Aug 12, 2013

The falling star

Morning round started with the specialist who came in early.

The lady in front of us was pale and obviously in slight distress, mildly gasping.

As the medical officers and specialists quickly did a run-through examination on the unfortunate lady in almost plain white, I ran and took a branula trying to secure a running line into the vein.

And the house officer, oblivious to all the emergency steps we're doing still in her own world, standing on the foot of the bed.

She wrote "S/B (seen by) Dr XXX (the name of the specialist)" and below written "Case and progress noted".

She didn't budge a single inch from her place of writing. Possibly was doing some kind of exorcism or external healing from writing on the medical case notes while her superiors all busy fluid resuscitating the lady.

Such is the quality of future doctors the whole innocent world are up against. Sadly.

A brief review of the case note revealed that she was being operated the night before for bilateral large endometrioma and currently suffering from hypovolemic shock possibly due to the underestimation of blood loss from the operation the night before.

Unfortunately, she was seen by the gynae medical officer on call but was not being fully assessed or scanned.
She was referred on table by the Surgical team after the glaring perineal findings came into the light (the laparoscope light).

Something that is very dishonorable about this whole incident is the lack of professionalism in the initial assessment.

The unfortunate lady would have been diagnosed correctly if she was being assessed with massive apathy because the bilateral endometrioma was as big as two ostriches' eggs.

She would have undergone an elective operation after good pain control and exclusion of the minute risk of malignancy.

Under a better controlled elective setting, it would possibly end up with reduced blood loss and dismiss the need for transfusion.

It would be less taxing on the on call team and the on call team can focus on other more dire emergency during the on call.

The gynae medical officer, Mr B was reprimanded only with a few words - I know you have brain, but you're purely lazy.

If this was the first time, then maybe it could have happened by chance, but it isn't unfortunately.

Mr B is a foreign student under training with our Master training programme.
They do not have salary as they paid for this programme.
Thus, his concept is that since the local students from Ministry of Health are being paid, therefore we should work harder than him.
And fair enough, our superiors (not all) conformed to the similar thinking, which I beg to differ.

We are paid salary but we're also being tied up for 5 years working for the government after we graduated.
Technically, we are also paying for the programme, similar to them.

Secondly, in an esteemed centre of training, I do not comprehend how can we let certain standards slide away just like that.

He is always missing from the wards and clinics.
What happens to the maximum 2 weeks of leave of absence for every 6 months of training?
If it was more than 2 weeks, isn't it a person need to be extended in his/her training?
Why lady trainees has to be on their toes and return within 2 weeks post delivery to assure non-extension of the Master training, yet some people just go missing more than 2 weeks without substantiated evidence of their absence?

There was just no team work in him.
He even can tell his teammate that he is not coming for ward round because he was invited the other day.
Do you actually need to be invited to ward rounds?
What kind of specialist are we breeding in this centre of excellence?

When there was shared and scheduled operation theatre hours, he refused to enter operation theatre.
And he boasted on how he could do a certain surgery by himself with supervision of lecturer, but end up his intraabdominal drain got stuck and required a relaparotomy.
Maybe it's just a rare unfortunate occurence, or perhaps it is due to lack of experience in assisting.

My eyes welled up with tears during ward round that day, knowing the clinical circumstances leading to the emergency endometrioma removal.
How could such a appalling and disgusting performance be accepted in the institution?
Even if he is a smart student, he is an excellent protege, he is possibly the exam top scorer, is that how we should accept the birth of a specialist who lacks professionalism and proper attitude for life and patient?

The saddest of all, his infamous role model for delinquency is well known by all the lecturers and Consultants but yet there are no formal response to such a shameful attitude, only table talk about him over meal time.

This inaction will only breed more to follow in his footsteps.

It is really unforgiving for this institution to allow such a candidate to be honored with the recognition of a specialist at the end of program without any correction of his current appalling attitude.

Is our institution still ardent to be stars of the sky or are we letting ourselves reduced to a falling star?

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