I've had a few days to calm down, and I'm going to sneak this post in between two posts, hopefully nobody will notice it, but it will allow me to vent a little bit. Yep, you guessed it, it's another work related post.
Where to start without giving too much private information away...
For 2 months, I have been aware of a patient who needed a caesarean section for delivery of her baby (because of previous caesarean) who had some other health problems which would necessitate special care of her baby. This individual had suffered some psychological and physical trauma from rape in the past, and had some anxieties about her caesarean. If she was asleep, she would have been fine for anyone to look after her. However, because she wanted to try to be awake for the sake of her baby, and have an epidural/spinal (where your body goes to sleep/numb below the waist but the top half is still fully mobile and functional) she was worried that the vulnerability of her position would bring back some bad memories. Namely, males in the theatre, touching her private parts, looking at her whilst she was flat on her back and paralysed... you can imagine what I'm trying to say. She requested to have an all female team looking after her if she was having an epidural caesarean section.
At first, I thought that her request was a bit unreasonable - this is a public hospital, and it is very difficult to be able to accomodate her request, as it depends on who is available on the day. I informed everyone that if the procedure was done electively, that I would do my best to accomodate her, and put myself, my female anaesthetic fellow or another registrar into the list so she would be comfortable and we would meet her beforehand so she could know who was going to care for her. However, if it was done as an emergency out of hours, we could not accomodate her requests because it was more likely than not that male doctors would be on site. She was OK with that.
As I was unavailable on the day that they decided to choose to have her caesarean electively, and my female anaesthetic fellow was on night shift so she couldn't do it either, I selected one of my other female registrars (training doctors) to do the caesarean, and she had a special interest in obstetrics, making her an ideal candidate. I emailed and spoke to my registrar about the circumstances and also gave a copy of the birth plan with the patient's requests and special words that we were to avoid using so as to not cause distress. The patient did not consent to some procedures being performed, but she was happy to do those to herself, and though her requests and demands sounded a bit unreasonable and demanding, when we met with the patient, she was a reasonable and understanding patient who told us that these were requests and if we could accomodate her she would be most grateful.
One downside was that the consultant anaesthetist assigned to that list (ie owns that list regularly) was a male. However, I thought it was a bit unfair to him to be removed from his regular operating time because of one patient, so putting a training specialist into his list so he could go and sit in the tea room and come into the room if the trainee needed help was acceptable - after all, that trainee has, for two years, done night shifts and copes with emergency caesareans and traumas/stabbings/major surgery on her own with no consultant anaesthetist on site, so I was confident that the patient was getting not only good care, but met the requests she had, without disrupting too much of our own day to day running.
Then the week came when it was going to happen and it went downhill from there.
I found out 3 days before the procedure that someone had allocated that trainee to another theatre. So I went to go swap her back, and spoke to the other female trainee that they had put in there, and told her that it wasn't that there was anything wrong with HER, but because the other trainee had been prepared and read the plan, it was better if she could do it.
I called the obstetrician who was looking after the patient to let her know of the plan, and she was happy. I was pleased that everything was going to go according to schedule.
Then the day before the procedure, I was called by the operations manager (who fills the surgery lists with anaesthetists or finds people to cover them) who had only just read my email and said that I would need to change the male anaesthetist to a female. I said this was not necessary as he could sit nearby and not be within eyeshot of the patient, but be ready to be available to assist the trainee if the need arose. The operations manager was not happy with that, and decided to go over my head and speak to the duty anaesthetist, who changed the allocations - putting a consultant anaesthetist into that list (who was female) as well as leaving the female trainee there who had not met the patient.
I was annoyed. My colleagues rang me up to tell me that I was being ridiculous by giving into the "demands" of the patient, and the patient was being unreasonable and that she was not a private patient and she should not be treated specially. I told them, that I had done it with MINIMAL disruption to our present allocations and operating schedule, even leaving a male consultant anaesthetist there because we had no appropriate female consultant anaesthetists available that day. I was not aware that there was one available, and the female they put in that list was one who was particularly insensitive and a bit troublesome, and would not follow the birth plan that we had been following and trying to accomodate for the last 2 months. I asked them to contact the obstetrician to let them know of the changes - they did not.
Fortunately, the procedure itself went well. However, I was displeased that the female consultant anaesthetist did NOT read the birth plan and used the words that were specifically asked not to be used during the procedure, much to my trainee's and my horror. And my trainee was upset because she felt that people did not trust her to do this caesarean and treated her like a fool or a new trainee even though she had been doing this for more than 2 years.
The patient herself was happy with how it all turned out. That at least was one goal achieved, and I should be happy with that.
However, I found out the day AFTER the procedure that the other members of the anaesthetic governing committee (of which I am also a member, being the head of my sub-department) were unhappy with my organisation of the whole scenario and I was to be reprimanded the following week. I was infuriated. How DARE they, when I was the one who was involved in the care of the patient, planning things for her well being. They were displeased because I had not discussed it with them. I had not discussed it because I didn't want people to make a bit deal out of it - if I could get away with minimal disruption, the better it would be for everyone. But because there had to be reallocation of the theatres and consultants and trainees, they were going to lay that on my doorstep, as well as the fact that I should not be giving into patient demands. I was so angry I drafted my letter of resignation from the governing committee, stating that if I have to ask permission to do every little thing, then there is no point in me having a brain of my own to provide sensitive and empathetic care to patients who rely on us to look after them in their times of need.
I have not sent my letter. I kept it saved on my hard drive and decided instead to throw myself into pet battles and World of Warcraft, and block out the crazy world that I work in. Where people who are supposed to care about others and help make them better, only care about which chain of command I am supposed to follow and probably to tell me off for putting a patient at risk. Which is where I beg to differ. They think that I put a patient at risk because I didn't have a consultant anaesthetist on site in the room with the patient, and was happy to have him 2 metres away - even though he was contactable. What do these people think happens after hours or on the weekends? There are no consultants around, and the trainees run the emergency theatre and deal with all the emergency caesareans, the ruptured aneurysms, the major road traffic accidents with severe head injuries, ON THEIR OWN WITH ONLY CONSULTANT COVER ON CALL if need be. The patient was getting better care than a patient on the weekend! And it was very safe - I would have let my own sister have that registrar looking after her and been happy.
I was extremely disappointed in my colleagues who seemed insensitive to or didn't care about a patient's special circumstances and their attitudes of HOW DARE someone ask for special care when they were a public patient! Are we not here to help our patients? If my sister had been raped and wanted a little bit of consideration for her caesarean to prevent some of the anxiety of being held down helpless, I am sure she and I would be most grateful for any assistance anyone could offer. I suppose if the patient was a diffiult patient and despite our best efforts continued to rant and complain at us I would have less sympathy for her, but this lady was genuine, was reasonable and sensible. People have to realise we do have limited resources in the public health system, but if we can help within our means - then by all means we should!
Maybe more of my frustration comes from my decisions being overidden like they don't matter. It could have been a sexist thing, but I think it is more a hierarchy thing because there is an imbalance of power within our department. There are 3 members of the governing committee who seem to make all the decisions and the rest of us just do as they say, and I have never liked that. I have stood against it countless times and been reprimanded for it. However, I have done all those things for the well being of my patients, not for any political, financial or personal gain, so I don't feel guilty about doing them. Like the time I wrote an email to the operations committees to remind them to please consider an emergency caesarean list as part of their theatre allocations - I got in trouble because I didn't ask permission before sending an email /rolls eyes. There are a number of incidents which seem to be like that. Perhaps it is my own ego which is at fault here, because I want my decisions to be listened to or at least considered, and I feel like I know better than they do, what is best for the patients under my care. I should learn to be more humble and not such an arrogant ass.
At my other work place, life is much easier. My opinions are respected, and OBEYED, and all my ideas are given thought and merit if they are sustainable or workable. I feel like a valued member of my department and I enjoy putting the work into it because I can see the rewards of my hard work, my initiative and of course, my skill set which is interdepartmental relations and negotiations.
I am so tempted to give up my position on the anaesthetic governing committee at my political hospital. It is a grand shame because I really enjoy what I do there - I am the director of Obstetric Anaesthesia, and I specialise in high risk obstetrics such as those at high risk of bleeding, have special medical conditions, premature babies/labour, and I am good at it because I am sensitive to the needs of others. However, it is impossible to do well at what I do if I have my hands tied, constantly. I feel disrespected, undervalued and sometimes, even held in contempt. Is it worth doing what I love and put up with this crap? I wonder if I give up the crap will I be happy? I suspect that I won't because I will miss it - this part of medicine is so fulfilling at times, so rewarding, that I feel like I can put up with anything to be able to keep doing it.
And so, the conclusion to this drawn out rant... when I am reprimanded on Tuesday, I will state that I was doing what I considered to be in the best interests of everyone, to allow us to provide the care that the patient needed with minimal disruption to our services. And that because I know the trainees better than 95% of the other specialists there because I take the time to know them and talk with them about their training needs, I am the person best suited to deciding whether someone is capable of caring for a patient with their consultant supervising from a safe distance. If something else is highlighted that shows me to be at fault, then I will accept the blame or the recommendation accordingly. However, if it is because I didn't ask permission to do something that is well within my right to do, because I hurt someone else's ego by trying to show good leadership, well, they will have a Navizor on their hands.
OK enough ranting. Back to pet battling.