Cats

The Intensive Care Unit (ICU) at City Hospital, Belfast was a circus. Every day of the week a different clown (read Consultant) took charge of the ICU. What was right on a Monday was completely wrong on a Tuesday. The same action would be pronounced ‘perfect’ by one clown and ‘abhorrent’ by another. To make things even better, they didn’t talk to each other. The flunkies (read Junior doctors) were the in-betweeners that got lammed from both sides as their shifts crossed over time-territories. They were the pawns on the frontline that took over the running of the unit from one clown at the beginning of a shift and handed over to the other at the end of it. The flunkies dodged the arrows of conflict between the clowns – on the phones, in hospital corridors and at handovers. They were the ones that ran around all night looking after the sickest patients in the hospital, only to be lambasted the next morning. They were the buckets in which the bile of bitterness was collected, the one that the clowns didn’t have the gall to throw at each other.

In 2004, I was one of those flunkies. After about 8 months of this non-sense, I was done. I was loosing my sense of self, my confidence in making decisions and most importantly, the pride in my job. It was time to stop and take stock. After a nasty night shift, I was handing over the patients to the day team. At one point the Consultant said to me ‘you need your head examined’. That did it. I couldn’t bear to go home only to return to this hell-hole ten hours later. I walked into the Psychiatry Outpatient Department which was on the way to the car-park. There were two empty seats in the waiting area. I planted myself on one.
“Do you have an appointment?” one of the receptionists asked me.
“No. I don’t. I can wait for as long as it takes. I work here. If I am not seen today I may not come back tomorrow.” I didn’t fully comprehend what I was saying but it was my truth.

Dr Ingram was a handsome young psychiatrist with kind eyes and a small beer belly, well couched in his grey suit. He understood. He gave me 6 weeks off on grounds of ‘work-related-stress’ and started me on Fluoxetine. I was also seen five or six times by a therapist. She was a kind elderly lady who listened. She suggested getting a cat.

At the Antrim Animal rescue home an adorable black and white feline peered at Saagar’s dad and me from her cage. It was her eyes that got me – curious and twinkling, like a child. They said this little girl had been there for a month. Before that she’d had a rough life on the streets for a few months. Her right ear had a wedge missing from its edge. We decided to call her Bella. We were advised to keep her strictly indoors for at least 6 weeks, till she got familiarised with the smells of the house. She found her way to the tops of kitchen cabinets and radiator covers, squeezed behind sofas and underneath beds, inside shoes and suitcases. The only place she didn’t like was her brand new soft bed.

On our trip to the vet for a basic check-up, we were told that the she-cat was in fact a he-cat. After much discussion, Saagar’s dad’s choice of name came up tops. ‘Mr Bronx’, the old faithful. He soon became a source of great joy, comfort and hilarity for us. We had him playing with balls of wool, soft toys with bells and chasing the beam of a laser pen. He was pure joy but kept his distance. Slowly he let us stroke and cuddle him. His purring beneath the palms of my hand soothed my soul and made me feel deeply connected with this four-legged being. Within a month we were having full-fledged conversations.

The Fluoxetine made me feel like a zombie. No joy. No pain. No love.
It was dehumanising. At times it made me terribly restless but I stuck with it. It was proof that pills can’t make you happy. May be they take the edge off, but at a price. The best thing about that time was that I could rest. I was left alone. I had some control on my days and nights, which I had not had for years.

After 6 weeks, it was time to go back to work. I did. My schedule was reshuffled to ensure I didn’t spend much time working in ICU. It worked. I got back on my feet. Later I discovered that other junior doctors before me, had had similar unpleasant experiences, complaints had been made about the sad state of affairs at that hospital but nothing had changed on ground. It was an open secret, not spoken about while the abuse persisted and continued to break innocent young doctors down.

Nine years later, Saagar was home from University and I got a phone call from him at work. “Mamma, can we get a cat? I found one on Gumtree.”
That evening we went over to a tiny flat in Sydenham occupied by a black family of four – mum and three kids. On a window sill lounged another family of four, a grey mother-cat with her three grey kittens. Six weeks old. The kittens were being carried around the flat like rags by the kids. They didn’t care if they lifted them by their ears or tails or bellies.They released the sweet little things from various heights above the floor, cornered them and held them tight. They told us about what the cats ate. We picked the littlest one, a grey and white mini-punk. We got a bell, a bowl and some toys for him from the pet shop and brought him home in a cardboard box. He was christened ‘Milkshake’ by Saagar, who became his loving mum that summer.

The sedate Mr Bronx was too old and too calm for the punchy young Milkshake who developed an attitude very quickly, but they found a way to co-exist, keeping a safe distance from each other.

Not once did it occur to me that there might be a connection between the circumstances in which we got the first cat and then, the second.

Bad doctor!!!

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Despite check-lists, protocols and guidelines, mistakes happen. As long as human beings carry out jobs, mistakes will happen. To err is human. Safety is an outcome of a person’s attitudes and actions within a given environment. Both, the person and the environment have a strong impact on each other and the outcomes. The bad mood of one person affects the whole team. Similarly, a stressful milieu for any reason such as lack of time and resources has a direct impact on the performance of each person in it.

In my 19 years in the NHS, the working conditions and morale amongst the staff have gradually worsened.  When things go wrong, clinicians, being visible on the frontline are expected and often willing to take responsibility. Holes in the system and staff morale are hidden. Only on a closer look are they clearly seen.

I sit in a unique position where I work for the same organisation that is at least partly, if not fully responsible for the fact that my son is not in this world any more. Yet, I know and see many doctors and nurses work way beyond their call of duty. However, our very own GMC took the case of a paediatric registrar, Dr Bawa-Garba to the High Court, supposedly in the best interest of the public. She had looked after 6 year old Jack Adcock before he tragically died of severe sepsis under her care. Her Counsel summerised:

“The events leading to [Dr Barwa-Garba’s] conviction did not take place in isolation, but rather in combination with failings of other staff, including the nurses and consultants working in the CAU that day, and in the context of multiple systemic failures which were identified in a Trust investigation.”

Yet, the high court convicted her of ‘manslaughter by gross negligence’.

A blog by concerned UK paediatric consultants stated that:

“On this day: Dr Bawa-Garba did the work or three doctors including her own duties all day and in the afternoon the work of four doctors.
On this day: Neither Dr Bawa-Garba (due to crash bleep) nor the consultant (due to rosta) were able to attend morning handover, familiarise themselves with departmental patient load and plan the day’s work.
On this day: Dr Bawa-Garba, a trainee paediatrician, who had not undergone Trust induction, was looking after six wards, spanning  4 floors, undertaking paediatric input to surgical wards 10 and 11, giving advice to midwives and taking GP calls.
On this day: Even when the computer system was back on line, the results alerting system did not flag up abnormal results.
On this day: A patient who had shown a degree of clinical and metabolic recovery due to Dr Bawa-Garba’s entirely appropriate treatment of oxygen, fluids and antibiotics was given a dangerous blood pressure lowering medication (enalapril) which may have  precipitated an arrest.”

The case has now been put to the Court of Appeal.

So, whose fault is it? No handover, no induction, no senior support, temporary nursing staff, poor IT services, shortage of doctors … whose fault is it? Obviously the doctor’s. Why this huge disparity in the way in which hospital doctors are treated as opposed to the others? It’s not ok for the sickest of patients to die in a hospital whereas fit and healthy young men and women are allowed to die in the community with not an eye-brow raised.

Parity of esteem? Bollocks!

 

Day 977

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Rebecca

Rose Polge. Rebecca Ovenden. Lauren Phillips.
All junior doctors. All deaths by suicide, in just over one year.
The only three publicly known. Total number not known.

Polge’s mother linked her suicide directly to conditions at work – exhaustion because of long hours, work related anxiety, despair at her future in medicine and the news of the imposition of a new contract on junior doctors.

This problem is not limited to the UK. Earlier this year, 4 deaths within 5 months in Australia propelled the launch of an urgent investigation into the problem. No such investigation in the UK. Indeed, the law here explicitly excludes suicide from the requirements to report work-related deaths. A GMC report in 2016 stated that the low morale amongst junior doctors was putting patients at risk. Signals of distress and a dangerous level of alienation are an indication that the system cannot simply go on as before.

At the 2017 BMA junior doctors’ conference, delegates gave the union a mandate to lobby for all suicides to be investigated formally by their employer, jointly with the GMC, Health Education England and the BMA.

In France, workplace suicides are a well-recognised entity.
Yes. Suicides are complex. There can be many contributory factors. But when there is clear evidence of a link to work pressures, that should be given appropriate attention.

Ref: BMJ Article: Suicides among junior doctors in the NHS followed by an interesting discussion.