House: Is it Worth Being Houseofficers?

Houseofficers are rarely asked, “Why did you not go home when ‘everyone’ was asking you to go home?”

The other day at the gynae emergency, it was past 4 pm and this particular houseofficer was not on call. Earlier, she had seen a patient but was yet to review the patient with the SR. She asked the reg if she could summarize the patient to another HO who was on call so she could get to an appointment she had (and was already late for) while the other HO reviews with the SR.

The reg refused.

This houseofficer then went to the SR who having listened to her, said she could leave.

I am not sure she told the SR she had a patient she wanted to review but she had handed over the documentation and all to a fellow HO.

Time came to review patient and SR got to know from the reg that the excused houseofficer was the one meant to discuss the patient.

The insults started.

Even though the SR clearly gave her permission to leave and she was not on call and she had handed the case over to someone on ground, the houseofficer was still insulted and called names in-absentia.

In this particular case, I’d say the HO should have waited or been straight up with the SR (if she was not).

WRONG ROTATION? WRONG TIMING OR JUST WRONG ME?

 

However, the gynae emergency was actually an unending horror movie for houseofficers.

Something must have happened to the SR. Or, maybe she was also just a victim of the ongoing departmental tension. It could also be that I just rotated through there at the wrong time.

Before I got to the gynae emergency, other houseofficers had told me about one of the benign and sweetest SRs who was just an angel. Boy, I was looking forward to working with her.

I got there and, blessed Jesus, I thought maybe they had swapped this angelic SR with some other being. She was easily irritated and would shout and insult us in Yoruba, telling us about how, “Your children will do the same to you.”

Truth is, she had some rules that I later understood to be very useful, one of them being to leave enough margins while documenting as the sheets get twisted and torn over time and vital documentations could get missing with them if they are too close to the edge.

In other units, not so much emphasis was placed on that, so, most of us were not used to it.

So, we forgot.

Then, she would go into this shouting parade and phew, it was terrible. By the way, the patients and patient relatives were not spared.

One morning, I caught the look of one of the patients as she watched the SR bellow at the houseofficers. She looked so bewildered and confused.

Two instances stand out. One of them is what happens when you are caught, as houseofficers, between a junior resident and a senior resident. While the other is what happens when houseofficers try to do the minimum required emergency care but your ogas aren’t having it.

CASE ONE.

 

Usually, chemotherapy patients come in for their chemo sessions on the ward and are attended to by the unit in charge.

This day, a woman comes to the gynae emergency and says she was directed there for her chemo session. It was to be her very first and she was terribly scared. The reg told us to write some extra materials for her which would be used with the drugs she already came with.

Assuming that the reg was in tune with the SR, we started working.

We had mixed all the drugs, a hard and long task on its own, when the patient started crying that she didn’t want to go on with the chemo again.

I sauntered to the SR to tell her, “Ma, the patient is saying she does not want the chemo again o”, thinking that we were on the same page.

“Which chemo patient? I do not know about any chemo patient. I don’t know when we started administering chemo in the emergency ward. You and your reg should sort out your patient.”

I thought it was a joke. I informed the reg of her reply and he just brushed it aside and told us to continue seeing the patient. Obedient houseofficers we were.

 

The lady and her mother were counseled on the need for the chemotherapy and a member of her managing team even came to talk with them before she eventually complied and consented again.

Chemo was started and then it was closing time. Her chemo session was to run till the next day, so we had to hand her over to those on call.

That’s when we discovered we had been dragged into some tug of war.

SR said to us, the houseofficers, “None of you is going home. Who told you to start chemotherapy for this patient? You started it… finish it. All of you are going nowhere. You think you can just do as you wish?”

I was stunned. Help me o, why is this on us? Why are you not facing your reg who was aware of your reluctance at taking this patient but still instructed us to go ahead? Or were we to disobey him? We are like directly under him, you know?

We sat and waited. The guys on call had come. They were all wondering why we were still around. For me, I was too tired to even explain much.

After a while, reg told us to be going. I was like, “Hm, is that the best? Should we not wait for her to let us go?”

The Reg insisted, “Go joor”.

As we passed by the SR, she just started shouting that. “How dare you? Am I a joke to you? How dare you defy me? Okay, go now. You will come back and meet me here.”

See, I was exhausted. At this point. I just sat down. Some other reg was there telling us to go beg her but I really did not see why we were to do that. This thing was not on us at all. Whatever beef was between her and the reg was not meant to draw us in but, this is Nigeria, look what we doing now.

When she finally allowed us home, I could hardly bring myself to say, “Thank you”, because, really…?!?!?!

CASE TWO.

 

Second instance, the gynae emergency was busy. A pregnant patient came in with about two to three days history of vomiting and diarrhea.

She was extremely weak and had to be supported into the ward by her people. Also, she looked quite pale.

Our SR was busy, our reg was nowhere to be found. We decided to start clerking her, taking blood samples for investigations, secured intravenous access and started resuscitating her with the appropriate fluids. One of us had gone to spin her blood to determine her packed cell volume to know if she would need to be transfused.

By the time our SR was free, I was so proud of us. I thought, yes, we know emergency medicine. We conducted and comported ourselves well. The work had been divided efficiently and patient is now stable.  Let’s review with the SR and see what else she may want to add.

L. O. L

We were talked down at like little children. The SR made us look so stupid. It hurt… badly.

What then were we doing there?

There was nothing she changed or corrected in what we did. She just said, “How could you touch the patient without informing me…?”

“Ma, you were busy…”

“Please, don’t give me that! What if a consultant had come in and asked me about the patient? What would I have said?”

“We are a team, ma. You were not lazing around. We would have just given the history and what we had done so far…”

“No, that is rubbish….”

I gave up. And allowed her to exhaust herself too. Then, when I thought she was done, we attempted to apologize, next thing…

“So, your mouths are too heavy to say sorry?”

I tried explaining that we did not want to interrupt her as some people consider that also rude, she just went on with her tirade of words.

Whatever morale I had for that day’s work plummeted.

Hers was the rare case of being told by others that so so person is nice and easy to work with, only for you to get there and meet gobe.

 

It was in OnG I started taking people’s statements with a pinch of salt. If they don’t out rightly say it, just be careful. If they did say it, confirm from other houseofficers or seniors who were there. Always have those who can bear you witness.

I mean, it is in this department that a consultant would just turn round during morning review to where the houseofficers are and be like, “Yeap, I feel like giving out extra calls today.”

Prior to this, everyone was laughing, learning and all ‘was well’, the next thing, extra calls are flying left, right and center and I’m like, “Guys, wait now, are we being serious right now”.

I think it got to a point where the houseofficers learned and perfected the skill of being invisible.

GOOD FATHER, BAD HUSBAND?

 

It was also in OnG I discovered how your personal relationship with an individual might be a far cry from how this same person relates with others. It’s like you, as an individual found some sort of favor with the person. You found his/her soft spot and they treat you okay. But, you are acutely aware of their treatment of others and it scares you.

Let me tell you about a secondary school friend.

The first time I noticed him, he was having this brawl with a senior. We were in SS 1. I don’t recall what led to the whole thing but  I remember the rage, the energy exuding from him, the way his eyes had widened. This guy was ready to punch any and everybody.

It was shocking.

We later went on to become very close that our classmates, juniors and even teachers thought we were dating. He was always looking out for me, doing the most amazing little things for me.

There were other occasions of his anger blowing up in front of me but I always found a way to justify him. Sincerely, the other party was usually at fault. But, the issue was the magnitude of anger he brought forth.

I had been told that the day would come when I would  be at the receiving end of his anger. It seemed impossible till it actually did happen. Oh, and I was not the wrong party this time. I think I cried that day.

Truth is, a person will treat everyone the same way, no matter what. The fact that he/she likes you presently is not complete immunity. It just means because of some proximity, you know when to move aside and avoid being caught up in the tornado.

This is the same with a particular Oga. I had heard being in his firm was the last thing anyone wanted but after few days of being there, I kept wondering why people were saying so.

Yes, at first, I was faced with the tension of his frequent percussions. “Are these houseofficers reading at all?” he would often say.

But, I also stepped up my game and the day I heard him say, “I like that girl from UCH, she knows stuff”, I could almost hug every random person I met.

So, I worked harder. I wanted him pleased with me. Reading well before his ward rounds became the norm. Firm activities were handled with extra care. All rumors of the firm being tough were thrown out just because I believed myself on good terms with him.

He never really said it to me. He never showed me any favoritism, well, except asking me lots of questions and pushing me to think the answer out when I was not being confident. But, I was no more just any houseofficer.

However, I knew that he was not exactly the best friend to the others in the department.

IN THIS SET T, E, O AND G, WHICH ARE MUTUALLY INCLUSIVE? EXCLUSIVE?

 

This man had a way of doing his things that put guys under a lot of pressure and tension. People walked on eggshells around him. You held your breathe till he was done with you. You may not have escaped if you sigh in relief too early.

The way it was, most of the toxicity in and around that department are said to have originated from the fear of him. It was transferred down to all and sundry. In fact, the most gentle person can turn malignant if pushed under his spotlight.

On the other hand, the excellence of the department also sort of centers round him. His patient load is oftentimes more than that of others. In the end, he gets things done.

So, do we have to trade in a less toxic environment for more excellent results? Are toxicity and excellence mutually inclusive? Without one, can’t we have the other?

PREGNANT WOMEN AND PREGNANCY/DELIVERY.

 

I see all these pregnant women, who until their care is placed under him, are not at rest. They would keep worrying about one thing or the other but the moment this Oga steps in, it’s like the Lord himself has arrived.

Talking about pregnant women;

There is a thread on post-partum (pregnancy) issues on twitter and women are sharing their experiences, most of them painful and scary and my anxiety about pregnancy just flew up again. A friend of mine was already talking surrogacy and adoption.

Alright. What are the things that contribute majorly to the trauma of pregnancy and delivery? Especially at delivery;

1. Pain.
2. Lack of emotional/psychological support.
3. Morbidity and mortality.

 

PAIN.

 

The first one is just out of here. The pain during labor has been described as indescribable and out of this world. I was in the labor ward during the OnG rotation and, my my my, I saw and heard all sorts said and done by women in labor due to pain. Many houseofficers can attest to this.

They would pull at their hair, hit the bed rails, the windows, the side table/small cupboard beside them, scream profanities in mixed languages. These women would pray to Jesus and Allah at the same time, call for help and yes, ask for caesarian sections.

In between all those, they would find a word or two for the man responsible for their current state.

Many houseofficers have had their hands squeezed to pallor, their hair pulled almost off their scalp and their efforts at being nice rebuffed.

It is a sight I have gotten used to but I have still not been able to place/picture myself in.

We give them analgesics for this pain but it is never enough.

[pain thresholds differ truly but the average woman actually needs more than just an instra-muscular analgesic].

You see these women rubbing their thighs, their lower backs as much as they can, their tummy, sweating, crying and this goes on for hours.

Do we tell these women about epidural? Are they aware that vaginal birth can actually be painless? Is affordability actually inquired or just assumed impossible? Do we allow them decide if they want to risk it or not or we just assume they won’t?

Are they educated that a painless vaginal delivery is as true, legal and womanly as a painful one? Do we make them realize they don’t have to carry on the ‘traditions’ of pain?

EMOTIONAL SUPPORT.

 

The second thing is support. Once these women enter the labor ward, they are more or less cut off from their family and friends. Yes, we want privacy for each pregnant woman in labor but, there are definitely other ways around this than denying a woman screaming for her husband the emotional succor his presence would bring her.

A patient of ours then, from start to finish, just kept shouting her husband’s name. “I just need to see him”, “Just let me hold his hands”, “I need my husband”,, “Can he just come in for a while?”

It was cute and heart wrenching at the same time that she would not have her request granted.

The whole of labor is draining, physically and emotionally. Those women need all the emotional and  psychological care and pillar they can get. They just need a familiar face and known hands to comfort them.

But we deny them that and it makes the whole birthing process more unbearable.

Some might argue, what if the husband does not want to be there?

It is simple; he won’t be there. Nothing spoil. The point is allowing the woman the blessedness of familiarity and something close to the normalcy she was used to.

And trust me, houseofficers, the medical team, sure need to know that y’all are not the best representative of ‘normal’.

MORBIDITY AND MORTALITY.

 

The third thing is the high rate of death associated with pregnancies and deliveries. Women keep dying from complications and issues that should be a thing of the past.

Some of these issues stem from what I discussed earlier; that mentality that adequate suffering equals deserving of honor and respect and worth.

Caesarian section is seen as taboo. One who does it has resigned her position from the Order of Hebrew Women. Many body building foods are struck off their food list. Then, add how they would rather suffer with the traditional birth attendants before going to a proper hospital.

Yep, death toll. And houseofficers certifying deaths.