‘You’re going to have to give me five minutes to calm down, so I’m just going to sit here and write some notes and then maybe we’ll have a chat about it afterwards’.
I said this as evenly as I could, to the SHO on front of me.
I was angry at work this week. Angry is putting it mildly and actually, if I was a cartoon doctor you would have heard the high-pitched screech as steam extruded from my ears.
It started with a request from a team for a cannula.
In a patient who I was informed was in their last days of life.
Who had an acute kidney injury.
Who was already deemed too unwell to benefit from dialysis or intensive care.
Whose potassium was high.
If you ask me to cannulate a patient in ‘their last days of life’ for an irreversible sequela of the reason for their acute decline, do not expect me to mindlessly push that metal through some skin without asking questions. I am not that monkey with their hands over their eyes.
I control these hands.
So, I got involved.
I tried to decipher from the notes whether or not this patient was actually dying in the short-term. Were the team agreed on this? Had the referrer gotten it wrong? Did the family understand this? Did the patient know?
The patient wasn’t alert enough to know; the husband thought that treatment for high potassium would give her a chance at ‘making it’.
I rifled through page after page of notes that were unhelpfully unwillingly to declare a bottom-line.
The ward sister was kind and said that the consultant was just at a meeting and it was due to finish, perhaps she could phone him and he could come and discuss. I said that would be really helpful.
So, I waited.
And while I waited the team’s registrar arrived on to the ward and confirmed that he couldn’t really answer any of these questions.
He said I should wait for the consultant.
Then without any discussion, he went into the room, cannulated the patient and left again.
That’s when the SHO approached to inform me of the latter.
That’s when the steam started:
Because I had been called away from my work to cannulate a patient who hadn’t even been escalated to a suitable senior within the parent team.
Because the patient had a cannula but still no answers to the question of where their care was going.
Because I was apparently the only person present who thought this was a problem.
Because if the issue here was just putting a plastic tube into a vein, I’d have done that myself forty minutes ago and actually, I’m pretty good at that; it’s why I was called.
So, I took five minutes to steady all the red-hot coals of anger in my head.
And then I tried to explain.
By the Secret Doctor
Read the blog and follow @TheSecretDr on Twitter and on Facebook
So, who is to blame here for your anger?
If something like that makes you incandescent with rage ,one would imagine the fact that the NHS appears to be going to hell in a hand cart, 2 psychopathic megalomaniac ‘leaders’ appear to have their fingers teetering over the nuclear button, the world is full of the persecuted and marginalised , gun sprees, Spanish police battering old ladies for daring to vote etc. etc.would put you in grave danger of a cerebral haemorrhage.Essentially,in the grand scheme of things, of course some thoughtless consultant / SpR mindlessly insisting that somebody unnecessarily cannulate somebody who should really be allowed to die with dignity and as little distress as possible is wrong / deeply unpleasant but really....I suspect you may need a holiday....or a large G&T....or do something more effective about it than writing under a meaningless psueudonym.
“Hope has two beautiful daughters; their names are Anger and Courage. Anger at the way things are, and Courage to see that they do not remain as they are.”
― Augustine of Hippo.
Just because terrible things are happening in the world, does that mean we should throw up our hands and accept substandard care for patients? If my relative were denied a well managed death and I were not given the opportunity for an honest conversation about appropriate treatment, should I just accept this because "in the grand scheme of things" a doctor such as Anonymous feels it's not really important?
If channelled appropriately, anger can be a valid response to the events that are going wrong around us.
I can't do much about Donald Trump or the Spanish police, but I might be able to improve things for my patients and their families.
seen on Waterstones today: "The gift of Anger" - by the grandson of Gandhi - who probably also read Augustine... :-)
two good things: getting angry appropriately, and stepping back before acting on it; Well done! (I very much fail at the second...)
Reading your comments and how flippant and uncaring you seem to be about someone trying to do the best for their patients and the frustration when thus us done badly, I really wonder at you being a dr at all! Perhaps it is you that needs to take a break and think again about the job you are meant to do and what it means to have the trust of people at their most vulnerable placed in your care! Disgraceful comments.
All this anonymity is frustrating should have anonymous then a digit do we can see who is who
From Anonymous 7
Shut up house monkey and just put in the cannula ;) It takes me back to the day I was asked to put a cannula into a recently deceased patient because it was mistakenly removed by the ward!
You will never survive the NHS if you continue to think independently and question things.
Don't get angry though. Instead, just revel in your superiority.
Superb “ discussion” !!!
As an Anaesthetist just had a wry, knowing, satisfied chuckle at the excellent cynical comments to the secret doctors blog. Quite refreshing compared to naive self righteous drivel that is so often written in this section and the “right on “, wet comments it frequently generates. I am seriously hoping that is the point. If so, so good to see there is still humour at work in the dictatorship of enforced non emotional response that is today’s real life “new “ NHS. ( Anonymous 67).
Anyone watched W1A ? the similarities in culture are hilarious.
Glad to see you still have it in you to get angry Secret Doctor rather than the apathetic resignation which afflicts many of our kin...
Maybe it was a futile cannula... maybe it was used later to relieve pain ...maybe it did give the husband a sense of control for an hour...
Quite a few years ago, my uncle was dying that night, he was in fact bleeding to death due to an inoperable tumour - he also had full capacity . A doctor came in and said take down the tarsfusion ...I ran out after and begged for the half bag of blood which was up just to be allowed to drip much slower...it was not going to be re-used anyway..until my uncle lost conciousness. It just seemed really important to maintain some sort of illusion until he slipped away ... I hope it was not only for my benefit ...
.... so maybe ....the registrar who had the time, at that point to put a cannula in...but not enough time to give the family & patient the considered time they deserved ....made a decision on balance, that putting in a cannula in would be of more benefit to the patient group.
Your anger (IMHO), was caused by the general epidemic of no one taking responsibility...everyone being "involved", but no one taking control ..and it being left until the last minute .....and your anger was justifiable
( PS I think it is a perfect pseudonym) Anon No 8 and one of your biggest fans
....and I cant spell transfusion ......Anon no 8
I'm sorry but quite frankly 11 yrs working in the NHS has left me jaded and with no fight left.
Nothing changes for the better so no point ranting/raving/even getting mildly annoyed and vocalising it.
Idealism - Utter waste of precious time in such an environment.
On a less depressing note, if you haven't seen it yet, watch Quacks on BBC iPlayer.
You can access anger management and coaching through your Trust or a number of other organisations. Alternatively if you really lose it because of caring too much about patient care you can be made to go on them by your managers.
Thank you Secret doctor, for caring, not enough doctors do. A Patient.
I'm long retired and wasn't in a cannulating type service anyway but should have thought an SHO ought to be able to cannulate. What is the Secret Dr doing that he/she can be called away from work on what appears not to be an urgent problem then spend 40 minutes+ indulging his/her conscience? No wonder the NHS needs more money.