispering furiously with the head.
The patient was looking really sheepish.
“He doesn’t like me. Does he. “ the patient said.
The man was so vulnerable. He’d been unable to walk much for these last weeks and wasn’t leaving the hospital but he was enjoying his life. His family visitted each day. He was a young man. No wife but a mother and father and sister. He liked to play board games with them and cards. He read books a lot. We all liked him. He was going to die but not tonight. Not on my watch. Not if I cold op it. I have a good gift for predicting life , it’s just a way of calculating the relative risks in my head. He could live another few months if he could get through this night.
The administrator scowled at me. The head of medicine went back home to sleep half a night.
The man lived. He was a whole lot healthier. His heart was happier in the morning. I caught an hour of sleep on a spare gurney before joining the rounds.
The head of cardiology stopped me in the hall.
“I heard you kept my patient alive last night. Thank you.” He said.
“The head nurse and I used that same infusion a couple of months back. The head nurse offered to monitor him after I ordered and set I up. Same problem administrator. But he wouldn’t tangle with her. Didn’t care what I said. You did the right thing. Thanks for saving my patient.’ He continue dwn the Hal.
When I saw the patient later I said ‘you didn’t tell me the head of cardiology had done the same thing.”
“Yea the administrator was trying to kill me that night too. I was afraid if you knew this had happened before you’d not have fought for me.”
It was so sad, this fellow with a failing heart worried the administrator wanted him gone and he was so vulnerable.
It was such a sad statement about the all powerful government men and the vulnerable patients. I’d feel a shiver go up my spine. The man lived for months. It was the way it was supposed to be. The administrator gave me dirty looks thereafter. A vengeful little shit. He carried a little black book and looking at me would pull it out and write in it.
They taught us in medical school how to fight disease. As a full fledged doctor I’d learn that that was just half the battle, having taken an oath to be the advocate of the patient I’d end up fighting the devil as often to save the patients life.
We’d have fun though. One of our favourite pranks was to have the nurse tell the resident on call about a new patient with horrendous impossible symptoms watching him scratching his head and his chest deflated and true befuddlement take over. Then we’d follow him to the room where one of the interns was hiding under the blankets.
“Surprise!”
You never saw such relief on a doctors face. The nurses and staff were always fun.
We had one guy convinced he was in contact with a dangerous microbe were putting him in isolation and calling the WHO only to say ‘surprise’ and get cursed.
One of my favourite pranks was to be on a crowded elevator and turn to my fellow intern and say rather loudly, “Your STD results came back and there’s no evidence of Gonorreha or syphylis.” Then I ‘d remain silent while he blushed and all the elevator would try to move further away from him.
I even got a staff man by telling his secretary that his mistress had delivered a 7 lb 5 oz baby, that he should come by obstetrics as soon as he could be free.
He nearly killed me but we all laughed at the consternation he described his secretary being put in and how she conveyed the message. Of course he said “I’ve no mistress.” But one of us had to go by to tell her it had been a joke because she didn’t quite believe him.
That’s about the time I met Bob Manness. He was a country general practitioner who had graduated a couple of years before me and was the friend of my surgical friend.
We were being told that if we wondered about our choice of speciality the best thing we could do was to take a year of general practice and be sure. Country general practice was the best of the best for learning medicine and surgery . I was still thinking of missionary work in Africa so this would help prepare me. There was doubt that getting a full surgical residency was going to be necessary because people thought that in the outback and wilderness where I hoped to serve there simply wouldn’t be the facilities I’d need to do anything advanced. Another year maybe of surgery and I’d be ready for that but a year of country medicine would certainly help me a lot more right now when I wasn’t sure if my hands were going to hold up. Leaving freed u the slt for a classmate who really wanted surgery but hadn’t made first selection.
Dr. Bob Manness was one of the great guys. This was the real Dr. Marcus Welby with a touch of Dr. House. He promoted his hospital and his town to me. It was his home town and he really loved it
“I’ve been alone this last year and can’t go on if I can’t get another doctor.” There’s 30 nurses, 30 beds and an OR but we’ve not had a surgeon for a few years. It originally had 6 doctors but they’ve left or retired. My colleague retired a year ago and since then it’s just been me. The government is planning on closing the hospital and I can’t go on unless I can recruit help. Would you consider it?” He was just short of begging.
I took a year off surgery feeling that Bob and his hospital had a greater need and that I would learn more serving there. It was 40 miles south of Winnipeg. I could commute. I’d discuss it with Maureen. She was planning on being a general practitioner at the time and could join me when she graduated.
Our mutual doctor couple friends had a homestead 20 miles south. She’d invite Maureen and me over so we could get an idea of what the rural doctoring was like . IT was great to be at their house with their children and the home made bread in her wonderful home, her and her husband doctors.
Bob meanwhile was doing everything he could to convince us too.
“But I was so happy when you were going to be a surgeon,” Maureen said.
Posts
No comments:
Post a Comment