House: The One Year We Lived at Work 7.

 

Job descriptions

I believe job descriptions and roles are vital in the proper running of any institution. They make sure the job is done. If there are no roles and everybody is left to take the initiative to do something, nothing will be done because everybody would be thinking somebody is doing the job, meanwhile, nobody is actually doing anything. I also believe when a person slacks in his/her responsibility, the person should be held accountable, reprimanded and expected to change for the better. However, I saw that instead of this happening, what was happening was a shift in responsibilities.

 

…closed, narrow or absent.

When a part of the body is said to be atretic, it means an opening or orifice which should be open is either closed/narrowed or completely absent. So, jejunal or ileal atresia would mean the jejunum or ileum is narrowed or absent, thus, forming some kind of barrier in the food pathway. It’s noticed within the first few days of life as food given to the baby accumulates rather than going down the digestive tract as it should and the abdomen starts swelling, baby starts vomiting and yawa sha gases. Of course, only surgery can sort that out and it entails cutting the narrowed portion, joining it to a distal normal portion and then creating a diversion for fluid and food for a while so as to allow the point of joining (anastomosis) to heal and not breakdown. After the surgery, the baby is only on intravenous fluids at first before attempts are made to feed via a tube passed into the stomach through the nose. (Hope I broke it down well enough).

Somehow, over the years, cases such as this we’ve had have not survived😥😥😥.Either they don’t get enough fluids or they get too much or they don’t get enough glucose or get overloaded or they are not making enough urine and it is not noticed on time or feeding is initiated too early. It was a sad history and I caught my consultants’ fever of ensuring at least one successful, living baby post surgery. Issue is, these identified possible causes of death were things meant to be handled by nurses. They put up the fluids, set them to the appropriate drop rate to ensure they don’t go too fast or too slow. They monitor and record urine output, so, if it is not adequate, they are meant to notice first and call the doctor’s attention. They feed the neonates on admission, both those who were taking directly by mouth (not direct breastfeeding of course) and those with tubes.

But, seeing as the babies had not been making it, surviving the surgeries, these roles were shifted to houseofficers…on the assumption that the nurses were not doing them well.

 

When I resumed PSU, we had one baby with jejunal atresia. A baby that needed all this close monitoring. So, we, houseofficers, were checking fluid rate almost every thirty minutes or hourly and adjusting as necessary. We were  checking urine output. And when the time came, we, houseofficers, were the ones feeding this  baby with NAN every two hours. All these in addition to all our other duties as houseofficers and this baby was not our only patient. So, two hourly feeding that did not stop after midnight, nor was to be interrupted by other departmental activities. It was hectic! My God!

In as much as I wanted this baby to be the one that would make it (and he actually made it, Praise Be), I was not pleased that these roles had been shifted and had now become like… the norm. A day came when I went to give the two hourly feed and I found out the NAN had not yet been prepared. I told the nurses on duty and the response I got…

“shebi you guys are the ones doing the feeding, you can as well prepare the NAN. There is hot water in that flask and the NAN is…”

I was shocked! 😲😲😲 It was just the height. I mean, we were already draining urine in the urine bag to measure. We were already putting fluid in the soluset and titrating accordingly. Now, we were down to preparing NAN too?

If I had insisted that this was for the nurse to do and walked away, that baby would have missed a meal and they don’t tolerate hypoglycemia well at all. Then, the consultant would have gotten angry at us, the houseofficers, for not feeding as at when due. And when the issue of the NAN is raised, guess who would still be blamed? It would be, “so, you could not make ordinary NAN and get it done with?” No mention would be made of the person who was comfortable passing up her duties just because she knew someone else would take the blame.

Thanks to God that baby made it and was discharged, but, our quality of life as houseofficers during that period was terrible. Imagine waking up every two hours to feed a baby, while still serving drugs at 6pm and 6am, sometimes 10pm too and still seeing consults when they come in, no matter the time. And still continuing the days work …clinic, theater, ward rounds.

 

Duty accountability

This shifting of roles was not limited to nurses/doctors. It happened with other hospital workers and doctors and it all boiled down to those in power not willing to hold them accountable for what they were supposed to be doing especially when they were not doing them right. They would rather harp on the houseofficers and maybe that’s because, to some, we were more of house-helps. And you know what this meant? These people slacking on their jobs also have the audacity to tell us to do some other weird job that they are employed to do because they think, “if their (houseofficers’) ogas can tell them to do those other ones, why can’t we also tell them to do even more?”. Which is why one of the nurses could tell a houseofficer colleague of mine to go ahead and change a neonate’s diaper. I’m glad she didn’t.

This is not about pride or ego. This is about each person respecting job descriptions. I don’t need to be reminded of my age when I insist on you doing your job while I do mine. I don’t need you telling me you could be my mother just because I asked you to please speak with respect. This is why some things never get better in Nigeria. Meanwhile, transfer these same set of people to ‘za abroad countries’ and see them almost licking the floor some young-in just walked on because they know if they slip up for just a second, they could find themselves clutching a box of their belongings, out of a job and with no good recommendation for another.

 

Imbalance health-professional-patient ratio

On the flip side, there is the problem of under-staffing and a distorted nurse patient ratio in the neonatal ward. But, this also points us back to the issue of not addressing a problem at its root. If you think the nurses would work better and be able to attend to patients better if they are more, then, employ more and ensure each person is putting in work equal to his/her paycheck. Meanwhile, bear in mind that these nurses work in shifts and not calls like doctors. (Just saying). If anyone accuses me of being mean on this matter, I won’t blame them because I saw some very terrible work ethics just because, “how old are these ones sef? I can give birth to you twice. “ And standing up to them meant lack of courtesy and manners. One even asked a houseofficer, “Aren’t you Yoruba? Don’t you have manners?”

Manners kee you there. 🙄🙄🙄

I survived PSU and I actually felt fulfilled because that baby made it and because my unit presentation was lit! Imagine three consultants commending you over and over. Of course there were corrections on doing some parts better but it was a wonderful presentation.

 

Orthopedic surgery

So, despite the stress we went through, I walked into orthopedics in high spirits.

Orthopedics is Baeeee

Fam! I agree with how Orthopedics is like a city set apart on a hill, not to be hidden in the usual surgery bushel. (Haq haq haq. See how I’m spinning wisdom. 🤣🤣🤣🤣)

But seriously, Ortho. in FMCA was not involved in the departmental activities other units had to be a part of and that was just one of the things that set them apart. I worked with consultants and medical officers that were too chilled, if there be anything like that. Ward rounds were cool, calm and collected. Patients were informed of their care and management plans. Theatre was involving. I sure wasn’t holding the saw to cut bones but I knew the pins, fixators, methods and why we were doing what. I could see actual rapport in the team. There was an ease in the day to day workings of the unit.

Ortho being Ortho, most of our patients had to stay on the ward for a long time. I made friends and learnt more about those patients beyond just a fracture, just a malunion, just a limb shorter than the other. The patients were comfortable sharing their opinions with the team.

 

Not a typical surgical unit

Let me give you an instance, we were in theatre that day. The anaesthetist was about giving the drug through the spine to numb the patient from around the upper abdomen downwards. Talk started. I think it was football… I mean, all of them are guys… And there was a lot of laughter and banter and it was all funny. One of the MOs said something directly to the consultant and we all laughed, including the consultant. That’s how a periop nurse carried it on her head o. “Dr. Xyz, that’s what we are saying. You people in Ortho have spoiled your subordinates so much that’s why they can be this free with you. See how all of you are jesting as if there is no heirachy in your midst. No respect. No fear at all. I mean, if it were this other department, the regs dare not even talk when their consultant is talking. One reg like that got a call that her sister was sick and she could not even approach her consultant to ask for permission. “

Hol up, hol up, hol up. And this is good, how? How is that the ideal thing? How does that portray respect? Are we even normal in this place? So, I must be walking and working with fear and trembling… Unto what end? And now that our Ortho consultants have chosen to be ‘crazy’ enough not to follow that path, you think we are missing out on something good? Ladies and gentlemen, I was livid. What the actual heck??? I would have given her a piece of mind if not that, looking at my people, they didn’t even give a hoot what she was saying. In fact, there was some pity in their eyes for her.

And to conclude how bae-ish Ortho was/is, we had a team outing on my last day in the unit. That’s from consultant down to houseofficer o.

We just talked ‘men stuff’. I was inducted into the menhood seeing as I was the only female among them. We talked about when these accomplished men were still struggling with finances, with female temptation and all sorts. We told stories. And we learnt life lessons. And we learnt to keep things said round that table… Round that table alone. Which is why I can’t share those stories with you. Sowwy. 😈😈😈

The seeming irony…

And before you ask, those people were not for once slack with their jobs. Never. This was/is a unit where everybody rolls up his sleeves to ensure patients are satisfied. Even the nurses on Ortho wards are up and doing. They do their work without being asked. They are proactive. They know their patients down to the very last. And they respect everybody. I think I would have gone for Ortho if I were surgery inclined. The principles of care are straightforward, you actually see the body heal itself and everyone is happy.

Then I moved to general surgery 3 and woh, God safe us!

 

A Little Note

1. Baby geh, #Peo, is grateful for the support and encouraging words. They aren’t taken for granted.

2. We are still aiming for 250 views on this post. Not backing down till it’s attained.

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