Sunday, December 28, 2008

My sexual harrassment complaint part 2

About a month after the unpleasant incident in the ICU, I was on call for the acute pain service.

At the CofE, all patients who are receiving patient controlled analgesia (PCA) have to have the orders written by anaesthesia and are rounded on daily by the acute pain service. In addition, any problems like inadequate analgesia and side effects are also dealt with by the APS, 24 hours a day, 7 days a week. Further the staff anaesthesiologist on the APS, not the resident fields all the calls.

When the service started in the early 1990s the only way PCA could be sold to the surgeons and nurses was to have this arrangement. It was also felt that the additional after hours calls would be an unacceptable burden on the residents so the staff took the calls. This is probably the only service at the CofE where you make a page and a staff physician calls back. The other reason for this arrangement is financial. In order to make it worthwhile financially it is necessary to bill for consults and visits on otherwise uncomplicated PCA cases.

For practical purposes the PCA orders are written by the anaesthesiologist who does the case and rounded on the the APS doctor. ICU cases are different in that PCA orders are normally not written and the patient is often not started on PCA until days after their surgery when they are stable and ready to be extubated. This means that the APS may be called at awkward times to start somebody on PCA. Most of us, would phone in orders rather than making a special visit to the hospital. It is relatively safe, ICU patients are usually still on a ventilator, have full monitoring and one on one nursing.

So it was that one evening after I had left the hospital I got a call from the ICU about a face-off patient, who they wanted to start on PCA. I phoned, identified myself, asked the nurse some questions about the patient and start to give verbal orders. At that point she asked me "are you giving my orders". I am a bit sarcastic and said, "No I have nothing better to do than phone you.....of course I am giving you orders". I gave the orders, she repeated them back to me. She then asked if I had anything to add and I said no and hung up. We rounded on the patient the next morning and there were no problems.

Why do I even remember this case?

Two weeks later I was forwarded a letter of complaint from the nurse. In it she complained that:

1. I failed to identify myself (how did she know who to complain about).
2. I made her answer questions about the patient on the phone.
3. I gave verbal orders on a patient I didn't know anything about.
4. I was sarcastic (guilty)
5. I almost made her cry.
6. When she asked if I had anything else to add, I simply said no. (guilty).
7. That I still had a grudge against ICU because of the incident I had been involved in weeks earlier. (Not true I am always nasty on the phone)

Now when I read the letter, I couldn't even remember the conversation, but by checking the time and date against my day timer, and because the phone call happened while I was waiting for medical appointment I was able to put together the conversation.

I wrote a letter to my chief stating that I felt that what I had done was both common and good medical practice; that I had not intended to threaten or belittle her and that under the circumstances I did not see any need to apologize.

A couple of days I got a phone call from my very "supportive" chief. This gist of the conversation was, "I see your point BH but this is a sexual harassment complaint and you know you can't win those so you better apologize".

Now the ludicrous thing about this was that the nurse also had to apologize to me for saying that I had acted as I had because of an old grudge against the ICU. So even after writing my letter of apology, the apology score was still BH 2 ICU 1.

Now this was the last year I was at the CofE and I had started to look at other hospitals by that time. Curiously I remember that around that time, I had decided that despite everything I figured I would just stay at the CofE. After this event, I told my chief that this was the last straw and I would be leaving. It was less the complaint, than the complete reluctance of him to support me that really pissed me off.

A month later I got an offer from another hospital and I no longer work at the CofE.

Saturday, December 13, 2008


One of the things we do in the OR in the name of patient safety is the "time out". This is not sending the surgeon to sit in the corner for 5 minutes although that would not necessarily be a bad thing. What we do in the timeout is before the surgeon cuts skin, a nurse reads out what the patient has actually signed the consent for, what side we are operating on and what allergies the patient had.

A few weeks ago I put a lady to sleep for a D+C. She had a few allergies which the nurse read out including epinephrine. "Let me guess", said the surgeon," it makes her heart beat fast". "Yes", said I who had actually talked to the patient, "that is what happened to her". And we had a good laugh. And as I told the surgeon, this is not the first epinephrine allergy I have seen in my career.

Of course we all know what probably happened. She went to the dentist and a little local with epi went into a vessel, she got tachycardic and the dentist instead of saying mea culpa, told her she was allergic to epinephrine. And it goes on her chart.

I barely understand immunology, histamine or IgE so I don't really expect patients to understand allergies either. What we in the medical field have failed to explain to patients is the difference between an allergy to a drug which means you must never ever have the drug again and an adverse reaction which means you may not want to have the drug again but can have.

An important distinction with patients "allergic" to local anaesthetics after misadventures in the dental chair, to penicillin because they got a yeast infection, to anaesthetics because they got sick. All these go on the chart however as if they really were allergies.

My personal favourite is the patient who came to the OR which a lactose "allergy" who requested she not be given Ringer's lactate. I tried to explain that while I normally used normal saline, that lactate and lactose had very little in common and that she could if necessary get Ringer's lactate. She was however adamant and probably still tells the story of the stupid anaesthesiologist who wanted to give her Ringer's lactate even though she told him she was allergic to lactose.

We also have the "latex allergy. I don't doubt for a second that some patients have a true anaphylactic reaction to latex. Most of the latex allergies however are patients who got a rash from wearing rubber gloves or as one patient when I asked what happenned with latex told me, "we were just told avoid it as a precaution". When I did this last patient, the surgeon yelled at me because I used a latex penrose drain over his gown in order to start his IV.

As more of our supplies are now latex free (at probably considerable extra cost) this is less of the problem. When I worked at the CofE, latex allergy meant stripping the room of everything that could possibly have ever come into contact with latex. On several occasions the casual mention by the patient that he might be allergic to latex on entering the room resulted in having to discard the entire set-up for a latex free set-up delaying the start of the case by up to an hour.

Monday, December 1, 2008

My sexual harassment complaint

I have thought for a long time about publishing this account.

If you read my blog, you will probably get the impression, that I don't suffer fools gladly, and that I occasionally and often unintentionally stir up shit.

Now in case I go into politics, I would like to state that anybody who uses their authority including their sexual gender to bully or disadvantage somebody is a complete slime bucket. I am sure most people share this revulsion. It is however this revulsion that makes accusations of sexual harassment so potent.

I am male and a doctor. Most nurses are female ( a significant number of ICU nurses are male though). Doctors who are mostly male are higher on the hospital food chain than nurses (although as a student and resident I fequently questioned this). In the hospital the relationship between doctors and nurses is often one of tension. Part of this is a good thing. If either side automatically deferred to the other, it would be to the detriment of the patient.

Now, when I first started working at the Centre of Excellence, it was pretty obvious that there was some real bad blood between anaesthesia and the ICU nurses. Everywhere I worked there has been some sort of tension; I think ICU nurses resent anaesthetists who aren't intimidated by all the machines and lines in the ICU. The first time I dropped a patient off in the ICU, one of the nurses asked, "Who is the idiot who sutured in this central line?". I told her I was the idiot and waited for the apology which never came. Anyway it seemed for the first few years all we talked about at staff meetings was the steady stream of complaints: ETT not taped in correctly, line tangled, O2 cylinder empty, patient brought into ICU at inconvenient time for them, and, incredibly, an accusation of billing fraud by anaesthesia. After a while it seemed like things got better but I suspect it was just that things that used to piss me off didn't matter any more and I just learned to do things that wouldn't piss them off. Sort of like a bad marriage.

Sorry that this is taking so long to get to the point but I have to give the background.

About a month before the event in question I took a patient back to the ICU after a major head and neck case. We called these face-offs and they usually last at least 16 hours. This one however had been done once before and only took 8 hours so we took the patient back to the ICU around 1600 hours. When you take a freshed trached, ventillated patient back to the ICU, it is a lot more complicated for anaesthesia than just taking a patient back to the RR. While the CofE does at least 3 of these cases a week, it seems like every time I take a patient back to the ICU it is like they have never done it before. I have to ask for a transport monitor, ambu bag and oxygen cylinder. I'm not sure whether my colleagues just take their patients back to the ICU apneic and unmonitorred. I have to usually connect the monitors, zero the art line, make sure the lines aren't tangled or pulled out during the move. I also have to make sure the patient doesn't wake up on the way to the ICU. In short phoning the ICU to tell them we are on the way, is low on my priority list and something I figure someone else can do. Besides at the CofE when a patient goes to the ICU, an orderly actually goes over there to get the bed so that the patient doesn't have to transferred twice. Sort of a warning that we're coming pretty soon.

Now I don't know whether somebody from the OR phoned the ICU that day. It was apparent when we arrived that they weren't ready for us. For example there wasn't a ventillator.

The second clue that they weren't expecting us was the arrival of the charge nurse into the room where I was ventillating the patient by hand while waiting for the RT and ventillator to arrive. She unleashed a string of invective at me which lasted at least 5 minutes. The jist was that I alone of all the people involved in the case should have phoned the unit.

Now I am married and went to medical school, internship and residency in the 1980s so I have had my share of public tongue lashings and maybe I should have just said sorry and slunk out but on this particular day, I felt that a line had been crossed.

After the ventillator arrived. I walked out in the corridor approached the charge nurse, took her to an out of the way part of the ward and told her that her behaviour was entirely innappropriate and that I expected an apology. She refused.

So, I wrote a letter.

About a week later, the unit supervisor phoned me to tell me that she had a investigated the incident, that what I said happened had actually happened, that it was not appropriate, and that the nurse in question would be writing me a letter of apology which I received in due course.

To be continued......