When I Really Needed a Hand

*Warning: this post contains graphic descriptions not suitable for the squeamish

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Christmas Eve (nearly 10 years ago)

Hand trauma call on Christmas Eve was always busy. Typical presentations included people who cut their hands with Stanley knives wrapping or making presents, housewives with stab wounds in the left palm, mostly from the knives slipping whilst they were trying to wedge an avocado seed out (use a spoon, ladies!), or clueless men who cut their fingers trying to open a can without a can-opener. Work was steady, I had been running between admitting patients in ED (Emergency Department) and operating in theatres all day. I was a junior registrar, only nearing the end of my second year training in plastic surgery. There was not a lot a second-year was supposed to do without senior supervision, however, I had been on this hand surgery team for nearly 12 months now, so I was accustomed to performing routine hand trauma surgery such as infections, lacerations, tendon repairs and simple fractures without calling my senior registrar in.

Our on call had two tiers – if I was out of my depth, I was to call the senior registrar (a final year trainee), who usually came in to give me a hand. If he/she needed help, then the consultant plastic surgeon on duty was called for either over-the-phone advice or had to physically turn up at the hospital. The nurses and other doctors could also bypass the junior registrar to call either the senior registrar or consultant if they felt that the junior was out of his/her depth, or doing something that may have not been in the best interest of the patient. Rarely, the consultants were required to be on site, apart from major complex hand trauma cases, which luckily were far and few in between. This was because our country had very strict firearm laws, motorcyclists also had to wear protective gloves by law and it was illegal to buy fireworks and firecrackers without a licence.

The senior registrar I was on call with was two weeks short of becoming a consultant. He had just passed his specialist exams and was finishing off his final rotation. Throughout the year I had been on call with Peter several times, and I knew he did not like to operate late at night. I had learnt to book all the more complex cases in the mornings and avoided doing procedures I was not comfortable with at night in case I needed him. As for the consultant who was on call over the Christmas weekend, Dr H, he lived by the motto: ‘Don’t be afraid to cope’. His phone was only to be used for nothing short of life and death. He never came in on call, unless the patient had private health insurance and was willing to pay for their surgery. It was unheard of for a junior registrar to call him directly, we valued our lives too much.

Back to my Christmas Eve, the day was progressing smoothly – at one stage, it looked as if I may even get home for Christmas Eve dinner. As I was writing up the last operating notes for the day, my pager went off. The tone indicated that it was a trauma call from ED. Probably another car accident. Guilt flooded me, but I couldn’t help smiling. This meant that no other cases could proceed unless it was life-threatening, and most likely this particular trauma case, if it made it to the operating theatre, will keep the emergency theatre occupied until early hours of the morning – therefore I could not do anymore hand cases tonight, even if they started piling up in Emergency. A trauma call at 7pm not only meant that I could go home for dinner, but that I may also get to sleep through the night! My steps lightened as I headed towards the ward to see my postop patients before heading home.

As I was about to finish the evening round, my pager went off again. This time with a phone extension from ED. I shrugged, whatever they were holding down there will have to wait until the morning when the trauma case is over. I headed to the desk and punched the numbers into the phone. ‘Tiff here, what you got?’

‘Oh, Tiff,’ it was the trauma reg on call. ‘Hey, I am so sorry mate, but I think this one is going to be all yours. You are going to love it, consider it my Christmas present to you.’ An evil chuckle followed.

I raised an eyebrow. We rarely get involved in trauma calls. Even if the patient had concurrent hand injuries, we only ever get the call a few days later when their main injuries have been taken care of.

I sighed, ‘I am on my way.’ With heavy footsteps and visualising all my evening plans disappear above my head in an imaginary puff of smoke, I headed to the elevator.

My colleague was not wrong. The patient was cleared of any serious injuries. The only trauma he suffered was that to his right hand. Mr D was a 65 year old right handed, retired lawyer. He was finishing off a rocking horse he made for his 6 year old grandson. He found the handle a little loose, so decided to re-fashion the rounded piece. However, when he was trimming it with a bench-top mounted circular saw, the wooden rod slipped and he ended up putting all four fingers through the saw instead. They were all taken off at base and was handed over to me unceremoniously by the nurse in a plastic bag.

After meeting the fingers, I went in to introduce myself to Mr D, noting that his injured hand was wrapped up firmly like a boxing glove to try and stem any bleeding. I looked at his x-rays of both the hand stump as well as amputated parts to assess both the level of amputation and the metal work that may be required to reattach the digits. After having had a serious chat with Mr D, I took the bag into another room and laid all four amputated fingers on the bench top. Then I took a marker and printed on each finger which ones they were. I checked the amputated ends and silently offered a prayer of thanks that the saw was high speed and sharp, as all four fingers showed clean guillotine-type amputation rather than avulsion-type injuries associated with slow oscillating saws. The latter usually involved more extensive injuries to tendons, nerves and vessels which often make replantation difficult with very poor outcomes. Even though the prognosis was looking good for Mr D, my heart sank. Replant surgery took hours to perform; one finger alone could take up to 4 hours, and I was looking at 4 fingers. There was no contraindication for me not to replant any of the fingers, as all of them looked clean-cut and despite his age, Mr D was otherwise fit and healthy, thus suitable for a long anaesthetic.

I checked Mr D’s details and smiled when I realised that he had private health insurance. Dr H would love this case, it was well known that replantation of a finger was well-paid by insurance companies. Remuneration for four fingers would be equivalent to almost a whole year’s private school fee for one child. I picked up the phone and rang Peter. He was also glad to hear that the patient had private health insurance, and promptly asked me to ring Dr H. I protested, as it wasn’t appropriate for me to contact the consultant directly. Peter said that since Dr H will have to come in to do the surgery anyway, there was no point for him to see the patient, and if he hadn’t seen the patient, he didn’t know enough details to talk to Dr H. He told me that Dr H would be pleased to hear from me.

I was naïve and believed him.

So I rang Dr H. At 8pm Christmas Eve.

To say that the conversation was unpleasant would have been an understatement. Dr H was livid that I had contacted him. He told me that he was having Christmas Eve dinner with his family and had no interest whatsoever spending the night operating. He was not interested in the patient’s insurance cover, and if the patient had presented at a public hospital, then he was to be treated as a public patient by training registrars regardless of his insurance status. Dr H then told me that under no circumstances was I to call him again directly, especially about this case. I could almost hear the phone being slammed down when the disconnection clicked in my ears.

I called Peter, as this is going to be a major complex case, so he had to come in. There was no way I was expected to carry out this surgery on my own even though I have read this procedure in detail and knew the basic principles. In practical terms, however, I had only seen two similar cases performed before and assisted in one. This was definitely not an operation that followed the rule of surgical training of ‘see one, do one, teach one’. Only the most senior of trainees were allowed to perform it unsupervised.

When I told Peter about my conversation with Dr H, he swore and made disparaging comments about lazy consultants. He then told me that he was having Christmas Eve dinner and he couldn’t possibly get away, so I would just have attempt the surgery on my own. I almost dropped the phone in shock, and protested that I was too junior to take on such a case. He told me that he is more than happy to talk me through it and give me advice on the phone, but he could not physically come into the hospital. I glanced at the clock as we were talking and realised that it was nearly 8.30pm. This meant that warm ischemic time for the fingers was over 2 hours now (as his injury was around 6.30pm). Warm ischemic time referred to the amount of time the fingers had been without blood supply while it was not on ice. If the fingers were to have the best chance of survival, they needed to be reattached within 6-8 hours of warm ischaemic time. Whereas cold ischaemic time could be extended to 24 hours. However, there had always been controversy associated with reperfusion injury and poor nerve regeneration with prolonged cold ischaemia.

I knew that staying on the phone arguing with Peter was delaying Mr D’s treatment, so I finally acquiesced to Peter’s request (much to his relief), and finished the phone call. I quickly documented both phone calls in Mr D’s chart and then rang theatres to let them know that he was coming up for a very long surgical procedure. While the transfer was taking place, I went to the office and pulled the hand surgery books off the shelf (this was before Google days). I quickly familiarised myself with the chapter of replantation again. Then I took the bag of fingers with me to the operating theatre. The nurses were still preparing equipment and the anaesthetist was just starting to put Mr D to sleep, so I set up an operating table in the corner, cleaned and tagged all the nerves and vessels at the amputated end with micro-sutures under the microscope, to save me time later on looking for them.

I knew I only had 4-6 hours to re-establish blood flow into these fingers. I also knew that if I did not plan this well, it would be at least 12-16 hours before I could get them all perfused, as normally it would take around 4 hours just to complete a one-finger replantation. So I devised a strategy in my head, part of which included planning ahead. Firstly I made sure all the equipment I required were ready to go, then I got a bucket of ice and put the fingers (wrapped in plastic) in it. I was trying to buy an extra hour or two by swapping warm ischaemic for cold ischaemic time.

As soon as the patient was asleep, I inflated the tourniquet on the patient’s arm, to stop any blood flow into the hand so that I could work in a bloodless field (and see what I was doing more clearly). I prepared the stumps on the hand and again tagged all structures under the microscope ready to be joined to the other end. Then, under x-ray guidance, I reattached all of the fingers with wires to realign the bones. This was achieved within 2 hours. Then I had to let the tourniquet off, as stopping blood flow to the arm for more than two hours could cause muscle damage in the arm and hand. Often if we needed to have the tourniquet on for more than 2 hours, we allowed blood reflow for 15 minutes between each tourniquet period; this was sufficient to minimise any lasting damaging. So I wrapped the hand tightly in a bandage to prevent excessive blood loss and un-scrubbed for quick coffee break while the tourniquet was down. I knew that for me to work efficiently, I needed to be alert at each stages of surgery, so I deliberately planned to use these reflow times as my breaks.

After 15 minutes, I spent the next 2 hours of tourniquet time repairing the tendons. There were two tendons in each finger, so that meant repairing 8 tendons altogether. Unfortunately when the tendons were cut under tension (as it was when one’s hand was gripping an object), the tendons retracted into the palm. Luckily I had thought of this during my stump preparation earlier on (while the fingers were on ice), thus I had already dissected out each tendon and pulled them back out, ready to be reattached.

At this point, I am sure most of you would be wondering why I didn’t join up the blood vessels first – if re-establishing blood flow into the fingers was so important to be done in a timely manner. Well, the reason was that both the bony and tendon work required a lot of retraction and manipulation of the fingers. If I had rejoined the blood vessels first (which were around 1-2mm in diameter and the threads we used to sew them together were thinner than human hair), then any traction or movement would have easily disrupted the repair. The repairs were also too frail to hold together unless there was some form of structural stabilisation of the fingers. The easiest way to explain it would be to equate it to constructing a building; one wouldn’t put the plumbing in place until the walls, beams, struts and foundations have been established.

Once all eight tendons were adequately joined, it was time to let the tourniquet down again. This was perfectly in plan with joining up the arteries (which brought blood flow into the fingers). Each of the fingers had two of everything, two arteries, two veins (vessels which allowed blood to flow out of the fingers), and two nerves. Arteries were best joined when the tourniquet was off, as blood flow often dilated these tiny vessels, thus made it easier to identify and place the stitches. I worked furiously under the microscope, with the aim to connect up only one artery in each finger as quickly as I could, thus to re-established blood flow into them within 8 hours of total ischaemic time. I breathed a sigh of relief when all four finger became pink on the table. I looked up and it was just before 2am. Then, at a less pressured pace, over the next 4 hours while the fingers were happily alive, I connected up the rest of the arteries, veins and nerves.

Unbeknownst to me, during those 10 hours as I was working quietly away, phone calls were being made outside. The nurses and anaesthetic staff were aghast that a second year trainee was attempting this procedure alone. The operating theatre nurse manager called Dr H and told him that I was performing the case on my own. Dr H told her that it was Peter she needed to ring. Peter was rung, and he told them that I had said I was happy to do the case alone and did not need him. He reassured her that he would have come in if I was having trouble. The nurse manager did at one stage poke her head in and asked if I was ok, and I just assumed it was a courtesy visit so I told her I was fine. Peter then rang the operating theatre about midnight to ask how I was going, he spoke to the nurse who picked up the phone. The nurse offered to put me on to speak to him directly, he declined. Apparently he didn’t want to speak to me and just wanted her to pass on a message. The message was that he was about to go to bed and if I was struggling, or feeling tired, I was to put whichever fingers I hadn’t attached back in the fridge on ice and rebook the patient for surgery tomorrow so that he could reattach the remainder fingers in morning. I snorted at the message in a very unladylike manner (much to everyone’s amusement as it matched their sentiments exactly) and kept going. No one made another phone call after that.

So the fingers lived. Mr D had the full hand of fingers to compliment his uninjured thumb when he left hospital 5 days later. He had a long road of rehabilitation ahead of him, but he was thankful that we managed to save all of them. I got called into the office by the Head of Department (HOD) on that same day as Mr D was discharged. The HOD had received an incident report from the Nurse Manager about how inappropriate it was for such a major complex case to be done by a junior doctor alone. I received a thirty minute lecture about biting off more than I could chew as a junior trainee, followed by another fifteen minutes on learning to know my limitations and recognising the need to ask for assistance.

A few days later, at the end of my last clinic with the team, I saw both Dr H and Peter being pulled into the office with the HOD. I asked the nurses what was going on and they told me that the HOD saw Mr D’s chart in clinic and asked them why this patient was in a public clinic when he was privately insured. All the nurses avoided giving him an answer so he flipped through the admission notes himself.

The following week, I had already moved onto another rotation at a different plastic surgery unit when I received my assessment report. I read, with surprise, what the HOD had written:

Tiffany improved well above her training level as a second year trainee during the last 12 months. She showed initiative in difficult situations and exhibited good insight in her abilities. She demonstrated natural aptitude in microsurgery. I would strongly recommend her for ongoing training with any plastic surgery unit.

Peter became a consultant and moved in with Dr H as his partner in private practice.

Not a Saint Hospital

One morning I found a note on my desk from my secretary. It said:

The Medical Director at St X would like an appointment with you to check that everything is going well for you at St X.

It wasn’t unusual to get a ‘summon’ from the Medical Director of these private hospitals. Usually, it is a low-key chat to make sure that the private surgeons working there are not having issues with the operating theatre equipment or staff, and that they have no complaints about ward care of their patients. It was just over 2 years since I have started bringing patients into St X for my surgical lists so I was expecting an invitation from the MD sooner or later.

I asked my secretary to shorten my next St X operating list, and arrange an appointment with the MD afterwards around 5pm for me.

This was the conversation:

MD: Hi Dr T, thanks for taking the time to see us. So, how’s everything going?

Me: Great. I have had no problems, the theatres are great, the nurses on the ward are helpful, my patients have had no complaints. They are liking the private rooms and….

MD: (Nodding vigorously and leaning forward to cut me off). Well, I want to talk to you about Mrs Y.

Me: Oh? Is she causing problems with the staff?

Mrs Y was a patient of mine on the surgical ward whom I had just admitted two weeks ago. She was a teacher in her late 50’s who sustained severe spinal injuries when she was a teenager and is now wheelchair bound. Mrs Y was also a long term insulin dependent diabetic who unfortunately had severe ketoacidosis last year and ended up in ICU, ventilated for 2 months. During her illness, they didn’t look after her pressure areas so she ended up with severe grade IV pressure sores over both the ischium and sacrum by the time she was transferred out of ICU. She was then discharged from hospital with this problem as no one wanted to deal with it whilst she was an inpatient. Mrs Y went back to teaching, and spent hours every day in her chair. When her blood sugars started to deteriorate and her family doctor noticed an unpleasant smell during one of her visits, it led to the discovery of her persistent pressure sores. By the time she came into my office, she was hyperglycaemic, septic with infection as both pressure sores were wide and deep enough for me to put two fists in each. I could see her ischial bone at the base of one, and the rectum at the base of the other, and because she was incontinent from her spinal injury, the wounds were severely contaminated with faeces as she sat in the wheelchair in her soiled diapers. Understandably, both her and her husband were by now, agitated and frustrated with unhelpful medical staff and hospitals.

I admitted her into St X, because it was a large tertiary private hospital with all specialties on hand. She required an urgent endocrinology review, infectious disease input, a general surgical procedure to divert her faecal output via a temporary colostomy, dressings and pressure care. Needless to say, she started to improve within 7 days. She required intensive nursing care with four times a day dressing change (to prevent accumulation of pus that was continually exudating from the wound) and two hourly turns to prevent development of new pressure sores while she was bed bound.

Mrs Y, at the beginning of the week, cranky from feeling ill and hating being bed bound, was not the best compliant patient. She was a teacher after all and did not like being told what to do. She was also a little distrustful of the nursing staff as it was poor nursing care in ICU which resulted in her current problems. However, after seeing herself improve over a week, she became the most pleasant and grateful patient on the ward. She helped the staff by setting an alarm clock and turning herself so that all the nurses had to do was to pop their heads into her room and check that she was in a different position. She also changed her own colostomy bags so that the staff didn’t have to deal with this particularly unpleasant job. The nurses told me that they enjoyed looking after Mrs Y.

I was rather surprised that the MD had brought her up in our meeting.

MD: No no, nothing like that at all. (He cleared his throat awkwardly). Patients like Mrs Y, well, we find it hard to accommodate them in this hospital.

Me: I know, I know, spinal patients should really be in dedicated spinal units, but there are no private spinal facilities for these patients. Mrs Y has been paying her private health insurance for over 30 years, so she didn’t want to go to a public hospital; she wanted to be looked after in a private hospital.

MD: We understand that, but private health funds in general don’t pay us very much for looking after patients like her. She requires intensive nursing care so we actually don’t get any profit for such a heavy nursing load.

Me: (Speechless for a second) So, let me get this right. You don’t want patients like Mrs Y because her admission doesn’t generate enough profit for the hospital?

MD: I just wanted to make you aware of this, so that you will remember in the future not to bring patients like her into our hospital. We would prefer day surgery patients, but if you feel strongly about keeping them overnight, we are more than happy to accommodate that. As for Mrs Y, I believe you are planning to keep her in hospital for a while?

Me: Yes. At least 3 months.

Both Mrs Y and I had a long discussion about this. She had agreed to take a whole semester out of teaching and come into hospital to have her sores treated properly. This meant bed rest with appropriate pressure care, no sitting in her wheelchair and regular dressings. I had explained to her in depth that if we could make her overall health better, these sores may heal without intervention. If not, they may need an operation. However, even with an operation, she will need to be off the surgical wounds for 6 weeks before she could sit on them. She knew she was in for the long haul, because she didn’t just bring her suitcase when she checked into the hospital, she also brought her Nespresso machine. According to Mrs Y, 3 months was a long time to go without good coffee.

I watched the MD’s face cringe.

Me: I can’t rush the healing process, and I have to wait for the infection to settle.

MD: Maybe you can find a little operation for her so that we can get a little more money out of her health fund during her stay?

Me: But she doesn’t need an operation. She just needs dressings.

MD: We are probably going to lose money if she stays that long.

Me: Would you like me to transfer her to the public hospital? (The MD looked up at me with surprise and a glint of hope in his eyes). I could just say to Mrs Y that St X doesn’t want you here because they are unable to make a profit out of your stay. They think you should really be in a public hospital despite the fact you have paid your private health premiums for the last 30 years…..

MD: No, no. (He started to clear his throat again). There is no need for that. I suppose since we are a hospital affiliated with the church, we can show charity by letting her stay her for a while.

Me: Righto. Is that all? (I started to get up to leave).

MD: But, (he stopped me turning towards the door), if you do a few more of your cosmetic cases here at St X’s, it may compensate for her stay.

He stood up and reached out to shake my hand.

Me: Well, I cancelled two breast augmentations this afternoon because of this meeting. I have transferred them to my lists at another hospital tomorrow.

I ignored his hand, turned to open the door, and walked out of his office without a backward glance.

Mrs Y stayed for the full 3 months and went back to teaching full time, sitting in her wheelchair with a beautifully healed bottom.

 

Doctors are the worst patients

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There are plenty of reasons why doctors shouldn’t get sick. The best one being – we make the worst patients. I, of course, am no exception. Despite having had plenty of practice in the past of being a patient, somehow, I just don’t seem to learn. Every time I get sick, I am always a doctor, trying to be a patient.

So why are we such bad patients? Because we think we know better. We are the one saving lives, and sometimes we refuse to admit that we are the ones that need saving.

6 weeks ago, I caught a viral infection, not hard when you work with sick people all the time. I kept working, because as far as I was concerned, if I wasn’t intubated on a ventilator in intensive care, or in a casket, I was not sick enough to stop working.

Reason #1: We don’t realise how crap we really feel until we stop worrying about how crap everyone else feels. When you are deeply buried amongst blood and gore during an operation, you concentrate on what’s in front of you, rather than the tightness and clogging in your own lungs.

Two weeks later, instead of improving, I developed a hacking cough which sounded like I was trying to expel my lungs in piecemeal. As I was struggling for breath whilst talking to patients in my clinic, one of my colleagues suggested that I go and have a chest x-ray done. I did. I looked at it with my colleagues (bear in mind we are both plastic surgeons who rarely ever have to look at chest x-rays), we decided that my lungs looked normal, that I would live and carry on. However, just to be on the safe side, I texted a photo of my x-ray to my husband, who is a lung surgeon, and looks at chest x-rays every day.

Reason #2: For every doctor who self-diagnoses, there is an idiot patient.

I received a text from the husband. Go and see a real doctor. I shrugged it off, he was obviously happy to look at everyone else’s x-rays, but couldn’t spare two minutes looking at his own wife’s x-ray.

Reason #3: Sympathy is sparse when you are married to a fellow medico (and surrounded by friends who are doctors). You have to be showing signs of multi-organ failure before you get breakfast in bed.

I carried on with my afternoon operating list, during which, couple of times I had to sit down because I felt light headed from being short of breath. I felt tired, and was taking more care than normal, but the list went on smoothly without a hitch.

Reason #4: It takes a sledgehammer to slow  down a surgeon. Because we are so focused on our work, we often don’t realise we are pushing our bodies to the limit until we collapse in a heap.

I got home late that evening, at which point my husband looked at my bluish lips, my ashen complexion and yelled, ‘What the F$#@ are you doing at home? You should be in hospital.’ He pulled up the x-ray photo I texted him and shoved it into my face, ‘you have right upper and middle lobe pneumonia.’

Reason #5: When we self-diagnose, we either completely miss the obvious, or become total hypochondriacs with the worst over-diagnoses. In my case, it was the former. Also, note to self- I obviously am not qualified to read a chest x-ray.

I climbed into bed in my work clothes. I couldn’t think of anything more mortifying than going into hospital for a cold and cough. There was no way I was going into hospital for this. So exhausted was I that I fell asleep within 10 seconds.

Reason #6: We never think we are sick enough to seek medical attention.

The next day, as I was doing an early morning ward round, I ran into a friend/colleague who is a general physician. He took one look at me, frowned at the sound of my wheezing and coughing, and promptly declared that I needed to be admitted to hospital for treatment. I told him that I had a full clinic, and will have to check into hospital later that evening. He suggested that I get myself into hospital as soon as possible; I told him that I couldn’t cancel all my appointments and let my patients down at such short notice.

Reason #7: We think that the Earth would stop spinning without us, and that our patients couldn’t possibly survive without us.

The day was particularly long – like a train in slow motion. Several patients looked at me in concern and told me I didn’t look well. I asked my secretary to shift all my appointments and operating lists for the next few days, so I could be admitted into the hospital. Some patients were angry and upset, some complained that they are busy people and already had arrangements in place for their booked surgery. Apparently my illness was going to interfere with their plans. Some were worried that their treatment were delayed and felt that I was neglecting them.

Reason #8: Some of our patients think they couldn’t possibly survive without us.

So I checked myself into hospital that evening. I was put on oxygen, given nebulisers, antibiotics and tucked into bed to rest. It was only when I was forced to do nothing that I suddenly realised how terrible I felt. My chest felt tight, my ribs ached, and my body gave in to the continuous coughing that rattled my bones. My limbs were like jelly and my muscles barely contracted, behaving like useless slabs of soft meat patties. I couldn’t sleep as the call bells pealed throughout the night, sounds of doors opening and closing interrupted my light slumber, and occasional moans and yells from other patients made me toss and turn. The next morning, the physiotherapist spent half an hour bashing on my chest to clear up the clogging in my lungs. We then decided to venture out of the room for a walk, and that is when I saw one of my own patients walking down the corridor on her zimmer frame with her physiotherapist. I looked down at my pyjamas in shame and high-tailed it back into my room. I started thinking about leaving the hospital.

Reason #9: Even though as doctors, we spend the majority of our lives in a hospital, we actually really hate staying in one.

When my physician came to see me, I spoke to him about the possibility of having my treatment at home. He was able to adjust my antibiotics and decided that I could be discharged as a ‘hospital-in-the-home’ patient, where I will be going home with my IV cannula in place, and just come back to day hospital for my IV antibiotics, physio and nebulisers once a day.

Reason #10: A colleague will always assume that as doctors, we would be trust-worthy, compliant, sensible patients. WRONG.

As soon as I arrived at home, I headed to the study and switched on my laptop. I reviewed all my dictation and letters, chased up lab results of my patients and caught up on some bookkeeping for my practice. The day after I was discharged, I had a case which could not be cancelled, so I asked my anaesthetic colleague to remove my IV cannula so that I could scrub for surgery, then to replace it after surgery before I headed back into hospital for my treatment.

Reason #11: We know how the system works and we have connections. Doctors will always find a way to circumvent treatment regimes to suit their activities.

But as I sat there at the end of the day, with the IV antibiotics dripping into my veins, and the nebuliser oxygen mask on my face, I suddenly felt so tired. So tired of it all, of putting on a brave face, of carrying on as if nothing is wrong when I felt so unwell, of worrying about my patients when I should be concerned for my own health, and most of all, I was just simply tired. My bones ached from exhaustion, and my mind was so worn out, it was completely devoid of any emotions.

Mentally, I was waving a white flag. My body was shutting down because it had reached its limits, and it was time I surrendered to the consequences.

Reason #12: It is terrifying for doctors to admit that we, despite our abilities to help people and save lives, are just like everyone else, mere mortals, in bodies that have limits.

After four frustrating, agonising weeks, I am finally on the slow road to recovery. It is only now that I have started to contemplate changes in my life, ways of improving my health, and strategies of looking after myself. In a moment of déjà vu, I felt that I may have been down this path before. Regardless, I was, at last, being a sensible patient.

That is, until next time.

Stalker #2

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It was the summer of 2008. I was driving to work one day, and my mobile phone rang. I answered it on my hands-free, thinking it was because I was running a little late for the ward round, and the nurses were being impatient. However, the sharp retort froze on my tongue when the caller introduced himself.

‘Hi Doc, it’s Bruce, I am the head of security at the hospital.’

Oh crap. They found out it was me who has been parking in the Director of Surgery’s spot on weekend call.

‘Could you give me call on this number when you arrive at the car park?’

Great, now they are going to make sure I don’t use anyone else’s reserved spots.

‘We need to escort you to and from the car park from now on. We have had to take out a restraining order against a patient of yours, and we have been assigned to ensure your safety.’

WTF?!?!

During my final rotation as the senior registrar in plastic surgery, I was often entrusted with difficult cases, or difficult patients. My boss at the time was the HOD (head of department). He was referred a patient from the cardiac surgery unit. It was an elderly 70-yar-old lady who had bypass surgery which unfortunately went pear shaped. She ended up in intensive care for a month with complication after complication. One of the consequences of her general comorbidities was break-down of her lower leg wound from where they harvested her veins for the bypass grafts. There was no sign of healing due to her poor general health.

When I saw her wound, I told the HOD that there was no way a skin graft would take. It was slimy with a biofilm of bacterial colonisation. The bed of the wound was completely white and scarred with no healing granulation tissue. It would be like laying turf on concrete. The HOD told me to take her to theatre and just lay a graft on it. He could tell that I didn’t agree by the silence that ensued.

‘I know the graft won’t take, Tiff, but we need to graft her. Her son is being difficult and demanding.’ At my raised eyebrow, he sighed. ‘I know, I know, it’s the wrong reason to operate, but he is making life hell for the cardiac team.’

I shrugged, documented his decision in the chart, spoke to the patient and booked her for theatre. 10 days after her surgery, the graft became sloughy, and the wound went yellow. Surprise, surprise, I thought, but I spoke to patient, explained why the graft didn’t take and she agreed that it was a long shot, but was very grateful I tried. We both agreed that more dressings were required. I didn’t give it any further thought.

Couple of days after that, I was caught up in an 8-hour case in the operating theatre, during which my pager kept going off. When I un-scrubbed from surgery, I noted that they were outside calls. I rang the switchboard, and they told me that there was a man who was very insistent on talking to me. I asked them if they knew who he was, they said he wouldn’t say. It was well past 7pm, so there was not much I could do, so I put it to the back of my mind and headed home. Then, my mobile phone rang whilst I was driving home that night, I thought about not answering it as I was about to enter the under-river tunnel, where I would lose mobile phone signal. However, the number showed that it was the hospital, so I picked it up.

‘Hi Doctor, I have one of your friends on the line looking for you.’

I rolled my eyes, must be one of my colleagues who wanted me to pick them up for work tomorrow. ‘Sure, put them through.’

‘Hello?’

‘Are you Doctor Tiffany?’

Something in his voice got my attention. It was not a voice I recognised. ‘Yes, it’s me. Who am I speaking to?’

‘You did an operation on my mother couple of weeks ago, and it was a complete failure. Now she has an infection in her leg, what did you do to her?’ He was yelling down the phone.

Initially, I was too shocked to reply. I remember vividly listening to the agitated heavy breathing that reverberated over the phone during the silence.

‘I am sorry, I am not sure who you are referring to, could you tell me who you are and your mother’s name please?’

Unfortunately that just earned me another blasting. ‘How can you not remember who you’ve operated on? What kind of doctor are you? My mother is…… you….. not good…… bad….find you…..’

There was no point. I was now in the tunnel and the signal was cutting in and out, which eventually cut off completely. I sighed. That was probably going to make matters worse now because he would probably think I had hung up on him.

When I exited the tunnel, I rang the hospital and spoke to the switchboard lady that connected me before. I asked her who he was, and whether there was any way I could get in contact with him, the switchboard lady sounded surprised and said, ‘but doctor, he said he was one of your really good friends and wanted to be put through to your mobile immediately because he was running late for a dinner you were both going to.’ I had to tell her that it wasn’t a friend but a patient’s relative. She apologised profusely. I had to point out to her the fact that if he really was my friend whom I was meeting for dinner, he would have had my number without having to go through her.

There was nothing I could do, and he never rung back.

It was two days after that, when I got the phone call from security. So I dutifully called them when I arrived at the car park. Within seconds, as if they were already waiting for me there, two men in uniform materialised around my car and walked me to ward. They reminded me to call security when I leave for the day.

When I arrived on the ward, sudden silence ensued. My residents looked at me with fear, and the nurses were whispering. I was just about to ask them what was going on when the HOD came out of his office. A look of relief passed his face when he saw me.

‘Tiff,’ he smile. Now, that was something rare, my HOD did not have ‘smiling’ as one of his usual repertoire of facial expressions. The look on my face must have been one of complete confusion, because he took my arm and literally dragged me along with him. At 5’3 to his 6’2, I had to run to keep up with him. ‘We are going down to see the Head of Security.’

So, at 7.30am, I found myself sitting in a small room in the hospital basement, opposite a large bald man in security uniform. He was leaning on his desk which appeared tiny under his bulging biceps. Loose paper littered the surface of the desk, some of which overspilled onto the floor around his chair.

Bruce the Biceps nodded at my HOD as if to ask him to start. I turned and looked at him. He cleared his throat and uncrossed his legs. ‘You remember Mrs Y?’ I nodded, he was referring to the lady from Cardiac Surgery whom I grafted nearly two weeks ago. ‘You remember how I told you his son was being difficult?’ I frowned, because I only very vaguely remembered anything other than clinical stuff from our conversation. ‘Well, apparently, he was told by his mother that the graft didn’t take, and then the nursing staff got her mixed up with another patient, and told him that the leg was badly infected.’ He paused. ‘Apparently he created a scene on the ward couple of days ago, and demanded to see the surgeon. The nurses told him that it was not possible as the surgeon was operating. During lunch break, he snuck behind the nursing station and was caught reading her chart by one of the nursing staff. He got your name from the operating notes. ‘

Mr Biceps nodded ‘he then pestered the switchboard all day to be put through to you, but they said that they could only page you. None of those pages were answered.’

I sat up, ‘But I was….’

‘Operating, I know.’ Mr Biceps reached over the table and patted my shoulder, ‘Switchboard also told me that he managed to get through to you on mobile phone late that night?’

I nodded and told him my story. He grimaced. ‘I really should re-do that protocol on phone safety.’

‘Anyway,’ my HOD said, obviously uncomfortable with the whole situation, ‘Apparently yesterday, he turned up on the ward again, demanding to see you. The nurses told him that you weren’t in the hospital for the day, he left the ward.’ He threw his hands in the air in frustration, as we both knew I was at work yesterday, ‘I don’t know, maybe they were trying to get rid of him. He then rung switchboard and asked which hospital you were working at. Switchboard was reading off the old roster and told him that you were at St M’s.’

‘But that was my last rotation,’ I said.

‘Yes,’ Mr Biceps nodded, ‘but he was just following the information he was given, so he drove over to St M’s, went to their front desk and demanded to know where you were. Their receptionist told him that you didn’t work there anymore and has been transferred here.’

‘Geez,’ I rolled my eyes, ‘the guy must have thought he was given the run around. The phone calls, then the hospitals…..’ I grimaced, ‘if he wasn’t pissed off before all this, he would have been livid by now.’

‘Uh, huh.’ Mr Biceps agreed, ‘and that’s when he lost his sh…. marbles. He accused everyone of trying to protect you, and that you were hiding from him because you were guilty of trying to kill his mother. He then threatened to shoot you.’

That got my attention. ‘He what?!?’

‘That’s when the front desk at St M’s called security,’ he heaved a sigh, ‘They should have held him, instead, the num nuts over at St M’s told him to leave and not come back. They didn’t even get his name. Then they called me.’ Mr Biceps shook his head. ‘It took me a whole day to work out who he was; I had to make phone calls to the ward, to switchboard and to your boss here.’

He looked at me sternly, ‘I don’t take death threats to our staff here lightly, so I called the police.’

‘So they have arrested him?’

‘Hush,’ my HOD patted my arm, ‘listen to him, there’s more.’

‘The police looked him up on their system, and realised that he had a gun licence.’ He and I both knew that gun licenses were hard to get in Australia, but it didn’t necessarily mean the person owned any firearms. He took a deep breath, ‘and he had half a dozen firearms registered under his licence.’

  1. Now not only did I have a loony after me, but a loony with guns.

‘But the law states that if anyone with a licence or firearms threatens anyone with witnesses, they can confiscate his licence and firearms,’ I said. My boss looked at me in surprise, he didn’t realise I taught Gun Safety courses.

He nodded. ‘Yes, so the police went to his house, cancelled his gun licence and confiscated his firearms,’ he paused, ‘but they also found a few extra unregistered firearms in the same cabinet.’ He then looked at me with a concerned expression, ‘Because they didn’t have a search warrant, they couldn’t look for any others.’

‘Wow, this is getting better and better,’ I said. My boss winced at my sacarsm.

‘They arrested him, but couldn’t hold him. They could only slap him with a fine for the unregistered firearms.’ Mr Biceps scratched his bald head in frustration. ‘So I asked them what they were going to do about your safety, since he may have other firearms which we don’t know about. They have applied for a search warrant and we have applied for a restraining order against him. I was told both of these should come through today.’

‘So,’ my HOD said, ‘he will not be allowed within 200m of the hospital. I don’t want you to go anywhere near that ward she’s on, I will assign another registrar to look after those patients.’

‘And you must be accompanied to and from the car park every day,’ Mr Biceps added. ‘We can’t afford to have any safety issues here at the hospital.’

‘That’s all great,’ I said, ‘but what happens when I am not at work?’

They looked at each other blankly.

My HOD recovered first, ‘he won’t be allowed within 200m of you either.’

Which was all sweet, but I wondered how either of us would know if we were within 200m of each other, since we had never met, and had no idea what the other looked like.

Lucky for me I never found out, because four days later, he was caught sneaking into the ward to see his mother and punched a staff member when he was being forcibly removed. They found a shotgun in his utility truck parked in the hospital car-park. He was arrested and kept in custody without bail. His mother was then discharged from hospital a week after that.

And I thought the highest rate of homicides for plastic surgeons are male patients unhappy with their nose-jobs. Funny how they have stats on that.

 

To Read about Stalker #1, click here.

Stalker #1

stalker 5

When I was a young resident working in the Emergency Department, a young Japanese sushi chef was brought in by his friend because he had sliced his fingertip off. Ok, everyone please refrain from making jokes about fingertip sashimi….. ‘Hmm hmm, but I would imagine it would be quite tough, especially with the nail’. Stop. It. Right. There.

I digress. I was assigned by my senior registrar to ‘patch’ him up, during which, I tried to make polite conversation to take his mind off the pain I was inflicting. He told me about himself and how he had only arrived in Australia 12 months ago. He told me about his restaurant, which I realised was the new one that I drove past everyday on the way to work. He asked me whether I cooked or if I preferred to have someone cooking for me. It didn’t take long for me to realise that Mr Sushi Chef was trying to chat me up. He asked me if I liked Japanese food, and I said I did. His friend (or ‘wingman’) beside him then said that my patient was ‘a very good sushi chef’. I nearly rolled my eyes, and refrained from commenting the obvious: he was so good at it that he sliced his fingertip off. I caught evil smirks on my nurse’s face as she turned away to get some equipment, which left me no doubt of the fact that this story would be doing the rounds as soon as we have finished in the procedure room.

After I have dressed his finger, given him instructions and antibiotics, I said my goodbyes (whilst trying to push him out the door) amidst his effusive gratitude. He then invited me to his restaurant for free sushi. I politely declined, but he insisted, so I just made some very non-committal noises to get him off my back. Mistake Number One.

The whole incident was forgotten a few days later, after everyone have had their turn at making a joke on my behalf about being hit on by a Sushi Chef who sliced his fingertip off with bits of raw fish. Yes, yes, I have heard it all, in all variations.

Until a week later, when a platter of sushi was delivered to our emergency department with a thank-you card, one that not only had my name on it, but the name and address of his restaurant, with his personal mobile number. Despite another round of jokes at the expense of Mr Sushi Chef’s sharp knife skills, (‘hey, Tiff, is that some finger pulp I see in your sushi.’), the platter was devoured within 20 minutes by everyone in the department. I had to admit that the sushi wasn’t bad at all.

When I left my shift that day at 10pm, I headed out the staff exit next to the ambulance bay. As I closed the door behind me, I saw a shadow from the corner of my eye.

‘Dr Tiffany, I have been waiting for you.’

I spun around and nearly got the fright of my life. It was Mr Sushi Chef. I frowned at him; the exit was a restricted staff area. Unease flooded me. I took out my badge, in case I needed to make a quick entry back into the department. He asked me if I enjoyed the Sushi he sent in the afternoon and that whether I had his number. I politely thanked him for the platter and told him that it was unnecessary. I decided against telling him that I wasn’t interested considering I was alone in a dark alley with him. I wasn’t too sure what he would do if I turned him down. I tried to make polite conversation with him, during which I found out that one of the receptionists had given him my finish time and my usual routine. He asked me if I wanted to go out for a drink, but I told him that I was tired and had to do an early shift the next day. He asked me to come into his restaurant tomorrow after my shift, and refused to leave until I agreed. So I did, and breathed a sigh of relief when he left. I quickly headed towards my car in the public car park and drove home. Mistake Number Two.

The next day at work, I rang the restaurant and breathed a sigh of relief when one of the waitresses picked up. I left a quick message to say I would be caught up at work and cancelled the dinner. I then went to see my supervisor and told him about the incident. It wasn’t my intention to get the receptionist into trouble, but I was concerned that next time, it wouldn’t be something as harmless as a persistent admirer.

Or so I thought. Flowers started to arrive. By now, the department was in an uproar of jokes. It did not matter that I was known to be in a long term relationship with a fellow colleague already (my current husband), everyone thought it was very sweet. By the end of the week, I had to write a note to him, thanking him for his gestures, explaining that it was unethical for me date a patient (I didn’t point out the fact that it was ok if the doctor-patient relationship was already finished), and that I was already in a relationship. I told him that he was very sweet, and some girl would be very lucky one day. Blah, blah, blah. I tried to make it as gentle as possible (if any rejection letter can be considered as such), and then I sent it to his restaurant. Mistake Number Three.

The flowers stopped.

One early evening, two weeks later, I found him waiting for me by my car in the car park. The first thought that hit me was how long he must have spent walking around the eight –storey car park to find my car. Secondly, how the hell did he know which car was mine?! In between those inane thoughts, I considered turning around and running back to the hospital, but at the same time, I realised he had already seen me. He was much taller than me, and It would have been no contest for him to outrun me in my kitten heels (I was on my way to meeting some friends for dinner). I slowly approached my car, but stood a few metres away from him.

He told me that he just wanted to speak to me, because I had broken his heart. I said that I was already in a relationship. He then said that I couldn’t possibly be happy in my relationship, otherwise I would have turned him down the first time and that he wanted me to be the lucky girl I mentioned in my ‘love letter’. He said that he waited for weeks by his phone for me to call after he had received the letter. The letter was a sign that we were star-crossed lovers like Romeo and Juliet. He was approaching me slowly as he spoke. It was at this point, I realised that I was dealing with a slightly deranged individual.

I had slowly manoeuvred myself to the car door, so I told him that I really wasn’t interested. He stayed still, but smiled at me knowingly as he watched me getting in the car. He said loudly just before I closed the car door that he already knew where I lived because he followed me home that first night. I told him that his persistence will not change my mind and he could follow me all he liked, because I was heading out for dinner with friends. When I arrived at the local pub, I was shaking so hard, I had to sit in the car for 20 minutes before I could join my friends.

The next day, some dead roses arrived for me, and a card declaring that I broke his heart again last night. This time, there were no jokes being bantered around. I had another meeting with my supervisor. I was to car-pool with a male colleague to and from work. There was no shortage of volunteers, as everyone knew my partner was seconded to the Emergency Department at Port Hedland Hospital over 1600 km away and I was living alone for 3 months. Many nurses offered for me to stay with them for a few weeks. Our emergency department trained the medics for SAS (Australian Special forces), so often, one of them would either offer me a lift home or to walk me and a colleague to the car.

One night, one of the SAS medics, Theo, drove me home. He had been assigned to me for 8 weeks and I had just spent the week making him efficient in stitching up wounds and putting in IV lines.  In return, he had driven me home for the last three evenings in a row. He lived at the barracks one suburb away from mine. When we arrived at my place, he pointed out that there was a brown Holden Gemini across the road which had been there the night before. I knew it wasn’t any of the neighbour’s and told him so. To my surprise, he got out of the car and walked to the brown Gemini. I called him back, but he just waved me off and told me to stay put. Yep, ‘stay put’ like I was one of his little soldiers.

He tapped on the window. While I watched him, bending over and speaking to someone through the window, all sorts of horrible images went through my mind. I could hardly hear anything as neither voice was raised. I clutched my phone and thought, what if he got stabbed, or worse, shot? I started to get out of the car, hoping to physically pull that 220-pound pure muscle mass away from danger. However, as I shut the car door, I saw that he had already turned away the Gemini and was walking back towards me.

‘Was it him?’ I asked. Theo nodded and signalled for me to stay quiet. He took the house keys from my restless hands and pushed me towards my unit. I imagined Mr Sushi Chef’s beady eyes looking at us, and almost felt my back glow with heat.

Theo shepherded me into the house, and quickly went around the lounge to switch all the lights on. He then opened the blinds at the front window and stood in full view of the street. I imagined he would have made an impressive shadow in my window frame. Whilst looking out at the car across the road, he took out his mobile phone, dialled a number and put it to his ear. A second later, I heard the brown Gemini splutter as its engine ignited. It headed off with a squeal down the road.

When the car disappeared from sight, he put his phone back into his pocket and lowered the blinds. ‘He won’t bother you anymore,’ he said, ‘but you can come over and have dinner with us. Stay the night if you are worried.’ At the word dinner, his eyes took on a glassy appearance, ‘I think Mandy is making curry tonight.’ Thoughtful silence followed. ‘The baby will probably keep you awake all night though.’ He winced at his own words.

I politely turned down his offer. Despite knowing his wife was an excellent cook (as evidenced by the incredible lunch boxes he brought to work everyday), crying babies was definitely not an additional enticement to his offer.

‘What did you say to him?’ I asked curiously.

He shrugged. ‘I told him I was a security guard and that if I saw either him or his car anywhere near you again, I will call the cops. I told him I knew his number plate, his phone number and his restaurant, which I will give to the cops. After which, he might get fined, or go to jail and he would lose his restaurant.’ He helped himself to a glass of water from the tap and sat down on my lounge.

I followed suit, glad he wasn’t leaving yet, and laughed at him, ‘That’s not true and you know it. The cops would have just ignored us.’

‘He doesn’t know that, he has only been in Australia for 12 months,‘ Theo winked. ‘Anyway, all the chefs are the same,’ he would know because his brother-in-law was a chef. ‘The restaurant means more to them than anything else in the world, they wouldn’t do anything to put it in jeopardy. And my guess is that he’s not even a permanent resident, so he can’t afford to get in trouble with the police.’

Theo was right. Despite the fact that we car-pooled together for another month, Mr Sushi Chef was never to be seen or heard from again.

 

Diagnosis: I Don’t Give a S#@% about myself

One of the most frustrating things I encounter at work is trying to help people who doesn’t want to help themselves.

Here are the 10 top clinical signs (for the novice):

1. The beautifully tanned patient who is sunburnt all over, (looking like he/she has just spent their weekend on the beach), and is about to go into the operating theatre to have a melanoma excised.

2. An obsession with blenders. The lap band is tight to maximise weight loss, the patient is supposed to be on a portioned healthy vitamised liquid diet. Instead, he lives on a  ‘vitamised diet’ of Big Mac and French Fries, liquified via a blender. ‘I just don’t understand why I am not losing weight…

3. The dangerous oxygen tank. The patient who just had 1/2 of his right lung removed for cancer – so now he is dependent on oxygen – lighting up a cigarette in the hospital courtyard. Taking a drag on their cigarette in between inhaling a whiff of oxygen from their mask. Honestly – if you want to kill yourself, that’s ok, but to blow up the hospital???

4. An X-ray that shows a new fresh hand fracture through plates and screws over an old fracture. Excuse: ‘Well, punching my fridge is better than punch my Dad in the face, rght?’

5. The MIA patient. The patient was called for the operating room, but he couldn’t be found anywhere. Because he was outside for his ‘last smoke’ before having half f his lip removed for  lip cancer. ‘You only told me that I couldn’t eat or drink before my anaesthetic, you didn’t say I couldn’t smoke.’

6. Patients with bags of ‘unfilled’ medication scripts. One is really unsure as whether these patient don’t take their prescribed medications (for their heart disease, cholesterol, diabetes, infections etc), because they can’t be bothered, they don’t want to or they just ‘don’t believe in taking medications.’

7. DNA’s (did not attend). Patients who have appointments for their cancers to be assessed and removed do not turn up to their appointments despite multiple phone calls, or simply, they have important work-commitments or holidays and need to move their appointment to 6 months later when things are quiet (and the cancer will be inoperable.)

8. The broken plaster on a broken arm. Sometimes, the non-existent plaster on a broken arm. ‘I know my arm is broken, but it got so itchy I had to take the plaster off’.

9. The gigantic fungating cancers. It takes time for cancers to grow. When I see a very very large cancer, I wonder why patients don’t come in when it was the size of a coin. Once I had a patient with a skin cancer on his chest. It was the size of a dinner plate, and it had already eaten into his breast bone. I asked him why he left it until now to come, he said that he only came in because it was growing into his neck and he couldn’t hide it behind his business shirt and tie at work anymore. Did he know it was a cancer? Yes, but he was too busy at work to take time off for an operation.

10. The smoker with a cigarette dangling out of his neck. The throat cancer patient who had his throat removed now has to breathe out of his tracheostomy. He was found lighting up with a cigarette taped to his tracheostomy. A short-cut highway of delivering poisons directly into his lungs. Well, I guess he won’t get oral cancers from smoking this way.

The Differential Diagnoses:
1. I have a severe case of NFI (No F&%$* Idea)
2. I am so f$%#@ scared that I’d rather bury my head in the sand
3. My health is my doctor’s responsibility because that’s their job to fix it

But sometimes we just have to face the harsh diagnosis of: I don’t Give a Shit about Myself.

 

An Impossible Letter to the Health Minister

This is an open email distributed by the doctors working in the public health system of Queensland Australia.
The Queensland state government has presented new contracts consisting of ‘improved’ work conditions for its doctors.
These conditions include:
1. If a doctor resigns, 6 months’ notice is required, or paymentf 6 months salary to the hospital is required for leaving
2. On dismissal, there is no process for appeal
3. Doctors can be rostered to do any shift, with no specification on having available junior staff support
4. Work conditions (pay, allowances etc) can be changed without notice by adminstrators
5. Work hours, duties, locations can be changed by discussion, not agreement
 
It is a contract which several independent industrial lawyers have advised against signing.
It s a contract where the government will own the doctors’ livelihood. Doctors will be held hostage by their contracts, which may come in conflict with patient care, as they may have to make decisions to appease the administrators, rather than what’s best for the patient.
 
*Please note, I didn’t write this email, but I wish I did.
 
 
Date: 7 March 2014 10:48:17 PM AEST
 
Subject: Nothing here is impossible Mr Springborg

Dear Minister Springborg and Premier Newman,

We have been told that your legislative changes are irreversible, and the train carrying these individual contracts has already pulled out of the station, and cannot be stopped.

We sincerely hope that your talks with the SMO representatives around the concerning issues in the contracts result in a successful outcome for all.

If SMOs are not convinced that our ability to continue to practice public health medicine with safety is secured, then the state will be in grave danger of losing its’ brightest and best.

Please listen:    We say to you that nothing in your legislation, and the individual contracts, is irreversible. This train wreck can most certainly be stopped.

You are dealing with a group of people who understand what is truly irreversible and impossible, as they have stood in the face of death and tried to stare death down, bargained against time with their knowledge, skills, equipment and courage, and sometimes failed, and often times not.

When you have to tell parents that their child has autism and intellectual impairment and that their lives will forever be filled with difficulty and challenge, and watch their grief unfold – that is irreversible.

When you watch a child bleed to death before your eyes as you pump blood in their arm only to see it pour out of the gaping hole in their skull, where it has been sheared off from a motor vehicle accident – that is irreversible.

When you tell parents that their baby has cerebral palsy and will never walk or talk, or even eat independently, because their brain is malformed or damaged beyond repair   –  that is irreversible.

Nothing here with your individual contract legislation is impossible to change – we’ll tell you what is impossible.

When parents beg you to save a child’s life after a second failed bone marrow transplant for leukaemia, as you’re watching them die from an infection they have no white blood cells left to fight  –  that is impossible.

When you’re trying to bring back a heart beat in a child who has been pulled from the bottom of a pool, an hour after its heart beat stopped  –  that is impossible.

Don’t you dare sit there and tell us that this legislation is irreversible and that stopping this contract roll out is impossible. Because we know that all it takes is a show of hands in a parliamentary room, and the swipe of a pen across a piece of paper.

No fancy machines, no million dollar drugs, no transplanted tissues, no 12 hour operations, and no miracles of fate.

Just understanding and good will from your colleagues and yourselves. And if you’re up all night to achieve that, then welcome to our lives.

We have each others’ backs, us medicos  –  we always have and always will.

Because we have all stood there with the sick and the dying, and we know how lonely that journey is without colleagues at our shoulders, and support and resources at our backs.

So we will stand together, even if we have to walk away, together  – until you listen, and pull on the brakes, and stop this train wreck from playing out to its end.

Please enter the discussions with good will, and open minds and hearts, and leave your egos on the coat rack outside.

The health of the state is in your hands – please don’t throw it away.

Sincerely, Senior Medical Officers of Queensland Health.