Friday, December 26, 2014

On being badass, when called for

I have a little horror story to share. 
File under, "No matter what, do the right thing, and be badass if it's called for."

The story goes like this: me, age 30-ish, working in a hospital. Chugging along, routine ortho rotation. Three months of respite from all the other routine rotations.
Get a new referral from the psych ward of all places. Woman admitted for depression, won't eat, says she can't lift her arm, mobilize shoulder.

So, I have the patient brought into the department. Asked her to tell me what she thinks the problem is. She says, well they put a tray out for me, but I can't eat, because I can't use my arm. 

I ask, can you tell me what the problem is with your arm? She says, I fell and broke it a year ago. The doctor put pins in it, but it still doesn't work. 

I say, really! Can you show me? 

She says, sure. She uncovers her arm. She is a thin woman, sixties, smoker. The heads of the pins poke out visibly under her skin. 

She says, I can move the shoulder, if I do this..  (she contracts her shoulder girdle muscles and her shoulder externally rotates, while her arm stays still, against her body) - I can move the shoulder, but it feels like the arm isn't attached. 

I am aghast. She is exactly right. 

I ask, what did the doctor say about this? Has he seen it? 

She says, no, he told me it was healed. He said the surgeon told him it was healed. 

My jaw is on the floor. What? he hasn't examined you? She says, no, he told me I was depressed and admitted me here. But I can't eat from the tray... 

By now I'm mad. I don't get mad very often, but this makes me outraged. I say to her, it looks like the pins didn't do their job. I'm going to phone your doctor and see if I can get this straightened out. He should at least take a look!

So, I send her back to the ward, and I get the doctor on the phone. He is the scaredest doctor I have ever talked to on the phone, before or since. 

I want answers and he has none. 
I ask him why he didn't examine his patient - she has a non-union for PeteSake. 
He says, yeah I should have, but I trusted the surgeon's word. 
I ask, who read the xray? He says, the surgeon. I ask (because I'm so mad I can't remember), who was the surgeon? He tells me. 

Oh FFS. The worst one in the city, maybe the planet - behind his back everyone calls him Dr. Abscess. Plus he is the head of the provincial medical association and Dr. Scaredy is terrified of upsetting him by contradicting him in any way.

Dr. Abcess is an idiot. And a socipath to boot. And Dr. Scaredy is willing to put Dr. Abscess's version of taking and reading his own xrays, and playing let's-pretend-this-fracture-is-healed, ahead of even examining his patient. 

So now we're dealing with two idiots, and here is this poor woman who is being told by them both that her arm is fine, and healed, and by the second who hasn't even examined her that the reason she can't lift her arm is because she's depressed! (Yeah, I'd be depressed too if I couldn't lift my arm or eat and a couple of idiots certified as real doctors were telling me that night was day.) 

This display of cowardly obsequiousness infuriates me even more. I ask, what would it take to get you to change your mind and examine her? How about if you order some new xrays? He says, I can't because Dr. Abcess is gonna know. I ask him, if I can get somebody else to do a new set of xrays and read them, will that convince you to examine your patient? He says, yes. 

Aha. The magic word. 

Then he says, what do you think I should do?

Imagine. Asking the lowly PT what he should do. He's up to his nasal septum in imaginary political doodoo and paranoia and it clearly has distracted his brain from even being able to think about duty of care.

So (madder than ever) 
I say something, slowly, like, look, if you cared about this patient, you would have examined her. You would not have taken Dr. Abcess's word about anything! You would take her off that psych ward and put her on the ortho ward and you would refer her to Dr. Genius (not his real name - a wonderful ortho surgeon with a black belt in karate who understood the body, even under anesthetic, and whose patients always got better with no complications). 

He says, OK, if you can get me new xrays, I'll do that.

So I did. I called xray, explained the problem, named names, was invited to bring the patient down.

I went and got her, wheeled her down to xray. 

I asked her to show the new doctor what she could do with her shoulder. 
He watched her spin her shoulder around on top of her humerus, and his eyes widened. 
Then he said, I'll order the new set of xrays myself. And he did. And the new report stated "nonunion". 

I call Dr. Scaredy with the news. 

By the next day she is moved to the ortho ward and put under the care of Dr. Genius. 

By 2 days later her arm has been reentered, the ends scraped off, re-approximated, repinned, and put in a big coil that delivers electric field therapy of some kind to the bone, a short-lived medical fad back in those days.

I saw her once more just to make sure she was OK. She expressed thanks for having successfully kicked stagnant hospital and medical butt on her behalf. 

I normally kept my head down, got along to get along, but in this case I felt pretty righteous about bossing stupid doctors around. Then I went back to normal.
No one said a word and no one got in trouble, even the incompetent physicians who should have.

Then I moved to a new province to start a new life as a manual physiotherapist, away from hospitals and all their chaos and interpersonal machinations. 

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